Lawrence I. Conrad, Michael Neve, Vivian Nutton, Roy Porter, and Andrew Wear

THE WESTERN MEDICAL TRADITION

800 BC to AD 1800

The authors (one of whom is the late lamented Roy Porter) are or were all members of the Academic Unit of the Welcome Institute for the History of Medicine. Separate attributions are not provided for the different chapters so there is no means of knowing who wrote which parts. The book is intended as a textbook so the tone is scholarly, but it is nevertheless calculated to appeal to anyone with a serious interest in the subject. As the subtitle indicates, it covers a wide period, from early Greek times to the beginning of the modern era at the end of the eighteenth century. The focus of the book is explicitly on western medicine, but since Greek ideas largely entered western awareness via the Arabs there is a chapter on Arabic and Islamic medicine.

Hippocrates may have been responsible for introducing the idea of the humours into Western medicine, but it was its adoption by Galen, a Romanised Greek, in the second century CE, that led to its later dominance of western medical thought. Galen's writings were accepted as authoritative for most of the Middle Ages. There were four humours (choler, black bile, blood, and phlegm), each with its associated temperament and connection with one of the four seasons. Disease was supposed to result from disturbance of the humoral balance. I would have liked to read more about this subject, which is alluded to a good deal in the text but perhaps not discussed in sufficient detail. There are interesting similarities between Chinese ideas and western humoral concepts but these lie outside the scope of this book.

In the fifteenth century Paracelsus introduced a different way of thinking. From this time on we get a conflict between Galenism and 'iatrochemistry', which sounds modern although the chemistry in question is largely alchemical in nature. Another innovation at this time was the increasing interest in anatomy, which led eventually to William Harvey's description of the circulation of the blood. This discovery was obviously essential to the development of modern medicine, yet Harvey himself was in many ways a traditionalist and regarded his work as supporting the insights of Aristotle.

One of the principal themes running through the story is the medicalisation of life and the increasing professionalisation of medicine, a trend that ebbed and flowed. I had not realised how widespread was the mediaeval assumption that the lady of the house would include the preparation of medicines alongside her cookery recipes; this died out only gradually. The influence of religion was strong throughout most of the period covered here and it was assumed as a matter of course throughout the Middle Ages that the help of God was required to supplement the efforts of the doctors. Another important element was medical astrology, but this had its dangers for the doctors, who might fall under suspicion of practising magic.

In a concluding section the authors consider how we should regard the panorama they have presented. One theme, they suggest, is the increasing gulf between the professionals—the doctors—and the patients they treat. This tended to raise the social standing of doctors; their efforts to distinguish themselves from the surgeons, who began life as barbers, are often amusing. Eventually, of course, the surgeons triumphed. Another theme is the oscillation between two views: the identification of disease categories on the one hand and the view of the patient as a unique individual on the other. This difference is still being vigorously debated today, especially by advocates of complementary medicine. Another point they make is that, at least until recently, the contribution of medicine to the well-being of society has often been relatively small compared with that provided by improvements in diet, housing, and public health measures.

The aim of this book is to site medicine very firmly in its wider social and political setting, and it succeeds well in this, perhaps somewhat at the expense of some of its intellectual and conceptual underpinning.

14 July 2009