Medical Practice, 1600–1900: Physicians and Their Patients ed. by Martin Dinges et al. (review)

Although scholars have already done considerable work on physicians and patients for the three-hundred-year period addressed here, we know less about the quotidian world of the medical practitioner in all its multifarious aspects. Medical Practice uses the genre of “practice records”—patient records, account books, and case books—to “meet the need for effective access to practice-relevant information” (p. 33).

Medical Practice, 1600–1900 can, not unfairly, be described as an interim report on the state of research. The volume’s twenty contributors belong to a collaborative research network that is studying these heterogeneous sources, differing in “historical usage, presumed purpose, temporal origin and material form” (p. 15). The men who kept these records differed in origins, training, and geographical location (but all practiced in German-speaking areas). The collection specifically analyzes the records of eight practitioners. The character of their practices differed: represented here are urban and rural practitioners, practitioners of several social backgrounds, physicians to the poor, homeopaths, and lay or unlicensed healers. The size and extent of their practices varied, as did the purpose of their record keeping: we find here examples of a reflection on the vita activa, an extended meditation on medical epistemology, and a decades-long “testing” of various therapies.

A reader might do well to flip to the very back of the book first, where he or she will find an informative section on sources that graphically demonstrates their heterogeneity, the physical materiality of the forms, and the general differences between more discursive handwritten records and tabular printed ones. Although the introduction proposes a tripartite typology (casebooks or observationes, serial journals, and printed forms), no attempt is made to force records rigorously into any single mold. This rejection of simplistic answers and definitions is also reflected in the rather unusual format the editors selected. The first half discusses broad issues, such as doctors and their patients, organization and finances, knowledge and therapy, and the greater context in which patients and practitioners lived. The second part takes up individual practices. In both, the collaborative nature of the research finds expression in collaborative authorship; of the thirteen articles, only three are written by individuals.

It is perhaps inevitable that the dominant character of a research report means that the authors proceed by setting out hypotheses and then testing them against the material their research has uncovered. It is perhaps equally inevitable that conclusions are often tentative and phrases like “more research is need” appear frequently. Occasionally, details overwhelm the larger interpretations. Not all findings are new; the results obtained often verify what medical historians have known or at least suspected on the basis of less quantifiable evidence. Often, as in the article by Annemarie Kinzelbach, Stephanie Neuner, and Karen Nolte on “Medicine in Practice: Knowledge, Diagnosis and Therapy,” the authors present a series of conclusions that either sustain or refute current interpretations. This examination of scientific publications and the medical practice of several physicians, for example, reorders the timing of an epistemological shift: “whether acquired knowledge was retained or altered as a result of empirical experiences was by no means dependent on when a particular physician lived and took his notes” (p. 128). The evidence also suggests that the putative decline of the patient narrative was not precipitous and patient “stories” remained as central in the nineteenth as in the seventeenth century. Perhaps less new is the discovery that therapies altered little over time. Interesting, too, is the conclusion that the yawning gap between patient knowledge and practitioner knowledge, considered a modern phenomenon, existed much earlier, at least in the seventeenth century and probably long before then as well.

While this collection of articles deliberately does not advance an overarching reinterpretation of the relationship between practitioners and patients, it does provide a great deal...