Reconstructing Paris Medicine

Caroline Hannaway and Ann F. La Berge, eds. Constructing Paris Medicine. Clio Medica, vol. 50. Wellcome Institute Series in the History of Medicine. Amsterdam: Editions Rodopi, 1998. xiii + 406 pp. Ill. $100.00 (cloth), $36.00 (paperbound); Hfl. 180.00 (cloth), Hfl. 65.00 (paperbound); £58.00 (cloth), £21.00 (paperbound).

Constructing Paris Medicine had its origins in a conference that took place at the College of Physicians in Philadelphia in 1992. Because of the long delay in publication, some of its most important essays have already been published in slightly different form. It is also missing the one or two French voices that would have made it more international in scope. These two caveats notwithstanding, it is both useful and enlightening to have the views of so many of the leading scholars of Paris medicine collected together in a single volume.

The articles, all of uniformly high quality, can be divided into two categories: those that examine some bounded aspect of Paris medicine without seeking to revise our accepted views of the entire subject; and those that question some of the central premises of the existing historiography of the Paris school. In the first category one finds L. S. Jacyna's characteristically elegant and illuminating examination of J.-L. Alibert's illustrations of skin diseases. Jacyna sees these illustrations as both representing a conservative and Christian reaction to the materialism of the eighteenth century and an "aestheticization of pathology" (p. 213). W. R. Albury utilizes the medical thought of J. N. Corvisart and François Broussais to analyze what he sees as a shift from the optimistic view of individual variation in the Hippocratic-Galenic tradition to a more pessimistic view in which the individual constitution is prone to imbalance and breakdown. More debatable, in my view, is Albury's subsequent suggestion that this latter view was congruent with (and partly explainable by) the aspirations of the medical profession of the period to raise its status. The problem with his argument is that there were many approaches to medical thought during this period, as Albury admits, and all of them, including belief in the healing power of nature, can be seen as congruent with a strategy of professional mobility; professional mobility thus becomes useless as an explanatory tool for analyzing these different perspectives. A paper by Jacalyn Duffin offers an interesting and balanced account of the conflict between Laennec and Broussais. An essay by Joy Harvey presents a useful examination of the persistence of Parisian clinical traditions from 1848 to 1872.

All of the papers mentioned above deserve more elaborate discussion than I can provide here. However, the major historiographic significance of this collection rests on a second set of papers that explicitly call into question the standard view of Paris medicine (henceforth referred to as SV) that is here associated primarily with the work of Erwin Ackerknecht. ¹ Michel Foucault's Birth of the Clinic ² has been less influential, according to the editorial introduction (p. 33), but this is very much a judgment about North American work in the history of medicine; a French voice or two in this collection might have reminded us just how central Foucault remains for European scholars. The extensive literature on Paris medicine is exhaustively and admirably discussed in the editorial introduction to this volume, but a quick and dirty version of the SV runs roughly as follows:

1. There occurred at the beginning of the nineteenth century a major epistemological shift that moved medical thought away from systems and attempts at nosology and firmly in the direction of empirical clinical enquiry--notably, a tradition of pathological anatomy in which clinical symptoms in life were correlated with anatomical lesions at the tissular level discovered during postmortem examinations. Associated with this shift was a new form of practical medical training that consisted of work at the bedside and in the dissection room.

2. One sees examples of such a shift in...