Medical fringe and medical orthodoxy 1750–1850

W. F. BYNUM and ROY PORTER (editors), Medicalfringe andmedical orthodoxy 1750-1850, London, Croom Helm, 1986, 8vo, pp. ix, 274, £30.00. In their neat introduction to this volume the editors state its programme: to examine "how the relations between regular and irregular medicine have been constituted in particular fields at particular times". Or more specifically: "the essays in this book are not just about the positioning and the nature of the divide between orthodoxy and the medical fringe, but are about its very creation....." The book aims to make a start on this necessary work, and so it does. But the essays were written independently and the editors have added no conclusions. The question for the reviewer seems clear: how far do these essays take us towards a broad, flexible interpretation of medical orthodoxy and heterodoxy in the century around 1800? How many of the essays are "fringe" to this central concern? Do they together suggest a coherent model ofmedical dynamics in this critically important period? The core of this book, for me, were the essays by Irvine Loudon and John Harley Warner, both of which present clear, well-documented theses about fundamental shifts in the organization of medical occupations. Neither is radically novel, but they are authoritative and perhaps complementary. Loudon argues, for Britain, that the recognition of each other by "general practitioners" was caused by the rapid increase in competition from chemists and druggists, who undercut the prices of surgeon-apothecaries and were thus stigmatized as unqualified intruders into the field of medicine. Warner discusses Jacksonian America, arguing that it was pressure from sectarians that caused orthodox practitioners to rally round therapeutic practices as representative of their common identity. Here, of course, the argument must needs be more subtle, for what was it that had caused "sectarian" tendencies where there had been no defined medical "church" or self-conscious orthodoxy? Part of the answer seems to be that medical sectarianism was often a direct expression of religious sectarianism, which nurtured oppositional styles and helped give content to medical sects as technical extensions of doctrines about life styles. Similar pressures became evident in Britain, especially in the 1840s, but by then general practitioners already had regional and national associations as well as the redefined London "guilds" (of apothecaries and surgeons), to which the state had granted a national regulatory role. The other essays might be classified into three groups: those dealing with the unorganized, individualistic world of eighteenth-century practice; those dealing with the sectarian and non-sectarian "fringes" evident in nineteenth-century Britain; and those which, for better or worse, are tangential to the main concerns. The essays on the earlier period appeared to me as illustrative or tentative rather than strenuously exploratory of the main theme. W. F. Bynum uses his survey of eighteenth-century texts on venereal disease to claim that "constraints on professional behaviour grew tighter during the second half of the century". This was an informal process, a change in the degree of self-promotion and extravagance which was acceptable among regular professionals. Such shifts of emphasis are elusive, and to capture them securely brings honour among historians; here the examples were intriguing, but I was left unsure as to whether the central point had been firmly established.