Practice makes perfect. Essay review.

It is rare to find two books published at around the same time and on a similar subject in the history of medicine and to be able to welcome them both with enthusiasm. But John Harley Warner's study of nineteenth-century American practitioners, and Irvine Loudon's account of medical practice in England between 1750-1850, merit such a response. Both deserve a wide readership among historians. The joint pleasure which these two books gives is all the more surprising since, although their object of enquiry is much the same, their styles, aims, and, to some extent, the authors' methods, are widely different. Yet for all that, they complement each other. The thematic similarity that brings these books together is the medical practitioner (with the emphasis very much on the latter term). Warner's study, however, extends to include practitioners in hospitals, while Loudon sticks firmly to the men excluded from the cathedrals of British medicine. Besides their subject matter, these studies have other gratifying similarities, most notably the vast range of everyday documents which the authors have unearthed in order to piece together a picture of the behaviour of regular doctors in the late-eighteenth and ninetenth centuries. In this regard, both books are splendid ethnographical accounts of what turn out to be relatively unknown tribes-American and British doctors-with whom we had previously held we were familiar. The studies are further similar in that both, in their own ways, are challenging. Warner's directly raises and confronts a number of theoretical issues, Loudon's does the same, but less overtly, by methodically playing social theorists at the game of dogged evidentialism. Here, however, similarity ends, for both authors not only report the behaviour of medical men, they interpret the actions of these practitioners. In many ways, Warner's study is the more path-breaking. To begin with, he tackles an area that medical historians have long but impotently bemoaned is central to the historical understanding of medicine: therapeutics. At the most basic level, Warner's book is a rich empirical study of therapeutic theory and practice in nineteenth-century America. Warner, however, goes further, turning the historian's previous neglect of therapeutics into a virtue. His command of the field enables him to advance claims about the importance of therapeutics that few are in any position to deny. According to Warner, therapeutics is the key to understanding what he construes as the crucial issue in nineteenth-century American medicine: professional identity. Regional …