Charles E. Rosenberg. Our Present Complaint: American Medicine, Then and Now .Our Present Complaint: American Medicine, Then and Now by Charles E. RosenbergReview by: By Roger CooterIsis, Vol. 100, No. 1 (March 2009), pp. 144-145Published by: The University of Chicago Press on behalf of The History of Science SocietyStable URL: http://www.jstor.org/stable/10.1086/599647 .

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to conceal its origins in order to lay claim to amore sober utility in the early nineteenth cen-tury. A degree of public status could also beconferred on technical knowledge by the in-volvement of organs of government, as WilliamJ. Ashworth shows in connection with the Brit-ish excise board and Leonard N. Rosenbanddetails in his account of state sponsorship of theEnglish papermaking industry in the eighteenthcentury. Finally, Adrian Johns applies his exper-tise on the early modern printing trade to sketchits transformation in the era of industrialization.He indicates how intellectuals of the time, suchas Charles Babbage, grappled with the problemof the mechanical reproduction of informationas the printing techniques they relied on werethemselves undergoing fundamental change.Once again, an attempt to analyze the situationin terms of a hierarchy of scientific and practicalknowledge is contrasted, by the historian, with amore complex reality of intersecting mental andmanual skills.

This central theme of the collection is reiteratedin the concluding reflections by Dear and Inkster.Each notes that the denigration of manual workhas been associated with definitions of science as apreeminently intellectual pursuit since classical an-tiquity, which (Inkster reminds us) was a society inwhich almost all physical labor was assigned toslaves. The authors of this volume have called thisdenigration of manual labor into question andthereby (as Dear and Inkster both indicate) havechallenged one aspect of Western exceptionalism.Science, understood as a purely conceptual accom-plishment, has been touted as a unique achieve-ment of the modern West. But if scientific knowl-edge is tied more directly to technical practices, itappears more comparable to those practices inother cultures. In raising this prospect, the bookgestures beyond the limits of its own geographicalcoverage and should inspire further comparativeresearch.

This is just one of the virtues of a verystimulating collection. The volume containsexcellent work by some of today’s leadinghistorians of science. As a whole, it has beenrigorously conceived and tightly organized. Ithas also been handsomely published by theRoyal Netherlands Academy of Arts and Sci-ences (it is available for free and completedownload from the academy’s Web site:ht tp: / /www.knaw.nl /cfdata/publ icat ies /detail.cfm?boeken__ordernr�20041102). Theprinted book is expensive, but it deserves wide-spread distribution. Readers should recommend itfor purchase by institutional libraries.

JAN GOLINSKI

Charles E. Rosenberg. Our Present Complaint:American Medicine, Then and Now. vi � 214pp., index. Baltimore: Johns Hopkins UniversityPress, 2007. $19.95 (paper).

This volume brings together ten of CharlesRosenberg’s essays published between 1995 and2006. Among them are the chapter on “holism inmedicine” that he contributed to ChristopherLawrence and George Weisz’s volume on thatsubject and an introduction to a volume on “his-tory and health policy” that he coedited. Theother essays—on bioethics, the idea of civiliza-tion, diagnosis, psychiatry, risk, genetics, andcomplementary medicine—have all appeared inleading journals in the history of medicine andhealth policy. Little revision seems to have beenundertaken to tie them more tightly together,leaving considerable duplication between thechapters (for instance, reference to homosexual-ity as a social construct appears in at least threeof them).

Historians of medicine will be familiar withmost of these essays and might wonder why theyneed reprinting. Although consistently thoughtful,sometimes penetrating, often eloquent, and fre-quently useful in laying bare the less-than-obviouscomplexities of certain ideas and cultural prac-tices, they are not exactly landmarks in historicalthinking or major incitements to it. Historiograph-ically and methodologically, they remain situatedin the sociocultural history of medicine that waslargely pioneered by Rosenberg. Above all, theyreveal his abiding faith in “medicine’s specialmoral authority” and his commitment to fine-grained, socio-intellectual contextual analysis inthe unpicking of that authority. The history ofmedicine, he insists again and again, is about “sen-sitivity to context and to the relationships amongindividual perception, social constraint, and thesituatedness of human agency” (p. 176).

But as the “Our” in the title suggests, thisvolume is intended as much for the generalAmerican public as for historians of medicine.The imagined audience is people, like Rosen-berg himself, who trust in modern medicine butat the same time worry over the vast inequalitiesin its delivery, its relentless corporatization, bu-reaucratization, managerialism, and fragmenta-tion, its intrusive administration, and the appar-ent diminished autonomy for patients andpractitioners alike. This is a public not onlyaccustomed to, and greedy for, ever-better tech-nological means to corporeal enhancement butone that (unlike Rosenberg) also shares much ofthe technocrats’ and managers’ liking for sim-plistic reductions to ideals and reified catego-ries. It is a public “of physicians and patients

144 BOOK REVIEWS—ISIS, 100 : 1 (2009)

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alike uncomfortable in their roles” who sufferfrom an “attitudinal malaise” (p. 2) in their un-realistic expectations of modern medicine.These are the readers that Rosenberg hopes toedify though his historical sagacity, that theymight better come to terms with the limits oftoday’s American medicine and the culture ofwhich they and it are a part.

More precise targets for these essays are cli-nicians, bioethicists, politicians and policy mak-ers, medical geneticists, and advocates of com-plementary medicine. To them, above all, thecommand goes forth to attend to “context, con-text, context” (p. 182) in order that they mightcomprehend that they are not above or outsideof history and may even come to learn from it.Whether the message will register is anothermatter. It seems unlikely, quite apart from thefact that the nature of Rosenberg’s argumenta-tion is highly sophisticated and often elusive.Disdain is the more likely response, given thehumbling involved in the discovery that one’sbeliefs are historically constructed and one’sactions constrained by what has already beenstructured. Rosenberg is surely strugglingagainst the odds here in hoping that historywriting can win a place of practical importanceand even that some of the above constituentswill join forces with historians. If (as the intro-duction begins) “these are difficult times topractice medicine,” they are also difficult timesto inculcate historical appreciation and perspec-tive. Indeed, readers may come away from thisvolume feeling that the historian who seeks toeducate those wielding authority in contempo-rary medicine is fated to realize his or her almosttotal irrelevance. As Rosenberg admits, we his-torians are “but spectators” at the dogfightsaround us—the occupants of a lonely perch,only made bearable, perhaps, by the company offellow practitioners (who are themselves lockedin a “complex discipline with its own constraintsand necessities” [p. 203]).

More fundamental is the question of whetherthe “complaint” that Rosenberg sees his essaysanswering through historical analysis is in factthe most intellectually relevant one for ourtimes. Some might argue that a volume lockedwithin what is itself a historically framed dis-course of moral reform occupies a fast-fadingepisteme, one that within the territory of medicalhistory was more suited to a time when academ-ics and social activists regarded “the medicalestablishment” as something sadly gone wrong.But times have changed—and not just in tandemwith changing socioeconomic and political cir-cumstances that bear on medicine as a profes-sional activity. Historical exegesis on the woes

of the latter in relation to its clients and politicalagents now seems far less historically interest-ing, important, and demanding than the questionof the ascension of what has recently been en-titled “the politics of life itself ” (see NikolasRose, The Politics of Life Itself: Biomedicine,Power, and Subjectivity in the Twenty-first Cen-tury [Princeton, 2007]) in relation to society, theeconomy, and politics as a whole (the question,if you like, of how biomedicine and biotechnol-ogy—now globally the place for venture capi-tal—have come to alter the nature of power andsubjectivity and the very idea of being human).For good or ill, the humanistic values that bothanchor and drive Rosenberg’s writing have be-come open to historicization, not least in rela-tion to their habitation in the discipline of med-ical history. From this perspective, Our PresentComplaint might best serve as grist for the millin the elaboration of history’s future problem-atic.

ROGER COOTER

Rainer Christoph Schwinges (Editor). Exa-men,Titel,Promotionen:Akademischesundstaat-liches Qualifikationswesen vom 13. bis zum 21.Jahrhundert. (Veroffentlichungen der Gesell-schaft fur Universitats- und Wissenschaftsge-schichte, 7.) x � 776 pp., illus., figs., tables,index. Basel: Schwabe Verlag, 2007. €89.50(cloth).

That curse of students and professors alike, ex-aminations, as well as the reward for passingenough of them, academic degrees, have oddlyenough not occupied a prominent place in mod-ern university historiography. Considering theemotional anxiety and social utility they pro-vide, these features of higher education deserve,finally, the attention of serious social historians.True, Sir Walter Raleigh once wrote that “inExaminations those who do not wish to knowask questions of those who cannot tell.” Perhapsthe pain and bother of these necessary ritualsexplain their being swept a bit under the rug.The tendency of an older university historygenre was to celebrate alma mater, revive theglow and glory of the past, and ignore hosts ofother questions from the painful to the practical.And yet examinations were precisely the basisof the slowly emerging meritocratic standardsthat contributed so much to Europe’s eventualascendancy in the world, gradually adding so-cial preferment by distinguished scholarlyachievement to the “natural” advantages of aris-tocratic birth or inherited wealth. Advanced uni-versity degrees came to function as almost the

BOOK REVIEWS—ISIS, 100 : 1 (2009) 145

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