New Medical Challenges during the Scottish Enlightenment. Vol. 78 of Clio Medica (review)

As Guenter Risse tells readers in his introduction, this book is the end note to his career as a historian of medicine of the eighteenth century. It is a fitting coda to his substantial scholarly achievements in the medical history of Scotland in the Enlightenment. Part 1 covers the tensions between charitable and scientific objectives in Edinburgh's Royal Infirmary, and the changing cultures of mannered debate and practical experimentation in Edinburgh's Royal Medical Society, and includes discussions of Brunonianism and of the press and the medical establishment. Part 2 focuses on hygiene and health in relation to Enlightenment notions of virtue, sensibility, and sympathy; on the nature, prominence, and, later, virtual disappearance of ague in Scotland; and on the so-called mill reek, the diseases associated with Scotland's lead miners. In part 3, on medical theory and practice, Risse discusses phthisis as presented in medical casebooks; gynecology and women's bodies; and hysteria (as a largely female condition) and hypochondriasis (as a mainly male one).

Risse has long been at home with primary sources relating to Edinburgh's Royal Infirmary, dissertations of the students in Edinburgh's university and Royal Medical Society, and medical casebooks and manuscripts of practitioners, professors, and students. The words and sentiments of the time are subject to detailed interrogation in clear and informed prose. Each chapter has a summary that, effectively, places the theme in its wider context. The book is both a "medical history from below" and a medical history attentive to civic and institutional context, to geographic factors, and to the complex connections between medical matters and social ones such as diet, health, bodily comportment, and (albeit differently for men than for women) moderation and modesty. It is an important contribution to a social history of Scottish Enlightenment medicine, for here we can trace the debates within institutions, read the notes of anxious bedside physicians, follow disputes in diagnoses, and understand how matters of livelihood and rank, then as now, limited access to health care. And it also provides, if less fully, a medical reading of eighteenth-century Scottish society—in its study of the connections between sympathy and moral virtue, health and regimen in the individual and the body politic; and, importantly, in the chapter on ague especially, in addressing the environmental and social changes that lay behind the virtual disappearance of the disease in Scotland by the late eighteenth century.

One of the book's strengths is, paradoxically, also one of its weaknesses: a concentration on the capital city of Edinburgh. Sources of information are scant for other towns and very poor for much of the countryside, but, as Risse himself agrees, claims about Edinburgh may not necessarily apply to all of Scotland or the Scottish Enlightenment.

A few quibbles: Readers might wish for a stronger connecting narrative and less overlap between chapters—a common result when a book is compiled from a series of previously published essays. The title is also somewhat unclear: what is the nature of these "new medical challenges"? The book deals less with medical novelty than with the enduring story of physicians battling illness, restricted by their own frailties and by the limits of knowledge and the technological capacities of the age. In addition, the book would have benefited from the inclusion of illustrations, which would have enabled readers to consider how much medicine's changing place gave rise to an iconography of the Scots physician or the hysteric patient, or the extent to which we can trace trends in medical illustration in books and journals, as sketched diagrams.

Finally, it is unfortunate that Risse did not take the opportunity to point to avenues for further research and to place the medical Enlightenment firmly in the context of Enlightenment studies generally. Yet he has significantly advanced our understanding of medical history in Enlightenment Scotland and is to be...