Aiming for Total History in Eighteenth-Century Medicine

Recent interdisciplinary studies of eighteenth-century epistemological systems continue to enrich our understanding of this period. Taken together, the two books by Sabine Arnaud and Adrian Wilson construct a conceptual space that widens the focus of the mutual relations between ideas and practices in the field of medicine in the long eighteenth century. Both follow Ludmilla Jordanova’s emphasis on the social construction of medical knowledge, considering many other matters that influenced the culture of medicine: for instance, healing and pedagogical practices; religious, political, and philosophical allegiances; patient-doctor relationships; and print culture. Wilson’s collection of eight essays, originally published between 1985 and 2007, presents an impressively broad spectrum of nuanced historical reconstruction, examining the preceding social contexts of institutions, concepts, and practices. Arnaud’s book takes a narrower view of medical history in its focus on categorical constructions of hysteria. Both books are recent and persuasive models of historical study that shift attention outward from the concepts and practices of medicine to the many other matters that impacted upon their institution and development.

Together, the two books span a period of approximately 150 to 170 years. Wilson focuses mostly on British medicine, while Arnaud’s work centers on French history. Their approaches to history also differ. While Wilson’s orientation is toward the recovery and reinterpretation of history, Arnaud’s project has an epistemological bent, “seeking to determine how the construction of the category of hysteria led to the introduction of determining conceptions about men, women, nervous illnesses, sexuality, and modernity, and proceeded to the affirmation of medicine as a discipline” (3).

Broadly speaking, Arnaud’s project examines hysteria in eighteenth-century print culture. She identifies seven discursive practices that the study of hysteria leaves open for further analysis: the role of language in the definition of a medical category; the inclusion of subjective medical writing genres (such as correspondence and autobiography); the movement in nosology from a multifarious pathology to a single term; the connection of epistemology and politics; pathology as a marker of modernity; the construction of sexual difference in pathology; and the elevation of the doctor’s status. This wide thematic scope becomes palpably unwieldy and at times the argument’s line is unclear. The six chapters in the book attempt to tackle each of these major areas, leaning heavily on French sources despite the promise of an inclusive approach. The third chapter most effectively executes the study’s aim by examining the pathology’s presentation to its aristocratic reader-ship vis-à-vis dialogue, autobiography, epistolary treatises, and anecdotes from a variety of English, French, and Swiss sources. Familiar standard texts emerge, such as Bernard de Mandeville’s A Treatise of the Hypochondriack, George Cheyne’s The English Malady, and Julien Offray de la Mettrie’s Ouverage de Pénélope, but lesser-known sources dominate and enrich the chapter, including physician-regent Pierre Hunauld’s Dissertation sur les vapeurs et les pertes de sang (1756), Claude Révillon’s Recherches sur les causes des affections hypochondriaques (1779), and correspondence by Samuel Auguste Tissot, Pierre Pomme, and Théodore Tronchin. Arnaud concludes the section on patient-physician correspondence with a rather large claim: “The writing of correspondence in the first person thus made it possible to open up a new dimension: that of experiment, which was to supersede observation as a scientific method and genre of writing and which would dominate in the nineteenth century” (119). This linear history in medical writing remains unclear, but Arnaud’s emphasis on eighteenth-century antecedents of the clinical model is indisputable.

Wilson’s collection presents an extraordinary breadth of historical expertise in the culture of eighteenth-century medicine. It is divided into three parts: part 1 is concerned with “micro-social processes” of early modern childbirth, “transactions which were interpersonal in scale yet regular in form” (viii). Wilson describes in...