From pen to scalpel

Professional healers are popularly called "doctors". It is by no means predetermined that the distinguishing mark of the physician must be erudition - rather than, say, experience, charisma or scientific skills. But the fact is that ours is a tradition in which the medical practitioner was habitually cast as a "learned man" (doctus) - back in the second century ad the great Galen insisted that the true physician had to be a philosopher. This too is central to the "job description" of the physician in Chinese and in Ayurvedic medicine, those other "medicines of the book". In the light of this, the enterprising idea behind this collection of 17 essays by an international panel of academics is to probe the history of the association between physic, "philosophy" (in the widest sense), the canonical texts sustaining that ideal, and to elucidate its cross-cultural dimensions.

Knowledge and the Medical Traditions gets off to a cracking start. In his editorial introduction, Don Bates lucidly sets the agenda, and then Geoffrey Lloyd's opening essay is a shining example of the (largely neglected) potential of the comparative approach. Without labouring to summarise the entire history of Greek and Chinese medicine, Lloyd provides discerning insights by spotlighting key issues (knowledge status, concepts of body system, philosophical foundations) and tracing comparisons and contrasts between West and East. If one rather feels that certain other contributors should have been told: "Go thou and do likewise!", the volume none the less affords much comparative food for thought.

Lawrence Conrad's account of the 11th-century Middle East perceptively explores the politics of scholarly naturalisation, as the Greek medical scriptures were smuggled into an Islamic civilisation already rich with a folk medical tradition. And Lesley Dean-Jones's "Autopsia, historia and what women knew", which discusses the authority of women's testimony in Hippocratic gynaecology, forms a nice twosome with Francesca Bray's typically insightful account of the theorising of women's health in late imperial China. Both plot the uneasy interface between professional knowledge and patient experience, especially when the patient happened to be female.

There are numerous other satisfying offerings, including a characteristically astute assessment by Nathan Sivin of textual status in classical Chinese medicine. And scholars will enjoy a further instalment of Luis Garcia-Ballester's masterful revaluation of late-medieval Galenism, with its play on medicine's double face as both art and science.

Fittingly perhaps, this is a volume built on impeccable orthodox scholarship. It might have been a diverting provocation to have included a Derridean postmodernist eager to deconstruct the very notion of sacred medical texts - or to challenge our "scientific" belief in a medicine whose foundation is held to be extratextual. And that in turn points to the key historical aspect absent from this thought-provoking investigation: attention to the decline and fall of the belief that the physician should properly be a man of the book. The nearest we get is Judith Farquhar's account of somewhat desperate attempts to rewrite "traditional medicine" in post-Maoist China, which in turns chimes with Lawrence Cohen's riotous report on the "epistemological carnival" among contemporary Ayurvedic scholars, each claiming to be more canonical than their colleagues. But what happened in the West, where (the story goes), the scalpel replaced the pen, the library finally gave way to the laboratory, and the fetishism of scholarship faded before the torch of science? Andrew Wear astutely shows "learned medicine" still alive and well in 17th-century England, but thereafter this volume falls silent. One is tempted to suggest that it was the demise of Latin that tolled the knell of learned medicine. Not the least value of this stimulating study might be to spark a sequel.

Roy Porter is professor in the social history of medicine, Wellcome Institute, London.