Clinical consultations and letters by Ippolito Francesco Albertini, Franceso Torti and other physicians: University of Bologna MS 2089–1

Dorothy and Roy Porter's book splendidly fulfills their intention to make it patientorientated and they trawl an impressive range of contemporary sources to do so. They show that personal confidence in a medical practitioner invariably weighed heavily and provide a corrective chapter, 'The Doctor's Point of View', lest readers imagine practitioners supinely accepted criticism and slights, distracted though they were by professional rivalry with the apothecaries as well as the myriad self-helpers and quacks. In unbureaucratic eighteenthcentury England there was certainly no institutionalized, womb-to-tomb approach to medicine, an attitude that some modern scholars find hard to grasp. The crucial problem for the rnedical historian remains one of sources, both typicality and reliability. It is impossible to assess in Georgian England how far diarists and correspondents represented patients. Clearly genderand class-specific, such records' survival rate remains a basic worry, for they may have been particularly susceptible to destruction by descendants if the contents were thought unacceptable in some way. In addition, the substantial numbers of eighteenth-century patients treated free at hospitals, dispensaries or by the parish surgeon remain hidden from historians; only those discharging themselves from hospitals each year indicate any other response than dutiful gratitude. Not all patients expressed their worst health fears, even to their diaries, family or friends, but they were likelier to record medical fees, prescriptions, regimen, and prognosis. That medicine became increasingly authoritarian by the mid-nineteenth century is not in doubt, but the authors rightly stress that in Georgian England it was not sexual, but class politics which motivated female patients. Predictably, practitioners' own surviving writings concentrate on patient data (medications prescribed, visits made, fees charged), only rarely noting the patient's personality, responses and the like. Some patients, especially the opulent, must often have been very trying and medical comments on this category are, for obvious reasons, scarce. Few can equal the referral note to another practitioner about a tiresome patient from Dr Henry Jephson of Leamington Spa, "I send you a fat old goose: when you have well plucked her, send her back to me!" The authors state and fulfill their intentions; their survey, as well as being wide-ranging, is highly readable and skilfully presented, even suggesting research that remains to be tackled (contemporary female practitioners). In the last decade medical history has gained a new emphasis and importance by concentrating on patients, instead of the earlier "great-name" approach, and Patient's progress is a good example of this trend.