The Western Medical Tradition, 1800–2000 (review)

This book forms the companion volume to The Western Medical Tradition 800BC to AD 1800, published by Cambridge University Press in 1995, and thus completes a magisterial overview of the history of medicine in Europe and America. Like its predecessor, this second volume is written by a group of academics, all of whom have a long and distinguished record of publishing on medical history, working at the Wellcome Trust Centre for the History of Medicine at University College London. It takes a chronological approach: the period is divided into four chapters, three by a single author, while the difficult task of covering the most recent developments between 1945 and 2000 is shared by Anne Hardy and Tilli Tansey.

The authors do not set out to present a radically new analysis of medicine in the nineteenth and twentieth centuries: rather they provide an account of the main features of medicine in their chosen period through a comprehensive overview of current scholarship. Their approach focuses on intellectual rather than social history. Indeed, there is a sharp contrast between the chapters in this book and Roy Porter's chapter in the earlier volume of The Western Medical Tradition, one that reflects a more general division in medical historiography. While researchers working on the eighteenth century have produced many works on patients, their experiences of treatment, and their relationship to practitioners, those examining nineteenth-century medicine have focused on the rise of "scientific medicine." Medical theory thus figures heavily in the Western Medical Tradition, 1800–2000. The two chapters on the nineteenth century, for example, explore the developments in France and Germany that led to new ways of viewing the body and the manifestations of disease through the use of instruments and chemical and biochemical analyses. All the chapters also explore the diseases which were perceived to present particular problems in each period and the efforts made to control them. Discussions of medical ideas are complemented by extensive examination of the dissemination of new ideas through changing forms of medical education, the increasing role of research in a variety of institutions, and the adoption of new medical technologies; the chapters also consider the advent of industrialised medicine (particularly in the area of drug production, but also in the treatment of soldiers). Reflecting the lacuna in the historical literature, there is relatively little material on the patient's experience, apart from that in Bill Bynum's chapter on the late nineteenth century. Much of the material draws on medicine in northern Europe and America, but the text ranges into colonial Africa, India, and Australia, and the international congresses on medicine held in the early twentieth century.

This is emphatically not, however, a book that repeats the old folly of portraying medical history as a story of progress, of medical genius providing an ever healthier and happier world for all. The rise of new research and therapy is placed firmly within its institutional, political, and economic context: the authors stress that developments in pathology and treatment were only possible in hospitals housing large numbers of patients. In turn, they show how patient demand for high-tech care helped to fund ever-larger hospitals. Bynum and Christopher Lawrence in particular paint a picture where progress is slow and sometimes tortuous, with institutions and individual practitioners occasionally reluctant to embrace new ideas, and sometimes impetuously grasping at new treatments that proved worthless (a habit that inspired the joke that it was important to take new treatments quickly, before they became ineffective). All the authors point to the downsides of progress: of the powerless patients in nineteenth-century Paris hospitals, or the shellshocked soldier patched up and sent back to the battlefield.

Although the chapters march chronologically through the period, they are not intended to give a slavish account of exactly the same subjects. Each is the individual author's own account of the...