Willem de Blécourt and Cornelie Usborne (eds), Cultural approaches to the history of medicine: mediating medicine in early modern and modern Europe, Basingstoke, Palgrave Macmillan, 2004, pp. xxiii, 241, £50.00 (hardback 1-4039-1569-5).

Abstract

Moving away from outmoded theories of “medical imperialism”, this collection seeks to reconstruct the “complex web of communications and re-configurations” in medical history. Addressing issues as diverse as heart dissection, masturbation, animal care, hermaphroditism and orthopaedics, in Europe between the 1600s and the present, it uses the concept and role of “mediation” to explore theories of sickness and healing. As identified by Roy Porter's foreword, the contributors seek to isolate the meanings of medical knowledge and expectations, rather than relying on filter-down or Foucauldian approaches to the development of modern medicine. Each of the essays claims to offer images of medical knowledge and practice that are more “rich”, “complex” or “comprehensive” than those currently in vogue. The eclectic range of subjects studied is promising, though its successes are mixed. Several contributors focus on “mediation” in terms of the construction and circulation of medical knowledge between texts and audiences, and between patients, practitioners and the wider community. Thus Louise Hill Curth draws parallels between human and animal medical theory and treatment to demonstrate the importance of “one medicine” in the humoral tradition. Micheline Louis-Courvoisier and Severine Pilloud, and Michael Stolberg use the extensive archival resources of the Genevan doctor Samuel Auguste Tissot. The former contributors focus on the formal and contextual composition of the letters and examine the social embeddedness of healing concepts. Michael Stolberg's account takes direct issue with the themes of “popularization” and “public understanding” that have become so central to medical history. Yet the stated aim of Stolberg's piece—to understand the impact of medical advice literature on the lay readership, rather than simply taking for granted that “dominant medical discourse will automatically be accepted”—is surely a standard objective of modern medical history research. A more promising approach to letters is suggested by Alfons Zarzoso's account of lay decisions over medical care and treatment in eighteenth-century Catalonia. That self-medication and advice from relatives and friends was commonplace during the period is well-known. Less extensively studied is the vocabulary of afflictions, and the accommodation of illness and disease within a specific socio-economic and political climate. In letters attributing disease to the localized impact of French Revolutionary disruption, rumour and fear became vocabularies for the transmission of disease theories. The remaining essays focus more explicitly on the problems of competing truth-claims and the limits of medical authority. Yarrah Bar-On draws on the memoirs of Louise Bourgeois to explore the functioning of medical knowledge as a form of “gossip”. Claims to (and the limits of ) medical certainty is also addressed by Palmira Fontes da Costa and Constance Malpas. Logie Barrow's story of nineteenth-century English vaccination shows how debates over medical authority did not take place in a vacuum, being embedded in (or mediated by?) wider political and social debates. This was no less so in earlier times, as illustrated by Catrien Santing's article on the heart in Counter-Reformation Italy. The remaining articles by Hera Cook and Toin Pieters on twentieth-century issues highlight the conflicts between individual desires for health- (or self-)improvement, and available medico-scientific resources. Each writer shows how the medical world responds with varying degrees of success to the needs and demands of the lay public. We are back to the theme of community participation in the world of the sick. In the modern age, however, that means taking account of, and using, a global media amidst the hum of rising public expectations about medical ability and advance. The revision of concepts like “mediation” is doubtless important to the expansion of meaning in medical history. It draws attention to what Zarzoso calls “medical pluralism”, and the historically-complex rituals of medical knowledge and practice. Yet the theoretical potential of “mediation” remains uncertain. Although the editors try to stabilize the term by focusing on the themes of transmission and reconciliation, its potential for generalization arguably disrupts influence and agency.