Les therapeutiques: savoirs et usages. .

Les therapeutiques: savoirs et usages. Sous la direction d'Olivier Faure (Lyon: Fondation Marcel Merieux, 1999. 486 pp.).

This book publishes the twenty-eight papers given at a scientific meeting held in Lyons, in 1997 at the Marcel Merieux foundation (which is linked with the famous pharmaceutical and vaccine laboratory). In the field of the history of medicine, the history of therapeutics has long been neglected, especially in France. In his introduction, the general editor Olivier Faure (professor in social history of medicine at the university of Lyons III) stresses the fact that Anglo-Saxon historiography has produced more studies on this subject than the French: studies by Ackerknecht in 1973, Vogel and Rosenberg in 1979, Bynum and Nutton in 1991 are important landmarks. Rosenberg, in particular, had pointed out how, until the XIXth century, doctors and patients were linked together in the same trust in the value of evacuating remedies. The course of the XIXth century saw the decline of this "heroic" age, under the pressure of the "therapeutic revolution": the common knowledge disappeared, a science-based pharmaceutical in dustry appeared, randomised clinical trials were needed, and patients had to trust their doctors without really understanding how new remedies were working.

This book is based on the same approach and intent to draw the lines of a social history of therapeutics, at the crossroads of the history of medical knowledge, medical professionalisation and doctor-patient interaction. The authors come from various backgrounds: most of them are scholars (some of them very young and still writing their theses, such as Pascale Kibleur or Christophe Broca), mainly historians, sociologists or anthropologists, some physicians or chemists. Most papers deal with the French situation, but two treat English sources (Bernier on Reid's treatment of phtisis in the XVIIIth century; Anderson and Berridge on oral history of local chemists at the beginning of the XXth century) and one (by Johanne Collin) deals with the prescriptions of a Canadian chemist in Montreal from 1857 to 1907. The period of time is also quite large, ranging from medieval times (Jean Pierre Benezet's study of a hundred apothecaries' inventories from Mediterranean countries in the XIIIth-XVIth centuries) to contempor ary cures of hemophilic and HIV patients. The interest of these various contributions is of course unequal: to appreciate the wide range of subjects dealt with, one can read two rather plain scholarly contributions by Patrice Bourdelais and Gerard Jorland upon the statistical methods of evaluation by doctor Louis in the first half of the XIXth century, and then jump to the last paper of the book, where Odile Marcel, though she is professor of philosophy at the university of Lyons III, relates in a very direct style her appalling personal experience as a patient struck by breast cancer.

The book is divided into three parts: 1) how physicians deal with therapeutics: from imaginary to scientific evaluation of their prescriptions 2) some practical examples of healing (from the experience of a XVIIIth century surgeon in Geneva to contemporary pharmaceutical laboratories) 3) patients' relations to therapeutics: how they negociate and appropriate them. One major interest of the book is that, besides well known sources (medical literature, statistics, journals, diaries, letters--and they are beautifully used by Michael Srolberg in his paper upon doctor-patient interaction at the end of the XVIIIth century), it points out some new ones: chemists' and hospital archives, oral history among different kinds of contemporary people (retired English chemists, peasants in Normandy in Haxaire's paper or Parisian HIV patients in Broqua's), and also new methods (computer analysis for popular medical recipes by Loux or linguistic analysis to deal with contemporary interviews of drugs consumers in the French cou ntryside by Haxaire).

There are several interesting key themes in this book. For instance, despite the opposition between scientific and popular medecine: exchanges between the two have been constant in both directions. Francoise Loux's paper on the rationality of popular recipes (collected by folklorists in the XIXth century) reconstructs a coherent conception of the sick body and the strong link between empirical and symbolical therapeutics. Even if they were not very efficient (from our modern point of view), many XIXth century academic therapeutics were well accepted by patients because they were built on the common conception of the human body as a part of the universe. The beautiful study of blood-letting in the XIXth century by Chantal Beauchamp shows that, despite the emergence of the bright clinical school with its new conception of illness, most French physicians and patients still considered blood-letting as a relevant therapy. Another theme deals with the mechanism of experimentation and assessment of therapeutics: sev eral papers show how these were stimulated by the confrontation with lay practices and heterodox theories, such as mesmerism or homeopathy; or in the XXth century, by the competition between clinical physicians and patented researchers in pharmaceutical laboratories (Sophie Chauveau). Dynamics in therapeutics seem to be all the more powerful when the illness appears to be incurable, such as in the case of rabies, well presented by Matthew Ramsey.

This book leaves many questions unanswered (for instance, nothing is said about the history of surgical therapeutics). One may regret the scattered character of the papers, some of them being very limited. But this publication must be considered as a real landmark for anyone interested in the young history of therapeutics, especially among French scholars.