Medicine in Society ed. by Andrew Wear (review)

BOOK REVIEWS Medicine in Society. Edited by Andrew Wear. London: Cambridge Univ. Press, 1992. Pp. 379. $89.95 hardback; $29.95 paperback. "The social history of medicine has come of age," proclaims the first line of the introduction to this collection of essays, which span the complexities of Classical times to predictions based on modern demographic trends. The book, once past the Middle Ages, is Anglocentric, and like most collections of essays, of varying quality. Overall there is an emphasis on medicine "from the bottom up," that is from the point of view of the patient and the society in which medicine operated, rather than the isolated and often practically irrelevant pronouncements of famous physicians. Taking this viewpoint is much easier said than done, and the essays in this book show the full range of outcomes. Vivian Nutton's opening essay on Graeco-Roman medicine and society shows masterful knowledge not only of the conventional histories of medicine, but of classical antiquity as well. In an elegantly synthesized and admirably concise work, he summarizes many current historiographical questions, offers eminently reasonable positions on them, and leaves the reader with the feeling not only of having learned at the hands of a master, but of slightly regretting that the essay is only as long as it is. Good prose and good history do not always accompany one another, nor does the effortless way in which Mr. Nutton handles masses of primary and secondary source material represent the norm. This essay alone justifies the book. Katherine Park next offers an effort on the Middle Ages. Perhaps because the period bears too directly on our own in terms of medicine and society (the university and the hospital are medieval inventions, while plague, leprosy, and other known diseases are discernible, and government involvement in medicine dawns) her essay is less satisfying. The next two essays, Roy Porter's "The Patient in England, c. 1660—c. 1800" and Andrew Wear's "Making Sense of Health and the Environment in Early Modern England," are workmanlike solid efforts. If not scintillating, they are at least products of serious scholarship and are coherently presented. By this point in the book, however, the emphasis on England begins and is only kept from being intrusive by the authors' knowledge of Western European developments in addition to those in Britain. Gunter Risse's essay "Medicine in the Age of the Enlightenment" comes as a rather startling contrast to the rest of the book. Its role is explained in somewhat ambiguous terms in the introduction of the book. Permission to reprint a book review printed in this section may be obtained only from the author. 468 Book Reviews The quality of the essays becomes immediately more satisfying with L. Granshaw 's "The Rise of the Modern Hospital in Britain." Had this essay been placed before that of Risse, the latter's essay would have suffered less from gaps in intellectual history between the Middle Ages and the Enlightenment. Although the essay is comparatively short, it is able to capsulize the essential points in the development of the hospital and its role in health care from the Middle Ages through the nineteenth century and into the twentieth. Irvine Loudon's essay on the period of medical reform (1750—1850) is cast in the same mold. Another carefully crafted, elegantly and clearly written essay, this piece lays out the historiography of the subject in an admirable way and then proceeds to treat its subject skilfully. The author's ability to see the components that have lead to opposing views of the reform movement allows a synthetic rather than a polemic conclusion. Elizabeth Fee and Dorothy Porter combine next in "Public Health, Preventive Medicine and Professionalization: England and America in the Nineteenth Century " and continue the strong series of essays that comprise the central part of this tome. Again, the rise of the concept of public health is placed in the larger sphere of the social history of the two countries (and to a lesser extent several European ones). Roy Porter's essay, "Madness and the Institutions," begins inevitably as a critique of Michael Foucault's concept of the "great confinement," a manifestation of absolutist...