The Masters of Medicine: Our Greatest Triumphs in the Race to Cure Humanity’s Deadliest Diseases by Andrew Lam, M.D., is an outstanding addition to the medical history genre. As both an historian and a clinician, Dr. Lam is especially well-qualified to write with authority in this category. He graduated summa cum laude and Phi Beta Kappa from Yale University (New Haven, Connecticut), where he majored in history. He received his medical degree from the University of Pennsylvania (Philadelphia, Pennsylvania) and completed residency in ophthalmology at the Wills Eye Hospital in Philadelphia, where he served as chief resident before completing a 2-yr vitreoretinal surgery fellowship.
Dr. Lam, the author of three previous books, currently practices retina surgery in western Massachusetts.
The book is brilliantly organized around the half-dozen diseases or conditions responsible for killing the majority of mankind: heart disease, diabetes mellitus, infection (bacterial and viral), cancer, trauma, and childbirth. Within this framework, the author has created a fascinating chronicle of the determination, intellectual curiosity, audacity, and serendipity that led visionaries to breakthroughs in the nonlinear journey to medical discovery. Dr. Lam is an engaging and perceptive narrator who relates compelling—and entertaining—stories in a conversational tone, weaving interesting and informative case studies and anecdotes through each chapter. For example, we learn a considerable amount about the medical experiences of former Presidents James Garfield, Franklin Delano Roosevelt, Jimmy Carter, and Ronald Reagan, as well as former Vice President Dick Cheney.
Although Dr. Lam appropriately underscores the admirable tenacity and painstaking diligence of many of the luminaries, including Marie Curie, John Gibbons, and George Papanicolaou, he also indicates that some discoveries were, literally, epiphanies. Frederick Banting, for instance, was not an endocrinologist, and Wilhelm Roentgen was a physicist, not a physician, whose epiphany sparked the invention of the new field of radiology. Moreover, serendipity played an important role in the discoveries of Alexander Fleming, Louis Pasteur, and Sidney Farber, to name but a few. Mavericks like Werner Forssmann, William Coley, and Ignaz Semmelweis were able to view problems from a new perspective, take astounding risks, display obsessive tenacity, and sometimes endure ridicule and ostracism for defending their beliefs.
The author does not shy away from illustrating how medical discoveries are often subject to human foibles and failings. Envy, self-interest, and paranoia ruined relations among the “discoverers” of surgical anesthesia, as well as among insulin pioneers Banting, Best, Macleod, and Collip. Nonetheless, the author also acknowledges that rivalry can induce competitors to excel, as happened with Jonas Salk and Albert Sabin, as well as with Louis Pasteur and Robert Koch.
Although all the chapters in this engrossing book are riveting and should be read in entirety, one chapter is particularly poignant and inspirational. The chapter on trauma, with its focus on wartime-associated injuries, should be required reading for all who care for trauma patients, or aspire to do so. The author takes great pains to deliver the message that “the only winner in war is medicine” because the constellation of new injuries resulting from combat necessitates innovative medical advances if victims are to survive.
The predominance of trench warfare in World War I was largely responsible for the horrific new medical challenges presented by disfiguring facial injuries. In World War I, the young surgeon Harold Gillies rose to the occasion with old—and new—methods of moving tissues in and around the face using skin flaps and fragments of cartilage and bone from the ribs, tibia, or pelvic crest. He improvised with advancement flaps, rotation flaps, and transposition flaps.
In August 1917, the Queen’s Hospital at Sidcup, in Kent, United Kingdom, dedicated to facial and reconstructive surgery, opened. There, Gillies introduced a multidisciplinary approach to deal with terribly disfiguring injuries. His team included internists, anesthesiologists, radiologists, dentists, mask makers, photographers, and an artist who was formerly a surgeon. Clearly, progress in anesthesia and antisepsis became foundational to surgical creativity. In this milieu, Gillies developed the tubed pedicle flap, which greatly augmented the size of viable skin flaps and the distance they could travel. (Although not specifically mentioned by the author, the creative contributions of Ivan “Paddy” Whiteside Magill, an Irish-born anesthetist, were critical to safe airway management in this subset of vulnerable patients.) Recognized as the modern-day “father of plastic surgery,” Gillies was awarded a knighthood in 1930 and, 30 yr later, Paddy Magill received the same honor.
In World War II, a New Zealand surgeon named Archibald McIndoe, a distant cousin of Harold Gillies, was placed in charge of the Queen Victoria Hospital in East Grinstead, approximately 40 miles south of London, United Kingdom. The Queen Victoria Hospital became the center of care for Royal Air Force casualties, where McIndoe found himself confronting a new challenge—severe burns—resulting from World War II hostilities. He introduced the burn victims to warm saline baths, open-wound dusting with sulfonamides, and Vaseline-coated dressings with salubrious results. Next, McIndoe took Gillies’s tubed pedicle to a new level by devising a technique of marching the tubular flap of skin up the body, end-over-end. This technique was called “waltzing,” and McIndoe was dubbed the “Maestro.” Not content to limit his attention to his patients’ physical injuries, the surgeon was concerned about his patients’ psychologic health and introduced many morale-boosting interventions. These included adding flowers, live music, and free beer to the wards. He also purposefully assembled a group of extroverted staff and vivacious young nurses to enhance camaraderie. A cluster of patients perfected their gallows humor by establishing a group called the “Guinea Pig Club.”
McIndoe also fostered, and relied heavily upon, the compassion of East Grinstead’s residents to help his patients readjust to civilian life. When patients ventured into town, frequently attached to bizarre-appearing facial flaps, citizens accommodated and acknowledged them. Restaurants and pubs removed all mirrors, and families invited the airmen into their homes for tea. The municipality soon gained a well-deserved reputation as “the town that never stared.” The citizens proudly recognized that the airmen’s face was the responsibility of the Queen Victoria Hospital, but that they themselves could play a vital role in restoring the patients’ will to live. It’s been widely said that it takes a village to raise a child. The citizens of East Grinstead profoundly understood that it takes a village to truly heal a suffering soul. Not surprisingly, when he died in 1960, Archibald McIndoe became the only civilian to have the honor of burial at the Royal Air Force church of St. Clement Danes in London.
In summary, I enthusiastically recommend The Masters of Medicine to a wide audience of physicians, nonphysicians with an interest in medicine and/or history, and potential future medical students. Indeed, medical schools should consider requiring The Masters of Medicine to be summer reading for incoming students. The author excels at identifying and then interweaving the multiple confluences of this sprawling subject. He has done for medical history what E.O. Wilson did for sociobiology, Stephen Jay Gould did for evolutionary biology, and Oliver Sacks did for neurologic disorders. Importantly, in his concluding chapter, Dr. Lam offers several trenchant recommendations to ensure that healthcare will not retrogress but will advance unabated. He looks forward to a world where regenerative medicine will enable victims of spinal cord injury to walk again; artificial intelligence will be exploited to accomplish swift and accurate diagnosis of countless puzzling conditions; gene therapy will offer cures for inheritable diseases; vaccines will prevent, as well as treat, cancer; and donor organs will emerge from stem cells.