Medieval and early modern medicine has been the subject of many texts in recent decades. Among these, the books of Nancy Siraisi, Gundolf Keil, Andrew Wear, and Andrew Cunningham have stood out for their methodological and insightful presentations of what is perhaps the most wide-ranging subject, the history of "old" medicine practised by learned doctors. The book by the late Roger French purports to be a monument to a life-long study of pre-modern medicine. It deals with the Latin tradition of European medicine, arguing that before the Renaissance western doctors learned their profession by reading Latin translations of Hippocrates and Galen. According to French, this Latin tradition comes to an end in the Enlightenment, when the natural philosophy dominated by Aristotle and the theory of the four humours slowly began to disappear from the scene of what became "scientific medicine" in the second half of the nineteenth century. At about the same time, Latin was replaced as a medium of education with the vernacular languages. However, one should not forget that Latin medical dissertations flourished, at least in Germany, until the end of the nineteenth century. The book therefore covers a wide chronological period, starting with the Greek sources of the Latin tradition, the luminaries of ancient medicine Hippocrates and Galen, and ending with Haller's theory on the soul which marked according to French a new age in medicine.
French begins by probing the contributions of Hippocrates to what he calls "medical wisdom" and by showing the influence Aristotle had on medical thinking. These chapters are not very original, but they present those readers who are not too familiar with Greek medicine with the main features. French makes quite clear that he does not aim at "a history of Greek medicine in a chronological and inclusive sense" (33). He presents an argument rather than a narrative survey, not only in the introductory chapter but also elsewhere in his book with its focus on the history of university-trained physicians from the Middle Ages to the Enlightenment. Another introductory chapter deals with Galen, the "Prince of Physicians" as he was praised by Renaissance medical texts. French shows how Galen rationalised Hippocratic medicine, e.g. by distancing prognosis from soothsaying. Among the other ancient medical authorities mentioned in this introduction are Celsus and Pliny. The third chapter delineates the formation of the Latin medical tradition in the Middle Ages, describing the early medical schools in the Eastern Roman Empire, for example in Ravenna, where Galen's work had been compressed to a canonic text known as the "Twenty Books." The early medical texts are characterised according to French by a "striking absence of theoretical material," the emphasis being on pharmacy and materia medica.
Another subject discussed at length is the early professionalisation of medicine. The beginning witnessed the feature of incorporation, i.e., teachers of medicine forming master's guilds. The process gained momentum in the twelth and thirteenth century, when medical education gained recognition while its practice was controlled by the State. Such a control presupposed that learned doctors agreed on what medicine was all about and how it was to be studied. In this context the appearance of canonical textbooks such as the famous Articella played a decisive role. According to French, whose previous studies on the Articella and its impact on medieval learning is well known among medical historians, it was through this canonical work that the "new logic" of Aristotle became known to the medieval learned doctor, who prided himself on the rationality of his medical practice. However, it seems to this reader that French fails to appreciate the extent to which the Jewish physicians of the Middle Ages deviated from this stereotype of the "Rational and Learned Doctor." French ignores altogether the larger socio-political dynamics that nurtured the difference in medical education between Christian and the Jewish medical practitioners.
French is on much firmer footing when he turns to an analysis of the decline of medical scholasticism in the aftermath of the Black Death. Of course, there were continuities, as can been seen from the medical curriculum taught at the major centres of medical learning in the later Middle Ages--Paris, Bologna, Montpellier and Padua. The Latin tradition continued in the classroom, despite the fact that humanist scholars in the fifteenth and sixteenth century tried to bypass this long line of medical knowledge and get to know the ancient authorities in their own tongue, Greek. Nevertheless, physicians who claimed that their philosophical medicine was the best and deserved a monopoly came into troubled waters when the plague of 1348/49, known as the Black Death, ravaged European cities as well as the countryside. People lost confidence in the ability of physicians to find a cure for this affliction. According to French, there can be no doubt that the two great epidemics, the plague in the fourteenth century and the French Disease in the sixteenth century, left marks on European medicine by accelerating or even causing a "crisis of theory" which led to the collapse of traditional natural philosophy associated with the name of Aristotle. One of the consequences was the rise of neo-Platonism in medical thinking, providing an explanation of the world that was based on concept of "subtlety," a term used to denote the natural powers of things that were considered "occult". The "new diseases" which could not been incorporated into orthodox medical thinking gave birth to the theory of contagion. According to the French physician Jean Riolan the Elder (c. 1538-1605) diseases were either manifest or occult; the latter he considered as poisonous, working through contagion.
A questionable aspect of French«s description of the weakening of the Latin tradition of medicine at the dawn of a new era in politics, society, religion is his assessment of Paracelsus, the famous medical reformer. French attributes Paracelsus' revolutionary zeal to Protestantism, completely ignoring the rather ambigous religious works of this much disputed physician, who had many followers and not just in Protestant circles. French also perpetuates the myth that the Fuggers, who had control of the sixteenth-century guaiac trade, contrived to promote its use in medical texts. This is one of the many black legends to be found in medical history, and has recently been debunked in Claudia Stein's monograph on the French Disease in early modern Augsburg.
The final chapters of this book examine how learned physicians reacted differently to the crisis in theory, by creating a new orthodoxy (e.g., Albert Kyper in the Netherlands) or by re-considering medicine as an empirical art. The famous English physician, for example, could be called a non-empirical Hippocratic. According the French, there were two areas of traditional medical learning that survived the crisis of medical theory until the beginning of a new age in medicine at the end of the eighteenth century: the knowledge of powerful drugs or natural substance and the practice of anatomy.
In a book of this scope, deficiencies are marginal though they should not go unnoticed. In the select bibliography (260-269) there is a conspicuous lack of several important titles published in other languages than English and French: for instance, Eduard Seidler's seminal work on the Paris medical school in the later middle ages, or Karl Eduard Rothschuh's classical textbook on medical concepts through the ages. The only noticeable omission in the book as far as its contents and title is concerned is a consideration of the actual "business of medicine," including references to what the patients of learned medical doctors found attractive about the rational art of healing in light of its well-known therapeutical ineffectiveness.
These criticisms aside, the book is a lucid and well-organized introduction to the European Latin tradition of medicine, covering a long time-span, synthesising a vast array of material and research into a coherent framework, useful to students and experts in the field alike. Those who are already familiar with Roger French's works will not be disappointed with his most recent book, which turned out to be his last publication due to his untimely death.