The Practice of Reform in Health, Medicine, and Science, 1500-2000 (review)

This long and heterogeneous collection is a festschrift for Charles Webster. Most of the chapters are about England (except for one each on France, Italy and New Zealand); only two bear directly on Scotland, one being an incisive study in intellectual history by Colin Kidd (about racialism in the Scottish Enlightenment) and the other a useful piece by John Stewart on the Welfare State and Scottish hospital planning, though other chapters contain a British dimension (notably chapter 5 by Pelling and chapter 17 by Jane Lewis on the regulation of the medical profession). As an edited collection it works better than most. All the contributions deal with debates that Webster either initiated or contributed to, the volume's chronological span (two-thirds of the eighteen contributions cover the early modern period, one third the twentieth-century) a testament to his own remarkable range over a long and varied career in the history of medicine.

The main theme that unites the volume is that scientific and medical developments cannot be understood outside their social and political context, an idea that Webster developed in The Great Instauration: Science, Medicine and Reform, 1626-1660 (1975) and continued into his later work on the National Health Service. Contributors engage more or less explicitly with Webster's vision and this lends coherence to the volume. The first chapter, by Howard Hotson, borrows from Webster's title and is perhaps the closest to his approach. However, the reader is won over to the mission more by the high quality of most of the contributions than by any adherence to form, the early modern offerings being especially praiseworthy. All offer very detailed analyses that lean towards the history of science and of ideas rather than the social history of medicine (as conventionally understood, rather than as defined at p. xi), which is, however, better served by the twentieth-century chapters. Most chapters are about policy makers and providers of, or thinkers about, care rather than about patients. Thus Pelling's chapter on 'Politics, medicine, and masculinity' is more about men than masculinity as it is understood by gender historians. Feingold's piece on the origins of the Royal Society is also a traditional approach that analyses the importance of clubs and associations. Lauren Kassell's apparently broad 'Economy of magic in early modern England' is in fact a fascinating case study of the astrologer Lilly's understanding of sigils (amulets 'in the form of a metal seal depicting images or words'), which bears on the social economy of magic in seventeenth-century England. Apparently curious contributions such as Penelope Gouk's on the way music helped to facilitate the reception of Paracelsian ideas also manage to fit into the scheme. The importance of political considerations to scientific and policy change is shown in most chapters, notably Pietro Corsi's on language and science in the Revolutionary/Napoleonic period in France. Religion too is an important component of the early modern chapters, for example in Jonathan Barry's revisiting of Bristol Puritanism.

The twentieth-century chapters are all by significant figures in medical history and are again of good quality. However, without a work of the stature of The Great Instauration to act as a guide, they are less focused, reflecting the disparate interests shown in Webster's other main work, The Health Services since the War (1988; 1996). Chapters 13 to 16 deal with provision of healthcare and the final chapter by Virginia Berridge is on the early history of anti-tobacco activism in Britain. The editorial touch is light. There is no introduction, but a notably personal four-page preface. Nor is there a conclusion and the volume ends with a selection of Charles Webster's prodigious output from 1963 to 2002. The length of contributions varies considerably, from Anne Marie Rafferty's eleven page offering on the international recruitment of nurses to...