And Lazarettos of the Late Medieval and Early Question of What Is a Hospital Also Allows Dedication to Spiritual and Psychologic

Book Reviews and lazarettos of the late medieval and early hospital. The doctor comes tumbling down modern period, these functions re-emerge at from his elevated perch, and joins the much other stages of the institutions' history. Nor, richer and more variegated world of for Risse, does the hospital after the "birth patients, nurses, volunteers, donors, visitors of the clinic" have a monopoly of the and cleaners. The rituals of the doctor's pedagogic and curative roles: we see the rounds are seen in the context of a wide hospital as an institution of teaching and variety of prior and competing forms. This learning and state-of-the-art medical care in is not hospital care as a dyadic patient/ many other prior instances. Then again, practitioner relationship, but rather a Risse's broad church approach to the history sensitive to the complex, textured question of what is a hospital also allows and multi-layered character of hospital life. him to include mental hospitals (and earlier The imaginative emphasis on the dedication to spiritual and psychological experiential dimension of hospital care healing) as part of the same institutional makes this erudite and compelling study matrix. memorable and often moving. Each variant of the hospital "type" is analysed through broadly the same prism. Colin Jones, In each case, the hospital's mission, nature University of Warwick of patronage or financial support, organizational staff, patient base and rituals of healing and care are woven into the story. Each section is given greater Caroline Hannaway and Ann La Berge immediacy and impact by Risse's use of the (eds), Constructing Paris medicine, Wellcome specific example of a personal Institute Series in the History of Medicine/ narrative-told through the individual's Clio Medica 50, Amsterdam and Atlanta, own words. With great ingenuity, Risse has GA, Editions Rodopi, 1999, pp. xiii, 406, turned up the personal account of one £60.00, $100.00 (hardback 90-420-0691-9), Aelius Aristides in AD 145 to preface £22.00, $36.00 (paperback 90420-0681-1). discussion of the temples of Asclepius. It says a lot about Risse's approach that in This collection originated in a symposium each case-as here-these micro-histories at the College of Physicians in Philadelphia revolve around a patient in a particular on new approaches to the history of the institution rather than a practitioner. Thus nineteenth-century Paris clinical school, the section on Enlightenment medicine starting with a critical reassessment of the begins with a case-study of a patient in the classic works by Michel Foucault and Edinburgh hospital whose history Risse has Erwin Ackerknecht (Foucault, Naissance de already made his own; thus too a particular la clinique: une archeologie du regard case in the University of California San medicall The birth of the clinic: an Francisco's AIDS wards begins a section on archaeology ofmedical perception, trans. the hospital's most recent incarnation. A M Sheridan Smith, both 1963; Approaching the hospital in this Ackerknecht, Medicine at the Paris hospital, way-almost as a Geertzian 1794-1848, 1967). None of the contributors anthropologist-through the "thick engages in a significant way with Foucault's description" of a particular case in a larger philosophical claims, but as a group particular hospital in a particular period they energetically confront a perception of means that the reader is unable to leave out Paris medicine that he as well as of hospital history those participants and Ackerknecht did much to perpetuate: a bit-players whose role is often neglected or radical transformation of medical thinking, effaced in other general histories of the education, and practice emerging in France

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.126, on 29 Sep 2021 at 06:09:24, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300068095 Book Reviews from the political and social upheavals of rather than surgery as the primary source of the 1790s. The result could fairly be called a the Paris clinical school. manifesto for a post-Ackerknechtian Three other articles address historiography. The familiar elements are Ackerknecht's terminus ad quem-the "dead still here-pathological anatomy, clinical end" (the title of his chapter 10) that he observation of large numbers of cases in a thinks Paris medicine reached around the hospital setting, and the rest-but middle of the century, with the contextualized and complicated in ways that revolutionary year of 1848 providing a call into question the image of a medical convenient chronological punctuation point. revolution on the banks of the Seine. Excessively attached to its clinical The book's title most aptly applies to the traditions, unreceptive to laboratory science, editors' introductory chapter, a very Paris lost its momentum; the many informative historiographical survey foreigners who had flocked there to study reaching back to writings by members of medicine now increasingly made their way the Paris school, who did much to shape its to Vienna or Berlin. On the question of public image; for Hannaway and La Berge, openness to laboratory science, La Berge the construction of the "myth" (p. 3) of shows in her study of medical microscopy Paris medicine began with them. Most of that the leaders of the Paris school made the remaining chapters are devoted at least room for the new technique, even though in part to debunking this legend. Two most remained devoted to an approach particularly meaty articles, by L W B based on clinical observation and gross Brockliss and Othmar Keel, challenge the anatomy. She stresses, too, that the notion of a sharp break with the past by exponents of microscopy, such as Alfred carefully examining the eighteenth-century Donne, saw the laboratory as antecedents. Keel has argued elsewhere that complementing rather than replacing the the French were followers rather than established methods. Joy Harvey examines pioneers. In the present article he focuses on the clinical tradition itself as it survived in anatomical and tissue pathology in Britain, medical education in the quarter century particularly the work of John Hunter and after 1848. Drawing on hospital gazettes Matthew Baillie. Brockliss's useful survey of and the letters of Paul Broca and Mary French medical education in the Ancien Putnam Jacobi, she shows the persistence of Regime rejects the image that we inherited an impetus that was far from spent. John from the reformers of the 1790s and their Harley Warner, in a lively article on successors: lazy professors, highly Americans who studied medicine in Paris, theoretical lectures, virtually no practical accepts the pattern of migrations described training, a curriculum dominated by the in Ackerknecht but rejects an explanation ancients. He points to changes in the based on shifting centres of medical curriculum after about 1760, especially in .innovation. The Americans, he argues, pathology and therapeutics, the acceptance primarily sought opportunities for of contemporary medical science, and the dissection and practical training less readily introduction of practical courses, though available at home; the turn away from Paris private instruction remained an important reflected similar priorities rather than resource for clinical training. Medicine in admiration for German scientific prowess. this account matches the dynamism of The three remaining chapters, by L S Ancien Regime surgery as depicted in Toby Jacyna, W R Albury, and Jacalyn Duffin, Gelfand's influential study, Professionalizing do not address Ackerknecht's problematic modern medicine: Paris surgeons and medical so directly, but each enriches our science and institutions in the eighteenth understanding of Paris medicine by placing century (1980), and Brockliss sees medicine some of its leading figures in political,

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.126, on 29 Sep 2021 at 06:09:24, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300068095 Book Reviews social, and cultural context. They also and conflicting views on throne and altar remind us that despite some commonalities, (Broussais was strongly antimonarchist and "Paris medicine" was hardly a monolith. anticlerical), the two were almost bound to Jacyna's perceptive essay on the clash. Duffin, however, characterizes many iconography of the illustrations in J-L of the differences as "semantic". She Alibert's voluminous publications on skin suggests, moreover, that the energetic diseases calls attention to the "pious exchanges provided mutual intellectual pathology" of this Catholic royalist, as well stimulation and served the larger purpose, as the aesthetic qualities that he perceived which each of the antagonists would at in disease. As physician-in-ordinary to some level have approved, of discouraging Charles X, Alibert accompanied the the use of empirically empty terms such as monarch on his coronation day to the "vital principle" and "irritation" in French hospital of Saint-Marcou in Reims, where medical discourse. Charles revived the old royal custom of As a whole, the book reminds us of the touching for scrofula. Although Alibert extent to which "the Paris school" is, stopped short of a literal belief in the indeed, a construct, which has much to efficacy of this procedure and sought offer but also real limits. It provides an natural explanations of cases in which excellent introduction to recent and current certain popular healing rituals appeared to work in a subfield of medical history which, work, he insisted on the importance of the however shopworn it may once have spirit in treating somatic diseases. Unlike seemed, continues to develop in exciting some of his colleagues in Paris medicine, he ways, thanks primarily to work of scholars remained a convinced dualist, rejecting outside France. (The authors are based in Cabanis's materialism. Albury's study of the Britain, Canada, the United States, and question of human individuality in the work Australia; the tragically premature death of of Corvisart and Broussais identifies both a Roselyne Rey robbed the collection of what shared divergence from the classic view of would have been the one French particular constitutions and a disagreement contribution.) Three of the participants over the implications. Both saw individual have published distinguished monographs variations as essentially pathological, but on topics related to their article in this the more optimistic Broussais had greater volume (Brockliss and Colin Jones, The confidence in the powers of therapeutic medical world of early modern France, intervention. For Albury, the representation Oxford, Clarendon Press, 1997; Duffin, To of health as an unattainable ideal, beyond see with a better eye: a life of R T H the powers of the Hippocratic non-naturals, Laennec, Princeton University Press, 1998; bolstered the physicians' professional and Warner, Against the spirit ofsystem: the authority. In this anti-Rousseauean world French impulse in nineteenth-century patients could put their trust neither in American medicine, Princeton University nature nor in their own devices. Press, 1998). Keel has completed a major Finally, Duffin's insightful study of the synoptic study of the origins and celebrated running debate between Laennec development of clinical medicine in Europe, and Broussais argues that the reciprocal which is now in press, and La Berge is accusations of incompetence and plagiarism, working on a book-length project on the fusillades directed at Laennec's "vital nineteenth-century microscopy. principle" and Broussais's reduction of The present volume should prove a disease to gastrointestinal inflammation, valuable resource for medical history concealed deeper agreements, especially on seminars, assigned in conjunction with the limits of pathological anatomy. Given Ackerknecht and Foucault. It will also their large egos, contrasting temperaments, provide the basis for an ongoing discussion

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.126, on 29 Sep 2021 at 06:09:24, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300068095 Book Reviews among scholars. Indeed, the time now seems control escalating numbers of paupers ripe for a Paris medicine web page, (p. 32). especially since many of the key French The beginnings ofthe Poor Law in texts have become available on-line through England can be traced to the 1601 statute the Gallica service of the Bibliotheque and, though extensively modified nationale de France (http://gallica.bnf.fr/). subsequently, its original intentions always We cannot all meet in Paris, but as a virtual remained paramount (p. 33). The original academic community we can perhaps help statute sought to regulate those willing to reconstruct Paris medicine, building on the work but who could not find any-they were important work of Hannaway, La Berge, to be provided with work; those who could and company. not work-they were to be offered charity; and tramps, vagrants and those who refused Matthew Ramsey, work were to be punished. Although the Vanderbilt University statute did not specifically mention the insane, it certainly influenced the philosophy and running ofthe mental institutions in subsequent centuries. The reluctance to Peter Bartlett, The Poor Law of lunacy: provide outdoor relief to the able-bodied is the administration ofpauper lunatics in mid- clearly discernible in later statutes, which nineteenth-century England, London and state that the indigent should be managed in Washington, Leicester University Press, institutions and put to work. Conditions in 1999, pp. xix, 310, £55.00 (hardback 0-7185- Poor Law workhouses were deliberately 0104-7). Available in USA from harsh in order to deter those perceived as Continuum, PO Box 605, Herndon, VA opting out ofwork. Uniforms identified and 20172. humiliated the inmates; individuality was stifled; food was barely adequate. Work for This book sets out to show that the roots men, women and children was hard, of the mid-nineteenth-century asylum relentless and monotonous. system can be found in Poor Law The Vagrancy Act (1744) updated the legislation. Bartlett challenges existing 1601 statute and recommended the building histories, which portray the asylums as the of Houses of Correction in all counties. realm of doctors, and argues instead that These were to control the unruly poor and the asylums were merely a facet of English vagabonds, and to confine the dangerously Poor Law, and that the Medical insane. Bartlett argues that the debate Superintendent had little power. Using the around the institutions advanced into moral Leicestershire asylum as a case study, he and scientific areas, seeking to understand examines the part played by Poor Law the causes of deviancy and to devise Officers in asylum admission procedures, strategies for transforming non-productive and the relationship between Poor Law citizens into upright ones. It was considered Officers, asylum staff, and lunacy inspectors. that no matter what the roots of deviance, Bartlett is clear that doctors were not a key whether social, biological, psychological or part of the administration process before spiritual, a period spent in an appropriate 1853 when admission to workhouses and institution would "reform" the poor, the asylums became dependent upon a medical criminal and the insane. The early certificate. Bartlett's thesis is that the nineteenth century saw the population of primary purpose of institutions such as England increase from 5.5 million in 1800 orphanages, houses of correction, to 9 million in 1832. There was a workhouses and asylums during the corresponding growth in the number of eighteenth and nineteenth centuries was to paupers. The Poor Law Act (1834)

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