It is clear from the title that this paper has an historiographical emphasis, one which might seem naive to the professional historian, but one which is not at all so naive to the historian of science or medicine. For me, these disciplines should speak to the present; my aim is to direct our attention to the failure of the history of medicine in this respect, and to suggest possible linkages with the human sciences, whose energies are so directed. I do not mean that its subject matter must be drawn from contemporary events—sometimes the very foreignness of the past allows an encapsulation of a situation which gives a clearer view both of the constraints operative within it, and of the unities underlying apparent diversity. This clarity can then encourage a more perceptive reflexion back to the present.

The history of the professions in the West since the French Revolution is a success story, a triumph, but not always an easy one. From the beginning of the nineteenth century in continental Europe the professions had a great attraction as careers presumably open to talent, but the demand for professional services developed more slowly than interest in professional careers and more slowly than the schools that supplied the market. Lenore O'Boyle has drawn attention to this discrepancy and the revolutionary potential of the frustrated careerists produced by it.

The Graeco-Roman world, with which I am concerned to the exclusion of the pre-Greek Near East, was a world of cities. Even the agrarian population, always a majority, most often lived in communities of some kind, hamlets, villages, towns, not in isolated farm homesteads. It is a reasonable and defensible guess that, for the better part of a thousand years, more and more of the inhabitants of Europe, northern Africa and western Asia lived in towns, in a proportion that was not matched in the United States, for example, until the Civil War. (Admittedly only a guess is possible, since statistics are lacking for antiquity.) The ancients themselves were firm in their view that civilized life was thinkable only in and because of cities. Hence the growth of towns as the regular and relentless accompaniment of the spread of Graeco-Roman civilization; eastward after the conquests of Alexander as far as the Hindukush, to the west from Africa to Britain with the Roman conquests, until the number of towns rose into the thousands.

With the continuing rapid growth of cities in Asia, Africa, and Latin America, social scientists have expected a clear shift of political power from rural to urban-based groups. The usual assumption is that this shift would stem from the process of urban economic growth which would lead to political centralization and political integration, both centered in the city. Such assumptions are found most explicitly in many ofthe theories of modernization developed in the 1950s and 1960s. Such theories were often derived from a so-called “Western” or European model.

The transmission of systems of ideas across wide cultural gaps is hard enough to study on any scale of human organization. It is particularly hard when two large, complex cultures meet under traumatic circumstances, as did China and the West in the nineteenth century. The myriad variables in such a situation dictate special care in defining the specific terms and conditions under which ideas are transmitted. The present case suggests three points worth attention: first, the precise language of the textual material that impinges on the host culture; second, the underlying structure of the historical circumstances into which this material is introduced; third, the process whereby the foreign material becomes important to sectors of society outside the group that first appreciated and received it and thereby becomes a significant historical force.

The greatest shocks suffered by revolutionary movements occur in the blossoming of revolution or in its defeat. The experience of the Russian Revolution of 1905–07 and of the period that followed, described by contemporary radical commentators as a “reaction,” is a case in point. In a half-dozen years the revolutionaries traveled the road that led from a promising, growing movement to actual revolution in which the parameters of their field of action expanded rapidly and then contracted to an environment of retrenchment and disillusionment. The effects of this experience upon individuals and organizations have not, however, received meaningful attention from historians or social scientists. An understanding of the experience of defeat is as significant as an understanding of the experience of success in the perception of revolutionary movements.