Knowledge and Practice in English Medicine, 1550-1680 (review)

Andrew Wear. Knowledge and Practice in English Medicine, 1550-1680. Cambridge: Cambridge University Press, 2000. viii + 496 pp. $74.95 (cloth, 0-521-55226-5), $27.95 (paperbound, 0-521-55827-1).

For more than twenty years, historian Andrew Wear has been publishing essays and editing volumes concerning early modern English medicine. As a senior lecturer at the Wellcome Institute for the History of Medicine, which recently regrouped at University College London, Wear has used its library's unparalleled collection of primary and secondary sources to explore a diverse range of subjects ranging from anatomy through drugs, health and the environment, pain, and religious conceptions of illness, among other topics. His recurrent themes of change and continuity, the popularization of medical knowledge, and the intellectual traffic between medicine and religion during the period 1550-1750, to name only some major ones, range across his various subjects. Wear's work permits readers to gain considerable knowledge of England's quotidian medical past, something previous historians tended to neglect in favor of details of anatomical and physiological discoveries by elite learned investigators who published in Latin. In many ways his work complements that of Roy Porter, his frequent collaborator, on British medicine during the long eighteenth century.

Now Wear offers a major synthesis of English knowledge and practice during a period, 1550 to 1680, that saw English medicine emerge from intellectual backwardness into Europe's front rank. During the same period England also experienced prolonged social, political, and religious discord, and Wear, like many other historians of early modern England, uses some of its unique fault lines to plumb the depths of English health care and belief. Not unlike an anthropologist, an analogy Wear makes in his introduction, he seeks to get "as close as possible to the medical mind-sets of early modern medicine" (p. 3). His subjects are not the indigenous people of a foreign culture, however, but rather vernacular medical texts on remedies, diseases, and regimen that informed lay and learned medicine alike.

In a reflection, perhaps, of his long-standing practice of presenting history in terms of continuity and change, Wear divides the book's 475 pages into two parts. After "setting the scene" in chapter 1 with well-presented summaries of population demographics, disease, and medical literature, in the balance of the first part's seven chapters he discusses medical "placidity," or what mostly stayed the same: regimen, remedies, surgery, and diseases, including an extended discussion of plague. The book's final three chapters move through "controversies" that arose from the Civil War of the 1640s onward, between traditional Galenist physicians and their rivals, Helmontian chemical doctors, to conclude with the rise of Sydenham's refurbished version of Hippocratic medicine. Citing excellent work by others, Wear does not include madness or midwifery, and he excludes magic and witchcraft because he finds them "not central to the literate vernacular medical tradition" (p. 6).

Even so, the book provides a rich feast, though space limits of this review permit only a few comments. One of Wear's overarching themes concerns the ubiquity of blurred borders between areas that subsequently became distinct. For example, the plethora of popular versions of learned medical knowledge and treatment that emerged from the mid-sixteenth century onward meant that ordinary people, especially those of the middling sort, shared a great deal of medical knowledge with their physicians. Medicine was not an arcane techné, but rather a body of practical knowledge that was easily mastered, usually by the women of a household. So, too, the borders between symptoms and disease were blurred, especially in humoral models that discussed fluids and qualities in terms that echoed an ill person's experience of fullness, for example, or heat. In the sense that religious doctrines and practices continued to be medical resources in their own right, Wear is quite right to emphasize overlaps between religion and medicine. Dying, as he points...