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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 government. Porter, without totally denying Foucault's ideas any value, discretely adds a number of other causes and responses that contributed to institutionalization of those judged insane. "Providers, Consumers, the State and the Delivery of Health Care Services in Twentieth Century Britain" by Jane Lewis puts into perspective the social forces in play in the development of health care delivery in modern Britain. The author shows how governmental belief that scientific medicine was the key to assuring a healthy population allowed the medical profession to secure its own position. This essay is most adroit in its evocation of the various contenders for power over health care. Anyone wishing an historical perspective on the British National Health Service would do well to start with this essay. The book closes with a translation of an article by Arthur E. Imhof, entitled "The Implications of Increased Life Expectancy for Family and Social Life" I consider this an extremely poor choice of an essay to close a book that, for the most part, is of high quality. Stephen R. Ell Department of Radiology University of Utah Salt Lake City, Utah Simians, Cyborgs, and Women: The Reinvention ofNature. By Donna J. Haraway. New York: Routledge, 1991. In her previous book, Primate Visions: Gender, Race and Nature in the World of Modern Science, Donna Haraway argued that scientific visions of monkeys and Perspectives in Biology andMedicine, 36, 3 ¦ Spring 1993 | 469 apes—supposedly reflecting the "real nature" of primates and illuminating the evolutionary foundations of human nature, unobscured by culture and history —are themselves profoundly shaped by culturally and historically specific assumptions about gender, race, class, and social order. In Simians, Cyborgs and Women: The Reinvention ofNature (consisting of 10 chapters adapted from essays published between 1978 and 1989), Haraway explores the social/historical contexts for a number of different accounts of nature, from primatology to sociobiology , immunology, and problematic feminist claims about "woman's nature" and common "female experience." Haraway, an historian of science and professor in the History of Consciousness Program at the University of California (Santa Cruz) begins from the premise that "nature is constructed, constituted historically, not discovered naked in a fossil bed or a tropical forest. Nature is contested" (p. 106). Claims about the nature of primate groups, human sexual dimorphism, or the immune system, prior to their shaping by human society, underlie our understandings of "human possibility within inherited constraint" (p. 101), and these understandings can be shown to change over time. In Chapter 5, "The Contest for Primate Nature: Daughters of Man-theHunter in the Field, 1960-1980" (originally published in 1983), Haraway documents , for example, how female primatologists, working within Washburn's intellectual "patriline...


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