The clinical consultations of Francesco Torti

amount of information about what contemporaries felt they knew and what they did in actual practice. The first twothirds of the book covers such topics as remedies, diseases, healthy living, surgery and the knowledge, prevention and cure of the plague. And through this Part I, Wear addresses the similarities, differences, continuities and changes reflected in the ideas and practices of learned physicians, empirics, lay people (to whom he pays considerable attention) and those dismissed as quacks and mountebanks. Nor is the account merely descriptive; these views are also interpreted and analysed in the context of the political, institutional, and intellectual circumstances of later sixteenthand early seventeenthcentury England. But, unlike most recent works on the medicine of this period, these larger dimensions of the story are not the focus but simply the framework within which the knowledge claims and practices are to be understood. Moreover, this provides a detailed background for Part II, which looks at the changes and continuities of the later seventeenth century in the face of the "new science" of mechanics and experimentation, accompanied by the decline of Galenism. As he has done before, Wear shows how these changes had some minor impact on practical medicine that was, in the main, more rhetorical than actual. In the course of this transition, the "Helmontians" tried to bring about a more radical change, not only in the discourse of disease and treatment, but in actual practices. In place of the centuries-old tradition of an "image of the body as composed of a series of channels through which humours and morbific, putrid, ill matter travelled" (p. 407), and which had to be eradicated through bloodletting and purgation, they promoted more gentle, more purified chemical medicines aimed at the diseases themselves. However, by the end of the century this revolution had failed, mostly, Wear argues, because of patient commitment to the ancient tradition, and resistance to such a radically new approach. The author's strict historical treatment of his subject would not have allowed him to speculate that traditional therapy might also have withstood change unless there had been a strikingly obvious improvement in the results, something that did occur at that time only in the application of Peruvian bark to intermittent fevers. But that was then a herbal not chemical remedy, to which the Helmontians had no special claim. This is a remarkably detailed account of actual knowledge and practices. Some readers will find it a bit repetitive, and maybe sometimes telling them more about a subject than they want to know. But this was a risk that I believe Wear knowingly took in order to furnish us with a subtle and very rich account of what was actually going on, and I'm glad he did.