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The Woman Beneath the Skin: A Doctor's Patients in Eighteenth-Century Germany.

The Woman Beneath the Skin: A Doctor's Patients in Eighteenth-Century Germany. By Barbara Duden (Cambridge, Massachusetts: Harvard University Press, 1991. viii plus 239 pp. $24.95).

Fortunately for historians with little command of German, Barbara Duden's important book Geschichte unter der Haut (1987) has recently been translated into English. From Duden's historically sensitive analysis of the notebooks of an early eighteenth-century German physician, readers can gain an understanding of the very different world of early modern patients and healers. Duden's approach to the relationship between the Eisenach physician Johannes Storch and his female patients is grounded in her own journey from a modern perception of the inner body back to the world that lay beneath the skin of Storch's patients, with whom he communicated largely through the mediation of letters or male relatives, rarely saw in person, and even less frequently examined with his own eyes and hands. The broad erudition and diverse methodology acquired during her own intellectual pilgrimage give Duden the tools to integrate Storch's recorded observations into a set of generalizations about the body experiences of suffering women in the 1730's, and about the ways that the doctor attempted to alleviate their miseries.

Whereas modern patients place their bodies literally in the hands of medical experts, Storch's medical authority was quite other. The women who consulted him often had a home remedy in mind, and wanted only his approval. Storch had to share his patients' loyalty with other healers who had gained their expertise through artisanal networks or simply oral tradition. He sometimes offered a competing regime, but more often had to be content to treat just the symptoms that the patient chose to describe to him. When he wanted to impose his own version of medicine on the problem, Storch had to convince the woman that the treatment he judged optimal fit with her idea of the offending source of pain.

Most modern persons have a view of the interior of their bodies as integrally separate from the outside world, and the skin as a defensive barrier against pollutants and phage organisms such as viruses and bacteria--however vaguely understood. Women (and men) in the early eighteenth century experienced the body as a contiguous part of their surroundings, social and environmental, and the skin as a porous mediator. Under the skin, where we envision an array of organs, functional systems, tissues, and nearly impermeable blood vessels, Storch's patients perceived a largely undifferentiated region where metamorphoses among body fluids took place. The womb was a dark region where new life might be nurtured or blood might stagnate, causing illness. Storch's conception of inner space was not explicitly Cartesian but a blend of Stahlian theories, vaguely Aristotelian notions of natural direction and intention, and the body interior as an "unstructured osmotic space." The latter two aspects of Storch's thinking resonated with popular conceptions, where inner body space was continually in motion. Pain was caused by a "flux," not a surge but rather a stoppage of the movement of a vital body fluid--blood, milk, urine. Women's physiology differed from men's primarily in the innate periodicity, not the presence, of bloody flow: interruption of the rhythm of the menses signalled a flux, and was not necessarily indicative of pregnancy nor the natural result of aging. Body fluids themselves were not inherently different, either; milk and blood could issue from the same orifices. What pain signified was impediment, and healing meant reestablishment of motion of body fluids, for their stoppage and unchecked hardening could cause death. Nor did the women have a normative measure of health: relative freedom from discomfort and the ability to carry out the necessities of daily living were the goals of their medical consultations.

For the social historian, the implications are perhaps more important than the details of early modern perceptions of the body and healing. Duden makes it clear that the person in his or her consultation with the physician retained ultimate control over the body. In later decades of the eighteenth century, physicians sought complete medical authority both over the body of the patient and over other branches of the healing arts, a struggle where the university educated doctor emerged victorious partly through the support of the centralizing state apparatus. Time and time again resistance to that "official" medicine was couched in terms of unalienable authority over one's body. The Foucauldian undertones of Duden's analysis lend credence to that interpretation, which works from the physician's point of view. But the question remains: How did the perceptual basis of medical authority get reversed in the mind of the patient?

Still in the spirit of awe for Duden's achievement and of gratitude for the wider accessibility to her work given by the present translation, I have reservations about both. I find less than apt Duden's contrasting the suffering bodies of her subjects with the laughing bodies of Rabelais (as depicted in Bakhtin's great critical analysis). Here I see rather a continuity with the notion of suffering as characteristic of the human condition, so cogently revealed in the work of the historian of medieval religion Carolyn Walker Bynum. The transmutation of blood into milk, of signs of bodily suffering into promise of spiritual nourishment prevalent in medieval Christianity are of one piece with the perceptions of the body beneath the skin held by Storch's patients. They explicitly connected pain and evil; the flux was an "evil thing." Rabelais, after all, was depicting Carnival, where the lusty bodies were laughing at institutional religion--and he, as doctor, might well have been laughing at institutional medicine. Folk spirituality contained a potent promise: a future free from the constraints of earthly bodies. At celebration, Storch's patients laughed as well, and felt themselves as one with the cosmos; when they consulted with him, it was to lessen the strictures of bodily suffering insofar as possible.

As for the translation: it would be very difficult to convey totally the fullness of Duden's intricate and evocative German prose in another language. But choices of wording need to be made that retain the integrity of text and context for which she so assiduously strives. To render a subtitle "Pains wander in the body" as "The Migration of Pain" robs pain of the vitalism, the subjectivity experienced by patients. "The Body's Past" instead of "The shadow of the past lies over the body" does the same and destroys Duden's carefully established connection between metaphor and meaning. To translate "Reizungen" as "sensations" rather than "irritations" in the context of page 124 obscures the unity of Storch's theoretical approach. Other passages similarly seem elided or even misinterpreted compared with the German text.

Mary Nagle Wessling University of California
COPYRIGHT 1993 Journal of Social History
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Author:Wessling, Mary Nagle
Publication:Journal of Social History
Article Type:Book Review
Date:Mar 22, 1993
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