Orland, Barbara

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Michael Stolberg, Die Harnschau: Eine Kultur- und Alltagsgeschichte, Cologne:Bohlau Verlag, 2009. Pp. 285. € 26.90. ISBN 978 3 412 20318 4.Why did historians of medicine largely ignore uroscopy as the presumably most importantdiagnostic tool of occidental medicine? Michael Stolberg, Chair of the History of Medicineat the University of Wurzburg, discusses historiographic as well as aesthetic reasons forthe remarkable lack of interest among recent historians. Certainly, unlike blood orother bodily liquids, common sense ranks urine among the feculent, impure andaltogether waste products of the body. Yet, even more important is that older traditionsof history of medicine considered the visual examining of a patient’s urine by modernmedical standards, regarding it as unscientific, incorrect and with only limited evidencefor a diagnosis. At best, historians treated uroscopy as the forerunner technique ofmodern chemical urine analysis, which is mainly used for the diagnosis of some urinaryand metabolic diseases.The historical interest that uroscopy has received is out of all proportion to its earlymodern relevance. Whether academic physicians, lay healers or patients, all of them con-sidered uroscopy to be the most pervasive and fundamental practice of diagnosis. Handeddown from the Hippocratic and Galenic texts, it was also among the most refined and var-iegated diagnostic tools of medicine that only slowly disappeared from medical practiceduring the era of the Enlightenment. Even in the nineteenth century, in some ruralregions, local healers were known for their use of uroscopy. Many people still trustedin this style of the examination of the body and its excretions. A patient’s urine narratedhis/her diseases, constitution and living conditions. It could be used as a pregnancy test,material for prophecy, or oracle as the worst comes. Not infrequently, the result of anexamination was experienced as a ‘judicium’, a judgement about life or death.Uroscopic examination was mainly done by the naked eye of the doctor or healer. Yettheir instruments also included tools such as the uroscopy flask, the distillation apparatus(iatrochemical tradition), the urine wheel and instruction manuals that helped to classifyurine. The uroscopy flask, a piece of glass that was circular at the bottom, symbolized theshape of the human body. A gritty or sticky matter at its bottom referenced the lower bellywhile the impurities in the top may help the doctor to find a sickness in the head. Yetessential for a proper diagnosis was identifying the colour of the urine. Since theMiddle Ages, some well-known diagrams, named urine wheels, differentiated about 20colours that were linked to specific diseases. Together with the consistency of theliquid, its odour, taste and the visible sediments, the optical appearance was the mostimportant diagnostic sign. These signs were obviously subtle, requiring perception andintuition. Yet they were also based on the rationality of natural philosophy and anatomicalknowledge about the hidden metabolic processes inside an altogether humoral body.Only with respect to the changes in styles of thought and technology can the declineof uroscopy therefore be explained.This task is well done by Stolberg’s book. Its initial aim is to give a cultural history of amost versatile tool of medicine (including a chapter on the representation of uroscopy inthe Dutch genre painting with not less than 48 coloured images). With respect to a widerange of sources, the author also argues plausibly why and how, since the seventeenthcentury, uroscopy gradually lost its epistemic value and changed into a quackishmedical device. Stolberg suggests that critical statements about a limited explanatorypower were the only ostensible arguments. To learned physicians the loss of prestige inthe exercise of their authority was even more important for the search of a new skilledknowledge. In other words, the decline of an alleged insignificant medical practice180 Book Reviewsleads to nothing less than the paradigm shifts in which medical theory and practice wenthand in hand with a transformation of the professional identity of physicians.Advance Access published 16 February 2011doi:10.1093/shm/hkr012 Barbara OrlandUniversity of BaselProjit Bihari Mukharji, Nationalizing the Body: The Medical Market, Print andDaktari Medicine, London; New York: Anthem Press, 2009. Pp. xiv+ 351. £60.ISBN 978 1 84331 315 1.In Nationalizing the Body, Projit Mukharji presents a meticulously researched constructionof the identity of Daktari physicians, or Indian practitioners of Western medicine, throughthe late nineteenth and early twentieth century in British Colonial Bengal. With new andcompelling views and evidence, Mukharji’s revisits a critical theme in the history of medi-cine in the colonial context. Namely, what is ‘colonial’ about colonial medicine? He makesa case therefore for moving beyond the frame of the colonial ‘encounter’. His work care-fully maps the discursive spaces that were created not only through the representations ofthe Daktari practitioners as they publicised their practice in an emerging medical marketand through a burgeoning vernacular press, but also through images of them seenthrough the eyes of colonial administrators, patients and the popular press.The significant historical question in this book is how are identities socially constructedand Mukharji draws initially on biographical narratives of well-known Daktari physicians,their responses during epidemics of the plague, cholera and ‘syndromes’ to reconstructthe shifting locus of their social origins and their challenges to colonial medical interven-tions during epidemics. He thereby reconstructs a fascinating world, where the seemingboundaries of ‘legitimate’ and ‘illegitimate’ medical ‘systems’ and their therapeutics andpractice are blurred and being constantly negotiated. By tracing the construction ofDaktari learning and its mobilization, Mukharji explores contemporary debates thatstraddled the realms of the public and domestic spheres, definitions of what comprised‘indigenous’ and ‘foreign’ as well as interpretations of colonial authority. He therebydemonstrates the multiple ways in which Western medicine began to forge a distinctspace and identity and in turn reflects on the ambivalent ways in which colonial authoritywas ‘seen’ and addressed.Mukharji begins with an unusual and original theme; by tracing the biographies ofDaktari lives and telling through this cast of actors the changing context of professionaland social origins, urban–rural networks, the shifts in colonial health services and edu-cation policies, the rise of private colleges and how ideas, technology and medicalmarkets were mutually shaping each other in this period. This beginning is vital andco-opts the reader into identifying with a small but vital cast of actors that appearthroughout the rest of the book. Physicians such as Khastagir and Narendranath are intro-duced at the outset and their work and engagements wax and wan through the latterpart of the narrative.The core of the book lies in the reconstruction of the efforts by Daktari physicians to‘nationalize’ or make less alien their medicine. He explores the dialogue betweenDaktari and indigenous medical practitioners such as Ayurvedic healers and traces anactive intellectual dialogue sustained between practitioners such as through Daktari’sdeployment of Ayurvedic notions of Din-Chary or daily routine. He also explores theefforts by Daktari physicians to undertake translation projects of Western medical textsin a manner as to give importance to ‘one’s local experience’ and argues that this demon-strated a re-appropriation of Western medicine based on careful, critical understanding ofBook Reviews 181

Michael Stolberg, Die Harnschau: Eine Kultur- und Alltagsgeschichte

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