Knowledge and Practice in English Medicine, 1550-1680 (review)

Andrew Wear. Knowledge and Practice in English Medicine, 1550–1680. New York, Cambridge University Press, 2000. viii, 496 pp. $74.95 (cloth), $27.95 (paper).

Discussions of the scientific revolution inevitably come around to medicine. When they do, they frequently offer Harvey’s discovery of the circulation of the blood as evidence that medicine, like physics, changed dramatically during the seventeenth century. Andrew Wear’s new book should go a long way toward challenging that picture. Wear does not set his book in precisely in these terms; it is rather something of an overview of early modern English medicine. However, one of Wear’s central structuring themes is that continuity, not change, dominated English medicine from the middle of the sixteenth century until the late seventeenth century. Thus, medical practice in the era of the “new science” remained remarkably similar to that of the previous century.

Wear bases his study on vernacular medical treatises, which he sees as central to mainstream medical thought in the period. He synthesizes the recent work of social historians of medicine, which frequently explores patients, the poor, women, or alternative healers, with work on more traditional subjects of medical history, so-called “elite” physicians and surgeons. Wear sees vernacular treatises as a point of convergence where lay and professional medical culture merged. In chapters on such central topics as remedies, diseases, prevention, surgery, and plague, Wear argues for what he calls a predominant “shared medical culture.” Doctors and patients alike shared a view of medicine that saw disease in essentially Galenic terms. They framed disease in terms of putrefaction and sought remedies based on evacuation. Moreover, both laymen and learned physicians held a view of general health that centered on assumptions about regimen, diet, and lifestyle. Wear also suggests that histories of the medical division of labor may have obscured the overriding similarities between physicians and surgeons, and this further contributes to his picture of a single, pervading, shared medical culture.

This medical culture was so entrenched, so widely held, that it largely withstood the first wave of the scientific revolution. In the second part of his book, Wear considers the challenge of the Helmontians to traditional medicine. Until now, the failure of the Helmontians has been attributed to their failure to establish an institutional base along the lines of the Royal Society, but Wear demonstrates that these early medical advocates of the new science also failed because they failed to convince patients of their new therapies. Here, Wear uses the model of the medical marketplace to good effect. Helmontians attempted to offer new milder drugs to a patient population steeped in the belief that powerful (and painful) remedies worked better. They tried to convince patients of the danger of evacuative remedies like bloodletting, only to find people still clamoring for that treatment. In a sense, Helmontians found that they had Galenists above them and below them—indeed, all around them. Wear does a nice job of offering a balanced picture. His story of medical continuity and failed revolution does not eschew change. In a final chapter, he gives the Helmontians due credit for introducing new ideas, notably the view of disease as a foreign entity, that would have significant influence in the eighteenth century.

Wear’s text covers a range of general topics very thoroughly, making it a candidate for classroom use. Indeed, on the surface it appears to be a general textbook on early modern medicine, and its quick release in paperback will encourage many to put it to that use. However, it should be said that its scope excludes the eighteenth century and the rest of Europe, so it cannot stand alone as a single text for a class on medicine in early modern Europe. Moreover, Wear’s historiographic purpose leads him to exclude certain topics that one would expect a general text to cover. Hospitals, for example...