Histoire sociale de la medecine (XVIIIe-XXe siecles).

Despite what its broad title might suggest, this volume, which is aimed at the cultivated French general reader, is a social history of medicine in France since the eighteenth century. Faure's exposition starts from the premise, which few historians of medicine would now dispute, that the field is best served by placing the history of disease and the struggle against it in the broadest possible social, economic, political, and cultural context. He would abandon the old triumphalist narrative of successive discoveries by the great names of medical science in favor of an account that gives more attention to ordinary practitioners, "external" constraints on medical practice, the limits of technological medicine, the experience of patients, and the history of disease itself. Faure also argues, unexceptionably, for trying to understand past medicine and science on their own terms rather than those of the present day.

In fewer than 250 pages of text, Faure covers a great deal of ground, surveying the major developments in the history of the medical profession, medical institutions, and public health, and the place of medicine in the broader culture; the previously uninitiated reader will also come away with a reasonably good sense of the "internal" history of medical ideas and practices. Faure's preoccupation with the social and political, however, leads him to emphasize the way in which key innovations depended on factors other than the internal dynamic of experimentation and clinical observation. Thus therapeutic advances in the Enlightenment depended greatly on patient demand and the intervention of the state and an aristocratic public (which championed smallpox inoculation, for example). The development of specialization starting in the early nineteenth century owed less to the growth of empirical knowledge and technical innovation, or even to the conception of disease as localized in particular parts of the body (as Erwin Ackerknecht suggested), than to the institutional segregation of certain socially marginalized populations such as the insane. The debate between contagionists and anticontagionists around the time of the cholera epidemic of 1832 reflected competing views of political authority and economic freedom (the liberal elites associated quarantines with the arbitrary use of power in the Old Regime) but also the reality of social division and the possibility that coercive measures might provoke popular revolts. The public health program that gathered momentum at the end of the century owed its impetus primarily to the social vision of the builders of the Third Republic. And Faure implies that certain medical concepts prospered in part because of their extramedical resonances; thus the idea of physiological equilibrium and self-regulation found in Claude Bernard's model of the milieu interieur subsequently appealed to a generation in search of a scientific basis for social stability and had its analogues in Durkheim's conception of social equilibrium and in the solidarism of Leon Bourgeois. Perhaps Faure's most suggestive general observations concern the interaction and reciprocal influence of the medical profession and what might be called the medical public. The former shaped public thinking to some extent through popularization and indoctrination, while the latter, by making choices as consumers of medical services but also by voicing opinions on all aspects of health care, helped shape public policy and ultimately the behavior of practitioners. But he unavoidably lacks the space to develop these points fully.

Students of French history will find in this volume a readable introduction to some of the major themes in the history of medicine and public health; students of the history of medicine and public health who can read French will find a useful survey of the French national experience. Both groups will appreciate the seven-page bibliography of essential secondary sources in French and English.

Matthew Ramsey Vanderbilt University