The Western Medical Tradition, 1800-2000 (review)

As Hal Cook observes in the introduction to this sequel to The Western Tradition, 800–1800 (Cambridge: Cambridge University Press, 1995), the thrust of this work is to comprehend medicine within the broader history of "the west." That makes sense: one may grouse well at the appropriateness of "the western tradition" with regard to the histories of particular nations, yet modern medicine, with its universalizing and expansionist premises, does seem a signal product of the global hegemony of Europe (northwestern Europe in particular, notes Cook) and North America.

The five authors of four great chapters have divided the last two centuries chronologically: Stephen Jacyna and W. F. Bynum split the long nineteenth century, with Jacyna treating the period to 1849, and Bynum the period to 1913. Christopher Lawrence treats the world wars and the interwar years, whereas Anne Hardy and Tilli Tansley wrestle with the last half century. There is partial symmetry: each chapter addresses issues of science and research, medical institutions, medical education, and relations with the state, but individual chapters address many other issues as well. Each highlights a theme—for Jacyna, it is the socio-political transformation of industrialism, urbanization, and liberalism, for Bynum the rise of science. Lawrence is struck by the stability and continuity of medicine at a time of political, ideological, and economic flux and catastrophic war. Hardy and Tansley contrast modern medicine's great and growing power with the public's dissatisfaction with it and its failure to cope successfully with a wide range of emergent problems.

The book suffers from two major problems. The first is a need for a dictatorial editor. Some repetition of topics across chapters will be necessary and desirable to overcome the artificiality of periodization, but here, such repetition often suggests insufficient coordination. There is gratuitous variation in historiographical discussions and practices of intratextual cross-referencing and citation. The background knowledge and interests of the imagined reader vary from chapter to chapter. Even in the bibliographical essays, one finds asymmetry: the secondary literature on chapter one gets less than two full pages; the other chapters receive six to ten.

More serious is an ambiguity about what needs explaining or in what terms. Do we take for granted medical institutions that will evolve according to their own logic or must we seek exogenous factors to explain that evolution? The poles are evident in the first two chapters, which escape their chronological bounds to overlap substantially. Jacyna wants to put medicine in the context of a historiography dominated by Marx and Foucault (25); Bynum appeals to the maturation of a medical science largely driven by internal factors (111–12). Although both of these authors can navigate along well-trod narrative paths, Lawrence and, even more, Hardy and Tansley must blaze their own narrative trails, chronicling profound changes on many fronts in the absence of widely recognized means for distilling detail.

Overall, the picture that emerges is of medicine as an independent entity whose relations to the rest of society are episodic, incidental, marginal, and relatively minimal. This is less an intended interpretation than a result of chronological and topical organization and of needing to cover too many topics in too limited a space. The result is a picture of western medicine as an uneven frosting (with lots of sprinkles) on the western world rather than as central ingredient: preoccupation with so many individual aspects and institutions of medicine comes at the expense of integration and of key elements of context (e.g. broad demographic change; lay images of the body and its relation to the cosmos, state, self, and others; social or religious movements; ideologies; the grand enterprise of omni-professionalization; shrewd political programs; or economic systems like global capitalism). Aspects of environment and environmentalism are dealt with in passing, yet one gets no sense of how important environment has become—as the focus of anxiety about health, the site of profound...