Book Review

The Western Medical Tradition, 800 B.C. to A.D. 1800

N Engl J Med 1996; 334:608-609February 29, 1996

Article

The Western Medical Tradition, 800 B.C. to A.D. 1800
By Lawrence I. Conrad, Michael Neve, Vivian Nutton, Roy Porter, and Andrew Wear. 556 pp., illustrated. New York, Cambridge University Press, 1995. $34.95. ISBN: 0-521-47564-3

This book surveys the history of the Western medical tradition from the time of Hippocrates (fifth century b.c.) to about 1800, when it began to break down under the impact of major changes in medical theory and therapeutics. It was basically a Greek tradition, built on a naturalistic understanding of disease, humoral pathology, Hippocratic medical ethics, and a high ideal of physicians. These familiar features were transmitted initially to the Romans and through them to the people of the Middle Ages (within Western Christendom, the Byzantine Empire, and the Islamic world), and later, after the rediscovery of the Greek and Roman classics, to Renaissance Europe. Hippocratic medicine was indeed the ars longa (“long art”) of Western culture, dominating medicine until less than two centuries ago.

Interest in the history of medicine has grown markedly in the past generation, and it has given rise to numerous specialized studies that have been influenced by the new social history. As a result, few historians have sufficient breadth to trace the entire history of Western medicine. It is therefore appropriate that a team of specialists was chosen to write this book. All are members of the Academic Unit of the Wellcome Institute in London, the leading center for the study of the history of medicine. The resulting work is no ordinary collection of commissioned essays, but a lively and highly readable book in which five of the leading medical historians writing today describe medicine as a social phenomenon and an integral part of Western cultural history.

The first three chapters, dealing with medicine in Greece, Rome, and the early Middle Ages, were written by Vivian Nutton. Nutton rightly excludes from his purview the medicine of ancient Egypt and Mesopotamia and begins with the invention by the Greeks of rational medicine (i.e., medicine that attributes disease to natural causation). Nutton, whose knowledge of classical medicine is unmatched, surveys the world of ancient medicine in masterly fashion. With broad strokes, which are balanced by precision and nuance, he describes the “medical market-place” of the Greek world, in which physicians had to compete with a variety of healers. In chapter 2 he traces the adoption of Greek medicine by the Romans, who had no native tradition of rational medicine, and its gradual spread throughout the cities of the Roman Empire. Nutton devotes special attention to Galen, the greatest medical researcher of the ancient world. It was through his voluminous writings (over 400 works) that the vast medical tradition of classical antiquity was transmitted to both Christian Europe and the Islamic world.

In Chapter 3 Nutton traces the rise of Galenism as a medical system and the emergence of Christian medical philanthropy, particularly as it achieved institutionalization in the birth of the hospital, which was a Christian invention. Lawrence Conrad, a leading expert on Islamic medicine, picks up the story in chapter 4 and carries it into the Arab world. The Arabs, like the Romans, absorbed Greek medicine and spread it throughout the lands they conquered. Galen was the key here. His own monotheism and teleology made his version of Hippocratic medicine appealing to the three monotheistic traditions (Judaism, Christianity, and Islam).

In chapters 5 through 7 Nutton, Andrew Wear, and Roy Porter trace the continuation of the Greek tradition in the late medieval (1000 to 1500) and early modern (1500 to 1800) periods. The growth of university medicine in the late Middle Ages, the rediscovery of anatomy by Vesalius, Harvey's discovery of the circulation of the blood, and the influence of the scientific revolution on medicine are among many subjects that are described with a sure hand. But the book is more than merely a retelling of the stories of famous doctors and celebrated medical discoveries. It also describes elements of healing that are usually neglected by the standard handbooks: women's medicine, alternative healers, popular and folk medicine, quackery, and the history of madness. It is in the attention given to these matters that one sees most clearly the distinction between the old medical history and the new. In the concluding chapter Michael Neve writes a historiographic essay on the development of medicine in which he summarizes the main themes covered in the earlier chapters.

The cumulative changes in medicine over the past 200 years have cut us off from the medical world of our ancestors. As the introduction points out, even the authority of outstanding medical pioneers differs today from what it was in earlier generations. “To a modern physician they are distinguished precursors; to one of 1790 they also imparted sound knowledge and useful practical information.” In spite of the barriers that separate the medicine of the present from that of the past, many of our attitudes toward medicine, medical ethics, and even physicians have been shaped by the tradition described here. It is a tradition that we have largely lost, although the story of its development and long dominance is well worth the telling. And it is told remarkably well in this book, which is probably the best and most authoritative social history of Western medicine available in one volume.

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