CH. 1

Starr begins his Pulitzer Prize-winning work with an interesting and surprising look at the very humble beginnings of the physicians and the evolving practice of medicine from the 1760 to 1850. My initial interpretations of the practice of medicine were that since the age of Asclepius, physicians and other healing practitioners were venerated and that their expertise was one passed down as a solemn oral history.

Starr's description of the diffusion and transformation of medical information astutely shoves my perception of the field of medicine off its pedestal. Not only was my perception incorrect from a historical perspective, but as the Introduction described, this is not even a universal guarantee of a prestigious career. It is incredible to consider the myriad of ways in which medical information (and medicine itself) has been passed on, warped, redefined, transformed, and rediscovered.

There were many transformations and interpretations of medical knowledge and what it meant to practice medicine throughout the eras, such as William Buchan's Domestic Medicine, displacing it from mystified Latin and technical terminology and supporting medical practice with the layman. That the concept of medical practice could shift from formalized academia to casual salt of the earth (and back again) is astounding.

What I find most interesting in these examples of the fluid and every changing "practice of medicine" is the story about James Still. Still's very elementary means of tapping into medical knowledge--buying a book and following its instructions--is a delightful counter to the common view of medical practice. I think typically, we are lead to believe that medical practice is a highly regulated body of knowledge where you have to learn from square one and must have accreditation and license to even begin providing basic care. The basic medical school education requires study in organic chemistry, physics, microbiology, and biochemistry to even begin schooling. Yet it is easy to forget that behind the lectures and the lecture halls and within the pages of text books is the raw history of medical instruction. Still's case is a reminder that the spirit of medical practice need not be mired in academia and rigid pathways to knowledge. Medical practice is not just in the office or in a sterile room. It occurs with everyday people applying scientifically supported knowledge to promote their health and the health of those around them.