¹ For an able and useful summary of the work of the Société, see Hannaway, C. C., ‘The Société Royale de Médecine and Epidemics in the Ancien Régime,’ Bulletin of the History of Medicine, XLVI (1972), 257–73.Google Scholar The Société published a small fraction of its transactions, reports, and correspondence. See Histoire de la Société royale de Médecine avec les Mémoires de Médecine et de Physique Médicale pour la même année, 10 vols. (Paris, 1779–98).

² See Desaive, J.-P., Goubert, J.-P., Ladurie, E. Le Roy, Meyer, J., Muller, O., Peter, J.-P., Médecins, clitnat et épidémics à la fin du XVIII^e siécle (Paris and The Hague, 1972).Google Scholar Peter’s essay in the above collection is ‘Une enquête de la Société royale de Médecine (1774–1794). Malades et maladies à la fin du XVIII^e siècle,’ first published in Annales E.S.C., XXII (1967), 711–51.Google Scholar This article is now available in English in Biology of Man in History, ed. Forster, R. and Ranum, O. (Baltimore and London, 1975) as ‘Disease and the Sick at the End of the Eighteenth Century,’ 81–124.Google Scholar Peter's other publications include: ‘Médecine, epidémies, et Société en France à la fin du XVIII^e siècle d'après les archives de l'cadémie de Médecine,’ Bulletin de la Société d'histoire moderne, 14th ser., no. 14 (1970), 2–9Google Scholar; ‘Les mots et les objets de la maladie. Remarques sur les épidémies et la Médecine dans la Société française de la fin du XVIII^e siècle,’ Revue historique, CCXLVI (1971), 13–38Google Scholar; ‘Lieux du corps,’ Nouvelle revue de psychanalyse, no. 3 (1971), 71–108.Google ScholarSee also his contribution to the collection edited by Foucault, M, Moi Pierre Rivière, ayant égorgé ma mère, ma soeur et mon frère … (Paris, 1973).Google Scholar

³ I have borrowed freely from Peter's reconstruction of medical theory in the eighteenth century in his article, ‘Lieux du corps.’ King's, L. S. studies have been extremely useful: The Medical World of the Eighteenth Century (Chicago, 1958)Google Scholar; ‘Some Problems of Causality in Eighteenth Century Medicine,’ Bulletin of the History of Medicine, XXXVII (1963), 15–24Google Scholar; ‘The Debt of Modern Medicine to the Eighteenth Century,’ Journal of the American Medical Association, CXC (1964), 829–32Google Scholar; ‘Medical Theory and Practice at the Beginning of the 18th Century,’ Bulletin of the History of Medicine, XLVI (1972), 1–15Google Scholar; ‘Causation: A Problem in Medical Philosophy,’ Clio Medica, X (1975), 95–109.Google Scholar Consult also, Rousseau, G. S., ‘Sowing the Wind and Reaping the Whirlwind: Aspects of Change in Eighteenth-Century Medicine,’ in Korshin, P. J., Studies in Change and Revolution. Aspects of English Intellectual History, 1640-1800 (Menston, 1972)Google Scholar and Rather, L. J., Mind and Body in Eighteenth Century Medicine (Berkeley and Los Angeles, 1965).Google Scholar

⁴ References to the Archives of the Société Royale de Médecine will be in the form of SRM. SRM 143, Dr. Berthe, ‘Les maladies peuvent-elles être guéries par les seules forces de la nature?’ no date, no place.

⁵ SRM 124, Dr. J.-G. Chifoliau, ‘Préjugés opposés aux sages précautions du gouvernement aux efforts des ministres de la santé et à la voix de la nature,’ Saint-Malo, 22 March 1780.

⁶ SRM 138, Dr. Ramel, ‘Mémoire sur la question proposée par la Société Royale de Médecine: Déterminer dans quelles espèces et dans quel temps des maladies chroniques, la fievre peut être utile, et avec quelles précautions on doit l'eviter ou la modérer dans leur traitement?’ Lent 1787.

⁷ SRM 115, Dr. Pierre Flandrin, ‘Mémoire sur cette question: Quelle est la meilleure maniére d'enseigner la Médecine clinique dans un hôpital?’ Lent 1793.

⁸ Two important articles by N. D. Jewson may be consulted on this and the related questions of medical knowledge, the social groups to which it caters, and the shifts from one cognitive system to another: ‘Medical Knowledge and the Patronage System in Eighteenth Century England,’ Sociology, VIII (1974), 369–85Google Scholar; ‘The Disappearance of the Sick-Man from Medical Cosmology, 1770–1870, ’ibid., X (1976), 225–44.

⁹ For an instructive discussion of the theory of the non-naturals, see Coleman, W., ‘Health and Hygiene in the Encyclopedic: A Medical Doctrine for the Bourgeoisie,’ Journal of the History of Medicine and Allied Sciences, XXIX (1974), 399–421.CrossRefGoogle Scholar

¹⁰ For a recent, informed, and highly suggestive analysis, see Elias, N., ‘Sociology of Knowledge: New Perspectives: Parts One and Two,’ Sociology, V (1971), 149–68, 355–70.CrossRefGoogle Scholar

¹¹ The abbé Expilly's demographic inquiries confidently affirmed population growth, but his studies on the subject were never properly circulated. Indeed, he himself suppressed their diffusion when his protector, controller-general Laverdy, left office. With this change in the administration, the physiocrats for whom population decline was an established fact almost ensured a monopoly for that belief. See Hasquin, H., ‘Quelques précisions sur l'oeuvre de l'abbé Expilly,’ in Etudes sur le XVIII^e siècle, ed. by Mortier, R. and Hasquin, H., II (Brussels, 1975), 169–84.Google Scholar Yet it must be noted that Turgot's great friend, the abbé Verri, rejoiced at the growing prosperity and population of the country. See Journal de l'abbe de Verri. Published with an introduction and notes by de Witte, Baron J., 2 vols. (Paris, 1933), 1,82–85,91,167–68, 346–47.Google Scholar

¹² For a brief introduction to the role assumed by and attributed to medicine in the total social and intellectual network in the Enlightenment see Gay, P., The Enlightenment: An Interpretation, Vol. II. The Science of Freedom (New York, 1969), pp. 12–23.Google Scholar

³ Coleman, W. deals with some of the problems in interpreting popular conceptions of disease in ‘The People's Health: Medical Themes in 18th-Century French Popular Literature,’ Bulletin of the History of Medicine, LI (1977), 55–74.Google Scholar His major source is the bibliothéque bleue. Further confirmation of its great popularity is to be seen in the many references to its diffusion in de Certeau, M., Julia, D., and Revel, J., Une politique de la tongue. La Révolution française et les patois: L'enquete de Gregoire (Paris, 1975).Google Scholar

¹⁴ On the provision of medical services as the fulfillment of the ideals of charity, see SRM 143, Dr. M. Berthe, ‘Les maladies peuvent-elles être guéries par les seules forces de la nature?’, no date: ‘It rests with the doctor to give the example of… social charity. It is especially accorded to him to be able to direct and apply it in the most advantageous way. He will thus scorn the vague indictments of cold heartedness with which the vulgarians besmirch him, and animated by an enlightened sensibility he will not be afraid to devote himself to the most scrupulous examination of all the physical illnesses tormenting our weaknesses.’ Many other examples can be cited, but I shall refer only to one more, since it is a good illustration of the doctors’ self-image as the self-sacrificing guardians of the poor sick: ’I have not heard that any of my colleagues here have refused to see the poor, far from turning them away, I have voluntarily taken them on. Advantage has not been our guide. I don't know anyone who has received anything from the intendant for that.‘ SRM 116, Dr. Desfarges to S.R.M., Meymac, 24 July 1784.

¹⁵ See, for example, SRM 145, Dr. du Boueix's views in his ‘Mémoire sur les dysenteries épidémiques qui ont régné depuis la fin d'août 1779, dans une grande partie du comte Nantais … surtout dans les campagnes voisines de Clisson.’ He writes: ’We have seen more than once entire and numerous families succumb to the combined causes of destruction without a single individual escaping. Doubtless there is no sensible man who, after this frightful and too true picture of the miseries and horrors, will not make sincere vows to alleviate the lot of so many unfortunates as cruelly maltreated by fate as they are essentially useful to the subsistence and success of nations.’

¹⁶ SRM 145, Dr. Pessault de la Tour to S.R.M., no date; SRM 131, Dr. Cales, ‘Memoire sur les abus en Médecine,’ post-1789.

¹⁷ King-Hele, Desmond, Doctor of Revolution. The Life and Genius of Erasmus Darwin (London, 1977) is one of those rare studies in which it is possible to see how physicians like Darwin were driven to work, either in assisting their poor patients or counselling their indolent, rich ones against the perils of boredom and alcoholism, from a sense of the ease with which men could slip into passivity. Darwin exemplified the men who believed in medicine's struggle against poverty and their faith in cumulative victories over pain and death. Much of his life was determined by his conscious will to keep working and acquire knowledge as the surest way to avoid the dangers to life. A similar psychology is clearly discernible in the observations of many doctors in France during the same period.Google Scholar

¹⁸ It was generally taken for granted that doctors would avoid the countryside if at all possible. Schemes to correct the urban-rural imbalance included better training for surgeons who would then be safely entrusted with rural medical care, SRM 116, Dr. Massie to S.R.M. 23 July 1776. An improved pay schedule to be financed by the government in whole or in part was also proposed, SRM 131, ‘Rapport du mémoire de M. Retz sur la réforme de la Médecine,’ by Dr. Saillant, 19 January 1778. Another suggestion was to relieve the tax burden: ‘The progress of medicine requires that the doctors in the provinces be relieved of taxes; they should not pay the taille, and the narrower the region [they serve], the more consideration ought to be given to it, since it is necessary to pay attention to the sacrifice they are making in renouncing the fortune they would inevitably find in a big city.’ SRM 144, Dr. de Courtive to S.R.M., read at the meeting of the S.R.M., 10 November 1778. There are many examples, in addition, of the great difficulties facing doctors in an alien atmosphere where their merits were unrecognized and their efforts remained unrewarded by a sense of achievement: see SRM 131, François Doucet, maître-chirurgien à Frolois près Ste. Reine en Bourgogne, ‘Mémoire sur l'etat de la chirurgie des campagnes,’ no date.

¹⁹ Guillaume, P., Recueil des réponses faites par la communautés de l'Election de Gap au questionnaire envoyé par la commission intermédiare des Etats de Dauphiné (Paris, 1908).Google Scholar

²⁰ Cf. Bonnin, B., ’Quelques aspects de la vie des classes populaires dans les campagnes dauphinoises dans la première moitié du dix-huitième siècle,’ in Images du peuple au XVIIIe siecle (Paris, 1973), 87–93. Bonnin notes that contemporaries were easily able to discern the major divisions in peasant communities between the small number of more or less substantial peasant proprietors and the mass of the propertyless or morcellaires, but were quite imprecise in making further distinctions.Google Scholar

²¹ Goubert, J.-P., Malades et Médecins en Bretagne, 1770-1790 (Rennes, 1974)Google Scholar; also ‘The Extent of Medical Practice in France around 1780.’ Journal of Social History X (1976–77), 410–27.Google Scholar

²² SRM 144, ‘Tableau de la maladie qui règne à Poireul-la-Ville,’ par Doucet, chirurgien, 8 February 1776.

²³ Foucault, M., The Birth of the Clinic: An Archaeology of Medical Perception, Trans. Smith, A. M. Sheridan (New York, 1973), p. 60.Google Scholar

²⁴ SRM 144, Dr. Deberge, Médecin de épidémies de la généralité de Soissons, ‘Sur la maladie épidémique dans les paroisses de Camelin et Cus de juillet 1785 à la fin de mars 1786 dans la première et de la fin décembre 1785 a mai 1786 dans la seconde.’

²⁵ High urban survival rates were commonly observed. Doctors made the point of distinguishing the deadliness of disease in rural communities from the relative ease of its treatment in the towns. See SRM 145, Dr. P.-J. Boucher, ‘Project d'éstablissement d'un Médecin pensionne pour les epidemies dans la Flandre Wallone à presenter a messieurs les administrateurs de la province,’ Lille, 29 October 1788. Further study is required before an assessment of the survival rates of the urban poor can be made. For a general study of the poor, see Hufton, O. H., The Poor of Eighteenth-Century France, 1750-1789 (Oxford, 1974), a wise and compassionate study.Google Scholar

²⁶ On the question of diet and nutrition, there is a growing literature. It may be sampled by the following: Hémardinquer, J.-J., Pour une histoire de l'alimentation. Cahiers des Annales no. 28 (Paris, 1970)Google Scholar; Ladurie, E. Le Roy, Times of Feast, Times of Famine: A History of Climate Since the Year 1000 (New York, 1970)Google Scholar; Bernard, R.-J., ‘L'alimentation paysanne en Gevaudan au XVIII^e siècle,’ Annales E.S.C., XXXIV (1969), 1447–67.Google Scholar The precise connections between food supplies and disease are a subject of debate. Indeed, virus mutations which are still imperfectly understood probably account for the appearance or disappearance of certain diseases, but must be seen in relationship with changes in material and cultural conditions. I am here arguing simply that malnutrition is a predisposing lethality factor. See Goubert, , op. cit., pp. 312, 382Google Scholar, for his treatment of the question. Appleby, A. B., ‘Nutrition and Disease: The Case of London 1550-1750,’ Journal of Interdisciplinary History, VI (Summer 1975), 1–22Google Scholar, argues that disease is an independent variable. On the interest in ergot, see, among others, the articles and books by the Tessier, abbé, a correspondent of the Société: Traité des maladies de grains (Paris, 1783)Google Scholar; ‘Memoire sur les effects du seigle ergote,‘ Histoire de la Société royale de Médecine avec les Mémoires de Médecine et de Physique Médicale pour la même Année, II, 587–615Google Scholar; ‘Expériences rélatives à Pinfluence de diverses graines sur la qualité du pain des habitants des campagnes,’ ibid., IV, 362–68. See the illuminating article on ergotism in Sologne by Poitou, C., ‘Ergotisme, ergot de seigle et épidémies en Sologne au XVIII^e siècle,’ Revue d'histoire moderne et contemporaine, XXIII (1976), 354–68.Google Scholar

²⁷ I am here referring more to the manner of sexual expression than to its freedom. Doctors were struck by the brusque animality of sexuality in the countryside. At the same time, many of them were convinced that village sexual mores were severe. In a previous article, ‘Resistance to the Revolution in Western France,’ Past and Present, no. 63 (1974), 94–131Google Scholar, reprinted in French Society and Revolution, ed. Johnson, D. (Cambridge, 1976), 248–85Google Scholar, 1 suggested that sexual repression was operative in the countryside. Since then, Ladurie, E. Le Roy, ‘Ethnographie rurale du XVIIIe siècle: Rètif, à la Bretonne,’ Ethnologie française, new series, II (1972), 215–52Google Scholar (although dated 1972, the article came off the press later), has confirmed this view especially in his discussion of paternal authority as the guarantor of sexual chastity. At the same time, there is evidence that preconjugal sexual practices in rural areas were permitted as a prelude to eventual marriage and followed prescribed rituals and rules in which parents acquiesced and were largely supervised by the young people themselves. On these matters, see Flandrin, J.-L., Les amours paysannes (XVI^e-XIX^esiècles) (Paris, 1975)Google Scholar; Lebrun, F., La vie conjugale sous l'ancien régime (Paris, 1975)Google Scholar; and especially Ussel, J. Van, Histoire de la répression sexuelle (Paris, 1972).Google Scholar It may be that the terms sexual repression and sexual freedom are inherently self-limiting, and that forms of sexual expression were more closely related to economic and social realities. In the case of the countryside, premarital sexual practices were often dictated by the limitations of income and by the need to prove fecundity. Hence there was sexual ‘freedom’ but usually with a prospective marriage partner. This kind of sexual expression is hardly equivalent to sexual freedom as we know it. See also Depauw, J., ‘Amour illégitime et Société à Nantes au XVIII^e siécle,’ Annales E.S.C., XXVII (1972), 1155–82, especially the section on premarital conceptions.Google Scholar

What impact the prevailing medical view on the dangers of premature sexual union before man reached his ‘full’ virility (usually set between the ages of 21 and 25) had in the countryside is hard to determine, but it is improbable that it was great. The fears doctors expressed of spermatic loss, by contrast, probably made a greater impression in urban bourgeois society and may have filtered down to rural people in the nineteenth century. For beliefs in the deleterious effects of spermatic loss, see Journal de me'decine, chirurgie, et pharmacie, LXVIII (1786), 429–35Google Scholar; LXIX (1786) 284–86; Boyveau-Laffecteur, , Traité des maladies physiques et morales desfemmes (4th ed., Paris, 1812).Google Scholar

²⁸ In her two brilliant studies, Purity and Danger: An Analysis of Concepts of Pollution and Taboo (London, 1966)Google Scholar and Natural Symbols. Explorations in Cosmology (London, 1970).Google Scholar Mary Douglas discusses the constraints of the social structure on individual perceptions of the body. I owe much to the clarity of her thought on these questions. Cf. also, Peter, , ‘Les mots et les objets de la maladie,’ p. 34.Google Scholar On Bakhtin's, M. treatment of the theme of the lower bodily parts, see his Rabelais and His World, trans. Iswolsky, H. (Cambridge, Mass., 1968).Google Scholar

²⁹ SRM 85, report from Le Comte in the subdélégation of Dunleroy généralité of Bourges, 21 June 1786. The first, serious attempt to come to terms with the social and psychological realities of childbirth in the countryside is offered by Laget, M., ‘La naissance aux siecles classiques. Pratique des accouchements et attitudes collectives en France aux XVII^e et XVIII^e siècles,’ Annales E.S.C., XXXII (1977), 958–92.Google Scholar On the displacement but not the total disappearance of the midwife, see J. Gélis, ‘Sages-femmes et accoucheurs; l'obstétrique populaire aux XVII^e et XVIII^e siècles,’ ibid., 927–57.

³⁰ SRM 134, Dr. Mallet de la Brossière, ‘De la fièvre miliaire de PAbbaye de Savigni en Basse-Normandie,’ 29 July 1790.

³¹ Barthez, M., Nouveaux éléments de la science de I'homme (Montpellier, 1778), I, p. 290.Google Scholar

³² SRM 143, Dr. Berthe, ‘Les Maladies peuvent-elles être guéries par les seules forces de la nature?’ no place, no date.

³³ SRM 145, Dr. du Boueix, ‘Mémoire sur les dysenteries épidémiques qui ont régne depuis la fin d'août 1779 dans une grande partie du comté Nantais… surtout dans les campagnes voisines de Clisson,’ Clisson, no date.

³⁴ SRM 147, Dr. Deberge, Médecin-en-chef des épidémies et professeur de Part des accouchements du département de l'Aisne to Dufour. 20 January 1790.

³⁵ T.R., ‘Notes sur les pratiques médicates usitées chez les Indiens du Perou,‘ Bulletin des science médicates, V (1810), 343.Google Scholar

³⁶ SRM 137, Crenolle to Vicq d'Azyr, St. Omer, 3 November 1779.

³⁷ From the English translation of Tissot's, S. A.Avis au peuple. Advice to the People in General with regard to their Health (London, 1766), p. 574.Google Scholar

³⁸ SRM 137, Maury to S.R.M., 7 April 1785.

³⁹ Didelot, M., Avis aux gens de la campagne ou traité des maladies les plus communes (Paris, 1772), p. 92.Google Scholar See also DrLorentz, , ’Mémoire médico-topographique de la ville de Schelestat,’ Journal de Médecine militaire. III (1784), 173Google Scholar: ‘There are few of our peasants who do not themselves draw off a pound of blood in the month of May, although they are very well, while they fear being bled in the course of illnesses which demand such treatment, especially if it is on a day which an almanac does not favor.’ Another doctor said that he was opposed to such drastic measures, because the physical condition of peasants could not tolerate them. See DrVetillart, , Histoire médicale des maladies dyssentériques qui affligent la province du Maine en 1779, pp. 21–22,26–28.Google Scholar On the almanacs, see Bollème, G., Les almanachs populaires aux XVII^e et XVIII^e siecles (Paris-The Hague, 1969).Google Scholar

⁴⁰ SRM 110, Dr. Clementis, ‘Mémoire sur une épidémie de petite verole qui a régné à Forcalquier en 1778.’

⁴¹ Suchet, L., Topographie physico-médicale de Chalons-sur-Saône (Paris, 1820), p. 166.Google Scholar

⁴² Davis, N. Z., Society and Culture in Early Modern France (Stanford, 1975), p. 244.Google Scholar

⁴³ SRM 131, Dr. Nicolas, ‘Mémoire sur la nécessité et les moyens d'etablir une police médicale en France, et les avantages qui en résulteraient pour l'état et pour les sujets,’ read at the 4 March 1777 meeting of the S.R.M.

⁴⁴ SRM 136, Dr. Baumes to S.R.M., 4 June 1787.

⁴⁵ SRM 137, Dr. Maury to S.R.M., 1 July 1782. For a study of folk-healing in a modern setting, see Romano, I. O. V., ‘Charismatic Medicine, Folk-Healing, and Folk-Sainthood,’ American Anthropologist, LXVII (1965), 1151–73.Google Scholar Romano's study is of Mexican-Americans in southern Texas. Boltanski, L., ‘Les usages sociaux du corps,’ Annales E.S.C, XXVI (1971), 232–33Google Scholar, argues that peasant societies relinquish their own collective discourse on the body and its needs and accept the medical specialist's on the grounds that they value and esteem his expertise more highly than they do the competence of members of their own culture. This reasoning overlooks the special esteem in which peasants held their own healers. They did not necessarily accord greater value to figures outside their own culture. Doctors were probably sought out as a last resort, and as doctors freely admitted their intervention was ineffective because peasants had followed the advice of their folk-healers, the steps in the healing hierarchy were only peripherally modified.

⁴⁶ SRM 107 contains a large number of these throwaways. On the reception given by learned medicine to medical recipes and cures devised by nonacademic healers, see M. Ramsey, ‘Popular Medicine and Medical Enlightenment: The Regulation of Secret Remedies in the Ancien Regime,’ a paper read at the meeting of the Society for French Historical Studies, Berkeley, April 1977. Ramsey, has another study on the subject, ‘Medical Power and Popular Medicine: Illegal Healers in Nineteenth-Century France,’ Journal of Social History, X (1977), 560–87.Google Scholar See also Goubert, J.-P., ‘L'art de guerir. Médecine savante et Médecine populaire dans la France de 1790,’ Annales E.S.C., XXXII (1977), 908–26Google Scholar, for his attempt to define charlatanism and his rescue of popular healers from the critiques of the professionals. There is evidence that the Gazette de Sante which was edited by Dr. M. Marie de Saint-Ursin in the Napoleonic period was asking on what grounds and against what measurements the distinctions between empirics and empiricism could be made. This is an area which I shall be pursuing. An interesting study in a related field provides evidence that scholars are perturbed by the ethnocentric pretentions of some members of the medical profession: ‘The rational-empirical elements were assiduously culled from their cultural contexts and touted as embryonic forms of modern medicine. The magical-religious- elements were held to be outside of the developmental line of modern medicine.…’ See Kleinman, A., ‘Social, Cultural, and Historical Themes in the Study of Medicine in Chinese Societies: Problems and Prospects for the Comparative Study of Medicine and Psychiatry,’ in Medicine in Chinese Cultures: Comparative Studies of Health Care in Chinese and Other Societies, ed. Kleinman, A., Kunstadter, P., Alexander, E. R. and Gale, J. L. (Washington, 1975), p. 590.Google Scholar

⁴⁷ See, for example, SRM 131, Dr. Calés, ‘Mémoire sur les abus en Médécine,’ Séguenville, post-1789 and SRM 116, abb´e Adézene, ‘Observations sur les maladies épidemiques,’ Béziers, no date. The abbé’s attack may have been prompted by the unmistakable signs of rivalry between priests and doctors who accused the former of engaging in matters that were not their proper concern. Doctors included hospital sisters in their condemnation. A doctor-regent of the University of Paris castigated the negligence, malversation, and arbitrary treatment in charity hospitals where the religious brothers and sisters dispensed ineffective and injurious drugs and even performed small operations with disastrous results: SRM 131, ‘Mémoire sur l'administration et le service de santé des hôpitaux de charité destinés au traitement des malades,’ 29 January 1777. The Gazette de Santé 11 November 1807, charged that it was indecent and dangerous to permit the clergy to assume medical roles, since their spiritual duties were in flagrant contradiction with their attempts to deal with the body. On the other hand, some doctors praised the cures for their assistance to the poor and even thought of enlarging their therapeutic role. This was the position taken by Ballexserd, J., Dissertation sur cette question: Quelles sont les causesprincipales de la mort d'un aussi grand nombre d'enfants, et quels sont les preservatifs les plus efficaces et les plus simples pour leur conserver la vie? (Geneva, 1775), p. 84.Google Scholar

⁴⁸ According to the Gazette de Santé (no. 1, 1785 and no. 15, 1787), young doctors who wished to establish a reputation, together with small printing companies who knew how to exploit the market, combined forces to produce these books which circulated in France, England and Germany, each translated from its original version. In reviewing an historical bibliography on medicine by M. Retz which had appeared in three successive years from 1785 to 1787, the Gazette commended its author for distinguishing the useful from the bad books on medicine.

⁴⁹ See, for example, the large compendium by DrNicolas, , Nouveau dictionnaire universe! et raisonne de Médecine, de chirurgie et de I'art veterinaire contenant de connoissances étendues sur toutes ces parties, etc.ouvrage utile à toutes les classes de citoyens, sur tout aux habitants de la campagne et mis à leur portée, 6 vols. (Paris, 1774).Google Scholar These were not self-help books, but rather books of advice for the local elite groups, for seigneurs and their wives, cure's, teachers of the young, qualified midwives, the occasional literate laboureurs, as well as doctors, surgeons and apothecaries. This literature is to be distinguished in most cases from the items in the bibliothe'que bleue. The physicians, however, were critical of both. Cf. Goubert, ‘L'art de guerir …,’ who found no reference in the materials he consulted (the administrative surveys of the Contrôle générate in 1786 and of the Constituent Assembly's Comité de salubrite in 1790 to condemnation of popular manuals or journals on health. This is indeed curious. Perhaps the physicians were less reticent in expressing their hostility to this kind of publication among themselves and through the established channels of communication they possessed with the Société.

⁵⁰ Pinel, P., ‘Mémoire sur la manie périodique ou intermittente,’ Mémoires de la Société d'Emulation, I (an VI–1798), 119.Google Scholar Rousseau was accorded high status, however, by doctors who endorsed his views on maternal breastfeeding and swaddling.

⁵¹ The list of diseases which are here presented is based on the findings in Peter's articles, op. cit. and Goubert, op. cit. Although the latter's study is concerned with the incidence of disease in Brittany, it is a fair guide to the geography of disease in other parts of the country.

⁵² SRM 137, Dr. Souquet, ‘Observations sur les maladies qui ont régné en Boulonnais pendant l'annee 1776.’

⁵³ SRM 121, Dr. Lejan, ‘Description de l'épidémie de Dann,’ no date. On the reluctance to seek medical help, see the additional following examples: 'As the sick constantly eluded the care and attention which they are sure of receiving from the government, as in general they were seen by their curés only when the fear of imminent death brought them, as well as their relations, out of their repugnance and their numbness, as the surgeons were called only after they have appealed for spiritual help, I have, in my visits to the countryside, found only registers for the dead.’ Méthode pour subvenir au secours des habitants de la campagne et même des villes qui sont pris de la maladie régnante. Dirigée par M. Dupichard, correspondant des maladies épidémiques et publiée par ordre de M. Du Ouzel, intendant de la généralité de Tours (Tours, 1783), p. 6. ‘It seems to us impossible to halt the progress [of smallpox], unless we stay there [Arcueil, south of Paris] and keep an eye on it. One cannot be deluded in thinking that one would succeed in ensuring that our prescriptions would be observed, nor in preventing the spread [of the disease], but one would at least cure the greatest abuses…,’ SRM 137, Drs. Caille and Soulet, ‘Sur l'invitation de la Société Royale de Médecine qui désiroit connaître ce qui passe à Arcueil rélativement à la petite vérole,’ no date. ‘Almost all the sick have been led to their graves without having known the nature of their illnesses, because the custom here is to call on the doctor only for serious illness. It is the surgeon rather than the doctor who practices medicine here.… Here there is very little money which is doubtless why the doctor is often overlooked.’ SRM 137, Dr. Maury to S.R.M., Sézanne, 3 April 1789.

⁵⁴ SRM 145, Dr. du Boueix, op. cit.

⁵⁵ DrRollan, M., ‘Mémoire sur la situation et le sol de la ville de Maubeuge et de ses environs,’ Journal de Médecine militaire, II (1783), 456.Google Scholar

⁵⁶ SRM 136, Dr. Barbolain to S.R.M., ‘Mémoire sur une maladie epidémique qui a régné dans les environs de Joinville en Champagne sur la fin de l'année 1779 et pendant les mois de Janvier et février de 1780.’

⁵⁷ SRM 135, Sellier to S.R.M., Amiens, 3 October 1786. There are numerous instances in which the doctors complained of peasant fatalism and compared it with similar beliefs in other cultures. Sellier, who was an architect, adduced the Turkish example of submission to the plague, to make his point.

⁵⁸ SRM 116, Dr. Desfarges to S.R.M., 20 November 1785: ‘The peasants do not appeal to anyone. They believe there is nothing to be done. Moreover, the priests tell them that their hour is decided and that it is useless to spend money for remedies that will not help.’ Coleman, ‘The People's Health,’ argues that rigorous deterministic views were not the key to popular attitudes to disease. Yet much of the evidence he cites may be analyzed in that way, especially Christian admonitions to the poor to ‘suffer, obey and die,’ see esp. 69–71.

⁵⁹ SRM 136, Barbolain, op. cit.

⁶⁰ Rochard, Professeur, Programme du cours des maladies épidémiques (Strasbourg, an XIII), pp. 12–14.Google Scholar

⁶¹ See Bion, J., ‘Est-il utile de tromper le peuple,’ in Images dupeuple…, 187–99. The Berlin Academy of Sciences and Belles-lettres in 1780 sponsored a competition on this question. According to Beguelin, who acted as referee, those who took the affirmative did so on the grounds that a radical and sudden improvement in popular enlightenment was unlikely. It therefore followed that policies were needed to prevent the misfortunes that the people themselves would create through their own ignorance. The two sides to the question, Bion argues, epitomized two antagonistic methods and hopes: the one stressed the educative and controlled function of the elites, while the other apotheosized the autonomous will of the people. Castillon, author of a critique of Holbach's Système de la nature, feared the sudden dispersal of error. Some errors, he wrote, could be useful and some truths could be too sad. Progress consisted for him in a movement from large to smaller errors. This position is quite clearly identical with the view of the physician I have cited.Google Scholar

⁶² On the subject of the cultural determinants of pain as well as on its phenomenology, there is a growing interest. For a brief, but stimulating introduction, see Illich, I., Medical Nemesis (London, 1975), pp. 93–108.Google Scholar See Fabrega, H. Jr., Disease and Social Behavior, an Interdisciplinary Perspective (Cambridge, Mass., 1974), pp. 239–40. Other works that have been useful are:Google ScholarWolf, B. C. and Langley, S., ‘Cultural Factors and the Response to Pain: A Review,’ American Anthropologist, LXX (1968), 494–501Google Scholar; Zborowski, M., People in Pain (San Francisco, 1969)Google Scholar; Bakan, D., Disease, Pain and Sacrifice, Toward a Psychology of Suffering (Chicago, 1968)Google Scholar; Szasz, T., Pain and Pleasure (New York, 1957)Google Scholar; de Moulin, D., ‘A Historical-Phenomenological Study of Bodily Pain in Western Man,’ Bulletin of the History of Medicine, XLVIII (1974), 540–70.Google ScholarThe Dictionnaire des sciences médicales, X, 178–239, in its article on pain by Dr. Renauldin, notes the cultural variations in pain response, and goes on to discuss the connections between pain, climate, temperament, sex, age, passions, occupation and so on: ‘In general, the man who leads a hard and fatiguing life, feels pain less vividly, than the sybarite or the effeminate man who is wounded by the fall of a leaf.’Google Scholar

⁶³ Thiaudiere, P. D, De l'exercise de la Médecine en province et à la campagne (Paris, 1839), p. 34. While this source is from a later period, its author's approach is identical with that of his earlier colleagues.Google Scholar

⁶⁴ SRM 126, Dr. Pujol to S.R.M., [?] 1789.

⁶⁵ See Boltanski, , op. cit., 212.Google Scholar

⁶⁶ Vetillart, , op. cit., p. 29.Google Scholar

⁶⁷ SRM 143, Dr. La Servolle to S.R.M., 29 January 1778.

⁶⁸ Ganne, A., L'homme physique et moral, ou recherches sur les moyens de rendre I'homme plus sage, et de le garantir les diverses maladies qui iaffligent dans ses différens âges (Strasbourg, 1791), p. 111.Google Scholar

⁶⁹ Lavergne, L.-M., Essai sur la topographic medicale de Lamballe et de ses environs en 1787 (Lehon, 1959), p. 12.Google Scholar

⁷⁰ Much of this concern can be found in memoirs on hereditary illnesses and on puericulture. As an example of the first, see SRM 120, Dr. Pujol, ’Mémoire sur les maladies hereditaires,’ no date; and of the second, ibid., Dr. Baumes, ‘Mémoire sur l'education physique des enfants pour servir de reponse a la question proposee par la Société Royale de Médecine à Paris dans la séance publique du mardi onze mars 1783.’ For an earlier discussion of the problem, see Ehrard, Jean, L'idée de nature en France dans la premiè;re moitié du XVIII^e siècle, 2 vols. (Paris, 1963), II, pp. 375–96, 575–608, 673–717.Google Scholar

⁷¹ SRM 131, Dr. W. Munnicks, ‘Des moyens pour détruire des abus qui s'opposent à la conservation des enfants en France, et qui pourront en même temps contribuer à fortifier les témpéraments des générations présentes et futures,’ Groningue, 31 August 1784.

⁷² SRM 115, Dr. Devaulx, ‘Observations et réflexions relatives aux moyens de perfection-ner l'art de guérir,’ Roanne en Forez, 1790 and 1791.

⁷³ Didelot, , op. cit., pp. 63–64.Google Scholar

⁷⁴ SRM 131, Dr. M. Nicolas, ‘Mémoire sur las nécessité et les moyens d'etablir une police médicale en France, et les avantages qui en résulteraient pour l'état et pour les sujets,’ Grenoble, no date. Read at the meeting of the S.R.M., 4 March 1777.

⁷⁵ DrNicolas, M., Mémoires sur les maladies épidémiques qui ont régné dans la province de Dauphiné depuis l'année 1780 (Grenoble, 1786), p. 122. Nicolas proceeded to outline in precise detail the kinds of food that should be distributed to the ‘genuine poor.’Google Scholar

⁷⁶ See the views of P.-M. Rolland, surgeon at Morlaix, SRM 130, ‘Mémoire ou projet d'établissement de charité pour le département de Finistère sur les épidémies rurales, les accouchements et le nourissage mercénaire, soumis à l'inspection de la S.R.M.,’ 28 January 1791. For the sick beggars, he suggested employment on the public works; for the indigent day workers, he cautioned against hospital treatment, since, chronically ill [des infirmiers naturels], they could never be persuaded or forced to leave their villages. Moreover, they were the backbone of agriculture and were needed to till the soil.

⁷⁷ See Foucault, , op. cit.Google Scholar for further discussion of this point. Similar observations have been made by Figlio, K., ‘The Historiography of Scientific Medicine: An Invitation to the Human Sciences,’ Comparative Studies in Society and History, XIX (1977), 262–86.Google Scholar Figlio's contributions to the discussion on how to relate the history of medicine to the larger questions of social and economic change are immensely important. See two of his earlier articles, ‘Theories of Perception and Physiology of Mind in the Late Eighteenth Century,’ History of Science, XIII (1975), 177–212Google Scholar and ‘The Metaphor of Organization: An Historiographical Perspective on the Bio-Medical Sciences of the Early 19th Century,’ ibid., XIV (1976), 17–53.

⁷⁸ See Waddington, I., ‘The Role of the Hospital in the Development of Modern Medicine: A Sociological Analysis,’ Sociology VII (1973), 212–24. I don't agree entirely with Wadding- ton's claim that workers, whether rural or urban, were exempt from the anxieties of having to expose their bodies to the gaze of the outsider. They quite simply had no choice..Google Scholar