The American midwife debate. A sourcebook on its modern origins

E. H. Ackerknecht, arguing that a history of therapeutics would be "the most useful book a medical historian could write", apologized in the preface to his own work on the subject (1970; English translation, Therapeutics from the primitives to the twentieth century, London, Collier Macmillan, 1973) that, owing to ill health, he had to limit himself to an outline of therapeutic principles in internal medicine. He pointed to "the role of fashion", the connexion between therapeutic activism and conservatism at certain moments in history, and the frequently unpredictable relations between medical theory and practice. Since then, various authors, like John Harley Warner, have tried to remove the vacuum around therapeutic history by attempting to place therapeutic action within a broader historical context: for example, through emphasizing how a particular therapeutic approach could at times function to satisfy social and emotional needs, or could work to establish prestige and status. The tripod of medical theory, therapeutic principles, and actual practice has slowly put its legs in firmer historical soil. Professor Koelbing, however, has chosen to adopt an older mode of writing in this volume. As he states in his introduction, although "the history of therapy is not only a history of concepts of treatment, pharmacy, and therapeutic operations .. , the field of therapeutics becomes hard to survey as soon as one enters into particulars". This he subsequently avoids, instead focusing on therapeutic principles in their relation to general medical theory from ancient Greek to modern times. He concentrates on western medicine, although he allows himself a thirteen-page excursion into traditional Indian and Chinese medicine, comparing their underlying concepts with Graeco-Roman ones. The chapter division follows commonly-used chronological blocks, with the familiar "darkness" of the Middle Ages (eight pages on Arabic medicine, eight pages on occidental therapies at that time). A separate chapter on psychiatric treatment is added at the end of the book. Throughout the work, Professor Koelbing makes use of the Celsian division of therapeutic modes in diet, pharmacy, and surgery, and medical ways of thinking into magico-religious, empirical, and rational. We are thus guided along the well-known path, illuminated by names of famous men, discoveries, and quotations from medical treatises: from humoral pathology via Galenic eclecticism into the early modern world, with a great turning-point in the nineteenth century, with its "improvements in surgery", the "rise of bacteriology", and an even greater acceleration in the twentieth century. As a general characterization, Koelbing observes a "therapeutic optimism" in healers through the ages. In spite of short periods of therapeutic scepticism (France) or nihilism, healers were, in general, self-confident, "the imperturbable self-confidence, that true knowledge never has and never will provide" (as the author quotes Magendie). The limitations of general introductory works of the "Grundziige" type are well known: it is simply very hard to introduce historical complexity when dealing with 2500 years in 250 pages. But by starting with the names, events, and basic concepts, more historians might be tempted to move on to the difficult network of therapeutical relations. G. van Heteren Wellcome Institute