Cultural Approaches to the History of Medicine: Mediating Medicine in Early Modern and Modern Europe (review)

This wide-ranging collection originated at a truly international conference held in Amsterdam in 1999. The contributing authors work (or worked) in nine different countries; the twelve chapters discuss case studies from five western European nations. Such a diverse line-up presented the editors with a real challenge—how were they to craft a book that was more than the sum of its parts? The subtitle reveals how they went about this task: the contributors were asked to focus on the ways in which the meaning of medical conditions and the nature of medical practice were (and are) mediated through multifaceted and complex social interactions, through forms of representation, and through sets of values and beliefs.

As a result, the editors instilled far more coherence than one would expect in a collection that ranges from the levitations of the sixteenth-century Roman saint Philip Neri to the orthopedic institutes of Restoration Paris, and to 1980s British TV documentaries. No one will read through these essays without seeing how laypersons have regularly imposed their own interpretations upon the meaning of particular bodily states, and how they have not simply passively accepted and internalized the dictates of medical authority. The reader will also swiftly grasp that the emergence of new forms of treatment needs to be seen as the result of interaction between social actors: the media, various kinds of medical practitioner, different sections of society, the state, and so forth. With characteristic generosity, Roy Porter's "More than a Foreword" describes the volume as "pioneering" (p. x). I am less convinced of its overall novelty: many of the early modern contributions develop a conventional image of medical pluralism and merely confirm the importance of religious understandings of disease and affliction.

Despite the titular invocation of the cultural, few chapters seemed to depart significantly from well-established approaches in the history of medicine. A number of the essays, though, are of high quality—I will certainly be giving Hera Cook's forcefully argued examination of the medicalization of sexuality in early twentieth-century England, Logie Barrow's account of nineteenth-century disputes over vaccination, and Michael Stolberg's summary of his work on medical popularization in eighteenth-century Europe a prominent place on reading lists. My reservations may be due to the sketchiness caused by the word limit imposed upon the authors: the volume would have been stronger if it had contained two or three fewer pieces, and if the remaining contributors and the editors had developed their ideas at greater length. In particular, the editors' short introduction, "Medicine, Mediation, and Meaning," is exceptionally thought-provoking and yet deeply frustrating because they did not give themselves enough space to clarify how they were using these and other important terms. What, I found myself asking, was the role of material culture and the biological in processes of mediation? (There seems to be a tension between the editors' critique of historians who present diseases as autonomous entities [p. 5] and Hera Cook's discussion of biologically effective forms of birth control [p. 200].) How does "mediation" change over time? Is it helpful to use the term to discuss both childbirth in the seventeenth century and interferon research in the late twentieth century? With room to address such questions, this would have been an exceptionally important book rather than an interesting collection of essays.