Medicine in the Twentieth Century (review)

Roger Cooter and John Pickstone, eds. Medicine in the Twentieth Century. Amsterdam: Harwood Academic Publishers, 2000. xix + 756 pp. Ill. $120.00; £75.00; 2126.00 (90-5702-479-9).

It is odd how a century's end immediately defines a historic period, despite the multiplicity of processes that continue evolving and developing in succeeding years. In the early 1990s it seemed difficult to get any perspective on the twentieth century as a whole; by 2000 it seemed not only possible but appropriate. Medicine in the Twentieth Century might seem an opportunist publication, but it is also timely. Roger Cooter and John Pickstone are to be congratulated on their foresight (and their courage) in undertaking this compilation. Defining an approach to medicine in the twentieth century, a century that saw such vast expansion in medicine—in the economists' phrase, a "take-off into self-sustained growth"—seems taxing enough intellectually; marshalling fifty-odd contributors to produce a volume for 2000 is a considerable organizational feat.

Faced with the task of subduing unruly Gaul, Caesar divided it into three parts; Cooter and Pickstone have done the same for twentieth-century medicine, dividing not by chronology, but by differing historiographic approaches. The first part of the book ("Power") deals straightforwardly with the horizontal building blocks of history. Here the reader will find a series of essays that provide a broad chronological picture of developments in the twentieth century: medicine in the Progressive Era, the interwar years, medicine and the welfare state. Colonial and postcolonial medicine, the pharmaceutical industry, and medical technology also find a place. Established scholars deliver succinct and informative surveys on their specialist areas. These essays are essentially textbook material: enlightening for historians working in other fields, useful for teaching, springboards through both texts and bibliographies into new areas of interest. Much the same can be said of part 3 ("Experiences"), which is organized by vertical building blocks, or "theatres of medicine," including hospitals, childbirth, children, age, war, supported lives, mental illness, cancer, malaria, and Chinese medicine.

More problematic is part 2, which takes the fashionable modern concept of "the body" as its organizing framework, with chapters that explore understandings of, for example, the healthy body, the immune body, the psychiatric body, the dead body. Stimulating as many of these essays are, the reader often gets a sense of historians talking among themselves without regard for any other readership. There are several fluid, interpretive essays argued by generalization and assertion with little in the way of supporting evidence. Several authors manage to avoid most or any factual content at all. Others—such as Naomi Pfeffer on "the reproductive body"—stand out for an informative and effective mixture of fact and interpretation. Since the intended readership of this collection is, according to the jacket, "general audiences," the nature of many of these essays does raise the question of quite what such audiences might hope or expect to find in a book on twentieth-century medicine.

It seems not unlikely that many potential readers would be looking for some sustained factual account of the developments in and—dare it be said—the achievements of medicine in the twentieth century. While modern historians are right fastidiously to avoid the triumphalism of past medical observers, and also to emphasize that "medicine" is many different things, there is something to be said nonetheless for some explicit recognition that Western "medicine," as commonly understood, was in 2000 able to deliver a very great deal more to a very great many more people than it was capable of in 1900, and that its abilities to alleviate and to cure had been transformed by pre-1900 standards. Somewhere in this monumental volume, this perspective has been elided, and while the reader emerges enlightened and enriched in regard to the complexities and subtleties of the modern historians' vision, the nonspecialist might be justified in asking whether medicine in the twentieth century did achieve anything worthwhile—and if...