Observations on Midwifery

fashionable at the time. The process is unconscious as each medical theorist is convinced he has at last found the real basis of the symptoms characterizing such diseases as melancholia in antiquity. This disease persists right through the Middle Age and the Renaissance but during the seventeenth and eighteenth century is slowly displaced by hypochondria which, until then, had meant something different. In the nineteenth century hypochondria is superseded by spinal irritation, neurasthenia and hysteria, which latter has quite a history of its own. Hypochondria slowly turns into nosophobia, the fear of diseases, which since Bleuler in 1916 has ceased to be disease and has become an attitude of mind. Neurasthenia turned in the twentieth century into neurosis. Dr. Fischer-Homberger omitted to mention that spinal irritation, too, lives on as a 'slipped disc'. Far from being a mere exercise in semantics, though this is a fascinating aspect of it, this book represents a thoroughgoing, abundantly documented treatment of the subject. We hear what Homer, Hippocrates and Galen meant by kholos, khole, khondros and hypokhondria. Robert Burton regards hypochondria as the most unpleasant form of melancholia. Thomas Bartholin, when dissecting, finds that there is no duct from the spleen into the stomach that could carry black bile. J. J. Waldschmidt (1644-89) finds that black bile is altogether non-existent. The whole thorny question of the nature of mental diseases and their interaction with the body is involved here, including the history of the idea of the 'soul' in medicine. Dr. Fischer-Homberger remains a sceptic from start to finish and never falls into the error of Goethe's Wagner who boasts 'how wonderfully far we have progressed. MARIANNE WINDER