The changing medical profession: an international perspective

But Parke, as medical officer, was fighting a losing battle. Attention to hygiene and the distribution of quinine tablets did nothing to prevent most members of the expedition-including Parke and Stanley-falling ill on several occasions. Stanley was close to death at one stage, while Parke's companion, Major Jameson, died of blackwater fever. Deaths were even more frequent among the African bearers, many of whom were recruited in Zanzibar, Sudan or Somalia, and unused to the climate and diseases of the equatorial jungle. However, Parke's efforts to treat the diseases which afflicted the expedition are well documented, and we gain from Dr Lyon's biography a valuable insight into the therapeutic practices of the period. The reader may be gratified to learn that the unappealing Stanley was treated for fever with castor oil and mildewed mustard leaf: a just desert if ever there was one. This collection of papers began as a supplemental issue of The Milbank Quarterly that was published several years before this reviewer became its publisher. The editors have increased the number and broadened the scope of the papers. The resulting book should become a standard introduction to comparative social science about the medical profession. Most of the authors use data about the history and contemporary situation of medicine to test sociological theory. In the first chapter, for example, Fredric D Wolinsky describes the contending theories of professional dominance, deprofessionalization, proletarianization, and corporatization. Although such theories have uses, historians will wince at his statement (p. 13) that "professional autonomy ... was conferred on American medicine around 1910, when the Flexner report ... was published." Such neglect of competent secondary sources is, however, rare among the sociologists represented here. Everyone interested in contemporary history as well as sociology will benefit from Eliot Freidson's updating of his earlier work in 'How dominant are the professions?' and from assessments of the medical profession in eleven countries by accomplished scholars (one a political scientist). Sol Levine contributes a thoughtful overview of 'Some problematic aspects of medicine's changing status'. The co-editors, in their introduction and conclusion, ably summarize contemporary problems in the social role of medicine. The most compelling papers are, however, by persons who are unconstrained by the conventions of a particular social science. Julio Frenk and Luis Duran-Arenas offer a provocative overview of 'The medical profession and the state'. David M Frankford, writing on 'The professions and the law', argues against the …