John Snow: anaesthetist to a queen and epidemiologist to a nation

Benthamism-which conceived of prisoners as "different from normal people ... [in need of] firm and extensive management from the outside" (p. 46). This carceral turn to an ideology normally associated with enabling citizens to seek their own greatest happiness was not unique to Britain. Alexis de Tocqueville, after all, had remarked on the "complete despotism" in American prisons, all the more noteworthy because of the new republic's "extended liberty". Wiener's essay offers the most sustained and nuanced reading of Benthamism and medicine-especially the dilemma faced by physicians contemplating efforts at "preventive medicine"-and is particularly incisive in cautioning against "binary thinking": envisaging prison medical officers as either lackeys of the penitentiary, or the prisoners' advocates. The complicity of prison medical officers in "surveillance, individualization, and normalization" is in fact the focus of Joe Sim's essay, which rejects the Enlightenment version of "rational progress and benevolent development which has dominated social science discourse about modern institutions in general and medicine in particular" (p. 103)-a vision, by the way, which has clearly not been in dominance for the past two decades, when most of the social histories of medicine have been written. Prison medical officers, in Sim's view, were unambiguously associated with the maintenance of discipline and order in the institution. To be sure, he has unearthed haunting examples of medical participation in inhumane and depraved medical practices to give pause to unreconstructed Enlightenment historians-if there are any living. Still, invoking the Foucauldian paradigm of "power/knowledge" by employing a term such as "prison medicine's knowledge base" suggests rather more than it delivers. Essays throughout this collection repeatedly point to the haphazard state of prison medicine in general, and psychiatry in particular surely the most controlling of medical specialties. Further, mental medicine appears to have been held in low regard by prison administrators and prisoners alike. Other essays in this volume-although narrower in scope-highlight the developing medical officer's role, and the rise of the first criminal lunatic asylum. Richard Smith identifies the challenge facing medical officers who contemplated providing psychological counselling to the prisoners, but worried that such service might bestow a medical imprimatur to the practice of keeping the mentally disordered in prison. And Sir Louis Blom-Cooper takes up the plight of the psychologically disturbed offender as he recounts the history of Broadmoor and subsequent attempts to attend to the special needs of criminal lunatics, reminding the reader of the seemingly inexorable progression …