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History in Focus

the guide to historical resources • Issue 3: Medical History •

Medical History

Cambridge Illustrated History of Medicine book jacket

Author's response


The Cambridge Illustrated History of Medicine

by Roy Porter (ed.)
Cambridge University Press, 1996

Dr. Graham Mooney

(Centre for Metropolitan History)

It's a pleasure to have the opportunity to reflect upon Graham Mooney's review of the The Cambridge Illustrated History of Medicine of which I was editor. Mooney raises broad and important points respecting books of that kind - ones attempting to put academic history across to a wider public, ones drawing more heavily upon illustrations and making use of other special design features (boxes, inserts, etc.).

These are issues which (for reasons good and bad) tend to get excluded from discussion within the pages of the work itself. When faced with writing an Introduction to this book I perhaps had the option, as editor, of laying my cards on the table and spelling out all the thinking (and the contingencies) that went into the shaping and framing of the volume. I could have discussed the principles of inclusion and exclusion, questions of balance of contributors (why no women? why no one writing from beyond the Anglo-American tradition about medicine and health beyond the West?); I could also have raised questions of autonomy and authority: does each author having his say, or is there a collective voice?. But I decided to 'get on with it', and plunge into the 'real' history as rapidly as possible. I did this, I think, because I believe that 'general readers' (as I imagine them) don't much care for academic navel-gazing. But I recognise that my reasons may be more personal (I personally don't much care for scholarly narcissism, or one might say maybe am apprehensive of too much self-revelation). And I acknowledge that what I see as commonsensical (the notional readers as I conceive them are buying this book because they want to know the history) might be alleed to contain a built-in authoritarian implication of its own (here is truth being handed down from the scholarly Empyrean). Anyway, for whatever reasons, The Cambridge Illustrated History of Medicine contains little overt self-reflection, and so it's good to have the chance to air them in Reviews in History.

I wish to concentrate almost exclusively on one matter, the question of the use of visual material. Nearly ten years ago I wrote a piece deploring the fact that most historians most of the time - and I certainly included myself amongst that dim-sighted majority - behave as visual illiterates and make all too little use of visual evidence and visual modes of expression and communication (1). In that, I suggested, they were encouraged by various forms of snobbery (prejudices against 'coffee-table books') and by publishers' anxieties about profit margins. During the last decade I have myself taken some tiny steps towards making better use of visual evidence, including delivering and publishing a public lecture entitled Seeing the Insane, about images of madness in the past - though the irony was that, for reason, of economy, all my visual material had to be excluded from the printed version (2).

Many of my peers and younger contemporaries have, in the meantime, been venturing into these terrains, and historians will welcome the setting up by Reaktion Books of a whole series called 'Picturing History' (I am, somewhat under false pretences, on t he editorial board, along with Bob Scribner, Peter Burke and the American historian, Sander Gilman). The explicit goal of 'Picturing History' is to encourage historians to write book primarily using visual source material (photos, maps, artefacts, icons, and so forth) and quite overtly arguing about the meaning and interpretation of such evidence.(3)

But a volume with 'illustrated' in the title is not quite the same beast; and the Cambridge Illustrated series (if I may for a moment speak on its behalf) is not meant in quite the same way. It's meant to put across in bold terms to a wider public up-to-date scholarly thinking on big historical topics (another volume in the series is Colin Jones' Cambridge Illustrated History of France ); and to use visual material to catch the attention, fix a point, stimulate the imagination, and so forth. For readers accustomed to getting more of their information and ideas through images (film, television) or media containing images (newspapers, magazines) than perhaps the book-bound researcher, pictures do tell stories.

But an illustrated history may easily end up betwixt and between. Certainly the business of illustrating the Cambridge Illustrated History of Medicine and matching text and pictures involved many compromises and endless bowing to realities (limits to expertise, budget limits, reproduction rights and costs, and often the lack of relevant visual material). In an ideal world, things might have been otherwise; on the other hand, I as editor felt grateful for that which could be achieved (I have never before been involved in a book in which the publisher was positively encouraging illustrations: routinely it is the other way round). On the positive side, there was a very strong commitment from the Cambridge University Press to produce a well-designed book that would be a pleasure to handle (good paper, wide margins, imaginative layout), and one in which the great majority of double-page spreads would contain a print, painting, photograph, diagram, map or table, or some special feature in a box (often itself illustrated). Thus the illustrations would not just be tacked on as optional extras, or all clumped together in the middle: the wish was that the eye would readily pass from the written discussion to the representation and back again. In that respect, the book marks a real advance upon almost any other history of medicine yet written by scholars.(4).

Yet, as every scholar who has ever been involved in a similar enterprise will know, problems inevitably arise. Some topics do not lend themselves well to illustration. In this volume surgery was simple: there's no end of contemporary prints of instruments and amputation techniques that are far more eloquent (not to say gory and gruesome) than paragraphs of text. But illustrating a chapter called 'Concepts of Disease' is not so easy. Does that then mean that we should have dropped the chapter on that subject merely because it didn't lend itself to visual treatment? Neither I nor my CUP editors took that view.

There's also a mundane and practical problem of familiarity. If one wishes to discuss Renaissance anatomy, there's an almost overwhelming temptation to reproduce one or more plates from Vesalius's De Fabrica - it is, after all, the most important such work, and the illustrations are quite stunning. But they have already been reproduced hundreds of times. Should one go for the historically important or the visually unfamiliar, the shock of the new? There's no answer, but much time was spent pondering such issues.

The other question that endlessly surfaced and to which Mooney rightly draws attention was that of how the illustrations should be explained. By and large it was not easy to provide detailed interpretation in the main body of the text - often because it did not become clear until a late stage (after the main text was written) that a particular image would be available and usable. In any case, it was thought important that illustrations should be self-standing. Hence it was decided that each illustration should have an explanatory caption, printed in the margins of the page. The drawbacks of this procedure are many and obvious. Not least, given the inevitable restrictions on space, it is very difficult adequately to draw attention to the complexities and multi-meanings of visual sources. One result (as I became all too aware when helping to write or edit captions) was that paintings charged with many intentions and significances - a Raphael of a biblical healing-miracle, or a Dutch interior featuring a doctor holding a urine flask - tended to get interpreted for their relatively 'literal' medical aspects, and discussion of other levels or foci of meaning (religious, moral, narrative, etc.) were excluded when there was room for no more than, say, seventy -five words down the side of a page.

In other words, many problems arise, both philosophical and practical, when it comes to 'illustrating history'. Confronting such problems proved eye-opening if sometimes frustrating. For me it proved a positive challenge. It's certainly given me an idea for a future project!

November 1996

  1. Roy Porter, Seeing the Past, Past and Present , cxviii (February 1988), 186-205. Back to 1
  2. It was published as the first Daniel De Moulin Lecture (Nijmegen: University of Nijmegen, 1990). A later piece about medicine and political cartoons - Image and Illness: The Body Politic, in Rick Allsopp and Scott de La Hunte (eds.), The Connected Body? (Amsterdam: Amsterdam School of the Arts, 1996), 41-49 - met almost the same fate. Back to 2
  3. Volumes published in that series include Sander L. Gilman, Health and Illness: Images of Difference (London: Reaktion Books, 1995), and Joanna Bourke,Dismembering the Male: Men's Bodies, Britain and the Great War (London: Reaktion Books , 1996). Back to 3
  4. I say 'almost' because Jean-Charles Sournia's The Illustrated History of Medicine (London: Harold Starke, 1992) - it appeared after the CUP project had got under way - is a very lavish production indeed, both in terms of the quality and quantity of illustrations. It is a translation from a French original. It would be fascinating to know its profit-or-loss account, or whether it was subsided. Back to 4

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