The Limits of Medicine

That's the book I'm currently reading (ISBN 0-226-30207-5). It's about "how science shapes our hope for the cure." Dr. Ed Golub, a well know immunologist, tells us how we have given credit to medicine in improving our lives when the credit really belongs to other factors. Our lives have been extended, not primarily due to medical discoveries, but to public health. We live longer today because of sanitation, access to clean water, personal hygiene and a higher standard of living. I've only just gotten into the first few chapters. Dr. Golub does a really good job pointing out how until recently disease and early death were so pervasive that there was very little comment on it. It's just the way things were. In 17th century France one person in four died before his first birthday. Another one in four died before their 20th birthday and another quarter never reached the age of 45. Dr. Golub quotes Voltaire concerning Rousseau first visit to Paris in 1742.

"The strong smell of excrement pervaded the environment, and the stench of public places was both terrible and ceaselessly condemned. The vile smelling effluvia of the faubourg St.-Marcel de Justice, in the Louvre, in the Tuileries, at the Museum, even at the Opera...the quays revolted the sense of smell." Excrement was everywhere: in alleys; at the foot of milestones; in cabs; in the gutters into which the cesspools were emptied; on the urine-stained walls of houses.

Things weren't much better in this country. NYC in 1865:

Domestic garbage and filth of every kind is thrown into the streets, covering their surface, filling the gutters, obstructing the sewer culverts, and sending forth perennial emanations which must generate pestiferous disease.

Is there any wonder that there was pestiferous disease? People died from infections due to their living conditions. But survival rates increased long before the discoveries of antibiotics and most vaccines. Remember, in 1865, the germ theory of disease was not commonly accepted in the medical community. Especially in the USA at that time.