This essay outlines a contextual approach to disease (and thus medicine) in society. The work of Owsei Temkin is retrospectively evaluated and shown to rest on an assumed (if often implicit) contextualism. The key components of historical contextualism are then articulated, including the historicity of disease, the reification of specific disease categories in terms of language and social practice, and finally, in contemporary society, the value placed on diagnosis, the bureaucratization of disease, and a logically consistent focus on boundary management and boundary disputes. It is a contextualism that demands a role for the biological as well as the cultural, for practice as well as pathological theory.