The practice of medicine, the patient–practitioner encounter and the institutional spaces occupied by medicine have always been arenas characterized by the notion of performance. Physicians were, and still are, expected to fulfil specific roles, in relation both to their patients and to their profession. Historical accounts of medical practitioners as an organized body of individuals have focused primarily on the construction of narratives underpinned by professionalization and the medical economy. In this atmosphere of market forces and professional self-identification, Michael Brown's complementary treatment of medical men in York between around 1760 and 1850 provides a refreshing and valuable strand of analysis. Performing Medicine takes us behind the facades of the increasingly imposing medical institutions so characteristic of the period and shows that cultural values underpinned the shift of practitioners from ‘civic gentlemen and liberal scholars’ to an organized collective of quasi-scientists (p. 226).

In Brown's terms, the book sets out to ‘address the relative absence of agency, ideology and ideation within the existing historiography’ (p. 6). He begins with an accessible yet thorough analysis of the context of late eighteenth- and early nineteenth-century York, the important provincial centre which is the focus of Brown's study. Here, we are introduced to the pervading notions of civility, politeness and the ritualized environment of the club; the concerns of practitioners about how their profession was viewed by the wider public were reflected in the organization of the medical men of the city into a ‘Doctors Club’, which informed and was informed by a culture of ‘politeness, gentility and sociability’ (p. 39).

Subsequent chapters examine significant medico-social events and shifts over the following decades. These range from the ‘asylum revolution’ (Chapter 3) to the much-studied and widespread outbreak of Asiatic cholera in 1832 (Chapter 5). Through these episodes, Brown argues that the cultural outlook of gentlemanly medical practitioners shifted: they increasingly saw themselves, and were seen by society more widely, as medico-scientists. We learn that the work of the medical officers of the York Lunatic Asylum was subjugated to the wider political and social agendas of various publics. In this regard, the York Asylum paralleled the case of Bedlam, and other medical institutions were not exempted from self-styled social reformers. Despite the apparent wider geographical reach of these themes, hinted at throughout the chapter, the reader is left craving deeper contextualization, particularly with other provincial centres. Brown himself notes in the conclusion to this chapter that ‘events at the Asylum can only be fully understood as constitutive of a much wider transformation’ (p. 104), yet the feeling remains that these broader changes are left untouched.

By contrast, in Chapter 5, the social and medical responses to cholera – which frame the emergence of medical societies across Britain – are used to illustrate the wider significance of York's cultural milieu. It is here that Performing Medicine is at its strongest, taking in aspects of public health, infectious disease, medical professionalism and legislation alongside the central narratives of culture and medical authority.

The epilogue gives a whistlestop tour of the centrality of culture to medical practice and organization from around 1850 onwards, taking in topics as diverse as Middlemarch, the Dangerous Drugs Act (1920) and Labour's landslide victory in the 1997 general election. Although it is interesting to see how the themes of the book continued over subsequent decades and indeed up to, and potentially beyond, the present, it could perhaps have been equally valuable to include some summative thematic material, drawing strands together from across the chapters and reflecting in more general terms on the period in question. More extensive comparative analysis with other, related professions, particularly during the early nineteenth century, would also have been welcome; the question whether medicine as a culture-dependent, performative and increasingly institutionalized activity was alone or somehow unique in this period is one which feels unanswered.

Although Brown explicitly concentrates on York as the subject of his study, this geographical specificity is, in the opinion of this reviewer, a positive rather than detrimental aspect of the book. The fact that one yearns for more extensive comparisons with other localities outside London is testament to the lack of attention which this subject has received from historians, rather than to authorial oversight. Brown is an inventive and entertaining writer, and the book has broad appeal beyond historians of medicine; it offers an approach which is of significant value for cultural historians, as well as historians of eighteenth- and nineteenth-century Britain more generally. In summary, then, the minor shortcomings of Performing Medicine are more than offset by its nuanced and sophisticated argument for a fundamental role for culture within the community of medical practitioners in late eighteenth- and early nineteenth-century provincial Britain.