The royal collage of physicians

Western Medicine
October 17, 1997

Western Medicine: An Illustrated History is one of several books that owe their existence to a legacy from Sir Henry Wellcome. The main purpose of his will was to create a trust for medical research, but one of the special clauses stipulated that a constant proportion of the trust funds be devoted to the history of medicine and that this subject be given its own library and museum. As a result, we have, in the Wellcome Institute, the largest history of medicine department in the world, and, in universities, a growing number of Wellcome units, which are making it possible for professional historians to be the main contributors to books, such as Western Medicine, that are rewriting the history of medicine.

In the course of this rewriting, the old heroes of medicine, such as William Harvey and Louis Pasteur, are not forgotten. But the emphasis is shifting away from famous persons and institutions and towards a socially oriented history that is concerned not only with outdated and current theories and practices but also with the points of view of patients and other persons who foot their bills. As a result, we have, in addition to the well-known story of how three different systems of medical ideas and practices (Chinese, Indian and Mediterranean) were eventually replaced by a single (western) system, an account that shows the new global orthodoxy being increasingly challenged by unorthodox practices, such as acupuncture, homeopathy, chiropractice and faith healing.

Western Medicine leads off with an essay by an art historian (Martin Kemp) who reviews "the types of visual material that are available and how we might interpret them in a manner that is sensitive to the original purpose of the images". He has chosen as an example of how "medical art can both convey a human truth and at the same time be of limited technical utility" an 1830s portrait, "A Woman Exhibiting the Monomania of Envy". The original was one of ten paintings commissioned by a doctor who was anxious to display various forms of madness in the corridors of a French asylum, and the copy is one of 13 illustrations deemed appropriate for an essay that shows the importance of pictorial evidence but also reminds us that "this evidence needs to be teased out with the greatest discretion in relation to historical contexts and modern viewing".

The decision to put the Kemp essay up front was the result of the editor, Irvine Loudon, being anxious to make the point that a true understanding of the history of medicine requires informed viewing of many types of artefacts, including plaques, statues, paintings, lithographs, cartoons and photographs. In a short preface he tells us that Western Medicine does not pretend to be encyclopaedic or comprehensive. Instead it includes one set of essays that retraces, in chronological order, events of medical importance since the Greeks first evolved a rational system of diagnosis and treatment; and a second set that deals with 11 themes of special interest to modern society. We are also told that the illustrations were "chosen carefully as an integral part of each chapter" and, sure enough, running alongside the main text, there is a subtext consisting of captions that explain why each picture was chosen and what it probably conveyed to a contemporary audience. For example, in an essay by James Longrigg on medicine in the classical world there are 13 illustrations, two of which have the following titles and captions: "Diagrammatic representation of the Hippocratic theory of the four humours, showing its development through the ages with accretions by Galen (tinted ring) and during the Middle Ages (white ring)" and "Instruments for extracting teeth and interlacing loose teeth with gold and silver wire illustrated in an early 13th-century manuscript copy of Albucasis. The instruments are treated as decorative devices on the page, with the result that they are no longer realistic or technically informative."

Even without the illustrations, the two sets of essays would have made a useful contribution to the history of medicine. But it is the pictures and their captions that bring the book to life and create lasting impressions of ancient and modern medicine. For example, in a chapter by Michael McVaugh on medicine in the Latin Middle Ages, there is a superb colour plate with the following caption: "A Hebrew medical manuscript. This 15th-century Italian manuscript of the medical textbook of Avicenna testifies to the continuing centrality of Arabic medical learning in the Renaissance and to the importance of Jews as medical scholars, teachers and practitioners. The principal scene shows a physician (in red) holding a walk-in clinic in a pharmacy, while the marginal images demonstrate common therapeutic practices such as thermal baths, cupping, phlebotomy and cautery." Equally apposite are ten illustrations in the chapter by Michael Neve on medicine and the mind. These include the famous engraving of "Melencolia" by Durer, "The Madhouse" by Goya and an engraving by a student who had recently been a patient in an asylum and was clearly familiar with the work of Hogarth.

High on the list of informative essays is one by Harold Cook that deals with the period from the scientific revolution to the germ theory, and shows how great were changes between 1628, when Harvey published De motu cordis et sanguinis, and the 1860s, when Pasteur and Robert Koch established the bacterial origin of disease. Between these two dates we have the Great Plague of London (1665); the beginning of the voluntary hospital movement in England (c.1740); the introduction of smallpox vaccination (1796); the first use of anaesthesia (1846); the first concept of cellular pathology by Rudolph Virchow (1850s), and the establishment of the Florence Nightingale School of Nurses at St Thomas's (1860). The 11 illustrations in this chapter are as follows: "A depiction of the large wards" (a painting of an 18th-century hospital); "A well-to-do young female patient", being treated with bleeding for love sickness; "A case of cowpox" (from Edward Jenner's journal); "Professor invigilating a medical examination" (at Edinburgh University); "A grand memorial" (oil painting commemorating the release of 49 insane patients from their chains in 1793); "The tradition of caricaturing doctors" (a lithograph by Honore Daumier); "Saints as Healers" (a 15th-century painting of an imaginary operation by third-century martyrs who later became patron saints of medicine); "The development of surgical anaesthesia" (photograph commemorating the first use of ether in a Boston hospital); "The Anatomy Lesson of Dr Nicolaes Tulp" (by Rembrandt van Rijn); "An anatomical wax head" (teaching material in the 18th and early 19th centuries); a fine 1830s lithograph of cell structure in an anatomical atlas; and an urban street scene showing the crowded and unsanitary conditions of large 19th-century cities.

From these samples of the 200 or so illustrations in Western Medicine one can see that Loudon (who was a general practitioner before becoming a professional historian courtesy of a Wellcome research fellowship) has gone a long way towards achieving his stated objective, namely, the production of a book whose chief purpose is to explain the nature, purpose and impact of visual imagery in medicine.

Alice Stewart is honorary professor of medicine, University of Birmingham.

Western Medicine: An Illustrated History

Editor - Irvine Loudon
ISBN - 0 19 820509 0
Publisher - Oxford University Press
Price - £25.00
Pages - 347

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