When Roy Porter
got into his stride there was probably no better communicator of the richness,
diversity, inter-connectedness and exhilaration of the social and cultural
history of medicine. In a considerably shorter format than he produced
elsewhere, Porter sketches in a vigorous and expansive manner a thematic taste
of the history of medicine from very early times to modern day dilemmas. The
book, so he confesses, is largely based on lectures given over a long period of
time, to many different audiences, but that serves to enhance the mental
picture of a somewhat manic gallop, interspersed with delightful titbits of
information and gossip that bring out the character of so many of the people
whose work he engages — you can almost sense the gesticulations, the running
thoughts and the enjoyment of the jokes, asides and scurrilous details he drops
throughout.

This history is
thematically arranged around the ideas of disease, doctors, the body, the
laboratory, therapies, surgery, the hospital and medicine’s relation to modern
society. In each of these relatively short chapters, the text itself is less
than 170 pages, he links together the intellectual development and the
happenstance of fortune to portray both an idea of progress and the
peculiarities of the particular form of medicine and medical establishment we
have today. At each point, however, he casts a humanistic eye onto the patients,
onto the sufferers; the ones who bore both some of the barbarities of
treatment, and the stigma of disease. He writes in the Preface that the "agonies
of the sick and dying haunt the story of disease and medicine" he relates.
As always, Porter’s identification with the human in the story is one of his
strong points.

He uses a vast
array of sources and his breadth of scholarship is first rate, and his profound
understanding of the wider cultural milieu hugely significant. The manner in
which he melds academic treatises with personal diaries and illustrates them
with literary examples conveys at every level, the cultural context. He sees
the value of Roderick Random alongside the papers of John Hunter, or how
a Punch cartoon adds understanding to a report from The Lancet.

Porter is
justifiably renowned for his work on the Enlightenment in particular, but less
so for his scholarship of the modern period. However, he does venture there in
an interesting way. Having shown the development of a scientific approach to
medicine and disease, he confronts the ethical difficulties of what may be
possible to do and what may be right. This, is many ways, leads forwards into
relatively unexplored areas, and Porter seems to be searching for the moral
vision apparent in earlier times. He clearly applauds some of the great public
health initiatives of the Twentieth Century, such as the National Health
Service in the UK, and similar enterprises elsewhere, but he seems very dubious
about the overall effects of gigantic service industry medicine has become.
Health, which once seemed an inalienable right, may be becoming a negotiable
commodity. For Porter that would represent a significant shift in its
historical trajectory. We may, he thinks, after an apparent golden age, be entering
an age of anxiety.

This may be a
weakness of this particular book. Porter may be a better historian than pundit,
and more comfortable in that role too. His survey of modern developments seems
more ill at ease, or insecure, as if he cannot quite see the path ahead. He
also seems considerably more pessimistic and perplexed by the paradoxes and
political interests that are moving us away from a concern for humankind,
medicine being arguably one of its greatest achievements, to a selfishness and
lack of concern for anyone but ourselves. After what is often a joyful and
marvelling exposition of the history of medicine, it is a sombre note on which
to end. Nevertheless, Porter’s extraordinary scholarship makes an invaluable
contribution. Even though it is brief, this book will stimulate and provoke, it
will engage and inform. It makes his readers miss him all the more.

© 2005
Mark Welch

Mark
Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of
Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre
for Nursing & Mental Health.

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