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From Colonial Times to Present Day, Tampa Doctor Authors Compelling Informal History

Curtis E. Margo, MD, wrote Glass Half Full: An Informal History of American Medicine, with a mission in mind: “to unravel, and to some extent celebrate, the convoluted history of the medical profession in the United States.” In it, he recounts the scientific and technological achievements of medicine in context with the values, beliefs and behavior of the medical profession itself.

“Because American medicine is too vast a subject to cover in a single volume, selection was crucial to telling the story,” said Margo, a professor at the University of South Florida-College of Medicine, and an ophthalmologist at the Tampa VA Hospital. “Admittedly, selection of content can be as precarious a task as it is creative a tool.”

According to his colleagues, Margo is spot-on with his exploration of the American medical profession through key events, major institutions, and the people who shaped its history. Lynn Harman, MD, a Hillsborough County physician, considers Glass Half Full “a compelling single-volume history of American Medicine … very pertinent background for current debates about our healthcare system.” Harman, the wife of Curtis Margo, is admittedly a biased observer, yet during the years of preparation and writing she was also his toughest critic.

Concerning the colonial landscape, which Margo addresses in the opening chapter, he said: “Medical practitioners in Colonial America consisted of an assortment of healers whose approach to the treatment of disease varied considerably, based upon background or training. Men graduating from European medical schools may have expected to take a leadership role in the medical community, but found their authority effectively challenged by a host of alternative healers.”

About the Boston smallpox epidemic of 1721, which pitted the Puritan minister and “amateur” physician Cotton Mather against the medical community over the use of variolation, he wrote: “Mather lost the battle over protective inoculation, but the medical profession in its victory displayed hubris and fallibility.”

On western medicine tradition, Margo noted: “The origin of American medical orthodoxy goes back to the ancient occupation of Hippocrates and Galen. The survival of orthodox medical practice in the United States during the nineteenth century was at times doubtful because physicians had little more to offer the sick than did charlatans or quacks.”

Margo pays homage to John Morgan and William Shippen, two friends who became famous enemies. They established the first medical school in America. “Morgan lived to see the high academic standards he established in the medical department of the College of Philadelphia dismantled because of the economic realities of American society,” he said.

Margo pointed to Benjamin Rush as “an American patriot and the most influential physician of his era.”

“He was a social activist who advocated humane treatment for the mentally ill and equal opportunity in education,” he said. “As an influential medical theorist, he mistook conjecture for fact and demonstrated no insight into scientific reasoning.” During the yellow fever epidemic of 1793, in which one of 10 Philadelphians died, Rush perfected “heroic therapy”—heavy bloodletting and purging. “His treatment of seriously ill patients,” Margo said, “cast a dark shadow over his professional career and made the public wary of medical doctors.”

Margo pointed out that George Washington’s demise was hastened by the use of therapeutic bleeding, and that his death coincided with a defamation suit against the editor of Porcupine’s Gazette for ridiculing Benjamin Rush and his use of bloodletting. “Rush won the defamation suit, but history credits laypersons with having greater insight into the harmful effects of bloodletting than leaders of the medical profession,” he added.

Other highlights from Margo’s Glass Half Full:

• On public health for profit: “Benjamin Waterhouse, head of medical theory at Harvard, attempted to monopolize the use of the smallpox vaccination in New England in 1799,” he said. “His attempt to restrict the use of this new technology for financial gain sparked the first public debate over the conflicting principles of medicine and business.”
• On frontier surgery: “Ephraim McDowell, a country doctor without a medical degree, was an unlikely candidate to perform the first successful ovariectomy,” he said. “After McDowell demonstrated the feasibility of pelvic surgery (and antisepsis and anesthesia made surgery relatively safe and painless), surgeons searched for a disease they could cure with ovariectomy. Hysteria was the perfect disorder.”
• On Civil War medicine: “Nearly twice as many lives were lost to disease during the Civil War than to battlefield injuries,” he said. “The surgeon generals of the North were more concerned about maintaining their independence from civilian authority than delivering quality medical care. The situation could have been worse if the Sanitary Commission had not demanded the Medical Department of the Army be held accountable for its performance on the battlefield.”
• On John Shaw Billings, medicine’s greatest unsung hero and creator of the National Library of Medicine: “As the intellectual force behind the design and construction of John Hopkins Hospital,” he said, “John Shaw Billings ushered medical education into modernity.”
• On William and Charles Mayo, founders of The Mayo Clinic: “Their illustrious careers were founded upon hard work and common sense,” he said, “but the creation of the multi-specialty group practice may be their greatest contribution to medicine.”
• On emergency room medicine: Margo tells the story of how Rosalyn Yalow, a world-renowned medical researcher got dumped from an ER following a stroke. “Hospitals have learned the hard way,” he noted, “that even a Nobel Laureate can look like a homeless person.”

Margo also highlights George Washington Crile, the Flexner Report, the molecular paradigm, surgical innovation, coronary artery disease, evidence-based medicine and health insurance.

“Medicine has always been a commercial enterprise, but the conflict between its humanitarianism and profit-making imperatives reached a crescendo during the last decades of the twentieth century,” he said. “The evolution of health insurance provides perspective into the schizophrenic personality of the medical profession.”

Margo begins the book with the acknowledgement that “for more than three decades, I’ve loved and cursed medicine, finding myself a variegated chameleon when it comes to my profession,” and ends it with “an invitation to contemplate the meaning of medicine in our society.”

Glass Half Full is available via Amazon.com.

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