Book review: Blood and Guts by Roy Porter

Blood and Guts by Roy Porter is a whirlwind tour of the history of Western medicine, organized by topic. Porter’s aim is to situate beliefs and practices in the culture of the times, a subject I find fascinating. He knows the territory inside and out, being one of the preeminent historians of medicine, and has adroitly managed to be comprehensive and brief, but not shallow. Hats off and thumbs up!

I’m writing this post as I type up my notes from the book, so you’re getting snippets that caught my attention, rather than a carefully crafted reprise. The book is a zippy read; if you want more, read the whole thing. I hit 1000 words for this post with just the first two chapters. Others chapters discuss with the same high degree of information and entertainment the body, the laboratory, surgery, therapies, the hospital, and medicine in modern society. 


plaguePorter begins five million years ago, when the Australopithecines emerged from our family tree. In a few million years, Homo sapiens spread across the globe, hunting and gathering. Porter says life was short and I guess it was, but the principal hazards were childbirth, starvation, accidents, and being eaten by wild animals. Not, significantly, infectious diseases, which didn’t become a serious threat until after the agricultural revolution moved people into year-round residence in ever-denser communities. Hello, Plague!

Domestic animals gave us tuberculosis, smallpox, influenza, measles, and the common cold (from horses!) The vermin that grain and farm animals attract spread salmonella, cholera, polio, typhus, diphtheria, and bubonic plague. I’m getting woozy just typing in all these names. Stable populations would build up immunities to some degree, then go galloping or sailing off to infect new communities. The Black Death took about 25% of Europe’s population in four years. European diseases wiped out 50-90% of the indigenous peoples of the Americas in the fifteenth century. Mind-boggling.

The twentieth century discovered the causes of most of these diseases and then developed actual cures, in a stunning victory over an ancient enemy. But new diseases arise, like AIDS, Ebola, and Lassa. Porter warns, “From an evolutionary perspective, man’s global fight against disease seems more like a a holding operation in a war without end.”


A medicine man

Prehistorically (and forward), healers were shamans, in tune with the supernatural causes of illness and accident, and communicators with potential sources of better luck and supernatural protection. “With the evolution of more complex settled societies, herbalists, birth-attendants, bone-setters, and healer-priests followed.” One might say, a class of health professionals arose once there was surplus food to sustain them.

When writing was invented, rituals, spells, and recipes for healing were among the first things to get written. In ancient Egypt, physicians might be female as well as male. The most famous was Imhotep, (male) chief vizier to Pharaoh Zozer (2980-2900 BC), “renowned as a physician, astrologer, priest, sage and pyramid designer.” Smart guy. Papyri have survived with his sayings about health and healing. “Egyptian medicine combined religious beliefs and magical techniques with an impressive array of practical drug treatments and surgical skills.”

Hippocrates broke with this millenias-old tradition, advocating a secular medicine based primarily on regulating the diet to maintain health. His teachings were similar to Indian Ayurvedic medicine in that they explained health and illness in terms of the humors: the four essential fluids which regulated the body. Health obtained when they were in balance; when out of balance, various forms of illness resulted.

A medieval doctor

Here’s an example: “If, perhaps through faulty diet, the body made too much blood, sanguineous disorders followed as one grew overheated and feverish. One might, by consequence, have a seizure, an apoplectic fit, or grow maniacal.” The obvious treatment is a little judicious blood-letting.

The job of the doctor under this system is to evaluate the state of the humors. This was done chiefly by studying urine samples. The doctor didn’t even have to leave his chambers; patients could send a sample to be analyzed.

Porter notes, “The appeal of the humoralism which dominated classical medicine and formed its heritage lay in its comprehensive explanatory scheme, which drew upon bold archetypal contrasts (hot/cold, wet/dry, etc.) and embraced the natural and the human, the physical and the mental, the healthy and the pathological.” It was a powerful theory, given the knowledge available.

The training and accreditation of physicians moved out of churches and into the universities from the twelfth century. Healing split into several branches. First in status were physicians, who were educated in these temples of learning and who limited themselves to diagnosis and prescription. They did not need to touch their patients or even necessarily visit them. They elicited symptoms, perhaps by means of an early modern questionnaire, from which they determined the nature of the disease and formulated a treatment. They also studied those urine samples.

Second came apothecaries, the professionalized class of herbalists. They were originally part of the Grocers’ Guild in England. Third were surgeons, the only ones who always laid their hands upon their patients. They had to be strong and fast to do their work, before the development of effective anesthetics. Both apothecaries and surgeons learned their trades through apprenticeships.

The doe-eyed Doctor Bashir

Doctors couldn’t do much more than alleviate symptoms until the nineteenth century, when things really began to pick up. Thermometers were available from the 1860s; sphygmomanometers measured blood pressure. Pain could be alleviated with opiates. Aspirin was invented by Bayer in Germany in 1896. The stethoscope was invented in 1816. We consider these basic diagnostic tools, although we do still surrender those urine samples. Microscopes (and better) make it increasingly possible to identify specific diseases and new medicines make it increasingly possible to cure them, rather than merely mitigate symptoms.

As the effectiveness of doctors rose, so did their popularity. “The average American visited the doctor 2.9 times a year in 1930; by 2000 this had doubled.” People learned that going to the doctor could help them; also they learned through advertising that there were many, many more ways to be sick than they would otherwise have imagined.


Porter, Roy. 2002. Blood and Guts: A Short History of Medicine. London: W.W. Norton & Co.




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