The rise and fall of modern medicine

there is the universal public provision of medical care. It is a broader definition than Rosen apparently used, and broader than some in public health would recognize. The clearest example of that focus is the book's longest chapter 'Conditional citizenship: the new political economy of health', the history of recent attempts, successful and unsuccessful, toward universal medical care. "Collective action" here refers mostly to the actions of national states, though it is not clear that "state" and "public" can be used interchangeably. "Population" is also troublesome, for clearly in some cases-particularly the new public health described in the last chapter-effects on populations come only by imposing exacting disciplines on individuals. This is "collective action" in an empirical sense surely, but it comes close to bringing all medicine into public health. The book's strengths are its later chapters-Porter's home territory. Much in the earlier chapters reflects the incompatible demands of synthesis and comprehensiveness. On the one hand the book's impact is blunted by attempts to include; on the other it remains open to complaint that the treatment is not comprehensive enough-chronologically, topically, or geographically (particularly in the case of the latter, reliance on sources in English exacerbates the problem). Coverage of the period prior to 1800, which Elizabeth Fee singled out as a problem in Rosen's text, is even more problematic here: the first three chapters cover too quickly too many disparate topics in too many times and places. Some will be bothered that occupational and environmental health get little coverage, that more is said about opposition to vaccination than about the conquest of smallpox, or that tuberculosis is relegated to the last chapter and nutrition neglected, or any number of other issues. And the European focus leaves out southern and eastern Europe most of the time. It is not clear that this book will succeed as a text. It reflects a field in flux; an exciting state for a researcher, but a frustrating situation for the student. Although chapters are broken into sections, the intra(and sometimes inter-) chapter organization is not always transparent, and on very many topics given teachers and students will surely want much more (or much less). Nor has Routledge done much to make the book attractive (though the chapter by chapter bibliographies will be useful). Several misspelled names and other typos mar the text. A longer and more comprehensive book or a shorter analysis would probably have been more successful. It is as a synthesis that the book will be most important; albeit, perhaps, a premature one. But one need not accept Porter's story as the final word to accept with giddy delight the invitation to think synthetically about the field, something that hitherto has been unavailable to public health historians.