Medicine in the Enlightenment (review)

In spite of a growing focus on the medical achievements of our century, the Enlightenment continues to attract numerous practitioners of our historical craft. This collection of fifteen papers is based on a 1992 symposium organized by the Wellcome Institute in London. As the editor accurately informs us, we can no longer subscribe to a simple model of medical Enlightenment portraying a coherent set of ideas and practices that transformed—even revolutionized—European society. Indeed, the various contributions in the volume offer fragmented and often contradictory views about the genesis and impact of ideas concerning such issues as vitalism, medical practice and education, midwifery, mind/body relations, mental illness, public health, and surgery. Thus, with the help of new archival and written sources, and subjected to a closer analysis, medicine comes to share in the dilemmas and paradoxes of the age of Enlightenment.

The range of subjects is quite broad, and the volume lacks a particular theme and geographical boundaries. Among the more extensive contributions are two dealing with French medicine. In discussing France’s medical reform program, Laurence Brockliss disputes previous accounts by arguing that it was led by physicians, rather than surgeons, with the purpose of securing and extending their professional power. Greater control of the marketplace and monopoly of medical education—primarily compulsory clinical training in hospitals—were the results. Ludmilla Jordanova, for her part, reviews Cabanis’s 1795 Coup d’oeuil or Sketch of the Revolutions and Reform of Medicine, a veritable manifesto of the sensualist school. His visual epistemology conceives the physician as an artist surveying and learning from the rich clinical scenes created in hospital wards. Jordanova also stresses Cabanis’s efforts to merge medicine with literature and art, and the employment of history as a cultural resource for medical reform.

Two papers address mental health problems. Jonathan Andrews’s contribution on the politics of committal deals with Bethlem, considered a state institution. Bethlem’s flexible boundaries between asylum, prison, and house of correction during the late seventeenth and early eighteenth centuries are placed within the context of England’s laissez-faire, heterogeneous localism, in contrast to France’s centralized, bureaucratic approach toward social control. In turn, Roy Porter’s article focuses on the role of England’s small private asylums, arguing that their foundation was encouraged by an ideology of “moral”—addressing the mind rather than merely the body—management. The individualized rather than routinized approach to the mad became a method of treatment designed to achieve control over their disordered minds and lives. Environmental control through segregation from family and friends could be important, but the critical factor was the ability of particular healers to impose their discipline and authority. Frequent contacts and the close observation of lunatics converted asylums into experimental laboratories, allowing for the flexible testing of therapeutic modalities, that ranged from conversation to the employment of swing chairs.

Regarding practice, a paper by Isobel Grundy featuring Sarah Stone’s tales from the birthroom, the Complete Practice of Midwifery (1736), contradicts the usual historical clichés of gendering this subject. Stone’s impressions from her early practice in rural Somerset followed by another in urban Bristol provides a much more nuanced picture that denounces midwife ignorance and lack of control because of insufficient anatomical knowledge, while also decrying the man-midwife’s excessive employment of the forceps. Mary Lindemann, for her part, presents a contextualized example of a German physicus in action, stressing the blurred boundaries between being an enlightened healer and a good neighbor. Finally, Andrea Rusnock follows the work of James Jurin, secretary of the Royal Society, who in 1724 published a book attempting to demonstrate the success of smallpox inoculation using numerical arguments.

In sum, Porter’s collection offers a wealth of new information, forcing us to further refine and revise our picture of eighteenth-century medicine.