The Western Medical Tradition, 1800–2000 (review)

This book is a continuation of an earlier volume, The Western Medical Tradition, 800 b.c.–1800 a.d., which was published in 1995. Together, the two constitute a comprehensive history of Western medicine. This second volume consists of four essays, each of which could have been published as an independent book. All of the authors cover both traditional history of medical science and practice, with frequent lists of contributors and contributions, and a substantial amount of social and sometimes political and institutional analysis. The authors tend to be Anglocentric.

The first essay, by Stephen Jacyna, covers 1800 to 1849. It starts with the Enlightenment tradition and includes both the Paris clinical school and the rise of the microscope, as well as sanitarianism and contagion. Jacyna addresses issues of professionalization (and lack of it), but his analysis is more abstract than that of the other authors and slightly dated, depending heavily on Foucault and other social theorists of the pre-1990 era.¹

Bynum, in a longer essay covering 1850 to 1913, gives a substantial and detailed history of the impact of science on Western medicine, including pathology, the germ theory, and the beginnings of immunology. He follows that impact into medical education, research, and hospitals, as well as medical technology, surgery, and the changes that the laboratory and statistics brought to the prevention and treatment of disease. Bynum uses the struggles of physicians caught between their patients and the state to explore the development of social aspects of medical innovation, conservatism, and organization, including the effects of medicine on the larger society.

Lawrence has a similarly detailed and comprehensive understanding of the period from 1914 to 1945. He writes of holistic thinking and scientific innovation. He is particularly effective in showing the way in which hospitals became central to health care—what Fox calls the system of "hierarchical regionalism" in medicine.² Researchers' methods and results in all settings complete the picture of health-care systems in different countries. Lawrence's discussion about the home, welfare, industrial medicine, and payment plans uses material from historical sociology as well as political analysis. His characterization of the impact of rigid, top-down scientific medicine by the Rockefeller charities around the world is particularly striking.

The last chapter, treating the years 1945 to 2000, by Hardy and Tansey, combines a great deal of institutional history with detailed information about what was discovered when, and by whom, and what the implications were. The authors introduce much information about changes in health and disease in Western countries, providing many suggestive charts and statistics. Health, especially preventive health, they show, was heavily political; they emphasize details of programs in Britain and international organizations.

Far more than most surveys of medical history, this one contains not only a factual narrative but also select examinations of the intersections between health care and Western societies.