Medical Theory and Therapeutic Practice in the Eighteenth Century: A Transatlantic Perspective (review)

Sponsored by the Humboldt Foundation and the National Library of Medicine, a conference in Halle, Germany, brought together a group of German and American historians of medicine in October 2005. Their task was to discuss the apparent schism between medical theory and practice during the eighteenth century on both sides of the Atlantic. Their thirteen essays, written in English and German but all provided with English abstracts, form the core of this volume. An additional conclusion, written by Mary Lindemann, attempts to bring the contributions into a broader historiographical framework.

Possibly following a format adopted for the conference, the editors divided the presentations into four separate parts, focusing on the linkage between medical theory and practice, the patient-physician relationship, and issues and uses of materia medica, as well as religion and society. Papers in each of these sections focus in depth on new sources of documentation, such as a manuscript of a German immigrant physician and religious leader in Pennsylvania and patient letters found in the medical consultation correspondence of the leading German physician and surgeon Lorenz Heister (1683-1758). Two other contributors analyzed unpublished physicians' letters as well as correspondence from a network of Pietist noblewomen concerning therapeutic trials and advertisement literature for a orphanage in Halle. Indeed, this city, with its two famous historical medical rivals, Friedrich Hoffman (1660-1742) and Georg E. Stahl (1659-1734), together with Protestant religious connections to Pennsylvania, play major roles in most of the essays. As one of the editors—the late Renate Wilson—admits in her paper, the entire collection, with the possible exception of a paper by Andreas-Holger Maehle, constitutes an alternative, sectarian window to the standard, well-developed rational Enlightenment story of medical systems and therapies.

Surprises abound. The essay written by Jole Shackelford uncovers the practice of Paracelsian uroscopy in Pennsylvania during the 1770s, grounded in astrological notions and chemical pathology. Based on a manuscript at the Library of the College of Physicians of Philadelphia, this formulary and therapeutic manual is a genuine treasure, with other contributors fleshing out the biography of its author, George de Benneville (1703-93). Medical history from below is also alive and well, with Marion-Maria Ruisinger and Michael Stolberg delving into patients' attitudes and behavior. Based on Heister's consultation letters and 340 medical cases, Ruisinger writes about bloodletting and the survival of the Galenic notion of plethora with its strategies for localized venesection for either directly stimulating stagnant blood flow or creating a diversion in spite of the new Harveyian circulation paradigm. The fact that patients either refused the procedure altogether or continued to demand particular vein sites for phlebotomy is construed as a sign of sustained patient autonomy. Stolberg's analysis is based on the medical correspondence of four leading eighteenth-century physicians: Étienne-François Geoffroy (Paris), Christoph J. Trew (Erlangen), and Samuel A. Tissot (Lausanne), with the Paracelsian Leonhard Thurneisser for comparison. Their consultations by post offer insights into a patient-physician relationship among social equals that illuminates diagnostic disagreements among professionals and consequently patients' uncertainty in the face of difficult choices.

In spite of Lindemann's efforts to integrate all these contextualized, local studies into the flexible boundaries of medical history, they remain, for the moment, valuable building stones toward a much broader synthesis of eighteenth-century medical theory and practice that should highlight the role of informed patients in shaping the encounter.