Bodies Politic: Disease, Death and Doctors in Britain, 1650-1900

In spite of its intellectual, literary and comic brilliance, this book contains a dark and disturbing, but revealing, message. In some ways, my melancholy reading of Bodies Politic has inevitably been shaped by Roy's recent untimely death. Roy Porter was without doubt the finest social historian of medicine this country, or indeed the world, has produced. Expansive, humorous, intelligent, and incisive, his broad range of historical works has excited and educated several generations of students of history over the past thirty years. His death leaves an unfillable void within the global history of medicine. At the same time, however, this book itself, completed well before his death, is haunted by elements of despair and uncertainty that should make us carefully reconsider not only the purpose and direction of our professional inquiries but also our own mortality.

Bodies Politic is a recent addition to an exemplary series published by Reaktion Books under the broad title `Picturing History'. The series, edited by Peter Burke, Sander Gilman, Ludmilla Jordanova, and Roy himself, aims to present a "new kind of historical writing in which images form an integral part". The series has already spawned several historical masterpieces: Sander Gilman's study of images of difference; Joanna Bourke's exploration of men's bodies in the Great War; Jeremy Black's account of the politics of maps; Nancy Leys Stepan's Picturing Tropical Nature; and Peter Burke's study of the use of images as historical evidence, among others. Like its predecessors, Bodies Politic is beautifully produced. Reaktion have a fine reputation for producing high quality books at comfortable prices. This series is no exception. Lavishly illustrated and printed to a high specification, contributions to the `Picturing History' series are enjoyable to hold and view as well as to read.

As one might expect, the beauty of the illustrations in Bodies Politic (137 in total, with 39 in full colour) is amply matched by the wisdom and smoothness of Roy's text. The book focuses particularly on visual and verbal representations of doctors, disease, and death from the mid-seventeenth century through to the turn of the nineteenth century. Ably exploiting the rapid expansion of printed material (medical almanacs, magazines, newspapers, novels and their associated visual images such as the political cartoon) across that period, Roy has woven a neat but complex discursive tapestry charting the changing faces, models, and meanings of early modern medical knowledge and practice in particular.

Successive chapters explore several key themes in early modern and modern histories of medicine and the body. In the opening chapters, Roy has succinctly exposed contemporary and deeply religious attitudes to the body as wretched, ugly and damned as well as classical visions of the ideal, beautiful (generally male) body. Several central chapters then chart the manner in which seventeenth and eighteenth century doctors visualised disease and how those visualisations emerged (and were sometimes mocked) in visual representations, shifting contemporary images of various medical practitioners (pointing particularly acutely to physicians' pretensions to fashion), the visible boundaries of the early modern sick role (including a neat exposé of the hypochondriac), and the manner in which both orthodox and heterodox practitioners vied with each other to take centre stage in the medical theatre or market-place. Competition for social and professional status, for the patronage of the élite, and of course for fees necessarily stimulated considerable professional bickering, rapidly seized upon and exploited by a multitude of eager and sceptical journalists and lapped up by an avid public. Chapter 8 accordingly clearly sets out the ways in which professional anxieties and distrust were displaced into humour.

Chapters 9 and 10 move the narrative forward considerably, both thematically and chronologically, and remind us of the sophistication and range of Roy's expertise. In the first of these two chapters, Roy has demonstrated how, as doctors increasingly claimed expertise in matters of social as well as individual sickness, disease, doctors, and death all became a familiar tropes in political satires and cartoons. Thus, writers and artists routinely and humorously figured both "the world through the body and the body through the world" (p. 229). Strikingly, visual images (not only broadly corporeal but often more particularly scatological or sexual) proved especially potent in this enterprise, since "under such circumstances pictures may say more than is permitted in words" (p. 229).

In Chapter 10, the final main chapter of the book, Roy extends his analysis more clearly into the Victorian period, carefully exposing the emergence of new, eminently abusable, stereotypical portrayals of doctors and disease in medical journals, Victorian novels and Punch. In particular, he argues that in a period of hero-worship, "the Smollettian brute was replaced by the medical man of the highest ideals, if also tragic flaws" (p. 258). He illustrates this with excerpts from contemporary fiction and with reference to the nascent genre of both literary and visual biographical memoirs.

There is much to marvel at in Roy's erudite and scintillating commentary. His writing neatly reflects the brilliance of the visual images and matches the literary genius evident in critical literary representations of doctors by Tobias Smollett, Samuel Johnson, and many others. The writing is thus informed, provocative and yet balanced. Take for example, the beautifully constructed summary, in a single sentence, of his vision and argument:

Rather, it [medicine] offered itself, and was received by its public, whether supportive or suspicious, in a broader perspective, as a repository of texts and tenets, advice and apothegms, `sick roles' and `well roles', a corpus of identities, teachings and practices to be respected - or reviled - for their theatrical, spectacular and even magical aspects, procedures best interpreted in anthropological, dramaturgical, liturgical, spiritual and aesthetic terms (p. 22).

There are also flaws in the book, particularly in the form of certain issues and questions that remain insufficiently charted. Notably, there is perhaps not enough discussion of female bodies. In part, this reveals the gendered dimensions of early modern medicine and politics, but the issues raised by this (and by anatomical illustrations of women's bodies, which are only briefly alluded to) deserve more extensive debate. In addition, Roy's coverage of the nineteenth century is palpably (and frustratingly) brief in comparison to his analysis of the early modern period. It is difficult not to feel that Roy had more to say on this, as on so many historical topics that came under his scrutiny.

However, there is a more significant strand of the narrative that is under-played, namely the existential impact of disease and death on people's lives, or as Roy himself put it in the context of Tristram Shandy's reference to the Grim Reaper, "the terrifying personal immediacy" of death (p. 124). Thus, while Roy's analysis subtly and creatively unpacks the meanings, messages, and notations of representations of sickness and death, death itself lurks in the shadows between the words, unexplored, uninvited, but necessarily potent. In concentrating on images and representations, Bodies Politic thus mistakes the essence or construction of illness and mortality for what Heidegger or Sartre would call (existential) human reality.

Of course, there is nothing wrong, from an intellectual point of view, in focusing on representations, especially visual ones. Indeed, Roy's approach in particular offers a breath of fresh air to a field that has too often ignored the visual, and prioritised the documentary, record. And yet, there are signs in the text that Roy himself understood, and was concerned by, the existential dilemma posed by this approach. In the preface to this book, he writes: "Be they visual or verbal, all facts are artefacts. What follows is, indeed, a study of the real thing - provided that it is accepted that representations are realities" (p. 12). At one level, this argues quite rightly for greater recognition of, and more careful attention to, representations of disease, death, and doctors. However, it also posits a reality beyond, and in some ways distinct from, those representations. In the first introductory chapter, the irony inherent in avoiding that reality is made more explicit. Referring to a scene from Samuel Foote's farce, The Devil upon Two Sticks, which serves as his "curtain-raiser" (p. 20), Roy writes:

One conventional representative device is inscribed humorously by Foote within another; not, in this case, the archetypal `play within a play' but the `print within a play'. The laugh is on the prating Welsh lawyer Squib and the apothecaries Julep and Apozem as they bicker with each other over its hieroglyphics - just as the likes of Rock and Misaubin would proverbially bicker over their diagnoses and remedies while patients passed away under their very noses. Since fathoming meanings of such prints and similar cultural productions is the business of this book, the last laugh may well be on its author - and his readers: are we all Squibs and Juleps? De te fabula narratur (p. 20).

The portents here are clear. While we engage in elegant intellectual debate about the past, life can pass us by. Although our bodies certainly constitute an "expressive medium", furnishing the "models and metaphors . . . needed to name and navigate life and give it meaning", we should remember that we are all destined to be reduced eventually to "a bag of bones" (p. 35). Historians, like doctors, "die like other men" (p. 128).

Roy Porter will be sorely missed by many. For several decades, his charm, wit, and intelligence have fortified, encouraged, and moved us. His writings will continue to do so for many generations. However, in Bodies Politic he has perhaps furnished us with our greatest lesson. While the rhetorical brilliance of this book might serve to distract us momentarily from the perils of living, it also illuminates and clarifies our sadness at Roy's death and, by permitting the image of death to haunt almost every line on every page of this fine text, warns us to acknowledge and respect our own (and other people's) mortality: et plurima mortis imago.