How the U.S. Health Care System Came to Be

You and I can probably agree that hemorrhoids don’t cause arthritis. Or tuberculosis, or even eczema.

But try telling Edwin Hartley Pratt that. The 19th-century physician and pioneer of “orificial surgery” convinced thousands of followers that smooth body cavities would cure a host of maladies, providing a life full of “uninterrupted delights.”

Pratt is just one of many physicians who make us giggle or cringe today, yet whose theories played an important role in the development of modern medical treatments. In Seeking the Cure: A History of Medicine in America, author Ira Rutkow invites us to sit in the observation gallery for medical procedures from Colonial America to today. We watch doctors examine President James Garfield’s gunshot wound, treat Houdini’s burst appendix and transplant a kidney between identical twins for the first time.

The book reads like our country’s own personal medical chart. Rutkow, a historian and retired surgeon, traces how doctors went from being poorly respected “bleeders” to the often-revered professionals they are today; how hospitals evolved from unsanitary death traps to state-of-the-art lifesaving institutions; and, ultimately, how medicine transformed into the multibillion-dollar industry that now consumes so much political energy—and so much of our money.

Rutkow shared some of his perspectives behind the book with us, from physicians’ true feelings about Medicare to the importance of having a doctor in the family.

(Read an excerpt here.)

Q. Did any stories especially impress you in your research?

A. All the stories impressed me, because I wanted to write about the most interesting ones. The opening story about Zabdiel Boylston’s smallpox vaccine, the development of anesthesia, orificial surgery, Houdini’s appendicitis—they are all just wonderful.

Q. When President James Garfield was shot in 1881, you write, it wasn’t the bullet that killed him, but infection from doctors who examined his wound with unwashed hands. This was at the height of the germ-theory controversy?

A. Absolutely, but it didn’t help him a whole lot.

Q. Why not?

A. In Garfield’s case, the younger 30-year-old and 40-year-old doctors were pretty much adamant about the fact that these new ideas about bacteria and germs—washing hands, cleaning instruments, keeping things antiseptic—were valid concepts. The older doctors pooh-poohed germ theory. But of course when the president of the United States gets shot, it’s very unlikely that he’s going to be treated by a 30-year-old. He’s going to be treated by the older, more professorial doctors.

Q. How many times did one doctor or another probe Garfield’s wound with a dirty finger?

A. In my research I found between 12 and 15 instances, but I’m sure there are many times that it happened and no one noticed. It was a very sad thing. If Garfield had been left alone he probably would have survived; if he had been shot 10 years later, he probably would have survived.