Miasma and Disease: Public Health and the Environment in the Preindustrial Age by Carlo M. Cipolla, and: Epidemics and Ideas: Essays on the Historical Perception of Pestilence ed. by Terence Ranger, Paul Slack

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926 Book Reviews TECHNOLOGY AND CULTURE unanswered in this volume. The editors argue, convincingly, for the importance of the laboratory in medical history. Some medical historians of late have acted as though the most important change in modern medical care has been a transition to hospitalized medicine. But, the editors here claim, the transition to laboratory-based medi­ cine followed and was at least as important. Perhaps. Probably. But the care of patients in hospitals located medical practice in a specific place. To talk about medical care and the laboratory one would like to see more attention to what health care deliverers did, not only what they said. While the authors are attuned to the contingent nature of how the research and the teaching laboratory was constructed, one wishes for more attention to how the clinical laboratory was constructed, and used, by practicing health care providers. There is an implicit assumption in some of the essays that a new rhetoric about laboratory­ generated medical knowledge in some direct way was responsible for widespread changes in medical practice. We need to know more about the relationship between rhetoric and care. This will come. Joel D. Howell Dr. Howell is in the Department of History and Internal Medicine at the University of Michigan. He has published widely on the history of medical technology and is now completing a book on the history of early-20th-century American medicine and technology. Miasma and Disease: Public Health and the Environment in the Pre­ industrial Age. By Carlo M. Cipolla. Translated by Elizabeth Potter. New Haven, Conn.: Yale University Press, 1992. Pp. ix+101; glossary, notes, index. $20.00. Epidemics and Ideas: Essays on the Historical Perception ofPestilence. Edited by Terence Ranger and Paul Slack. New York: Cambridge Univer­ sity Press, 1992. Pp. ix + 346; notes, index. $49.95. Since the 19th century, medical historians have emphasized the impact of bacteria and other wee creatures and poisons that were accepted as causes of a variety of epidemic diseases, including the highly mortal and dreaded plague, cholera, and assorted fevers such as typhus, typhoid, and malaria. These classic historical accounts concentrate on efforts to improve the public health by eradicating disease through improved water supplies, drainage, street cleaning, food inspection, and other measures that involved a good deal of technological expertise and public expense. However, a much broader interpretation of the history of epidemic disease is shared by those who wrote and edited these two books. Building on earlier histories, these scholars exemplify the cutting edge of new approaches to medical history and provide models for historians of science and technology to broaden their studies. TECHNOLOGY AND CULTURE Book Reviews 927 Carlo Cipolla’s Miasmas and Disease is a slim volume, his most recent book on the history of the plague in medieval Italy. His other works are more analytical and interesting to read, particularly for those less well versed in the history of medicine. Miasmas provides the raw data, that is, the reports of the Florence Health Board and correspondence of the communities’ governors during the first half of the 17th century. Cipolla is a leader among a generation of Italian medical historians who have built their fine reputations on interpreting documents and placing them within a totality of physical, physiologi­ cal, psychological, social, and economic boundaries. (Unfortunately most of their publications are not available in English.) Cipolla believes that each age and culture has been afflicted by certain pathologies. In preindustrial societies infections prevailed, while in industrialized regions degenerative diseases were prominent. For the reader interested in getting an overview of the most severe epidemics that have afflicted people since antiquity, as well as the range of data and skill required to interpret their impact, the volume edited by Terence Ranger and Paul Slack is recommended, especially the editors’ introduction, which argues that medicine and science are less value free than some historians have claimed. Social prejudices and fears, as well as sympathy for the poor and those stricken with disease, shaped governmental efforts to stem the tide of epidemics. On the scale of a terrifying epidemic, disease has served to bring out the worst in human nature as well as the best. Epidemics...