Also influential has been the work of Thomas McKeown on population growth in modern Britain, who is generally read as maintaining that medical intervention had next to no influence on the fall in death rates in industrialised countries until well into the twentieth century.

This situation is in part a reaction to earlier histories of medicine that assumed changes in the medical understanding of disease automatically converted into progressive preventive or therapeutic results. Particularly thin on the ground have been studies of the impact of medicine on morbidity and mortality, and beyond that investigations into the part played by diseases, or medicine, or both together, in shaping wider historical changes. There have been fewer studies of the 'impact' of medicine on society, except for work around medicalisation and on how changing medical views of the body and disease have interacted with popular and elite beliefs.

The emphasis in the new social history of medicine has very much been on the 'social' in medicine and how the wider 'society' impacts upon medicine. In turn, this approach has spawned a relatively new genre of the history of disease, where medical historians consider a disease over a longer period, weaving changes in understanding and management with epidemiological and cultural history. A popular theme in this vein has been the history of epidemics, which has allowed historians to focus on a particular place and time, and to explore the social context of disease and medicine at a moment of social crisis.

There are many recent studies of doctor-patient relations as revealed in casebooks or diaries, of alternative healers in particular towns, of individual asylums, and of health and medicine in specific regions or countries. A characteristic of much of the new work, following from its attempt to set medicine in its specific social context and its reaction to older universal histories, has been its relatively narrow focus in time and place. Also, previously well-worked seams, such as the development of the medical profession and medical science, have been the subject of new studies and major revisions. How 'new' the social history of medicine actually was is debatable, but there can be no doubting the proliferation of work on topics such as patients, non- orthodox practitioners, madness, and healing and disease outside of Western cultures.

Reflections on the history of medicine in the second half of the twentieth century make much of the discipline's break with its association with the history of science, and the development of the new approaches and interests signalled by the coming of the 'social history of medicine'.

Imperialism 2 (1999)