Theodore Dalrymple

Through whiggish spectacles

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Roy Porter

Allen Lane, pp. 185, £

The distillation of a vast quantity of historical material into a tolerably readable concentrate is a considerable skill, the historian's equivalent of good popular science, and the late Professor Porter manifestly had that skill. To produce a history of medicine, little more than 150 pages long, that is not a completely arid list of names is a considerable feat, though not one that calls for deep originality of thought, which was never the strong point of Porter's large, indeed manically enormous, oeuvre.

A short history like this must have an organising principle, and the one that Porter chose was the Whig interpretation of history. It is difficult, indeed, to see what other organising principle he could conveniently have chosen, for if the idea of progress applies to any human endeavour, it must surely apply to medicine. The degree to which we owe our present magnificent state of health (compared with that of all previous generations, though not perhaps with our imagined state of perfection and immortality) may be disputed; but what is indisputable is that doctors now have a therapeutic armamentarium of undreamed of efficacy. The writer of this review, for example, would long ago have died or, even worse, have sunk into a state of complete lethargic amentia, to spend the rest of his short life as an idiot in a mental asylum, were it not for modern medicine.

But we are not grateful for the advances that have made our lives for the most part pain-free; and while Porter points out the paradox that so-called alternative medicine has flourished again precisely as scientific medicine has become more effective, he does not delve very deeply into the meaning of this paradox. In the first place, alternative medicine is a misnomer: it is additional, not alternative, since most consumers of it enthusiastically consume the services of 'orthodox' physicians as well. In the second, I believe that it is often a manifestation of egotistical opposition to established authority, even - or especially - where that authority has some intellectual justification. So fragile has become our sense of individuality in mass society that we can assert it only through opposition to authority. I see this every day in my hospital.

Porter arranges his chapters by subject matter: disease, doctors, the body, the laboratory, therapies, surgery and the hospital. He provides a potted history of each, the digest of a large amount of material. It is slightly alarming, however, that a man who spent so much of his life writing medical history should make so many medical howlers: for him, the hookworm is yards long and beri-beri is caused by vitamin A deficiency. There are many other such errors which point to the dangers of medical history (at least the Whig interpretation of it) when it is not written by a doctor. The danger of medical history written by doctors - usually in their retirement - is that it often becomes a form of ancestor worship.

There are no startling insights here - one doesn't read Porter for that kind of thing - and no leaps of the imagination. There are no memorable epigrams and nothing to suggest a sense of humour, except the occasional reproduction of an 18th-century print. One doesn't take away from him any lingering or strong impression, let alone a clear idea. Rather, like so many of his books, this one (presumably his last, though it is possible that his phenomenal output will proceed posthumously) is a useful compendium for someone seeking an introduction to the subject that has a good bibliography.

Porter was at his best in social history, when he was cutting and pasting the vivid words of 18th-century characters. This is a dry and rather routine performance, but such performances are not without their utility.