Book Review

Medicine in Society: Historical Essays

N Engl J Med 1993; 328:819-820March 18, 1993

Article

Medicine in Society: Historical Essays
Edited by Andrew Wear. 397 pp. New York, Cambridge University Press, 1992. $69.95 (cloth); $19.95 (paper). ISBN: 0-521-33351-2 (cloth)

The past two decades have seen something of a revolution in the study of the history of medicine. Traditionally regarded as a byway of history, the preserve of physicians who focused on “the history of great doctors, great discoveries and great ideas,” the field has been transformed in recent years under the influence of the new social history, emerging as an exciting and important area of study. Numerous monographic studies have both broadened the definition of medicine and appreciably deepened our understanding of the historical relation of medicine to society. The subjects of recent interest include the changing status of physicians over time, alternative kinds of healing, the point of view of the patient, the history of public health, the development of hospitals, patterns of sickness, and changing views of disease. These and other themes are explored in this book, in which Andrew Wear has brought together some of the leading social historians of medicine, whose essays span the periods from the Greeks to the 20th century.

The essays focus on several areas that have been the subject of recent scholarship: the traditionally unregulated medical marketplace, the efforts to license and professionalize medical practitioners, the medicalization of society in the past century, and the history of madness. The chapters that deal with recent centuries are oriented toward British medicine, but parallel movements in the United States are discussed as well.

The first three essays (by Vivian Nutton, Katharine Park, and Roy Porter), which focus on the ancient, medieval, and Renaissance periods, provide the essential background to an understanding of the development of modern medicine. Greek medicine (transmitted by the writings of Hippocrates and Galen) dominated learned medicine till the Renaissance, whereas a multiplicity of healers (surgeons, apothecaries, midwives, empirics, barbers, and others) offered medical care. Magical and rational practices were intermingled, self-help was widely advocated, lay medicine was extensively practiced, and faith healing was commonly sought.

The greater part of the book deals with the development of medicine and public health in the past three centuries. Essays by Wear and Guenter Risse trace the beginnings of modern medicine in the late 17th and 18th centuries, when there was an increase in the number of learned practitioners, changes in medical theory (from a humoral to a chemical or mechanical view), and a growing recognition of the influence of environmental and hygienic factors on health. It was the 19th century, however, that witnessed the advent of modern medical care. This involved the transformation of the hospital from its historical role as a charitable institution for the poor to a central position in health care, the training of physicians, and medical research (the subject of an essay by Lindsay Granshaw); the professionalization of medicine under state regulation in France and England (explored by Irvine Loudon); the rise of public health medicine, which brought about increased state regulation of society (examined by Elizabeth Fee and Dorothy Porter); and the bacteriologic revolution of Pasteur and Koch and the creation of scientific medicine (described by Paul Weindling).

Weindling traces the advent of scientific medicine that, at the beginning of the 20th century, produced an “epidemiological transition,” in which acute diseases were replaced by chronic diseases as the chief causes of death, as a result of the pronounced decline in morbidity from infectious diseases. The 19th century also witnessed the rise of the asylum as an attempt to treat the insane humanely -- the subject of a fascinating chapter by Roy Porter on the history of madness. Jane Lewis describes another modern phenomenon, the introduction of national insurance plans, which gradually led to the widespread belief that health care was a universal right. The concluding essay by Arthur Imhof (which contains numerous graphs) demonstrates the influence of increased longevity on social behavior, particularly in the decline of religious belief.

The essays of Imhof, Weindling, and Lewis point out that in spite of its much-vaunted progress over the past two centuries, modern medicine is not without its ambiguities. The advent of hospital and scientific medicine has reduced the power of the patient (who has become “more of an object and less of a person”), whereas the participation of the consumer in the management of medical care remains negligible. Hence the rise of much recent criticism of health care on the part of governments, social critics, and the public. These essays provide an admirable historical context for this criticism.

This book makes the recent work of medical historians available to a wider audience of nonspecialists who are interested in the historical roots of modern health care. The essays are comprehensive in their sweep, are informed in their assessments, and take full account of modern currents of scholarship. The work thus deserves a wide readership among health care professionals, who -- if they do not know where current medical trends will lead them -- will at least learn where they began and how they have developed.

Gary B. Ferngren, Ph.D.
Oregon State University, Corvallis, OR 97331