Western medicine: an illustrated history

Students of the history of medicine long complained that there was no single volume available that expounded to a general audience the results of the massive changes that have taken place within the subject over the last thirty years. Now, English readers have a choice between three such histories of medicine, and a fourth, written by Roy Porter alone, will appear shortly. Of those in print, the Wellcome Institute's The western medical tradition, Cambridge, 1996, covers in greater depth and at greater length than the others the period from the Greeks to 1800, and a sequel is greatly to be wished. The Cambridge illustrated history of medicine, Cambridge, 1996 (the shorter Porter), ranges from Egypt and Babylon to speculation on the future of medicine. Its six contributors treat broad themes chronologically, and its illustrations are partly integrated with the narrative and partly placed at the centre of separate discussions of topics of interest. The new Oxford Western medicine: an illustrated history, the lightest of the three in weight, has more contributors, nineteen, and more words that its Cambridge rival. All three, it is fair to say, succeed in their main aim, of transmitting the new history of medicine to all those interested, and all have something to say to fellow medical historians, as well as to the general public. In scope, choice of themes, and illustrations, they complement one another, and although comparisons are inevitable, they should not obscure that fact that each should be regarded as essential reading, if not as an essential purchase. What should one demand of a good history of medicine? My choices would be accuracy, lucidity, coherence, balance, and enough individuality to mark it out from its competitors. On these criteria, this book scores high. Factual errors are few,' and many chapters are well written and put together. But those on unofficial medicine and on patients lack verve, often descending into academic jargon: "although a new epistemology reconceptualised specific disease entities so that the 'medical gaze' focused to a greater extent on their physical signs, the resilience of history-taking in medical encounters indicates that the patient's own story continued to be heard". The rest of this review will focus upon the other three qualities, which interact to give the Oxford version its particular merits. As befits a work edited by a doctor and artist, it asserts its individuality from the start, with a brilliant chapter, by Martin Kemp, devoted to the use and interpretation of visual evidence within medicine and by historians. Both cautionary and challenging, it is an exemplary introduction, sweeping away much loose thinking about the past, as well as meditating on the images contained elsewhere in the volume. Its impact is perhaps lessened a little by the failure to provide cross-references to the actual images, and by the decision (also in the shorter Porter) to give no index of noncolour illustrations. Even after using the index of acknowledgments and the captions, many questions remain frustratingly unanswered; p. 17, the text refers to the Renaissance and Fabrizio's appointment to Padua in 1565, the illustration comes from a reprint of 1648; pp. 161-2, which hospitals are represented? The plate on p. 108 has been reversed; others are fuzzy or too small to see essential details, and activities described in the caption on p. 273 have been lost in the cropping of the colour plate opposite. Maps are few, and confusing: on p. 180 Peking is depicted as the source of the Black Death, and the map on p. 181 does not make clear which diseases are transmitted where. But, in general, the illustrations extend the message in the text, and like those in the other volumes, contain much that is new and unusual. The more strictly historical sections are divided into seven chronological and eleven topical chapters. The former group covers the Greeks; Europe and Islam (interestingly concentrating on an exchange of ideas down to the last century); the Middle Ages (ending around 1400); the Renaissance; a long sweep