Medicine and Society in Early Modem Europe.

Medicine and Society in Early Modem Europe. By Mary Lindemann (Cambridge: Cambridge University Press. 1999. 249 pp. $18.95/paper).

Lindemann provides the student and scholar with a "revisionist" overview of the history of early modern medicine. She bases her study on the "new history of medicine," but is as critical of some of its conclusions as she is of the traditional history of medicine which preceded it. By describing the medical landscape through the changing lens of historiographical fashion she provides the reader with a critical understanding of the state of the field. Traditional medical history focuses on the "progress" of science and medicine; its impact on health and society; and the great physicians and scientists whose novel ideas and discoveries brought about the "triumph" of medical science. The new history of medicine problematizes the progress and chronology of science and medicine and the importance and far sightedness of individual scientists and physicians. In place of this triumphal history, revisionist scholars attempt to uncover the shared medical beliefs and practices of healers and sufferers from an anthropolog ical and sociological perspective. In addition, such scholars examine the changing roles and functions of various sorts of medical institutions, the nature of and changes in formal medical training as well as the evolution of the patient-healer relationship. This perspective allows for the discussion of advances made in medical knowledge and medical interventions but does not see such advances as having proceeded in a linear or absolute fashion.

In her first chapter "Sickness and Health," Lindemann describes the inter-penetration of naturalistic and supernatural approaches to disease in the early modern era. According to the reigning Hippocratic-Galenic discourse, the environment as well as an individual's "humors" helped to create a state of healthy equilibrium or unhealthy disequilibrium. In addition, certain notions related to ideas of pollution or immorality were seen as possible causes of disease, as in the case of leprosy. While traditional historians of medicine claimed that only laypeople held such "superstitious" notions, in fact, healers and sufferers shared a similar, if not identical, set of assumptions about the body, health, and healing. Moreover, such beliefs cut across social, economic, and cultural differences. Most people attempted to cure their illnesses with or without the help of healers and dealt with mental problems in ways which reveal a coherent set of beliefs and practices. In regard to mental health, in particular, Lindeman n faults Foucault and his followers for imposing a strict and inaccurate chronology on the history of mental institutions and for implying that early modem people saw mental illness as less disturbing or problematic than we do.

The second chapter "Epidemics and Infectious Diseases" focuses on the nature and impact of epidemic diseases, such as plague and smallpox and infectious diseases, such as syphilis, tuberculosis, and influenza. Noting that it is quite difficult to determine the exact nature of plague, Lindemann argues that it is equally problematic to disentangle "the effects of plague from other factors that made the 1300s so disastrous." She reminds us that the "century was a period of endemic warfare, famine, and declining populations even before the plague hit." (43) Moreover, influenza and tuberculosis had as serious demographic consequences as plague and smallpox. All of these diseases provide ample proof of a constant battle against disease, from more ordinary skin ailments, eye infections, and circulatory impairments to the more dramatic problems such as plague, smallpox, and influenza. While historians have tended to focus on the latter because they have left a large body of evidence, most people struggled daily with the former, more ordinary problems.

In the third chapter on "Learned Medicine," Lindemann discusses the pioneers of modern medicine and science, such as William Harvey, Paracelsus, and Sir Isaac Newton. She views them as no more prescient regarding the "rise of scientific ways of thinking" than anyone else of their era. They disagreed with each other and diverged from our notions of "doing science." When William Harvey spoke of pulmonary circulation, "he argued that: 'When ... Nature wished the blood to be filtered through lungs, she was forced to make the extra provision of a right ventricle.' Harvey saw the body much as Galenists did, as a vessel filled with vital forces." (74) While Paracelsus' ideas challenged the Galenic system by teaching that diseases were specific entities rather than an imbalance of humors specific to each individual, his overall conceptualization of disease was no more modem than any Galenist's. He believed occult forces permeated the world; employed the notions of microcosm/macrocosm to explain physical phenomena; an d believed that the stars influenced human behavior. Thus, Lindemann indirectly challenges Butterfield's notion that there was a scientific revolution that "reduces the Renaissance and Reformation to the rank of mere episodes.... changed the character of men's habitual mental operations ... while transforming the whole diagram of the physical universe." [1] She accepts Steven Shapin's more neutral assessment of the period as being characterized by " 'a diverse array of cultural practices aimed at understanding, explaining and controlling the natural world, each with different characteristics and each experiencing different modes of change'." (77-79)

Nonetheless, Lindemann does chart a kind of progress: by the end of the eighteenth century "physicians throughout most of Europe had shed the successive skins of Galenism, iatrochemistry, and iatromechanism.... [And t]he dominant 'theory' of the day was an empiricism that stressed observation and experience, and which was moving toward a more restrained use of drugs and treatments and a renewed emphasis on regimen and hygiene." (91) In addition, she argues that the medical enlightenment was a "profound transformation in mentality" which is best "reflected in attempts to correct deficiencies in environmental conditions, to augment the size of population and to cultivate better health of the people." In addition, the steady interest in anatomy combined with assigning seats of disease to specific organs which accompanied the rise of clinical medicine, allowed medicine to become truly "objective", i.e. based on quantifiable results.

In the chapter on medical education, Lindemann traces the trend which brought about the reunion of physicians and surgeons after centuries of social and academic division and rivalry. In this domain Lindemann includes a short but satisfactory sketch on midwifery training and the rise of male-midwifery. As she points out, men were not trying to take over the domain of childbirth and midwifery but rather regulate it. A longer bibliography which reflected the enormous work of the last twenty years would have been helpful in this section. In her discussion of surgeons Lindemann stresses that physicians acted more and more like surgeons as they concentrated on organs as sites of disease. "Lectures and practical demonstrations, combined with walking wards of hospitals were how the 'modern' surgeon was educated." As surgeons severed ties with barbers and barber surgeons they entered the academy. Lindemann mentions the surgeon Pierre Dionis as the first surgeon to lecture in anatomy and surgery in Paris in 1672. In fact, the surgeon Barthelemy Cabrol lectured on anatomy at the University of Montpellier in 1595. [2]

In "Hospitals and Asylums," Lindemann contrasts the older, bleaker story about medieval and early modern hospitals with the newer, more positive revisionist version. In the former, physicians were cast as the heroes who successfully medicalized hospitals which were believed to have been dank, unhealthy refuges for the marginal classes and where medical treatment was secondary to simple care taking. In more recent studies, early modem hospitals are seen as having had multiple functions, with a great variety of actors including lay and ecclesiastical nurses, administrators, apothecaries, surgeons, and patients all of whom helped to shape the institutions. Moreover, studies indicate that the high mortality rates believed to be "typical" of early modern hospitals had begun to decline before the clinical revolution.

The Reformation had radical consequences, according to Lindemann, for poor relief and medical care. Political, religious and economic disorder of the late fifteenth, sixteenth, and seventeenth centuries disrupted or destroyed many hospitals from England to Italy. These disruptions along with other factors contributed to the secularization and medicalization of hospitals. As hospitals became medicalized, they lost their previous functions as orphanages, poor houses, and refuges for the mentally ill. Lindemann also reminds us that hospitals must be seen within the larger social, economic, political, and religious movements which were taking place and which transformed European society. Rather than becoming repressive institutions that shut up undesirables as Foucault and others have claimed, more recent research suggests that they served as a way station for the poor and for others who moved in and out of such places with relative freedom. Finally, Lindemann points out a large area that requires greater study: the history of the patient. Her interest and concern about this aspect of the history of medicine relate to her call for "a more humane history rooted in flesh and blood."

In the next chapter on "Health and Society" Lindemann looks at "institutions without walls" by focusing on public health issues. She challenges persistent myths such as the notion that people in the past were victims of ever-present disease. The latest studies indicate that most common diseases were acute and rapid: one either recovered or died quickly. Childhood was the riskiest period. If you survived childhood, you had a good chance of becoming a mature adult.

Lindemann also discusses the relatively neglected area of private and corporate contributions to public health and the way in which private and public forces combined to create private institutions for public benefits. She mentions, for example, an orphanage founded in 1741 in London by Thomas Coram. (p. 156) On the institutional level, in contrast to the present, public health in the early modem period was the responsibility of bureaucratic rather than medical personnel. Medical men only began to dominate boards of health early in the late eighteenth century, though such arrangements varied by region. Shifts occurred during the eighteenth century as boards of health became part and parcel of governments. These shifts reflect the influence of mercantilist and cameralist thinking which argued that the health of populations was a key aspect to the health of the state.

The state's interest in public health brought with it a greater regulation of medical practice. The nature of this regulation varied by state and region. While France's medical community was divided into specific occupations with its own rights, privileges, and territory, this was not true for Italy and Spain where physicians and surgeons were not separated into distinct corporate groups.

In the final chapter on "Practice," Lindemann discusses the day-to-day realities of medical care. She emphasizes the number and variety of health care providers in the early modem era including itinerant and village healers, surgeons, apothecaries, midwives and, of course, physicians. Choice varied by region as well by social milieu. Categories which separate lay from professional practice didn't reflect reality. The same is true for distinctions between magic, religion and healing. The role of religion in healing waxed, waned, and expanded again in the eighteenth century. In spite of the continuing importance of religion and magic, few people limited themselves to those options.

As this review suggests, Lindemann's book ranges far and wide in the history of medicine and society. I have only a few quibbles with her interpretation of this vast subject. Lindemann seems to take Thomas Laqueur's The Making of Sex at face value regarding the chronology of the one-sex and two-sex model for sexual difference. (p. 14) As Katherine Park and other historians have pointed out, the early as well as late modem situations were much more complex that Laqueur's schema suggests. Also when discussing common beliefs on health, including notions about humors, spirits, and habits, Lindemann does not mention class as a factor which shaped people's ideas about what kinds of diseases afflicted different sorts of people. For example, aristocratic women who ate heavy, rich meals and engaged in little physical exercise were often seen as more prone to certain kinds of medical problems than the robust, physically active peasant women. Overall, Medicine and Society in Early Modem Europe fills an important gap: it summarizes and evaluates the last twenty-five years of scholarship in a lively and critical way while providing students in a variety of fields a detailed summary of many of the insights and conclusions which this scholarship has accrued.

ENDNOTES

(1.) Hubert Butterfield, The Origins of Modem Science, 1300-1900 (London, 1949), p. viii.

(2.) Louis Dulieu, La chirurgie a Montpellier de ses origins au debut du XIXieme (Avignon, s.d.), 80-82.