This short work by noted medical historian Michael Bliss of the University of Toronto focuses on three events that led to the transformation of the public view of medicine in North America, from a profession that was often powerless to alter the course of serious illnesses in the late 19th century, to one in which scientific advances and changes in medical education led to the possibility of cure of dreaded diseases and, more importantly, the hope for further cures in the early 20th century.

Bliss first describes the smallpox epidemic in Montréal in 1885, a disease preventable by vaccination at that time, which claimed the lives of over 3,000 residents within the city's limits in less than one year. The majority of the deaths did not occur among the poorest residents, who were largely vaccinated by their personal physicians in childhood. Instead, the victims were concentrated in the French Canadian population within and outside of Montréal, who erroneously believed that vaccination against smallpox was a dangerous tool designed by the English speaking medical community to sicken them. This opinion was supported and encouraged by several anti-vaccinationists in the French Canadian community, whose proclamations were eerily similar to those of the current lot of scaremongers in the anti-vaccine community.

The second story concerns the career of William Osler, the "father of modern medicine", who was trained and later taught at McGill University, before he accepted a position as Physician in Chief at the new Johns Hopkins Hospital and Medical School. Johns Hopkins was founded by a wealthy philanthropist, and the medical school was based on the training methods of the prestigious schools in Europe; as a result, Hopkins became the gold standard for medical education in the United States, even superseding the University of Pennsylvania, the oldest medical college in North America. Osler, one of the "Big Four" founding professors at Johns Hopkins Medical School, wrote the famed textbook The Principles and Practice of Medicine as he waited for the medical school to admit its first students, which was published in 1892 and continues to be widely read today; created the clerkship system, in which medical students moved from the classroom and laboratory to the hospital wards and clinics to observe direct patient care; and instituted the modern internship and residency programs for medical school graduates. His teaching methods, thoughtful approach to the patient and collegial collaboration with other specialists continue to be practiced and taught to this day.

The final segment describes the discovery of insulin by Frederick Banting and his colleagues at the University of Toronto in 1922. The hormone was isolated from pancreatic extracts, purified, and then tested on diabetic animals. It was first administered to a human patient at the Hospital for Sick Children in January of that year, and it had an immediate and long lasting effect, as the then teenage boy would live for another 13 years. The most famous of Banting's early patients was Elizabeth Hughes, the 15 year old daughter of the US Secretary of State Charles Hughes, who was close to death from starvation, the standard treatment for diabetes in August 1922, as she weighed only 45 pounds. She was brought to Toronto and administered insulin, which led to a remarkable recovery. Hughes went on to lead a full and active life until her death in 1981 at the age of 73. Banting was awarded the Nobel Prize in Physiology or Medicine in 1923 at the age of 32, and he remains the youngest Nobel laureate in this field.

At just over 100 pages, The Making of Modern Medicine serves best as an introduction to Bliss and his previous books, on which this one is based, and to the reader with little or no knowledge of the history of North American medicine. Thanks to this book I will read William Osler: A Life in Medicine and Harvey Cushing: A Life in Surgery, Bliss's noted biographies of these two giants of medicine, in the near future. ( )

The Making of Modern Medicine is a Canadian medical historian's view seen through Michael Bliss' eye and extensive research of what he sees as some of the key medical turning points in the transformation of medical care - having patients discard fatalism and a religious acceptance of medical suffering to believe or develop some faith in health care and the capacity of doctors to treat disease. Centered on the time period of 1885 - 1922 in North America, Bliss presents readers to the shift in modern medicine from a physicians' helplessness in the face of an epidemic disease towards medical researchers' abilities to wage war against the ravages of disease.

To communicate this transition, Bliss divides the book into three sections meant to highlight what he sees as the key transitions on the path to modern medicine. The first transition - away from fatalism - focuses on the devastating smallpox epidemic in Montreal of 1885/1886, when 3,164 Montrealers - 2% of the city's population - died of smallpox. This epidemic raised alarming questions as almost all of the deaths were of people who had never been vaccinated against smallpox. Yes, a vaccine against smallpox did exist at the time but attempts to stem the epidemic were hampered on numerous fronts including discovery that the public vaccine supply was contaminated and the vocal outcry against vaccination by prominent anti-vaccinationist physicians and church leaders. This in turn fueled the already existing ethnic tensions that divided the French-Canadians from the English and the "English notion" of vaccination. The fact that 91.2% of Montreal's deaths were among the French-Canadian population and 85.9% of the victims were children under the age of 10, is a chilling statistic to read. The result: vocal public opinion urging for expansion of public health measures so that such ghastly events should never happen again.

The second transition - secularism - is the movement in America for educational reform in medicine and the establishment of prominent medical schools, such as Johns Hopkins. At the time, institutions such as Harvard's medical school were notorious medical diploma mills and reform was needed. This section focuses on the Canadian physician Dr. William Osler, who was made head of medicine at Johns Hopkins and was one of the four founding medical fathers of that great institution. Osler is credited with bringing clinical clerkships to American hospital wards and expanding the intern system to create a category of resident physicians and surgeons to produce in time highly qualified specialists. This section also focuses on Harvey Cushing who made large advancements in the then infant field of surgery.

The third transition - mastery - focuses on the discovery of insulin in Toronto in 1922 by Fred Banting, Charles Best and James Collip made possible by the establishment of research centers funded by wealthy philanthropic patrons like Eaton, Flavelle and Rockefeller.

While this book has a decidedly Canadian focus to it, Bliss does an amazing job communicating his vast knowledge into a highly readable account of the great leaps made in medicine and medical research during the time period. As Bliss mentions in his epilogue: "Human history is often a tale of woe and misery and evil, but not always. Medical history is often a tale of setbacks, quackery, misery, and, ultimately, always death." Yes, life is finite, or to use Osler's term, it has a fixed period that physicians cannot cure. As amazing as the discovery of insulin may have been, it is a maintenance therapy only, and as Bliss says, an imperfect one at that. Since the discovery of insulin, the total amount of diabetes in the human population has increased, with diabetes mellitus a greater menace to human health - via the surge in late onset type 2 diabetes - than it was in the days of Osler, Banting Best and Collip.

Overall, a good introduction for anyone with an interest in the development of modern medicine in North America during the time period. ( )