Practical medicine and its literary genres in France in the early modern period
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March 2008 |
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Translation by Karine DEBBASCH |
All digitised materials
Introduction
The concept of literary genre, although imprecise and the object of debate in literary studies, is of undeniable interest for a phenomenological analysis of the literary productions of a given time or a given group [1]. It accounts for the normative or regulatory conventions determining not only the creation of forms – the number of which is finite – that this production can take, but also their recognition by the readers, who pre-understand them and therefore go towards them, a process which Jauss labeled the "horizon of expectation." The concept is also of particular interest for historical analysis, as it allows one to better understand the intellectual, cultural and social aspects of the "production" and "consumption" of works, the conventions that govern them or, on the contrary, the possible (and permitted) overflows or transgressions.The initiative aiming at shedding light on the collections of the BIU Santé and giving the whole community of researchers access to the most significant works in the field of medical practice in France in the early modern period is an opportunity for us to try and apply the concept of literary genres to this particular field. Although the medical practice production does not feature the diversity or the formal complexity of Literature – with a capital "L" – it seemed to us that the concept of literary genres and the methodological approaches developed for their study [2] could be applied to the field, particularly in an approach of the history of ideas and cultural history of medicine. The early modern period, which conventionally covers the 16th, 17th and 18th centuries, and is characterized by major cultural phenomena, i.e. the Renaissance and the Enlightenment, seemed to us to be the ideal temporal framework for such an application [3]. For practical reasons, our research was restricted to the medical production printed or distributed in France, and kept today in the French collections, notably at the Bibliothèque Nationale de France (BNF), whose catalogue, systematic and now electronic, provides one with a unique working tool for such a study [4].
Methodology
Identifying the printed production in practical medicine in the early modern period
It is fairly easy to identify the printed productions chronologically insofar as the printing date of books is nearly always known in the early modern period; but identifying them thematically is not so easy, and it entails closer consideration of the definition of practical medicine, particularly during the period under study. Indeed, the line between practice and theory, or between art and science, old though it is in medicine – it probably originates in Ancient Greece – has not been devoid of fluctuations or debates concerning its position, or even its pertinence [5]. Without entering into specifics concerning the debates that the physicians of the early modern period inherited from their medieval predecessors, particularly on the question of the "liberal" vs "mechanical" statutes of medical practice (a very sensitive question in terms of prestige and social hierarchy), we opted for a pragmatic definition of medical practice – one which transcends time periods – as the ‘global’ act of caring for individual patients, ie taking into account the following components: pathological characterization (in contemporary terms of diagnosis and prognosis), treatment and prevention. In order to limit the heterogeneity of the literary production, we have decided not to analyze the literature that deals with surgery or with specific treatments (such as thermalism, electrotherapy, etc.) or the documents on special diseases or the ritual "questions" and "theses" of students in Medical Schools.A double exploration of the electronic catalogue of the printed material available at the BNF was therefore led for the period prior to 1800 ; the first one focused on the words from the titles that were in relation to practice and its components ("practice", "diagnosis", etc. and their Latin equivalents "practica" or "praxis", "dignotio", etc.), and the second one focused on the shelf marks in series T ("medical sciences") that were in relation to practice and its components, according to the categorizations established by the librarians of the BNF (which was the imperial library at the time) in the middle of the 19th century. Particular attention was paid to discordances between the results of these two explorations, as well as to the shelf marks that stopped being incremented or on the contrary that started being incremented during the period.
Morphological analysis, typological and phylogenetic approaches to genres.
We chose to adopt a typological and phylogenetic approach to genres and conducted a multi-criteria morphological analysis of the titles, the structure and the content of the books, along with a fine chronological analysis, in order to identify the continuities as well as the process of internal transformation and the ruptures that were to found new genres.As far as the titles included in the digitized series are concerned, we chose to focus on "major works" that had benefited from multiple re-editions or from old editions and/or from French translations if they had been initially written in Latin or in a vulgar language other than French. Having to retain no more than 6 to 12 works per genre, and trying to achieve a well- balanced repartition between authors of the 16th, 17th and 18th centuries naturally led to difficult choices.
The genres that were established in the medieval period and their modern transformations
The last centuries of the Middle Ages witnessed the growth, and even the hypertrophy of practical medicine [6]. With the development of university teaching of medical practice and the multiplication of professors in practica in universities, the production of books related to practice both increased and diversified. They fell into the four main genres that were established as early as the beginning of the 14th century : the practicae, the collections of consilia, the regimina and the antidotaries or pharmacopoeias. These four, unchanged genres were still to be found in the printed production of the first decades of the early modern period. Indeed, the diffusion of the print first triggered a recirculation of the texts that were available, many of which were already old. The Practica, seu lilium medicinae (Practice or fleur de lys of medicine), by Bernard de Gordon from Montpellier, written in 1305, and whose eight different editions, Latin or French, printed between 1480 and 1574, are now kept in the collections of the BNF, is an example of the recirculation that governed all the domains of literature and knowledge.
The practices and therapeutical treatises
The genre of the Practica medicinae, assiduously illustrated by the 14th and 15th century masters, was taken up and illustrated by a number of their successors in the early modern period. The typically medieval form of the Medical Practice, characterized by an explicit title and a succession of short chapters presenting etiological, semiological and, most importantly, therapeutical developments on diseases, presented a capite ad calcem – the fevers and the "general" diseases appearing before or after the topographical inventory, or in the "heart" chapter – was often illustrated in the 16th century, from Symphorien Champier (Practica nova in medicina, 1507) to Jacques Fontaine (Practica curandum morborum corporis humani 1591) and even quite late in the 17th century, with for example Daniel Sennert’s Medicina practicaNevertheless, in the middle of the 16th century the typical medieval form of the Practica was seriously challenged by various authors (some of them important ones), who chose to abandon the a capite ad calcem order in favor of regroupings based on either etiological or physio-pathological considerations. Laurent Joubert for instance, in his 1572 Medicinae Practicae priores libri tres…, separated the fevers from distemper and the various functional symptoms and disorders. The groupings could also be made (but more rarely so) by practical activity, as Jacob Wecker did in 1589: in Practica medicinae generalis, he presented the various types of diseases, localized and general, then the prognoses and indications for these diseases, the diets, the simple remedies, the compound remedies, the surgical instruments, and finally the treatments for external affections. Other authors went as far as to abandon the very name of Practica. The titles of books adopting the form of a Practice, be they by Alexander Benedictus: Omnium a vertice ad calcem morborum signa, causae, indicationes et remediorum compositiones utendique rationes… (1539), by Jacques Houllier: De morbis internis… (1571)
The genre of the Practica nevertheless kept being illustrated in the 17th century, either under its old form (with Sennert and Rivière, already mentioned) or under a ‘modernized’ form, for example in Felix Platter (Praxeos medicae, 1625The genre of the Practica, with the previously mentioned characteristics, was subsequently eclipsed for almost a century, starting in the last decades of the 17th century. Hermann Boerhaave, the inventor of clinical medicine, did use the term Praxis medica for some editions of his commented aphorisms (Praxis medica, sive commentarium in aphorismos Hermanni Boerhaave De cognoscendis et curandis morbis, 1728
Digitised materials
The collections of cases, consilia, consultations and observations
The genre of collections of consilia, or epistolary consultations, appeared in Bologna at the end of the 13th century, after the model of collections of judicial advice. It then developed in Italy, where the writing of the consilia themselves became more learned and academic, notably in Padua – see for instance, at the beginning of the 16th century, the very learned consilia by Giovanni Da Monte, collected by his pupils and published in 1559 [12]. It took time for French physicians to adopt the genre: its first illustration appeared in 1582, with the posthumous publication of Jean Fernel’s collection of 70 Latin consilia organized a capite ad calcem by Guillaume de Plancy. This work was extremely successful: it was indeed re-edited 16 times until 1644. But it is in France that the very first collection of cases presenting complete histories of diseases (ie until their conclusion) seems to have been collected and published. They were actually bibliographical cases collected from Galen’s work by Symphorien Champier (Claudii Galeni Pergameni historiales campi..., 1532). In the following decades, the collections of cases referred to as "histories," "curations" or "observations," collected from the writings of great masters from the past, but also more and more frequently from the archives of the physicians themselves, became more numerous [13]. One should notice that the term "observation", which ended up prevailing in the 17th century on its (almost) synonyms "history" (used by Champier) and "curation" (used by Cardan or João Rodrigues, known as Amatus Lusitanus) to refer to the particular – the (organized) narration of a case of disease – had first been used to refer to the general – as a commentary or a synthesis of particular observations – notably by Van Lom in 1560 (and by Sydenham, cf Infra). The quality and success of François Vallériole’s Observationum medicinales… (first edition 1573In the 17th and 18th centuries, the sub-genre of the collections of consilia-consultations, epistolary or not, providing snapshots of the state of the sick, remained quite rare in France. Apart from the consilia by Baillou
On the contrary, the sub-genre of the collections of observations – that were not labelled "clinical" before… 1867 – developed quite considerably, particularly in the 18th century, when the genre grew almost exponentially. Among the heterogeneous, nearly heteroclite production of collections of cases, either personal or taken from previously published books or collections (the precedent Champier set was notably followed by Abraham Zacuto, then by Fabry de Hilden), cases that were selected for their rarity (or sometimes for their marvellous features, as in Fabry de Hilden or Schenck) or for their illustrative nature, or for the fact that they supported the authors’ theories (as in Platter, previously mentioned, or in Lepois), or (most frequently) to highlight the great skill of the physician, underlined by the unhoped-for recoveries he was able to produce (Cardan for instance, in the third part of his Methodus medendi
Digitised materials
Rules for the preservation of health
The literary genre of the regimina sanitatis, or rules for the preservation of health, like the previous two genres, developed quite considerably in the Middle Ages [15]. Initially written for princes or aristocrats, on the personalized epistolary model of the pseudo-Aristotelian Secret of secrets, the regimina took a different, more general and academic form in the 13th century, when hygiene started being taught at university. Their structure followed the six "non natural" or "necessary " things – air and the environment, food and drink, sexuality, exercise and rest, sleep and wake, and the passions of the spirit (happiness, sadness, fear and anger) – six things that were supposed to act in a synergic or contradictory manner on the functioning of the body and the balance of the humors [16]. The regimina gave rules on how to choose "what comes in" (food and drink), rules on the excretion of "what goes out" (urine, stool, sperm, etc.), on the control of the air and the environment, on the exercise and rest of the body and the soul, on sleep and wake and finally rules on the control of emotions and passions. At the end of the Middle Ages, they became more and more specific and differentiated, addressing very diverse physiological or contextual categories (ages, complexions, countries, seasons, trips, etc.). They also were more and more frequently transcribed in vernacular languages, and directed to a broader educated readership, not without a link with the genre of medical vulgarization we will address later.The genre of rules for the preservation of health is represented across the whole early modern period – as is the doctrine on the six non-natural things that was its theoretical foundation – but its form varied in time, and was often atrophied, nonetheless revealing new attitudes of learned medicine towards hygiene [17]. Contrary to what happened in numerous medical fields, where the return to ancient texts, and particularly Greek texts, was accompanied with a rejection of the medieval productions, hygiene apparently failed to be agitated with major intellectual jolts in the 16th century. Arabic, then Salernian and "Villeneuvian" hygienes had indeed been developed in the wake of Galenic hygiene and were all based on the "non-natural things" – even if Galen had not used precisely that term in his De sanitate tuenda. The only discrepancies noticed in the Renaissance came from readers of Celsius, "the Latin Hippocrat" as he was sometimes called [18], whose famous sentence at the incipit of chapter 1 Book 1 of his De re medica – sanus homo et qui bene valet et suae spontis est, nullis obligare se legibus debet : a healthy man, sane of body and spirit, is in no way supposed to follow these rules – was in total contradiction with medieval hygiene. Joost Van Lom went as far as to devote a whole book to the Celsian book (Commentaria de Sanitate Tuenda in primum librum de Re medica Aurel. Cornelii Celsi, 1558
The popularity of these views, largely expressed in the medical literature of the years 1570 to 1630, probably accounts for the meek interest of the medical authors of the time for a question that seemed not to request any further attention. Indeed, apart from Ficin, whose astral Platonism applied to hygiene had a quite limited posterity, few major authors of the early modern period visited the genre, which seems to have been abandoned to the enlightened profane – Luigi Cornaro’s Trattato de la vita sobria (1558), for instance, was translated into several languages (in French in 1647) and was re-edited dozens of times until the end of the 18th century [19] – or to the printers, who re-edited Arnaud de Villeneuve’s regime until 1580, and the "Salernian health code" until 1782 ! The latter book, a heterogeneous collection of behavioral rules (mainly concerning food, with a discussion of numerous products) and simple remedies against benign diseases, written in the 12th century in a succession of short versified chapters, already commented upon by Arnaud de Villeneuve, knew an unprecedented editorial success in the years 1625-50: there was indeed a philological (Latin) edition by the Parisian physician René Moreau (1625, re-edited in 1673This editorial vogue almost eclipsed the late original (if not innovative) work by Nicolas Abraham de la Framboisière (Le gouvernement nécessaire à chacun pour vivre longuement en santé [The necessary government for each one to live a long, healthy life], 1600, re-edited several times in his Complete Work
The intellectual decline of the genre of rules for the preservation of health amplified further in the 18th century, when the French creation was extremely weak, almost invisible even, in the heart of a production that remained dominated by the work of Cornaro and his commenter Lessius, by that of the abbot Armand-Pierre Jacquin (De la Santé, ouvrage utile à tout le monde... [On health, a book for everybody’s use], at least four editions between 1762 and 1771), by the rules of the Salernian School
Digitised materials
Pharmacopoeias
Before an autonomous pharmaceutical field developed at the end of the 18th century, on the model of surgery, with specialized professionals and a specific body of knowledge, apothecary was under intellectual if not organizational tutelage of university medicine, which had the monopoly of pharmacy teachings [20]. The physicians (and surgeons), who wrote prescriptions that are today qualified as magistral, were also to have thorough knowledge on how to prepare drugs. This knowledge was presented in formulae books, which were first called "antidotaries" then, in the middle of the 16th century, "pharmacopoeias". These extremely practical reference books were written by physicians or by colleges of physicians, and they had a normative value for apothecaries who were to conform to the indications they contained.The main medieval pharmacopoeia, Nicolas de Salerne’s antidotary (12th century), a collection of 140 alphabetically classified formulae with summarized indications on their use [21], was printed as early as 1471 and frequently re-edited in the following decades, accompanied with various commentaries (by Platearius, by Jean de Saint-Amand, etc.) and most importantly with the antidotary written by pseudo-Mesue (12th century), called "Grabadin", who chose to present the formulae by type of composition, administered internally or externally (12 chapters successively devoted to electuaries, opiates, solutions, confections, potions, syrups, decoctions, trochisci, pills, powders, plasters and oils). The Canons by pseudo-Mesue, a book devoted to evacuative or dissolving medicines, sometimes completed these heterogeneous volumes that were printed as late as the 1520s (afterwards only the Grabadin and pseudo-Mesue’s canons kept being printed).
The genre of pharmacopoeia indeed was soon to be illustrated in the early modern period, and numerous physicians of the 16th century devoted important efforts to the genre, starting with Antonio Musa Brasavola, a physician from Ferrare, whose considerable pharmaceutical work was published as early as the 1530s (De medicamentis tam simplicibus, quam compositis catharticis…Moyse Charas, in his Pharmacopée royale galénique et chimique (Royal Pharmacopoea, Galenical and Chymical)
Digitised materials
On the margins of established genres, ferments and transgressions
If one defines a literary genre through the example of the four previously considered forms – as a series of books that have similar titles, structures and contents, and that deal with one or several components of practice (diagnosis, prognosis, treatment, prevention) – one is forced to admit that no genre other than that of the Therapeutics developed in the field of medical practice during the early modern period. Although the medical literary production of the field took no new form from the 16th to the 18th centuries, it still was quite active in the domain of semiology, diagnosis and prognosis, in which the ferments of original approaches developed, although they did not give way to the formation of a genre, in France, before the 19th century (it appeared slightly earlier in the Germanic areas). The literary production was also active in at the margins of the field of medical practice : on the one hand on the line between practice and theory, where part of the transgressive work by Fernel, Van Lom or Sydenham is to be situated, although it was not immediately followed with the emergence of a literary genre – that of "pathology" developed in the 19th century, much later than that of "nosology" which fugaciously bloomed in the second half of the 18th century ; on the other hand in the field of medical vulgarization in which physicians, transgressors in their own way – here, of the codes of their profession – contributed to creating new literary forms of vulgarization, such as "medicine for the Poor", "charitable medicine" or "domestic medicine".
Semiology, diagnosis and prognosis from Dubois to Bordeu
For semiology, diagnosis and prognosis, the genre of medical semiology did not appear in France before the first decades of the 19th century, after the publication of the work of Broussonnet (in 1797) and especially Double (in 1811) and Landré-Beauvais (in 1813). The Revolution may actually have delayed of one or two decades the development of a genre that was present in Germany as early as the end of the 1750s. Without going into the details of the history – difficult and little represented – of diagnosis and of medical semiology, we will nevertheless summarily remind the reader that the (current) conceptualization of diagnosis as the identification of the disease(s) affecting the patient developed in the wake of the ontological conceptualization of the disease, in which diseases are considered as entities independent from the patient – a view which prevailed (again) in Europe at the end of the 17th century [26]. So far, physicians had a mainly dynamic, or idiosyncratic conception of the disease: they did not consider the disease of its own, but the disease in a given patient, and they attached particular importance to the analysis of the disruption of balance that determined the troubles, considering the (present) pathological state of the subjects, their (previous) state of balance, and the causes participating to the disruption. It was more important for the physician to know the disease than to recognize (diagnose) it, thanks to a multi-dimensional evaluation whose purpose was to define "what was wrong" but also determine how to re-establish the balance, which was usually achieved by acting on the contraries of the causes having led to the pathological state. This multi-dimensional or multi-axis analysis of the patients required specific reasoning and specific semiologies, which were the object of discussions in the 16th century.Indeed, a new interest for medical semiology appeared in the 16th century. Among various other reasons [27], the humanistic re-reading of several Galenic texts seems to have been determining. The four treatises on the Difference of diseases, Causes of diseases, Difference of symptoms, and Causes of symptoms, that of the Affected Loci as well as the Methodus medendi and the Therapeutic Method to Glaucon revealed indeed far more complex – some historians even said contradictory – Galenic conceptions of diagnosis than what was conveyed in the vulgate of the Ars medica [28], which constituted the main medieval heritage on the question [29]. In the middle of the 16th century, authors like Argentorio in Italy, Dubois, Fernel and Rondelet in France took up the challenge of the non-congruence of the Galenic texts (one with the other, but also with those by Aretaeus of Cappadocia and by Celsius that had been "rediscovered") and opened the way to new approaches of diagnosis and semiology, sometimes within the framework of a broader reflection on the very notion of "pathology" (for Argentorio and especially for Fernel, see below). If these new approaches were probably more consistent than that of Galen, they nevertheless did not converge enough to create the conditions for a theoretical normalization necessary, in our eyes, to the emergence of literary genres : for semiology, diagnosis and prognosis, there were works but no genre yet in the early modern period.
Jacques Dubois was (again) the first author, in 1539, to attempt an accessible synthesis of the Galenic semiology. In his Methodus sex librorum Galeni in differentiis et causis morborum et symptomatum in tabellas sex ordine… followed by De signis omnibus medicis hoc est, salubribus, insalubribus, et neutris, commentarius omnino necessarius medico futuroThe clarity and the relative simplicity of Fernel’s presentation [30] probably account for its popularity in France, where it was taken up by numerous authors of the late 16th and early 17th centuries, such as Jacques Aubert (Ratio dignoscendarum sedium male affectarum et affectuum praeter naturam 1587, re-edited in 1596) or Nicolas Abraham de La Framboisière ("Pour discerner les maladies" [To differentiate diseases], Law I of the 1608 Loix de medecine [Medical Laws], re-edited numerous times in his Complete Works
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The line between practice and theory: pathology and nosology, from Fernel to Pinel
Despite the large success of the MedicinaThe main work by Joost Van Lom (Lommius), Medicinalium observationum libri tres, quibus notae morborum omnium et quae de his possint haberi praesagia judiciaque roponuntur
The literary genre of "nosologies," which developed after the double publication in 1763 of the Genera morborum by Linné and the Nosologia methodica by Boissier de Sauvages (a revised French version of which was published in 1772
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Medical vulgarization from Liebault to Buchan
Books of medical vulgarization were written as early as Antiquity; Celsius for instance, who was not a physician, wrote his De re medica in the 1rst century for a large audience with a view to giving the readers the possibility to treat their own illnesses. In the Middle Ages, besides the regimina sanitatis already mentioned, numerous manuscripts comprising formulae against common aches and diseases had also been circulated [42]. The printing press however permitted a much larger diffusion of medical vulgarization literature, which became accessible to more and more numerous literate people.In the early modern period, numerous physicians contributed to developing and renewing this literature. Indeed, vulgarization was sometimes considered to be a logical continuity of practice, or an activity that resulted from charity, or that was simply aimed at helping other people, especially as regarded fairly standardized prescriptions such as health rules or the treatment of unimportant diseases – which actually tended to be taken care of in the family circle or the community, without having recourse to professionals. But some physicians had a more reserved, or even a clearly negative opinion of the divulgation of professional knowledge (that had to be defended); they considered it might be used unwisely and endanger people’s health [43].
Another vector of vulgarization was the fact that thanks to the printing press old medieval books were re-circulated until the late 16th century, or even the early 17th century; three-century-old books such as the Trésor des PauvresIn the middle of the 16th century, new books rejuvenated vulgarization literature a little, without transforming it utterly. The "best-sellers" by the Parisian physicians Charles Estienne and Jean Liebault, Agriculture et maison rustique (1564, re-edited numerous times until 1689) and Thresor universel des pauvres et des riches ou Recueil de remèdes faciles, pour toute sorte de maladies qui surviennent au corps humain, depuis la plante des pieds, jusqu’au sommet de la teste, tant intérieures qu’extérieures
It is first of all the case of Le Médecin Charitable [The charitable Physician] (1623) by the Parisian physician Philibert Guybert, followed by L’Apothicaire charitable [The Charitable Apothecary] in 1625It is also the case of the Traité des maladies les plus fréquentes [Treatise on the most frequent diseases] by Jean-Adrien Helvetius
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Conclusion. Literary genres, the history of ideas and the cultural history of medicine
To conclude, one can first of all say that the concept of literary genre can be fruitfully applied to the printed production in practical medicine of the early modern period : the genres do feature the standardization of some aspects of this production on the one hand, as well as its variations on the other, and one can identify, on its margins, both the transgressive works – some of which were the starting point of new genres – and the domains without any constituted genre, i.e. without a minimal convergence in the production. In spite of some inertia explicable by the stability of medical practice and its components, and by the fact that the training needs of students and future practitioners have known no major evolutions during the early modern period, new genres nevertheless surfaced, and constituted genres significantly evolved.The genre of "medical practice" proved to be quite durable. In spite of the scission and autonomization of an exclusively therapeutic genre – after the reading of Galen’s Methodus medendi by Renaissance physicians – and an eclipse that lasted over a century, the genre of practice was once again illustrated at the end of the period (and kept being illustrated) – with only minor formal modifications, such as not using the a capite ad calcem order any more in favor of the categorizations that reflected the nosology known at the time. The genre of collections of particularia, initially comprised of advice or epistolary consultations, developed quite dramatically in the early modern period, notably through collections of histories or cases, labeled "observations," as early as the end of the 16th century. The genre of practices was illustrated by numerous medical personalities of the time. As for pharmacopoeia – which integrated the chemical remedies at the beginning of the 18th century after a few somewhat unstable decades – and rules for the preservation of health, they went across the period without any major formal transformation. Despite decreasing interest of the medical elite for the rules for the preservation of health, the fact that this genre survived in the early modern period is quite significant. The minimal consensus on the theory on the six non-natural things that persisted during the whole period allowed the genre to perpetuate, even if only meagerly illustrated by second-rate personalities. One observes the inverse situation for semiology: not a single genre emerged, probably due to the absence of preeminence, after the medical Renaissance, of a unique conceptualization of diagnosis. The latter could only be Galenic (or mainly Galenic) then, and the adaptations one made (Dubois, Argentorio or Fernel) never converged enough to create the conditions necessary for a genre to emerge – at a time when the ontological conceptualization of disease was becoming more and more popular. The triumph of this conceptualization at the end of the 18th century allowed in the next century the development of the genre of semiologies, then of the genre of pathologies after the quick extinction of the genre of nosologies (and the assimilation of pathological anatomy). Even further in the margins of medical practice stricto sensu, the genre of vulgarization knew unequalled development, paradoxically allying great inertia of content and structure with great volatility of titles. It is actually within the genre of medical vulgarization that varieties very close to those usually observed in literature constituted : successful "major works" generated immediate infatuation and numerous imitations – here in title – of varying quality.
This study also permitted to notice once again the influence of the work by Fernel, through his consilia – a traditional genre – as well as through his transgressive book (Pathologie and Thérapeutique), by Jacques Dubois – far more "Galenist" than Fernel – and also by Rondelet, Joubert, Valleriole, Lommius, Rivière, and naturally Sydenham. It also allowed one to recall the "best seller" status of Salerne’s Régime, of the Pathologie, Thérapeutique and the consilia by Fernel, Lemery’s Pharmacopée and Van Lom’s Tableau des maladies. This study of literary genres finally allowed one to confirm again the importance of the period from 1530 to 1550, which constituted the beginning of the medical Renaissance in France, and led to an important renewal of the works in almost all the genres of practice as of the years 1570-1580. The decades that followed were admittedly less buoyant, but they were not immobile either, with the persistence of a French creation, maybe more from Montpellier than from Paris, and also the penetration after their prompt translation of the work by Dutch, English then German physicians (fewer Italian ones in the 17th and 18th centuries) in the domain of practice.The author thanks Danielle Jacquart for her commentaries and suggestions on this text.
Notes
1 After a period when the belief in "structure" somewhat eclipsed the concept of literary genre, the latter is currently being rehabilitated in arts studies. 2 From the end of the 19th century to the end of the 20th century, roughly speaking from Brunetière to Schaeffer, including Jolles, Jauss, Genette and Todorov, there have been numerous and various methodological approaches to genres and literary forms. For an easily accessible synthesis, see Antoine Compagnon, http://www.fabula.org/compagnon/genre.php 3 On medical thought during the period, see M.D. Grmek. (dir.) Histoire de la pensée médicale en Occident. 2. De la Renaissance aux Lumières [History of medical thought in the Western world. 2. From the Renaissance to the Enlightenment]. Paris, Seuil, 1997. 4 The question of literary genres was also of concern to generations of librarians, who had to classify books. The indexation of the books belonging to the category of "medical sciences" at the BNF, made at the end of the 1850s, shows that the question of medical genres was given a lot of thought, as we will see below. 5 On this demarcation and the ensuing debates, see N. Palmieri "La théorie de la médecine des Alexandrins aux Arabes" [The theory of medicine from the Alexandrians to the Arabs], in D. Jacquart (dir.), Les voies de la science grecque [On Greek science], Geneva, Droz, 1997, p. 33-133, and D. Jacquart, La médecine médiévale dans le cadre parisien, XIVe-XVe siècle [Medieval medicine in Paris in the 14th and 15th centuries]. Paris, Fayard, 1998, p 416-32. 6 See D. Jacquart "La scolastique médicale" [Medical Scholastic], In M.D. Grmek (dir.) Histoire de la pensée médicale en Occident. 1. Antiquité et Moyen Age. [History of medical thought in the Western world. 1. Antiquity and Middle Ages.] Paris, Seuil, 1995, p. 202 sq. 7 The complicated history of this posthumous text written after Jean Duret’s practical lessons on Houiller’s text intended for Parisian pupils has been reconstructed by I.M. Lonie, "The "Paris Hippocratics": teaching and research in Paris in the second half of the sixteenth century", In A. Wear, R. French, I.M. Lonie (Eds.), The medical Renaissance of the Sixteenth Century, Cambridge, Cambridge University Press, 1985, p. 155-174. 8 On the influence of the Methodo medendi by Galen, see J. Bylebyl, "Teaching methodus medendi in the Renaissance", In F. Kudlien, R.J. Durling (Ed), Galen’s method of healing, Leiden, Bryll, 1991; and A. Wear, "Explorations in Renaissance writings on the practice of medecine", In A. Wear, R. French, I.M. Lonie (Eds.), The medical Renaissance…, p. 118-145. 9 This contestation of the genre of the Practice in the 16th century caused librarians of the Bibliothèque Impériale to hesitate in their categorizations : printed editions of the medieval practicae were all classified in TD29, and the "practices" written after the 16th century are generally regrouped under the shelf mark TD30, but the works that are labeled "methodus medendi" – some of which have the very same contents as practicae – can be found partly in TD30, but also in TD4, TE6 and TE17… 10 The work was indeed comprised of 1472 aphorisms or sentences that structured it in as many paragraphs. Boerhaave particularly liked the aphoristic form, which he had also used in his famous Institutiones medicae in usus annuae exercitationis domesticos (1710, translated into French in 1740), which were comprised of 1260 sentences. 11 The Médecine pratique de Sydenham avec des notes, "translated from the English" by Jault (1774) is in fact nothing else but the Observationes medica, published in London in 1676, the content of which (discussed further) does not in any way correspond with the title given by Jault and his publisher. 12 On the history of the medieval consilia, see J. Agrimi, C. Crisciani, Les consilia médicaux, Turnhout, Brepols, 1994. 13 Several factors determining this phenomenon, quite striking in the eyes of historians of medicine, have been mentioned, including the taste of Renaissance people for the rare and mysterious, the re-discovery of the Hippocratic model of the Epidemics (printed for the first time in 1515), the renewal of empiricism and/or more broadly speaking an epistemological evolution that lay more emphasis on the senses and observation in order to acquire knowledge. On this very important question, see for instance N.G. Siraisi, The clock and the mirror: Girolamo Cardano and Renaissance medicine, Princeton, Princeton University Press, 1997 and G. Pomata, "Praxis historialis : the uses of historia in early modern medicine" In G. Pomata, N.G. Siraisi (dir.), Historia: empiricism and erudition in early modern Europe, Cambridge, MIT Press, 2005, p. 105-46. 14 As for the genre of practices, this evolution in the genre of the collections of cases can be seen in the hesitations and fluctuations in the categorizations made by the librarians of the Bibliothèque Impériale : the collections of consilia and of consultations were for most of them classified in TD34, whereas the first collections of cases (Amatus, Valleriole) were classified in TD5. Afterwards, the two categories indiffently harboured one type of work or the other. 15 The main reference on the subject is M. Nicoud, Les régimes de santé au Moyen Âge : naissance et diffusion d'une écriture médicale en Italie et en France (XIIIe-XVe siècle). Bibliothèque des Écoles françaises d'Athènes et de Rome, Rome, École française de Rome, 2007. 16 On the doctrine of the six things, elaborated by Alexandrian medicine and developed by Arab medicine, see N.G. Siraisi, Medieval and early Renaissance medicine, p. 101, M. Nicoud, Les régimes de santé au Moyen ÂgeAux origines d’une médecine préventive… [Rules for the preservation of health in the Middle AgesThe origins of preventive medicine] and N. Palmieri, "La théorie de la médecine des Alexandrins aux Arabes…" [Medical theory from Alexandrians to Arabs], op. cit. 17 The librarians of the Bibliothèque Impériale who indexed the dietetics books and the regimina sanitatis made the odd choice of a chronological classification : the shelf mark TC8 essentially comprises titles posterior to 1772, TC9 comprises the ancient books by Galen (De sanitate tuenda), Celsius and Plutarch, TC10 comprises medieval works (among others Salernian School and Arnaud de Villeneuve), TC11 modern and 19th century works… 18 On Celsius, Latin author of the 1rst century, his "re-discovery" and his fortune in the early modern period, see for instance Pedro Conde Parrado, Hipócrates latino: el De medicina de Cornelio Celso en el Renacimiento, Valladolid, Secretariado de Publicaciones de la Universidad de Valladolid, 2003. 19 In 1991, Cornaro’s work was edited in French (along with the Conseils pour vivre longtemps [Advice to live long] by Leys or Lessius, 1613, which was often associated to it in the 17th and 18th centuries) with an introduction by G. Vigarello. 20 The actual separation between apothecaries and grocers – and the world of merchants in general – did not occur before 1777 in Paris; the first schools of pharmacy, forerunners of the faculties of pharmacy, were created in 1803. On the establishment of controls of apothecaries by physicians in the medieval period, see D. Jacquart, La médecine médiévale…, op. cit., p. 303 sq, and on the first steps of independence, see B. Dehillerin, J.P. Goubert, "A la conquête du monopole pharmaceutique: le collège de pharmacie de Paris (1777-1796)" In J.P. Goubert (Ed.), La médicalisation de la société française, 1770-1830. Historical reflections press, Waterloo (Ontario), 1982, p 237 sq. 21 Numerous manuscripts of "the antidotary of Nicholas" had been circulated in the Middle Ages, some of them with (often partial) translations into French. Paul Dorveaux, the historian of pharmacy, has edited two of these (P. Dorveaux, L’antidotaire Nicolas, deux traductions françaises de l’Antidotarium Nicolai, Paris, H. Welter, 1896), which are now accessible on the Internet site of the BIU Santé. 22 The outline of Jacques Dubois’s pharmacopoeia (simple remedies and how to prepare them, then compound remedies for internal then external use) was most regularly re-used afterwards, notably in Les ordonnances sur la préparation des médicaments tant simples que composes, the fifth tome of the Œuvres by Nicolas Abraham de La Framboisière. 23 The librarians of the Bibliothèque Impériale in charge of indexation tried to separate the medieval pharmacopoeias (TE2) from the modern ones (TE146-7) and the latter from the medical subjects "medical material" (TE138-9) and the "chemical" pharmacopoeias (TE131). When they became mixed, both "Galenic" and "chemical," the pharmacopoeias were most of the time classified in TE146, but some of them ended up in TE131 or in TE147. Similarly, one can find in TE147 numerous books (such as Jacques Dubois’) dealing with the preparation of both simple and compound remedies. 24 Let us remind that the use of "emetics" (antimony tartrate) by Louis XIV, who probably suffered from typhus during the Flanders campaign in 1658, hastened the victory of the "chemists" in the "the war over antimony war" that had been raging for nearly a century. In 1666, antimony was inscribed on the list of purgative medicines authorized by the Faculty. 25 Nicolas Lémery (1645-1715), like Charas, was a Protestant apothecary before he became a physician and converted to Ccatholicism. On Lémery, see above all Fontenelle’s Éloge de M. Lemery (1715). 26 It was more a return to ontological conceptualization than a de novo development. On this point, read Mirko Grmek’s analyses, notably in Volume 2 of his Histoire de la pensée médicale, op. cit., p. 157 sq. 27 On this subject, see I. Maclean, Logic, signs and nature in the Renaissance, Cambridge, Cambridge University Press, 2001, p. 279 sq. Repeated confrontations with the plague and with new contagious infectious diseases (syphilis, sweating sickness, whooping-cough, etc.) certainly played a role in the renewal of ontological conceptions of disease and – as a consequence – in the increasing interest for medical semiology and diagnosis. 28 The Ars medica (or Tegni) comprised several chapters devoted to the signs of health, disease and neutral state. On the late and medieval Alexandrine discussions of these Galenic categories, see N. Palmieri, op. cit., p 122 sq. 29 In particular due to its presence in the Articella. The Articella was still largely distributed in the first decades of the 16th century – the last edition took place in 1534. On the Articella and its content (Galen’s Ars medica, the Hippocratic treatise of Prognosis, Philarete’s De pulsibus and Theophile’s De urinis), see the Articella Studies: Texts and Interpretations in Medieval and Renaissance Medical Teaching, no. 2. Cambridge: Cambridge Wellcome Unit for the History of Medicine, and CSIC Barcelona, Department of History of Science, 1998. On Galenic diagnosis, see L. Garcia-Ballester, "Galen as a clinician: his methods in diagnosis" In L. Garcia-Ballester (ed.), Galen and Galenism. Theory and medical practice from Antiquity to the European Renaissance. Ashgate, Aldershot, 2002, p. 1636-71. 30 The "Fernelian diagnosis" comprised two stages : the first one consisted in "finding the place where the disease resided," which was done following a method very close to that described in chapter 5 of Book 1 of the Affected Parts. The second stage consisted in "recognizing the disease as well as its cause." The signs that were used to find the affected part were found in the "excrements," in the research of the "affected function" and in the nature and situation of the pain and of the "related accidents;" they were also used in the second stage to characterize both the disease and its cause (J. Fernel, La pathologie ou discours des maladies (French edition), Paris, 1655, p. 110 sq.). 31 It is the precept of carefully separating the various sorts of diseases one finds in the Méthode thérapeutique à Glaucon that seems to have inspired Rondelet a method that allowed him to identify the "species" from "genres" of diseases after successive steps of Porphyrian division. Rondelet applied this method to the identification of species of pain (differenciated according to their localizations), tumors, hemorrages, purulent, bilious or pituitous evacuations (divided according to their flavor, color and place), membranes, animals (worms, fœtuses), species of sweat, retentions (of stools, urines, periods), then to the identification of the distemper causing general affections (fevers, cold fluxions) and species of wounds, ulcers, fractures, birth conditions and cutaneous affections. 32 Indeed Feyens, professor in Louvain, presented the signs of health, neutral state and disease (divided into diagnostic and prognostic) and the signs of crisis, then the signs related to the natural things, non-natural things, and counter-natural things (notably through the study of the functions and excrements) and finally the signs specific to the affections of the parts (divided according to the five senses that could be affected). 33 The categorization chosen by the librarians of the Bibliothèque Impériale reflects the existence of these specific literatures : the categories TD15, TD16 and TD19 essentially comprise the treatises devoted to urines, the pulse and crises (respectively 16, 17 et 15 titles printed in France before 1789), whereas the category TD13 mostly contains general semiological and diagnostic treatises (10 titles). The category TD21 gathers together editions of Hippocrates’ treatise Prognosis and editions of his commenters, notably Galen (40 titles), and TD22 the other treatises devoted to prognosis (11 titles). 34 On the notion of crisis and the related literature, see J. Pigeaud, La crise, Nantes, Editions Cécile Defaut, 2006. 35 Fernel, in his way, was also taking up Ibn SinnaAvicenna’s project to develop a science of diseases within theoretical medicine. Let us quote an extract from the preface to the Medicina : "C’est pourquoy [le médecin] est du tout occupé en ces deux choses, de conserver la santé du corps et d’en chasser la maladie, et il peut plainement faire ces deux choses s’il ne cognoist auparavant combien il y a de genres et de differences, leurs causes et par quels signes on les peut discerner ; c’est pourquoy on disposera ainsi par ordre les cinq parties de toute la Medecine. Premierement sera celle appellée physiologice, c’est à dire la physiologie ou discours de la nature humaine, qui explique entierement la nature de l’homme sain, toutes ses facultés et ses fonctions ; en second lieu, la pathologice, c’est à dire la pathologie, ou discours des maladies, qui enseigne les maladies et affections qui outre nature peuvent survenir à l’homme et quelles en sont en les causes et les signes ; en troisieme lieu, la prognostice qui traitte des signes des maladies par lesquelles les medecins prevoyent les choses futures, le cours des maladies et quelle en sera l’issüe ; en quatriesme lieu l’ygiene, c’est à dire le regime de vivre, qui conserve par un bon regime de vivre la santé du corps entiere et parfaite […] et en cinquiesme lieu, la therapeutice, c’est à dire la therapeutique, qui chasse la maladie du corps. […] Et partant la Medecine est composée des cinq parties, dont les trois premieres sont occupées dans la contemplation et la simple cognoissance des choses qu’elles considerent et les deux dernieres consistent entierement dans l’action, employant tout leur office pour conserver la santé ou pour chasser les maladies ; d’où vient que quelques-uns ont reduit ces cinq parties à deux, à la theorie et à la practique" (Preface to the Medicina, traduction by Charles de Saint-Germain, 1655). On the Alexandrine and medieval categorizations and divisions of the parts of medicine, all of them separating etiology and semiotics, see N. Palmieri (op. cit., p. 42 sq.), who nevertheless underlined the "precariousness of the theoretical status of semiology". In 1541, Leonhart Fuchs (Methodus seu ratio compendaria…), leaning on Galen, had also presented a division of the parts of medicine into five categories, but they were physiology, hygiene, etiology, semiotics and therapeutics. 36 For example Rondelet, in his De dignoscendis morbis, reminded that a disease was not only a "species" but had to be characterized according to its force, "time", localization and various "particular properties" : "Morbus alius est non in specie, sed in magnitudine, vehementia, paruitate ac remissione, aut in magis aut minus periclitando. Ob hoc non solum in curandis morbis contrarietatem remediorum invenire oportet, sed et justam quantitatem, quae a morbi magnitudine, tempore, loco et consuetudine indicatur. Quemadmodum enim non sufficit communem phlegmones curationem, ex morbi essentia cognovisse, sed ex varietate partium, insita facultate et sensu […] sic ad perfectam morbi cognitionem necessaria est morbi cujusque particularis proprietas, ut ea cognita justam quantitatem et conferentis remediis speciem inveniamus, quod non solum contrarium esse debet, sed est parti affectae accomodatum, secundum indicationes particulares". G. Rondelet, De dignoscendis morbis In Methodus curandorum omnium morborum corporis humani…, p. 637 (1575 edition). 37 On this work, see J. Duffin, "Jodocus Lomnius’s little golden book and the history of diagnostic semiology". J Hist Med Allied Sci. 2006; 61: 249-87. 38 "Videtur profecto ea meditatio potissimum, cum ad aegri salutem, rectamque curationem, tum ad medici fidem atque dignitatem spectare. Primum enim, quia novisse morbum proximus est ad sanitatem gradus, nemo sane hanc aut praesagire, aut reddere afflictis recte potest qui non animadvertere genus aegritudinis quod sit, non ejus eventum omnem praenunciare, certis indiciis norit." Medicinalium observationum…, Letter to Brussels senators. 39 J. Duffin suggested it be considered as the first modern treatise of semiology. While we agree with his her analysis, we nevertheless chose to discuss it with the treatises of pathology and nosology, for the similarity in layout with the first nosologies, but also and mostly for its date of publication (1560) and its transgressive nature, which called for a connection with Fernel’s Pathologie. 40 One quote from the Preface to this work throws light on Sydenham’s reasoning approach : "All the diseases must be reduced to precise and determined species, with as much care and as much accuracy as the botanists in their Treatises on plants. Because there are diseases that, although they belong to the same genre and have the same name, and also present some similar symptoms, are nevertheless of quite a different nature, and require quite a different treatment too." Observationes medica, London, 1676. 41 The systematic (as opposed to synoptic or divisive) nature of the arrangements or classifications of diseases that Boissier de Sauvages called for and that was implemented by most of the authors of nosologies in the 19th century, actually confers to the genre the status of a privileged observatory to analyze the medical theories (and trends) of the time. 42 D. Jacquart, "Hippocrate en français. Le Livre des Amphorismes de Martin de Saint-Gilles (1362-1363)". In D. Jacquart (Dir.), Les voies de la science grecque, op. cit., p. 241-319; and D. Jacquart, La médecine médiévale dans le cadre parisien, XIVe-XVe siècles, op. cit. 43 Laurent Joubert, who created the literary genre of "Erreurs populaires" ["popular errors"], considered indeed that the "physicians who had divulged too much" were partly responsible for these errors. On this subjet, see J. Coste, La littérature des erreurs populaires, une ethnographie médicale à l’époque moderne [The literature of popular errors, a medical ethnography in the early modern period], Paris, Champion, 2002. 44 The literature of vulgarization (of a medical or lay origin) was on the contrary quite easily distinguishable from the literature of "secrets," which French physicians actually did not illustrate much. The librarians of the Bibliothèque Impériale have mainly classified this literature of vulgarization under the shelf mark TE17, which regroups most of the medical works (along with some more academic titles such as the translations and commentaries of Galen’s therapeutic books, Dubois’ treatise Morborum internorum prope omnium curatio…, etc.), and the shelf mark TE18, which also regroups a few books of secrets (Fioravanti, Digby, etc.) as well as the profane productions of Mme Fouquet, Francois Salerne, etc. 45 For these editions, see P. Albou, Histoire des "Œuvres charitables" de Philbert Guybert, Saint-Amond-Montrond, P. Albou, 1997. 46 C.E. Rosenberg has listed 142 editions of Buchan’s Domestic Medicine, in the Anglo-Saxon sphere only, in one century. C.E. Rosenberg, "Medical text and social context: explaining William Buchan’s", Bulletin of the history of medicine 1983; 57: 22-42.
