Performing Medicine: Medical Culture and Identity in Provincial England, c. 1760-1850 by Michael Brown (review)

Judging from Michael Brown's Performing Medicine, the history of the medical profession in Britain is in a state of fine-tuning. Brown says this himself in so many words, and his rich study supports his view. Brown wants to move on from the sociological and economic models (given an exhilarating individualist twist by Roy Porter) that challenged complacent developmentalism and to moderate their reductionist tone with something more in line with the mores, morals, and practices of the late eighteenth and early nineteenth centuries. Here he catalogues a move from the clubbable culture of Enlightenment medicine to scientific professionalism, in Brown's words from "medico-gentility" to "expertise, professional self-identification and a political engagement with the care of the social body" (p. 9). This shift is familiar enough, but the details from the local history of York that Brown has excavated and uses to tell his tale make this an important piece of historiographical adjustment and, in the very best sense, a delightful antiquarian study.

Chapter 1, "The Doctors Club," takes its name from the appellation given to the Thursday meetings that York practitioners organized at a tavern where they dined, drank, and self-improved. But this was no professional body; the members included aldermen and merchants. It was a quintessential eighteenth-century social gathering for self and civic betterment. The nugget in this chapter is the autobiography of the apothecary and aspiring gentleman Oswald Allen. The memoirs of this earnest, parochial social climber provide Brown with a wonderful window into the machinery that made medicine and nearly everything else move in the eighteenth century: patronage and charity—dispensed or received in the context of "politeness, gentility and sociability" (p. 39). In chapter 2 Brown shows how medical manners and knowledge passed seamlessly into everyday gentlemanly life. York doctors wrote on medicine but also natural history and agriculture. Esteem of a medical man's "liberal mind," as one called it, no doubt served to flavor judgments of his competence. Chapter 3 is a reinterpretation of the history of the York Retreat and the York Lunatic Asylum, challenging triumphalist and moral management readings of their histories. These Brown successfully displaces—or at least supplements—with a tale of the labyrinthine workings of patronage; again a micro story taken from the general picture of Georgian power politics.

The next three chapters are perhaps slightly less striking as reinterpretation but just as good as the earlier ones when read as great local history fleshing out a familiar narrative. Here Brown looks at the increasing insularity of York medical men, cultivating science and ambivalently courting state service after the Poor Law Amendment Act of 1834. These initiatives were concretized in the founding of new (strictly) medical societies, medical schools, and anatomy lectures and in attacks on unqualified healers.

Brown's important book places two rather different, but temporally conjoined, medical cultures firmly in their periods, and, rightly, he uses his epilogue to criticize modern reports on medical education that, to justify their conclusions, lazily draw on anachronistic notions of a medical profession with a single long history. But, revisionism ever being the historian's trade, there is a another story to be kept in mind and worked out. For example, Brown employs John Gregory's writings as significant evidence for the cultures he studies. Quite right: Gregory repeatedly made the point that medical manners were gentlemanly ones, that physicians should be widely learned, that science was important but clinical experience far outweighed it, and that, as a body of knowledge and a practice, medicine should be furthered by all talents; it should be "laid open," as he put it. But his colleague William Cullen had a quite different image of medicine. It would be rooted in the new sciences, notably chemistry, practiced by a bounded profession immune from public meddling and serve the state through its great institutions, such as the...