La introducción de la clínica en Valencia: Félix Miquel y Micó, 1754-1824 (review)

Jorge Navarro Pérez. La introducción de la clínica en Valencia: Félix Miquel y Micó, 1754-1824. Collección Científicos Valencianos, no. 3. Valencia, Spain: Ayuntamiento de Valencia, 1998. 305 pp. Ill. No price given.

This book deals with the pioneering changes in the medical syllabus implemented at the University of Valencia that led to the adoption of clinical teaching in Spanish universities at the end of the eighteenth century, which led in turn to the introduction of a medicine based on pathological anatomy--the first scientific framework of contemporary medicine. Following a pattern common to the writings of the group headed by Prof. López Piñero, the volume is composed of an ample introductory essay of more than one hundred pages, and a selection of the writings of the key figure in the story, the first permanent professor of clinical teaching in the local university, Félix Miquel y Micó.

The new syllabus (dictated in 1787) emphasized practical teaching in botany, chemistry, and pathology, through both the anatomical theater and the hospital ward, and necessitated the appointment of new chairs--among them a clinical one, endowed with a certain number of hospital beds in the General Hospital of the city. It appeared after the foundation of the Royal Schools for Surgery, fully planned along such lines. The writings of Miquel included in the book--five different pieces, dated from 1788 to 1820--depict well the new content and doctrinal changes brought about by the growing influence of observational medicine, through the examples of Boerhaave, Cullen, Stoll, Pinel, and Alibert. The typography is generous and there are a great number of illustrations taken from the rich library of the Valentian school of medicine.

The introductory essay is clearly written, well argued, and richly footnoted. The author makes extensive use of university documentation, combined with textual analysis of the short written production of Miquel and the background of pertinent critical bibliography. Local developments are always related to the national context. Some contradictions can be observed, however. The most important of these concerns Miquel's initial--and standard--laudatio of the reign of Charles III (d. 1788) as the main reformist epoch of the Spanish Enlightenment, in comparison with the dark recession of the times of his heir, Charles IV. This statement conflicts with the chronology of the very story depicted in the book, as shown by the following quote: "during the reign of Charles IV--starting in 1788--the process of renewal of teaching led by the University of Valencia and the Royal Schools of Surgery spread and consolidated" (p. 59)--a fact hardly consistent with the supposed end of reformism at that time! If Valencia approved the founding of the chair for clinical teaching at the General Hospital in 1787, it was only ten years later that it could be implemented. Navarro's conformity with standard knowledge is indicative of the general trend of his analysis. His study scarcely diverges from the general explanation advanced by López Piñero (between 1960 and 1974) of the development of medical sciences in Spain--namely, that the long decay of the sciences during the seventeenth century in Spain improved under the Bourbon monarchy in the next century when accelerated steps were taken to keep pace with European science, a process that heightened in the second half of the eighteenth century once "scholarly traditions" and "contact with international circles" were regained. This move forward ended amid the fears engendered by the French Revolution, which encouraged once more the isolation of Spain--a tendency reinforced by the absolutism of Ferdinand VII (d. 1832), in power after the successful war against Napoleon's France (1808-17).

The strength of Navarro's narrative is the precise exemplification of his theory: he puts the flesh, the names and the stories, upon...