In a deliberately mixed metaphor, Christopher Hamlin suggests, early on in this fascinating and ambitious book, that ‘Fever has been the invisible elephant in the china shop of the medical past’ (p. 13). In the history of medicine fever is everywhere, wreaking havoc on both epic and intimate stages, from the numberless victims of the Black Death to the sentimentalised child-patient of Sir Luke Fildes’ The Doctor (1891). And yet the very ubiquity of fever, as well, perhaps, as its complex intellectual history, means that it has largely escaped sustained historical attention. While we have numerous accounts of the occurrence and treatment of certain diseases once denominated fevers, such as plague or cholera, we have not yet had a satisfactorily longue durée history of fever as a concept; at least until now that is. What Christopher Hamlin’s book does, and does superbly well, is to trace the long history of fever, to delineate its changing languages, meanings and manifestations from ancient through to post-modern times. What is now thought of as a symptom of disease was, for much of the human past, regarded as a disease in itself, or rather as a constellation of distinct but related conditions. Also, and as the title More Than Hot suggests, whereas heightened bodily temperature is now the signifier sine qua non of fever, its definition, understanding and presentation has, historically speaking, been far more complex and contested than this.
It is rare that a book of more than three hundred pages can be considered a ‘short history’, but so varied and complex is the story of fever that it is no more than what is essential for the task Hamlin has set himself. As he charts the history of fever, the reader is struck less by a sense of linear intellectual progress than of cycles, undulations and fluctuations, a pattern which mimics the periodicity of the condition itself and which can occasionally leave the reader feeling as woozy and disorientated as the stereotypical fever patient. A great deal of this fluctuation in meaning has to do with the descriptive and diagnostic language of fever. As the early nineteenth-century Irish doctor John Murray said, ‘It is a dangerous practice to treat fevers according to their names, which are and ever will be arbitrary’ (p. 192). Hamlin’s account, which is divided into four parts covering (1) the ancient and early modern periods, (2) the eighteenth century, (3) the nineteenth century and (4) the post-modern period, therefore begins, appropriately enough, with a chapter entitled ‘Words’. This chapter explores the complex, contradictory and often unrecoverable semantic world of ancient fever, a diverse language encompassing ‘a cacophony of peculiar comparisons’ (p. 28) which only gradually gave way to Galenic systemisation. The following chapter, ‘Books’, cleverly mimics its predecessor as the simplified Galenism of the Renaissance devolved into the ‘free for all of brilliant obfuscation’ of the seventeenth century before Thomas Sydenham, Herman Boerhaave and others attempted to ‘compress the wildness into textbook coherence’ (p. 59). Part 2 begins with a chapter on ‘Communities’ which explores the growing social dimensions of fever as it came to be associated with institutionalised populations and the urban poor and as the imperative to stop its spread functioned as the logic for a marked increase in charitable medical provision. The following chapter, ‘Selves’, meanwhile, explores the experience and symptomology of fever, as heat (subjectively felt rather than objectively measured) together with delirium came to prominence as key signifiers within a nerve-centred medical cosmology, one in which fever was also increasingly gendered feminine. Part 3 begins with ‘Facts’, a dense chapter which charts the rise of lesion-based understandings of disease, particularly in relation to the inchoate distinction between typhoid and typhus, as well as the rise of poisons and toxicology as a model for conceptualising fever. ‘Naming the Wild’ explores the key role of fever, particularly malaria, in the imperial project, while ‘Numbers and Nurses’ considers the triumph of temperature as the defining quality of fever and the implication of this for patient management and treatment. Finally, Hamlin concludes with a single chapter, ‘Machines, Mothers, Sex and Zombies’, in which he demonstrates how the concept of homeostasis served to rob fever of much of its dread, as it came increasingly to be seen as a natural and necessary consequence of the body’s own immune system and as heat came to be regarded as a cure not a killer. In this chapter Hamlin also considers the shift of fever into the realm of childhood, a matter to be managed by mothers as much as nurses, as well as the twentieth- and twenty-first century’s use of fever as a metaphor and a model for everything from sexual desire to biological annihilation.
More Than Hot is a wonderfully compelling and hugely valuable contribution to medical history. Hamlin has set himself a remarkable task and has accomplished it with considerable aplomb. It is richly detailed and exceedingly knowledgeable; every page positively drips with research and ideas. Occasionally, some chapters can overwhelm the reader with names, narrative and nuance. This is particularly true as Hamlin moves into his established area of expertise in the nineteenth century. Also, while this is primarily an intellectual history, it also aspires to cultural analysis. However, because of the sheer quantity of work needed to disentangle the intellectual dimensions of the story, the cultural aspects sometimes feel a little slender by comparison. The material on Mme de Sévigné, sensibility and intersubjectivity in Chapter 4, for example, could easily have been extended to half a chapter or more. But such observations are less an indication of any oversight on Hamlin’s part than they are of the fascinating nature of the material. This book has been keenly anticipated by many scholars for some time and I very much doubt any will be disappointed. More Than Hot already promises to be a classic of medical history.
