The Medical World of Early Modern France.

The Medical World of Early Modern France. By Laurence Brockliss and Cohn Jones (Oxford: Oxford University Press, 1997. xviii plus 960pp. $150.00).

A book this expensive and this long is not likely to attract many readers, however enticing the subject matter. Even specialists in the history of early modern medicine or of the French ancien regime will want to feel that the cost and time involved reading are justified, either because the book offers new insights, reformulates significant debates, reveals much that is not already known, or in some other way livens up the field.

Although plenty of new information is served up here, and the authors are both fine scholars with established reputations in precisely this field, it is not at all clear that this book works. Part of the problem is that the two have quite distinct writing styles--one methodical, one flamboyant--and the contrast between the sections is rather jarring. Also, the organization of the book is convoluted and makes for quite a bit of overlap and repetition. "The Enlightenment," for example, is both a brief section (C) of Chapter 6 and the whole next Chapter (7). "The Sick and Their Practitioners" is both a whole chapter in Part I (5) and also a section (E) of Chapter 8 in Part II. But most importantly, the subject matter would have been better served if the authors had exercised more restraint. Most writers fall in love with their material, but most also fight the urge to present every last morsel, and instead discriminate and distil. Here, as the introduction boasts, we have a book built on an archival foundation that is "unusually broad ... unusually deep ... unusually rich (p.7)," but the steady barrage of anectdotes and minutiae culled from these archives is numbing. The authors claim to open up a world "which historians have barely suspected," and they call attention to the "breadth of [their] conceptual apparatus" (p.33). But the original arguments sink from sight in the sea of details, forcing the authors to reiterate them (over and over!) in an effort to keep them afloat. The result is repetitive, organizationally cumbersome, and inexcusably lengthy. The famous apology from the sender of a long letter because he didn't have the time to write a short one comes to mind here....

That the effort of Brockliss and Jones--both active contributors to this field for many years--backfires here really is a pity, because it means that this book will probably be used as a sort of encyclopedia rather than a contribution to large and compelling historiographical controversies. What could have been a new and elegant revisiting of a subject colonized by Foucault will probably instead become a reference tool. Readers are sure to mine the extensively detailed index, maps, charts, tables, footnotes and bibliography for choice tidbits on the particular doctor or midwife, region of France, period, or illness that interests them, but they are unlikely to start at the beginning and follow the argument, because the argument gets drowned and can not evolve in an intellectually satisfying way.

The authors suggest a new vocabulary to replace the polarization of the high/low, elite/popular, licit/illicit medical dichotomy. Taking issue with Matthew Ramsey's formulation, they substitute for it an image of a core, or corporate medical community of trained physicians, surgeons and apothecaries, surrounded by a medical "penumbra" composed of colorful irregular healers. Emphasizing that the membrane between these groups becomes increasingly permeable across the nearly three centuries studied, they argue that the sick of all classes had choices and access to many different kinds of medical practitioners when they were in need, and did not stigmatize the increasingly influential charlatans of "Quack Street." Despite fierce efforts on the part of the core (or corps) to safeguard their turf and monopolize medical authority--by virtue of more rigorous qualifications, royal patronage and licensing, statist claims of legitimacy, or patriotic devotion--this was a system in dynamic flux, with lots of traffic acro ss the divide, a "unitary" rather than a "bifurcated" medical universe, increasingly shaped by consumerism and the fashions dictated by public opinion. Going against the grain, the authors "eschew the language of professionalism" and "avoid teleological theories of any stripe." (p.32)

But in the end they get rather tangled on their own reformulation and language. Occasionally they even contradict their own argument for fluidity, saying that the affluent avoided charlatans and favored the learned corporate elite (p.287), and that there was actually little erosion of the division: "there were two parallel networks of medical service: one for the rich and one for the poor." (p.296) "Incorporated and unlicensed healers generally served a different circle of clients." (p.337) Toward the end of the book, the following wordy conclusions are more confusing than illuminating: "As well as being more commodiously lodged within the erstwhile medical core, and containing a high admixture of graduate physicians, the medical penumbra was thus far more diverse than before." (p.656) Or "These case histories highlight the extent to which medical practitioners of every stamp and background were being drawn into the ambit of the press alongside individuals drawn from the medical penumbra." (p.665) So, despit e the authors' refreshing effort to counter the oft-told story of triumphal medical progress during this period, their praiseworthy determination to stress that even at the great Paris School of the early 19th century there was still a great gap between promise and performance, and their healthy eagerness to demonstrate the plasticity and plurality of medical styles and services during this period, the picture they present is bewildering.

Some chapters deal with medical ideas, doctrine, and the arsenal of therapies--bleeding, purging, urine tasting, cutting for stone, puncturing the skull, cauterizing wounds--that comprised the early modern repertoire. Others analyze institutional structure, and still others address the larger sociopolitical context of France. The opening five chapters stress that in the 16th and 17th centuries, health and illness were seen as essentially in God's hands. Expectations of healers, then, were limited, and the important thing was to have a "good death." Later, thanks to Enlightenment optimism, the lessening of mortality after the Marseilles plague of 1720 and the upswing of population (although this was not immediately apparent), the public image of medicine improved as did the demands on it, driving it to become less theoretical and more clinically practical.

However, contrary to more traditional scenarios, we are not moving here out of darkness and into the bright light of progress. The authors argue stenuously that the system in the 16th and 17th centuries, often depicted as backward, worked pretty well, quite smoothly in fact. There is an interesting analysis of how the medical consultation functioned, involving the patient and all the members of the household in a united effort to bring about a cure. This jolly picture necessitates a rather peculiar and forced re-reading of the medical comedies of Moliere, who brilliantly satirized both the practitioners of the 17th century and their gullible clients. The playwright, our authors are constrained to argue, was "unrepresentative," completely wrong with his "vicious" satires, "grossly unfair," and the picture he painted "completely distorted the truth."(pp. 337-344).

The second part of the book deals with the 18th century. The insights into the Enlightenment are certainly not surprising, stressing the secularism and optimism of the age regarding health and happiness on this earth, the growing influence and importance of debate and opinion in the public sphere, the origin and growth of the scientific and medical academies, the progressive policies and reforming ministries of Louis XV and XVI. This is a grafting of recent ancien regime intellectual and administrative historical scholarship onto the medical discussion. It is not out of place there, but it sheds no new light.

In medicine, the 18th century was characterized by the shift from fear of mortality to preoccupation with morbidity, after the containing of plague in 1720--an administrative, not a medical, triumph, by the way. Fatal diseases gave way to chronic diseases. Also fewer wars were fought on French soil. The faith in progress, the move from theoretical rationalism to practical empiricism, the increasingly widespread view of health as a commodity, the new notions of hygiene and preventative medicine, the growth of public courses in private amphitheatres, the ascendancy of surgery, the flourishing of the periodical press and especially of medical journals--all led to an "expansion of the medicable." Self-help manuals proliferated; anything and everything and anyone and everybody could be treated and probably fixed. Here there are some interesting and new discussions of the role of the numerous hospitals in early modern France--a story which had been previously obscured by Foucault's dating of the birth of the clini c in 1790--and of the importance of the military as a testing ground for medical and surgical training. The Royal Society of Medicine, a "supracorporative medical agency," gave a temporary boost at the end of the century to the physicians who had been pushed aside by the surgeons. But even this new organization could not effectively police or stern the tide of medical entrepreneurialism.

The book ends with an awkwardly worded discussion of medicine during and immediately after the Revolution, when the old hierarchical medical world yielded for a time to the citizen savant and the "ecoles de sante." Many doctors played significant roles on the changing revolutionary stages, pushing for freedom and openness in their field as well as in society and politics. But after the egalitarian patriotism of the "Jacobin moment," expertise and formal training were once again prized, and finally medicine acquired more "scientificity."(p. 821)

Although the thesis of this book seems unsatisfying, it certainly does present lots of sources for future scholars to work on, and suggests many avenues for fruitful further research.