In their introduction to the recently published Dictionary of Medical Biography the editors, Bill and Helen Bynum, point out that the "history of medicine" no longer exists as a discipline; it is now the "social history of medicine". In other words, rather than a catalogue of the achievements of the great names of medicine and its related sciences, the field now encompasses a much broader view of the influences that have modified the health of societies, including political, cultural and economical issues set against a background of people's changing beliefs about the nature of disease and their aspirations for its control.
While admirable in many ways, this new approach to medical history tends to portray the activities of doctors and their institutions and the evolving medical sciences as a self-sustaining culture that, at least until very recently, had little relevance to the health of society. Rather, the gradual extension of our lifespans over the centuries has resulted from social change reflected in improvements in hygiene and nutrition and a growing awareness of the public and politicians about the relationship between disease and lifestyle. The real challenge for the historian is to try to unravel the relative roles of these complex influences on healthcare and how they amalgamated to produce the remarkable increase in longevity in the richer countries in the 20th century and, incidentally, the reasons for the gross disparity in standards of health, both within and between different countries.
Roy Porter, the distinguished historian to whom this collection of essays is dedicated, somehow managed to straddle this increasingly diverse discipline and present its complexities in a way that was both balanced and intelligible to both specialists and general readers. Although best known for his work on the English Enlightenment and the history of mental illness and psychiatry, his extraordinary output covered almost every aspect of medical history. His Greatest Benefit to Mankind, A Medical History of Humanity from Antiquity to the Present , published in 1997, is undoubtedly one of the most balanced and readable summaries of the field that is currently available. In all his work, ranging from his insightful studies of the Enlightenment to the sometimes hilarious world of medical quackery, his deep sympathy and fascination with the characters that he portrayed, whatever their rank, shines through his writings.
It must have been very difficult for the editors to choose a series of articles that would do justice to this extraordinary man. In the event, they have compiled 18 short essays, the breadth and diversity of which would surely have pleased him. Ranging from the natural cultivation of the 18th-century cucumber and the politics of medical reform in 19th-century Britain, through accounts of the often bizarre history of psychiatry, including an absorbing story of culpability for death under hypnosis, to the superiority of French dentures in the 18th century, they are fascinating vignettes of the social history of medicine.
They are spiced with the kind of wry humour that would certainly have appealed to Porter; the Rowlandson engraving of a mouthful of "Frenchified porcelain teeth caught in the unwittingly hilarious rictus of a French smile" should certainly encourage older readers to seek an early appointment with their dentists.
The history of medicine, never mind the social history of medicine, has undoubtedly been neglected in the education of doctors and medical scientists. One of Porter's other great achievements was to present his subject in a way that emphasised the value of an understanding of the past when trying to get to grips with the problems of the current medical scene.
This aspect of his work is reflected in several of these essays. For example, there is an absorbing account of his rather ambivalent feelings about Thomas Wakley, the messianic mid-19th century editor of the medical journal The Lancet , whose reformist activities suggest the interplay of a genuine wish to improve medical care yet at the same time maintain the integrity of the medical establishment, set against a background of personal ambition.
Nothing changes; it will certainly require a historian of Porter's ability to make sense of the political short-termism, lack of cohesion among the medical establishment and all-round administrative incompetence that underlay the crisis in the provision of medical care that occurred in this country in the years immediately after his death in 2002.
Both professional historians and general readers who wish to obtain a flavour of the work of this outstanding historian will enjoy this excellent collection of essays. Impecunious students and others who are discouraged by its price can obtain a genuine flavour of Porter's work by reading Blood and Guts: A Short History of Medicine , one of two of his books that were published after his death. Based on his lectures, this is another fine legacy of a remarkable man.
Sir David Weatherall is regius professor of medicine emeritus, Oxford University, and chancellor of Keele University.
Medicine, Madness and Social History: Essays in Honour of Roy Porter
Editor - Roberta Bivins and John V. Pickstone
Publisher - Palgrave Macmillan
Pages - 312
Price - £55.00
ISBN - 9780230525498