Needful history

A book with a title like The Cambridge History Of Medicine makes an obvious claim to be definitive, but also stakes its territory in the domain of tertiary documentation—we don’t expect its authors to be sharing the bleeding edge of their research, or making controversial claims, but to be providing a digest of the scholarly consensus in their particular sectors of the field. As it’s the second book I’ve read in my trawl through the history of medicine this suits me well—I want a plausible, narratively fertile version of the healing arts in the fantasy world I’m designing, not one that goes out on a limb with regard to the kinds of things that people might do in the name of health. I have to assume that the authors were the major names in the subject at the time the book was published, and I certainly do know that the late Roy Porter, its editor and a major contributor, is one of the towering figures in this field.

The book was first published in 1996, and this revised edition dates from 2006. As such it’s clearly out of date in many particulars, especially in areas like gene therapy, immunotherapy, the treatment of AIDs, and the great epidemiological elephant in the room, which has made many of this field’s seemingly obscure concerns matters of importance in the daily lives of just about everyone. Its final chapter, written by Geoff Watts, is entitled ‘Looking to the future’, and is followed by a revisiting of this theme, written ten years later in 2006. The second look forward is an interesting reflection on the changes that decade brought, and on the very risky scholarly practice of making predictions, but it certainly makes for an odd sensation in the reader. Medical science will never move as fast as information technology, for example, but its technical storm-front moves pretty damn rapidly, and events in the world at large have served to sharpen my awareness of medical issues recently—I couldn’t help thinking ‘if only you knew what this vaguely interested layperson knows’…

This stuff, of course, is not what I’m interested in this book for, interesting as it is. I’m researching for fantasy fiction, and as such my attention is focussed on earlier periods in the history of medicine. I’m looking to elaborate a theoretical set-up based on the humoral system that informed both the Hippocratic writers and the later Galenic medicine, but also to postulate a rather more technically accomplished understanding of health and healing, and this aim is well suited by the particular focus of the Cambridge History. Although it covers antiquity and the medieval period, its primary historical focus is on the period beginning in the Renaissance that leads directly into the age of modern medical science. What were the specific changes that led from a time of ill-informed theory and ineffective therapeutics to one in which, by and large, doctors have some idea how to make us better?

I won’t rehearse the answers to that question here, although the period of medicine’s transformation was clearly one in which society more generally shifted from a reliance on the word of authorities (written or ruling) to the idea that empirical investigations would disclose the truth about the natural world. The Scientific Revolution and the Age of Enlightenment had some of their profoundest long-term impacts in the world of medicine, and in the general expectation of the individual that they might, in wealthy countries, live a life unblighted by unexplained ailments. What this book has helped me to understand is that, if medicine in my invented world is to be a fully integrated part of its cultures and societies, then I need to think of it not simply as a set of practices and procedures, but as something with a history. I need to know how medical knowledge has been produced and distributed, and the kind of medicine practised by my characters should not be an endpoint, but a transitional stage, like all disciplines, between something and something else. By imagining that process, I’ll be able to understand how medicine relates to conservative or progressive pressures in my wider societies, and how those relations impact the perspectives of my characters.

As with William Bynum’s The History Of Medicine: A Very Short Introduction, I have no real way of judging how ‘good’ a book this is. Its editorial standards certainly seem high, and its writers have made an effort to keep their prose reasonably moist. I have to simply accept its credentials as an official utterance of Cambridge University Press, and thus of the scholarly institution which lends its name to that publisher, and hope that nothing egregiously ill-informed has slipped through its processes. However, its purpose for me is to feed my thought processes, and provide me with some technical detail with which to flesh out my imagined world’s medical practices. On both counts it’s served me very well.

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