Review Article: Health in Europe 1500-1800

It is not often that a tutor is handed an entire course on a plate, ready for consumption, served up complete with material for the lectures, case studies, points for seminar discussion, essay questions, as well as primary and secondary readings for student use. But that is exactly what the pair of books under review provide. The Open University has a tradition of offering us extremely useful compendia such as these, pioneering the publishing of course materials in the 1970s, via a range of media, including print. To what extent can books such as these be used by tutors in other, more traditional, educational environments? What would students take away with them from the course as outlined is these two books? I must confess to an interest from the start. As someone who has been teaching the history of early modern medicine for some ten years, both to medical and history students, I have acquired my own preferences and biases. These have also been shaped by my own research projects, in religious history, popular culture, and Italian social and cultural history. However, I hope that my own experience will prove a help rather than a hindrance in evaluating the potential of these two books.

Historians of medicine have an embarrassment of riches when it comes to the choice of course textbooks, all published within the last decade.(1) Yet for those of us who benefited from, and contributed to, a more social and cultural approach to the subject, relative to the early modern period, there was comparatively little choice. Without doubt the strongest and most useful survey text is Mary Lindemann’s Medicine and Society in Early Modern Europe.(2) Part of Cambridge University Press’s important ‘New Approaches to European History’ series, Lindemann’s book manages three things. Eschewing historical overview or synthesis, it identifies different methodologies and approaches to the topic, not necessarily those sympathetic with the book’s own broadly social and cultural orientation. Thus each chapter begins with a historiographical discussion, highlighting the very different emphases and views that historians have taken with regard to a particular theme. Second, it neither celebrates the rise of medicine, in a way that traditional Whiggish or presentist-minded views did, nor does it stray into the opposite pitfall of painting an uncritically relativist and rosy picture of the past. It manages to strike a balance between what we ‘know’ about disease in the past and what actors in the past ‘knew’ about it. Finally, it goes some way to redressing the imbalance between English and continental coverage, in a field long dominated by Anglo-Saxon historiography. The work of British and North American historians has led the field and done much to shape it, but it has meant that the voices of other European regions have been heard less clearly in textbooks than ought to have been the case. I have been happy to adopt Lindemann’s book as a course text despite what I would consider its limitations, which include a stress on the eighteenth century and a cursory discussion of the links between medicine and religion during the early modern period.

The nature of the two books under review, designed as they are for an Open University course, permit a much larger scale than is common for most textbooks. The first book, The Healing Arts: Health, Disease and Society in Europe, 1500–1800, provides the general survey, while the companion volume, Health, Disease and Society in Europe, 1500–1800: A Source Book, gives us short readings of primary and secondary material. It means that a chapter in the first volume on, say, the care and cure of mental illness (chapter nine) provides us with a general introduction to and historical survey of the theme, as well as several case studies (the casebooks of Richard Napier, the hospitalisation of the insane in two German towns, and the reforms of William Battie). Each of these case studies comes complete with exercises and discussion points, which refer the student to an article or document extract in the second volume. The documents alone are worth the price of the two books. Not only do they represent the first such collection of sources on early modern medicine, but their coverage is very broad indeed: from early-fifteenth-century Italian letters of medical advice to eighteenth-century Parisian surgical instruction; from the published writings of a French midwife to the rules of an English voluntary hospital; from a treatise on the duties of the Christian physician during time of plague to a newspaper account of smallpox inoculation. Hitherto sources of this type have been available in a very few journals, such as Social History of Medicine, with its occasional ‘documents and sources section’; otherwise publication has been rare, especially of non-English source material.(3) The result is that the Elmer and Grell sources volume can also be used on its own, independent of volume one.

It is the first volume in particular, The Healing Arts, which merits our attention, marking as it does the coming of age of the social and cultural history of medicine. It is the culmination of some thirty years of research that has transformed writing and teaching in the history of medicine. This has meant a shift away from the ‘great men’ focus towards attention to marginalised or neglected groups in society; away from an exclusive interest in medical practitioners towards the experiences of sufferers and patients; away from the allure of retro-diagnosis (that is, applying modern biomedical knowledge to the illnesses of the ‘rich and famous’ of the past) and towards how contemporaries understood disease in their own time; and away from a university- and hospital-centred account of medical knowledge and practice towards one influenced by notions of medical pluralism (the co-existence of alternative or complementary therapies and systems of belief). The essays in this book succeed in providing a cross-section of this research, addressing recent issues and debates in a thematic way. (The thematic approach does lead to some repetition, although this is not necessarily a bad thing in a student textbook.) The essays engage with the new approaches without jettisoning the achievements of previous generations of scholarship. Thus the ‘ideas’ focus of the great men tradition, all too often seen as a worthy end in itself, is not abandoned here (as if the ideas themselves no longer mattered to our understanding of the past), but is re-configured as an exploration of how these ideas were transmitted and put into practice at different levels of society. Ideas form the heart of the first essay, Sachiko Kusukawa’s survey of medicine in Western Europe in 1500. In addition to exploring the content of Greco-Roman medicine, it surveys how ancient medical knowledge was studied and how it was used around 1500, adopting the city of Rome as her focus (itself a nice conceit). Silvia De Renzi’s essay on old and new models of the body (chapter seven) looks at changing ways of understanding and representing the body, from William Harvey through to Albrecht von Haller, while not forgetting the (limited) impact this had on actual medical practice and patients’ expectations. Likewise in the chapter by Peter Elmer on mental illness (chapter nine), referred to above, we read of categories and definitions of insanity, as well as contemporary treatments and practices, and how these were shaped by wider concerns in society.

Elmer’s contribution is illustrative of something else, too. It confronts head-on the tension present everywhere in ‘translating’ medical ideas and practices of the past to students in the present: how do we reconcile our own categories and knowledge with those of people in the past? In the case of mental illness, do we adopt the categories of the modern psychiatric profession, and reduce past experience to these, or do we rely completely on the definitions and views of (in this case) our early modern forbears, however unconvincing or radically different some of them may now be? The former approach risks being overly Whiggish, judging the past at the expense of a superior present or trying to set the record straight. The latter approach, which sees madness as cultural and historically specific, risks straying into an extreme form of relativism and social constructionism, in which mental dysfunction does not actually exist but is the product of a specific political system. Elmer’s own preference, and that of most social historians, is to avoid an essentialist view of madness, which would regard it as an unchanging phenomenon, opting instead for an exploration of the categories and perceptions of the time. In clearly and concisely highlighting the terms of the debate, and the historians and other scholars involved in it, before proceeding to his own discussion, Elmer provides readers with a useful framework for understanding the often troubled relationship between ideas and practice – both in terms of historical actors in the past, as well as historians’ representations of them today.

The book’s greatest strength, however, lies in the place it gives to religion. Most textbooks on early modern medicine do now stress the important place religious belief and practice had in the medical sphere, but only to pass quickly on to other (more secular) things. The Healing Arts restores religion to is proper place in the history of medicine, reconstructing a world that its contemporaries might have recognised. This does not just mean looking at, say, healing miracles (anybody can do that); rather it explores religion-medicine links in a variety of different contexts. The essay by Ole Peter Grell, on medicine and religion in sixteenth-century Europe (chapter four) is, not surprisingly, entirely devoted to the subject. Grell takes us from the impact that Lutheran Protestantism may have had on Vesalian anatomy, through the spiritual rationale behind Paracelsian chemical medicine, to the impact both Reformations had on the provision of health care. In the process we learn more about religious reform in Denmark than is the case in most history of medicine surveys. But what of the rest of the book? The religion-medicine link is explored in detail earlier in the book, in a section by Kusukawa (in chapter one). It resurfaces later in De Renzi’s discussion of hospitals (chapter six) and in Elmer’s treatment of Richard Napier (chapter nine). Otherwise, the link gets all but lost in later chapters, so it is difficult to trace its changing nature during the course of the period. The exception to this is Mark Jenner’s intriguing discussion of the secularisation and commercialisation of wells and springs as places as sites of healing, in the context of an essay on environment and health (chapter 11).

The book comes to a close with Laurence Brockliss’s essay on organisation, training and the medical marketplace in the eighteenth century (chapter thirteen). It is refreshing to read a survey of eighteenth-century changes and developments from a French, as opposed to English, perspective. It may be that Brockliss’s contribution goes too far in presenting France as a sort of template, at the expense of other European regions about which we now just as much (such as Germany and Italy). There is no doubt that France was a model in many areas during this period, surgery being one obvious example (to say nothing of the Enlightenment itself); but the changes in the structure of medical practice and provision in France, referred to in detail, could have been compared to patterns elsewhere. Physicians, their knowledge and practice, figure prominently in the chapter, as do surgeons and surgery. Indeed both branches of the medical community have an understandably important place throughout The Healing Arts. Thus surgeons and surgical techniques also feature in Grell’s essay on war, medicine and the military revolution (chapter ten). By contrast, apothecaries, pharmacy and materia medica figure hardly at all. New World remedies make a very brief appearance in Andrew Wear’s essay on medicine and health in the age of European colonialism (chapter twelve), but that is about all. Wear is one of the few scholars to have looked at remedies in the context of medical knowledge and practice.(4) Otherwise the numerous recent monographs dealing with early modern medicine and health have little to say about either apothecaries and their practice or the materia medica of the period.(5) This neglect is reflected in textbooks dedicated to early modern medicine, with the possible exception of The Western Medical Tradition, which does discuss botany and medicine, though not apothecaries per se.(6)

One other gap in The Healing Arts regards what we might call popular, domestic or local medicine, for lack of better labels. I admit to having my own (longstanding) axe to grind here.(7) But in a book such as this, which sets out to examine every aspect of medical care, it seems unhistorical to ignore such a large slice of medical provision – the first, often only, port of call for many sufferers. That there has been debate among historians about whether something we can call ‘popular medicine’ actually existed in the early modern past strikes me as all the more reason to have it included it somewhere in the book. Personal axes aside, this pair of books represents a masterful contribution to the teaching of the history of medicine. It succeeds in carefully guiding students through a complex and (relatively) new field, paying close attention both to the attitudes and perceptions of contemporaries, as well as the range of historiographical approaches and methodologies.

Notes

1. Cambridge has produced two very different collections, the Cambridge Illustrated History of Medicine, ed. Roy Porter (Cambridge, 1996), and The Western Medical Tradition, 800 BC to AD 1800, ed. Lawrence Conrad et al. (Cambridge, 1995). Shortly after these, Oxford’s own contribution appeared, entitled Western Medicine: an Illustrated History, edited by Irvine Loudon (Oxford, 1997). Roy Porter put his own stamp on the field in two separate general works, in addition to his own numerous monographs on the subject: The Greatest Benefit to Mankind: a Medical History of Humanity from Antiquity to the Present (1997) and, more succinctly, Blood and Guts: a Short History of Medicine (2002). Directed more particularly at medical students is Jacalyn Duffin’s History of Medicine: a Scandalously Short Introduction (Toronto, 1999), which, despite its title, manages 432 pages on the subject.Back to (1)
2. Mary Lindemann, Medicine and Society in Early Modern Europe, (Cambridge, 1999).Back to (2)
3. One happy exception consists of the vivid and often poignant memoirs of a Dutch midwife, translated and annotated by Hilary Marland, Mother and Child Were Saved: the Memoirs (1693–1740) of the Frisian Midwife Catharina Schrader (Amsterdam, 1987).Back to (3)
4. See Wear, Knowledge and Practice in English Medicine, 1550–1680 (Cambridge, 2000), pp. 46–103.Back to (4)
5. Discussed in David Gentilcore, ‘Apothecaries, “Charlatans,” and the Medical Marketplace in Italy, 1400–1750’, introduction to ‘The World of the Italian Apothecary’, monograph number of Pharmacy in History, 46 (2003), 91–4.Back to (5)
6. In Andrew Wear’s chapter, entitled ‘Early Modern Medicine, 1500–1700’, in Conrad, Western Medical Tradition, especially pp. 298–310.Back to (6)
7. I grind it further in ‘Was There a “Popular Medicine” in Early Modern Europe?’, Folklore, 115 (2004), 151–66.Back to (7)