For tomorrow we diet?

For tomorrow we diet? Eat drink and be merry: the British at table 1600–2000 An exhibition at Fairfax House, Castlegate,York, UK, showing until 4 June 2000, and then at the Iveagh Bequest, Kenwood House, London from June 27 to Sept 24, 2000, and at the Assembly House,Theatre Street, Norwich from Oct 14, 2000 to Jan 7, 2001. ood and its presentation at the table during any particular period”, claims the guide to this exhibition, “is as distinctive as the costume of the time and can reveal as much about a society that created it as contemporary literature or architecture”. This is a bold claim, but one which can, I think, be justified. Whether this exhibition fully succeeds in doing so is perhaps less certain. The elegant rooms of Fairfax House have been used to display meals and table-settings from different periods, skilfully recreated by Ivan Day. Around the walls are pictures and artefacts illustrating the material and social contexts of eating. Proceeding through the house takes us from the late Elizabethan period, not to the present, but to the late Victorian world of Mrs Beeton. We start in the library, but by a leap of the imagination must project ourselves into the garden of a stately home of around 1600, where a table laden with sweet things has been set in an arbour. In the centre, a banqueting house made out of sugar stands on a marchpane designed as a knot garden, with beds of caraway and ginger comfits and fruit marmalades. Around this focus are many other sweet-

meats and sweetbreads, arranged on edible plates and dishes, a novelty introduced to the English in the 1590s by the work of Girolamo Ruscelli. This obsession with sugar reflects its high price and hence its role as a status symbol in the 16th and 17th centuries, a point which could have been made explicit in the exhibition guide. This naturally led to an upsurge in dental caries among the well-off, and it is a relief to turn to the depiction of Lord Cobham and Family (c. 1570), where young children are seen feasting on fruit—notably apples and cherries. The next set-piece recreates a Country House Breakfast as laid out in Mrs Garter Feast served for John Beeton’s Book of Household Management (1892) Holles, Duke of Newcastle, at enhance the feeling of rich abundance. Windsor in 1698. Here the table is set On our way to the next meal, we pass for the second course, and the emphasis through the Fairfax kitchen, where is on the abundance and diversity of sugar flowers are being dried and, a the foods, which include roast fowl, and more homely touch, plain bread is elaborate pies of wild boar and lobster. baking in the oven. Upstairs, we pass The physicality of the food is celebrated through Anne’s Bedroom—where we rather than disguised—birds are disare treated to a range of prints and paintplayed with their legs and wings ings on the theme of over-indulgence, attached, leverets with heads and ears some humourous, some moralising, intact. In the middle of the table great including Hogarth’s visceral study pyramids of fruit and sweetmeats Frances Matthew Schutz in his Bed (1755)—and the Viscount’s Bedroom, where the fashions and rituals of teadrinking are explored. In Johann Zoffany’s group portrait The Dashwood and Auriol Families (1787), the consumption of tea is presented as a sort of still centre of empire, the stately Britons of India taking their refreshment while agents of news and commerce throng around the margins of the picture. The next table-setting chronologically (although not The Table, St Fagan’s Castle by Sir John Lavery (1905) physically, due to the layout of

Dominic Brown for Norfolk Museums Service

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For personal use only. Not to be reproduced without permission of The Lancet.

DISSECTING ROOM

Nigel Corrie for English Heritage

and elaboration, here it is the architecture of the ta b l e- s etti n g —cu tl er y, glassware, mirror plateau, and flowerstands—that dominates. The expression of wealth, taste, and status has now passed in large part to the table hardware, a reflection of the technical advances of British craftsmen, changing tastes and sensibilities, and changes in the relative cost and prestige value of foodstuffs themselves. These points, which bring the history of the table into the mainstream of social, economic, and cultural history, are not, however, brought out in the main part of the display or in the guide, but must be gleaned from the thematic cabinets which form the “time trail” at the end of the exhibition. This down-playing of the dynamic elements in the story is perhaps the exhibition’s principal weakness, and contrasts with the Museum of London’s recent presentation London Eats Out (see Lancet 2000; 355: 323–24). The final set-piece represents a late-Victorian breakfast table, laid after a plan in Mrs Beeton’s Book of Household Management. We see metal equipage of electroplate and Sheffield plate, massproduction techniques that had brought

A picnic for the millennium

the house) recreates a Regency dessert course of about 1815, in the magnificent Red Saloon. It is evident that an important transition has taken place over the course of a century.Where previously the food took centre-stage, both in quantity

Show me the evidence The evidence for vascular surgery J J Earnshaw, J A Murie, eds. Kemberton:TFM Publishing Ltd, 1999. Pp 210. £37·50. ISBN 0953005259. ven experienced vascular surgeons have difficulty evaluating the many new technical and endovascular developments in the young and expanding specialty of vascular surgery. These difficulties are even greater for other physicians, such as general surgeons and radiologists who deal intermittently with aspects of vascular disease. Thus, The evidence for vascular surgery is a longed-for addition to the literature on vascular surgery, and covers the whole spectrum of vascular diseases from carotid stenosis to venous ulceration. Not only is the surgical point of view discussed but also indications and possibilities for the radiologist. The sections review the background, basic prin-

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ciples, and standard and new techniques of vascular surgery, always with reference to the latest studies. Also, standard surgical approaches are compared with the new endovascular procedures. Conclusions from studies about the application of surgical techniques to clinical practice are provided in summaries. By contrast with other books, the conclusions in this book are based on examination of the evidence and not on methods favoured by various authors. The quality of the different chapters is excellent and there is a thoughtful, balanced, and logical guideline in each chapter. The section on carotid endarterectomy gives exact guidelines about the indications for operation. Detailed information is provided about how the

a variety of tableware within the reach of middle-class households. Although the overall effect is fairly simple, the range of foods on offer here is much greater than the average modern breakfast table, and includes kidneys, ham, tongue, and cutlets, as well as fish and eggs. Developments of the 20th century, including the revival of hand-painting and crafting, and the spread of specialised tableware for children, are consigned to the “time-trail” cabinets. This exhibition claims to show us “The British at Table” over five centuries. In fact, much of what we see reflects the well-off to super-rich English in banquet mode. Certainly a few touches—such as Joseph van Aken’s Grace Before a Meal (c. 1725)—remind us that for most of the population throughout much of the period under consideration food was simple, sometimes scarce, and table decoration either homely or non-existent. The poor and middling are marginal to this exhibition, however, as are the Welsh and Scots. The depiction of a Scottish “high tea” in James Guthrie’s Midsummer (1892) reminds us of national and regional variations in diet and in the rituals of eating, a theme which might with profit have been pursued. Despite its short-comings and an overall lack of dynamism, the exhibition is visually striking and is well worth a visit, either in its present home at Fairfax House, or in its future incarnations in London and Norwich. James A Galloway Centre for Metropolitan History, Institute of Historical Research, Senate House, London WC1E 7HU, UK

results of carotid endarterectomy can be improved by standardising both anaesthetic and surgical techniques. The sections on endovascular technique in carotid surgery techniques review the current data and give an outlook on the future from the radiologist’s and the surgeon’s perspective. Peripheral-arterial disease is introduced with a short section about risk-factor management.There is a good summary of the current evidencebased knowledge of the management of intermittent claudication and acute leg ischaemia. In the sections on abdominal aortic-aneurysm repair, the risks and results of elective surgery, including recent clinical experience with the new technique of endovascular aneurysm repair, are discussed. The reader is given a perspective on the technical possibilities and difficulties associated with endovascular repair, such as leaks from the graft and graft migration. Four chapters of the book are dedicated to venous diseases—special stress is laid on the role

THE LANCET • Vol 355 • May 27, 2000