A Cultural History of Medical Vitalism in Enlightenment Montpellier (review)

This work is in many respects a "prequel" to Elizabeth Williams's 1994 book, The Physical and the Moral: Anthropology, Physiology and Philosophical Medicine in France, 1750-1850. About a third of that book is directly concerned with Montpellier vitalism, and this new study incorporates most of that material, while expanding on it considerably.

The introduction to A Cultural History situates the work in the context of revisionist Enlightenment historiographies—principally those of the Frankfurt School and of Michel Foucault. Seeking to extend the Foucauldian perspective, Williams states that her task is to reveal within Montpellier vitalism "the dehumanizing potentialities of science" (p. 3). A reading of the book as a whole, however, suggests that this opening statement is more a rhetorical gambit than a serious commitment. To say with confidence what is dehumanizing in Montpellier vitalism, one needs to know with confidence what it is that constitutes "the human"—but from a Foucauldian perspective, the status of such knowledge is always highly questionable. Fortunately, Williams does not spend much time on this inconsistent project.

What Williams does spend time on is drawing together the institutional, sociopolitical, and intellectual history of the Montpellier Medical University from the early eighteenth century to the Napoleonic era. The careers and doctrines of Montpellier luminaries such as Sauvages, Bordeu, and Barthez (as well as many other lesser lights) are set out in detail. But so too is the ongoing dialectic of Paris and Montpellier as alternative sites for the creation of medical knowledge, with each city making claims to being the privileged locus of this knowledge—Paris on the basis of its universalism, and Montpellier on the basis of its particularism.

Montpellier vitalist doctrine provided a counterpoint to Parisian medical orthodoxy. It was an "exotic" import into the capital, but one that depended on its domestication there for its cultural success. Although never fully accepted by the Paris Medical Faculty, it was embraced by persons of influence both at the court and in the salons. It was well represented in the medical articles of the Encyclopedia, but it posed no direct challenges to religious or social tradition. Leading Montpellier medical figures tended to "circulate" through Paris, establishing themselves there via patronage or other connections, achieving (or at least seeking) a high social and professional profile for a number of years, and then returning to Montpellier afterward. These career trajectories periodically renewed the transmission of vitalist doctrine to Paris while at the same time maintaining its "outsider" status, on which at least part of its attractiveness depended.

From the 1780s, however, Parisian medical discourse was increasingly able to assimilate vitalism, and thus to downgrade Montpellier as the originating site of vitalist thought. The centralizing tendencies of pre-Revolutionary medical reformers were extended by the governments of the Directory, Consulate, and Empire, and in the ensuing reorganization of French medical institutions Montpellier became, in practice, an outpost of Paris medicine rather than the source of a distinctively local form of medical knowledge. The resurgence of Montpellier apologetics during the Restoration period, as Williams notes, had more to do with the medicopolitics of that time than with any real improvement in Montpellier medicine's institutional status.

Our expectation of medical history these days is that it should be neither hagiography nor hatchet-job. By this standard (as well as many others), A Cultural History is a success. Williams points out the impressive cultural achievement of Montpellier vitalism, and also its elements of racism, sexism, class prejudice, and other standard features of past societies that continue to haunt us today. The book is well documented with extensive references to archival and published material. I have only one complaint about presentation: given the strong focus on locality in some parts of Williams's argument...