The Medical Mandarins: The French Academy of Medicine in the Nineteenth and Early Twentieth Centuries (review)

The French Academy of Medicine has often figured prominently in the pages of medical history—usually as a hallmark of obstructionism during the Pastorian era. George Weisz’s account sets the record straight on this and other misconceptions. Moreover, he presents a lively scientific, social, and cultural history of the Academy from the late eighteenth century through the early twentieth.

A central concern is the role of the medical elites (represented by the Academy) within the power structures of French society. As Weisz shows, the medical elite, a guildlike subculture in the late eighteenth century, was transformed in the course of the nineteenth century into a pivotal force within a new national bourgeoisie. The members of the Academy lived, married, and politicked within this broader dominate class, especially during the first four decades of the Third Republic. However, by the 1930s something had substantially altered these social relationships and practices: after World War I, Academy members returned to something like the insularity of the late eighteenth century, deserting the political corridors of power they had once haunted. Weisz speculates that demands for scientific achievement along with newly implemented competitive examinations (the concours) put new pressures on those who wanted to achieve in the medical establishment. At the same time, politics became less appealing. The “certainties of early republicanism, based on the belief in laicism, science, education, and public health, disintegrated during the interwar period” (p. 280).

The debates and writings of the Academy are examined from the perspective of a number of important issues within the historiography of science and medicine. Weisz focuses especially upon the decades he calls the “golden era” of debate—roughly from the 1830s to 1910. One chapter is devoted to the Academy’s intense involvement with analyzing and appraising health spas and mineral-water therapy, but other medical matters are covered at length as well. Weisz finds compelling reasons to question two truisms of French medical history. The famous therapeutic nihilism of French clinical medicine of the mid-nineteenth century is contradicted by the eagerness of the Academy to approve and promote an array of therapies and medicines, and to preserve the right of practitioners to develop and introduce new remedies among their clienteles. Likewise, the Academy’s reputation as a lodge of old fogies fighting off the threats of scientific discovery also will no longer stand up: Weisz shows instead that within its program and debates new scientific ideas took central place at least by the last half of the nineteenth century, when the corps of the Academy was increasingly made up of researchers. He points out that it was surely due to its status as a body of scientific discussion that Pasteur, who had ample other choices of venue, chose to address the Academy of Medicine. ¹

Beyond the subject matter of the debates, Weisz looks at the issue of knowledge formation: What counted as scientific evidence and proof? Under what conditions could the academicians arrive at consensus? He argues: “Certainly almost anything could be said: but not just anything could compel agreement” (p. 183; italics in original). By the last half of the century, what counted as scientific evidence encompassed a wide range of methods: scientific experimentation and quantification joined clinical observations (the detailed case record) and theoretical speculation. The general acceptance of scientific fact and the creation of consensus were of course complex processes. Weisz contends that agreement on factual knowledge and the reaching of consensus were “socially constructed” in that “pretty much anything—ideology, professional interests, disciplinary concepts, intellectual values—could enter into the process” (p. 183). The “bottom line” was therapeutic possibilities: could a new idea about physiology or etiology, or a new serum or compound, be reasonably expected to help some patients without seriously endangering them?

The quest for new remedies led some academicians toward the new sciences. From this account, Weisz argues against another tenet of...