The first section deals with his life from the cradle to 1845, the year he published the first edition
of his Die Pathologie und Therapie.
turbulent 1840s, and his political involvement in Tubingen led to his forced departure to Zurich.
Soon after completing his medical studies, he spent a period in Paris and this seems to have
kindled a love for travelling that took him repeatedly to Vienna, London, and even to exotic
places like Egypt, where he worked for a time after 1850.
Physiology was hismain preoccupation during these earlier years, and his first six publications
are in general medicine. His first psychiatric paper, on 'Psychische Reflexactionen', appeared in
1843, and his magnificent book of 1845 was published after another eight medical and
neurological publications. In this long first section, Dr Warhig-Schmidt analyses Griesinger's
views on physiology, philosophy, and his opposition to Naturphilosophie.
The second halfofthe book is dedicated to Griesinger's psychiatry. It starts with a penetrating
analysis of the state of alienism in the Germany of the 1840s and of its uneasy relationship to
brain physiology. A glimpse is also offered ofthe early process that led to the divergence between
asylum and academic psychiatry, which was to hamper so much the progress ofboth during the
second half of the century. It ends with a fifteen-page study of Griesinger's 1845 Textbook,
which, on account of its freshness and depth, merits separate English publication. Dr
Warhig-Schmidt fails to explain, however, one of the running mysteries in the history of
psychiatry, to wit, how did Griesinger manage to write such a comprehensive textbook, which,
apart from the usual theorizing, contains a great deal ofclinical material, when in fact he had had
a meagre experience with the mentally ill?
But it would be wrong to begrudge this oversight. Like all good historical books, this one
includes over forty pages of notes, a list of Griesinger's writings, and a good bibliography. One
hopes that the author may want to regale us with a second instalment, in which the later
Griesinger, the founder ofthe Archivfuir Psychiatrie, the fierce critic ofthe therapeutic pessimism
ofasylum psychiatrists and the champion ofacute psychiatric units and psychiatric education, is
considered with similar care.
.. Griesinger grew intellectually in the Germany of the
G. E. Berrios
University of Camnbridge
PAUL U. UNSCHULD, Medicine in China. A history of ideas, Berkeley, Los Angeles and
London, University of California Press, 1985, 8vo, pp. x, 423, £33.95.
In complex societies such as that of China an enormous variety of differently conceptualized
systems of therapy is encountered, all of which are representative of Chinese culture. The
author's intention is to contribute to an understanding of plurality and change in health care
concepts. China, with a long established literacy from the fifteenth century BC to the present
time, provides the necessary historical sources. During this period of nearly 3500 years, the
following types of medicine were practised: (1) oracular therapy from the cracks in sheep's
shoulder bones; (2) demonic medicine ascribing the source ofthe disease to demons; (3) Buddhist
and Taoist religious healing; (4) pragmatic drug therapy; (5) the medicine of systematic
correspondences including acupuncture; and (6) modern western medicine. The author
distinguishes Buddhist medicine from religious (presumably Taoist) healing, thus dividing the
process into seven systems. Item (4), for reasons given later in this review, would be better named
"empirical plant therapy". Many of these systems overlap most of the time, and it is a matter of
the preponderancy of one or the other at a given time.
This excellent presentation ofa vast panorama is marred by the author and his two translators
being insufficiently acquainted with English usage. He consistently translates the word "patient"
as "victim", uses the word "gall" indiscriminately for "gall bladder" and "bile", speaks of
illnesses instead of diseases, and refers to Chinese yao as "drugs" rather than "remedies" or
"materia medica". This goes so far that he calls Ts'ai-yao "the gathering ofdrugs" rather than
"herbs" or "plants". The word ch'i is consistently translated as "influences"-admittedly, there
isnomodem Englishwordfor thisancientconcept, but inwestern literature it appears aspneuma
inAntiquity and during the MiddleAges right up to and including the Renaissance. Ifhe felt that
the general reader was not sufficiently acquainted with this term it would have been better to
retain ch'iand putaexplanatory note at thebeginningofthe bookor at the first mention. Hemay
have chosen the word "influences" in connexion with astrology but the latter plays a very small
part in his description ofChinese medicine, and ch'iappears quite apart from astral speculations.
The book, which is part ofthe series Comparative studies ofhealth systems andmedical care, is
informative on the swing of the pendulum in modem times, in accordance with government
directives, between partial adherence to the Confucian system including shamanistic and
demonic features on the one hand, and the Legalist system including rational experimental
medicine and the findings ofmodern science on the other. But such a simplification cannot do
justice to the detailed study of the subject contained in this beautifully produced work.
C. G. URAGODA, A history of medicine in Sri Lanka, Colombo, Sri Lankan Medical
Association (6 Wijerama Mathawa, Colombo 7), 1987, 8vo, pp. ix, 326, illus., US $20.00.
The intention of the author-a distinguished local chest physician-was to write a short
history, as he states in his preface, at a leisurely pace. Two equally distinguished and influential
colleagues encouraged him to complete it in time for the centenary of the Sri Lankan Medical
Association (formerly the Ceylon Branch ofthe British Medical Association until independence
After a short introduction, the book begins with ancient medical practices, which embrace
Ayurveda and Siddha-a similar system practised only by the Tamils.
The first foreign influence was that ofthe Portuguese, who arrived inColombo in 1505. As they
occupied only the coastal areas, their occupation was marked by incessant hostilities with the
Kandyan kings of the interior. The Portuguese medical influence-although Western-had an
Oriental flavour as well. They were responsible for Mannar and Jaffna Hospitals. They were
subsequently expelled by the Dutch in 1658, who, in turn, occupied the maritime provinces. They
governed their territory through the Dutch East India Company, founded in 1602. This company
built the Colombo Hospital, whose walls were over 50cm thick, not for the local population, but
for its own European employees. It was restored in 1985. The Dutch were also responsible for
introducing a system akin to the present-day barefoot doctors to cater for the health needs ofthe
Dutch rule ended in 1796 with the British capture ofthe coastal provinces, and the annexation
ofthe Kandyan Kingdom in 1815. The author gives credit to the British for creating a sound basic
structure of medical care which, after independence, was comprehensive enough to continue
despite havingchanged little in outline up to modern times. The teaching ofmedical students was
at first based on the Bengal Medical College, Calcutta, founded in 1839. Students continued to go
there until 1870, when the Colombo Medical School was established.
A miscellany of diseases and disciplines completes the text. The former includes opium
addiction, smallpox, leprosy, and tuberculosis; the latter ophthalmology, dermatology, and
There is a table ofcontents, an index, and an excellent bibliography of nineteen pages. Each
chapter ends with its own notes and references.
This is a first-class single-author short history, chock full of facts. It also illustrates the effects
ofWestern influences, both good and bad, on a small island. It still has lessons for us in the West
I. M. Librach
Chadwell Heath, Essex