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
practica
(first edition, 1629) and Lazare Rivière’s
Praxis medica
(first edition, 1640, translated
into French in 1682), two books whose structure is very
similar to Bernard de Gordon’s Practica or to
Arnaud de Villeneuve’s Praxis medicinalis
(written before 1300 and re-edited for the last time in
1586).Nevertheless, 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)
[7] or by Guillaume Rondelet: Methodus
curandorum omnium morborum corporis humani…
(1573),
all suggest that the use of an old term is
avoided (quite significantly, Rondelet added to the
internal title of his book "Curandi morbo Methodus,
quae vulgo practica dicitur"); those by Jacques
Dubois and Leonhart Fuchs, respectively Ratio medendi
morbis internis prope omnibus... (1549)
and De
Medendi methodo (1539)
, clearly reveal the
competition with Galen’s model of Methodus medendi.
This major text, "restituted" by Linacre in 1519, had
indeed a profound impact on the conception and the
writing of 16th century therapeutic works
[8]. It probably contributed to deterring a number of
authors from writing Practices in favor of books
that had an exclusively therapeutic content, the
most famous example of which (and the most imitated in
France) certainly being the Thérapeutique by Jean
Fernel, third part of his Medicina
(1554,
completed after his death and translated into French in
1655) [9]. 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,
1625
) or François De Le Boë known as Sylvius (Praxeos
medicae idea nova, 1671-4
). Both authors presented a
categorization of diseases that was mainly based on the
declension of the affected senses and functions, then on
the pains and disorders of excretions (for Platter), or
on the affected humors (for Sylvius), or else under a
third, ‘hybrid’ form, characterized by the
addition of consultations or illustrative cases.
The latter form seems to have appeared in France with
the "Loix de médecine pour procéder méthodiquement à
la guérison des maladies, pratiquées sur toutes sortes
de maladies, es consultations faites avec des plus
célèbres médecins de ce temps" (Medical laws to
methodically cure all sorts of diseases, with
consultations by the most famous physicians of the time)
by Nicolas Abraham de La Framboisière
(1608, re-edited
several times), who proposed three general
methodological chapters ("Pour les discerner [les
maladies]" (To differentiate [the diseases]), "Pour juger l’issue de la maladie" (To appraise the outcome of
the disease), "Pour bien penser la maladie" (To cure the disease appropriately)) before following the
a capite ad calcem order to present the
diseases, each one being illustrated at the end of the
chapter with one or several personal consultations (the
fevers appear in the chapter on heart diseases). This is
also the form that Abraham Zacuto or Zacutus chose: his
Praxis historiarum, in qua morborum omnium internorum
curatio ad principum medicorum mentem explicatur…
(1643,
re-edited several times) is composed of a series of
observations made on the "princes of medicine" (Galen,
Avicenna, Rhazes, etc.), classified in
the a capite ad calcem order, and followed (or
preceded, according to the editions) of a perfectly
classic Practica, structured in short chapters
that follow the same order. As for Felix Platter, he
wrote a separate book of observations, Observationum,
in hominis affectibus plerisque, corpori et animo,
functionum laesione, dolore, aliave molestia et vitio
incommodantibus, … ad Praxeos illius tractatus tres...
accommodati
, which he classified, as the title
indicates, in the order of the senses and damaged
functions already given in his Practice.The 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
), but neither
the content nor the structure of the book corresponded
to the forms of the Practica; they did not create
a precedent either [10]. The same goes for books dealing
with various aspects of practical medicine in the 18th
century, notably for two very influential books by
German physicians: Medicinae rationalis systematicae
by Friedrich Hoffmann (translated into French under the
title Médecine raisonnée [Reasoned Medicine]
in 1739
) and the
Traité de l’expérience en général,
et en particulier dans l’art de guérir [Treatise
on experience in general, and on medical experience in
particular] (1774)
by Johann Georg Zimmermann
(translation of Von der Erfahrung in der
Arzneykunst..., 1763-4, re-edited until the 1820s)
[11]. With the French translation of Synopsis
nosologiae methodicae by the Scottish author William
Cullen in 1785, both by Pinel under the title Institutions de médecine pratique [Institutions
of Practical Medicine]
or by Bosquillon under the
title Eléments de médecine pratique [Elements
of Practical Medicine], the genre of the practice
found its last, in extremis illustration in
France before the Revolution. Indeed, in spite of his
original title evoking a nosological work, Cullen used a
structure in short chapters that tackled the
etiological, diagnostic, prognostic and therapeutic
aspects of diseases (classified in fevers, phlegmasia,
rashes, hemorrhages, fluxions, nervous diseases,
adynamia and spasmodic affections, vesania, general
swelling and skin diseases).
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 1573
) and of Van Foreest’s
Observationum et curationum medicinalium…
(first edition 1587
) – two authors who explicitly
inscribed their work in the tradition of the Hippocratic
Epidemics – probably account for this extremely
important evolution of semantic usage. Basically
stabilized at the beginning of the 17th
century, the terminology used by the authors then allows
one to identify without difficulty two sub-genres
of collections of particularia: that of the
collections of consilia, that have become
"consultations" in French, and that of the collections
of "observations," soon the most quantitatively
important [14].In 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
, written in the years 1570-90 and published in
1635 (almost 20 years after their author’s death), it is
not before the years 1740-45 that works featuring the
(also posthumous) consultations by Pierre Chirac and
Jean-Baptiste Silva, by Louis-Jean Le Thieullier and
then by various physicians from Montpellier were
published; those by Paul-Joseph Barthez were published –
once again posthumously – in the years 1807-1810. 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
, entitled
De admirandis
curationibus et predictionibus morborum, presented a
series of cases that were particularly enhancive to the
author), some collections present a great
historiographic interest for their very precise
description of symptoms as well as for the details they
provide on both the way patients were cared for
and the way the treatment was perceived. The collections
by Baillou (Epidemiorum et ephemeridum, 1640
), Rivière (Les
observations de médecine,
1688
) or De Le Boë (a series of 32 clinical cases on the
model of the Hippocratic Epidemics, with a
day-to-day evolution, collected in the 1660s, and given
at the end of his Opera medica, 1681
) are
particularly remarkable.
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
, re-edited in 1724 and 1745), which must have
contributed to popularizing Celsius and his more simple
views on hygiene, merely requiring moderation and
temperance and believing in "nature" for everything
else. 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
1673
), a new translation by Michel Le Long (1633,
re-edited in 1637
, 1643, 1649 and 1660) and a burlesque
version in rhyming verse by Martin (1650, re-edited in
1657, 1660, 1664 and 1680).This 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
), by André
Du Laurens (Discours de la conservation de la veue,
des maladies mélancholiques, des catarrhes et de la
vieillesse [Discourse on the conservation of eyesight,
on melancholic diseases, catarrhs and old age],
1594, re-edited in 1597
, 1600, 1606, 1608, 1615, 1620
and 1630) and probably discouraged any original creation
in the field. The books by Porchon (Les
Règles de la santé, ou le Véritable régime de vivre que
l’on doit observer dans la santé et dans la maladie… [The rules of health, or the true health code
one should follow in health as well as in disease],
1684
and 1688) and Pinsonnat (Régime de santé pour se
procurer une longue vie et une vieillesse heureuse…
[Health code for a long life and a happy old age],
1686 and 1690
), presenting the most traditional rules
for hygiene under the form of pleasantries, anecdotes
and little stories, attest indeed to the almost dilettante manner in which physicians tackled
hygiene at the end of the "grand siècle". 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
, several times re-edited, and by
George Cheyne’s book (Essai sur la santé et sur les
moyens de prolonger la vie [Essay on health and on the
ways to prolong life], translated from English in
1725
and re-edited several times), always structured by
the six things (in the following order
: air, food and drink, sleep and wake,
exercise and rest, evacuations and obstructions,
passions) but with no allusion to sexuality any longer.
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…
; and the series of the
Examen omnium
catapotiorum, vel pilularum...; electuariorum, pulverum,
et confectionum..., loch.., simplicium
medicamentorum..., trochiscorum, vnguentorum, ceratorum,
emplastrorum cataplasmatumque, et collyriorum, quorum
apud Ferrarienses pharmacopolas usus est
) and also
with Jacques Dubois, who commented upon pseudo-Mesue’s
Canons (Ioannis Mesuae Damasceni de re medica
libri tres, 1561), but most importantly was the
first author to use the Greek term ‘pharmacopoeia’ to
refer to the knowledge necessary to both physician and
apothecary (Pharmacopea, his, qui artem medicam, et
pharmacopeam tractant exercentque, maxime necessarii
1548). This book, translated into French in 1574 and
several times re-edited until 1625
, proposed a
particularly clear synthesis presenting both all the
"simple" remedies that could be used and the way to
prepare them (roots, herbs, flowers, seeds, fruits,
wood, barks, saps, liqueurs, resins, gums, metallic and
terrestrial and animal), i.e. what was called the
"medical material," on the model of De materia medica
by Dioscoride, several times edited and commented upon
since 1478 ; and all the "compound" remedies, separated
into remedies for internal use (preserves, syrups, elegmas (or potions), apozems, electuaries, pills,
trochisci, powders) and remedies for external use (oils,
ointments, cold creams and plasters) [22]. The order in
which Dubois chose to present the compound remedies, not
very different from that of Grabadin, was used again by
Laurent Joubert in his Pharmacopoeia (1579,
re-edited in 1581 and 1588
), although the latter divided
the (compound) internal remedies into "preparative"
remedies (syrups, preserves), "evacuative" remedies
(electuaries, pills, elegmas) and "fortifying" remedies
(opiates, powders, tablets, trochisci), then by Brice
Bauderon (whose 1595 Pharmacopoeia
was re-edited
a great number of times until 1681). The persistence of
this categorization, very similar to that of Grabadin,
reflects the long influence of pseudo-Mesue on the early
modern period, an influence that also bore quite
directly on – among others – François Ranchin’s Œuvres
pharmaceutiques (1624,
re-edited in 1628
and 1637), which were "dictated to the
pharmacist companions" and notably included "a learned
commentary on the four theorems and canons by Mesue,"
whose text, as well as a "treatise on simple purgative
remedies after Mesue," was presented in Latin, in
French, then commented upon.Moyse Charas, in his Pharmacopée
royale galénique et chimique (Royal Pharmacopoea,
Galenical and Chymical)
published in 1676, was the
first author to adopt both a formally different
structure and a different content for pharmacopoeias
[23]. In this work (re-edited in 1682, 1691 and
1753, translated into Latin in 1684), the "apothecary of
the King’s Garden" – who was protected by Antoine
d’Aquin, first physician of Louis XIV who was to become
the "physician-chemist to the King of England" – broke
all the codes of previous pharmacopoeias (even in the
new title, which nonetheless reminds one of La
royalle chymie [The Royal Chemistry], title given to
the French translation of the Basilica chymica by
Oswald Croll in 1624
) to collect on the one hand the
"so-called Galenic pharmacy of the Ancients" and on the
other the "chemical pharmacy of the Moderns," which had
just won decisive successes [24] and was entering its
phase of assimilation. After a first part presenting the
various ways to prepare remedies, far more numerous than
in Dubois, Charas presented, in volume 1, the internal
"Galenic preparations" (infusions and decoctions, juleps
and apozems, emulsions, potions and boluses,
masticatories, injections, clysters and suppositories,
wines and vinegars, robs, preparations, jellies,
preserves, syrups, honeys, potions, tablets, powders,
opiates and electuaries, trochisci, pills), then the
external preparations (oils, balms, ointments and cold
creams, plasters, cataplasms, fomentations and baths,
epithems, escutcheons, perfumes, frontals, lotions and
collyria); then, in volume 2, the "chemical
preparations" of vegetables (distillations, tinctures,
elixirs, extracts, salts), of animals (human cranium,
blood and urine, viper, harts’ horn, toad, etc.)
and finally of minerals and metals (stones, coral,
pearl, aqua fortis, alum, vitriol, sulfur, arsenic,
gold, silver, iron, mercury, antimony, etc.)
before concluding with a collection of "particular
remedies taken from several famous authors" (mostly from
d’Aquin). The Universal Pharmacopoeia by the
Cartesian chemist Nicolas Lémery [25], published in 1697
(re-edited in 1716, 1729, 1734, 1738 and 1764
),
accompanied by the Dictionnaire ou traité universel
des drogues simples [Dictionary or Universal Treatise of
Simple Drugs]
, a work that belonged to the
″Universal Pharmacopoeia″ (1698, re-edited in 1714,
1727, 1733, 1759) brought to completion the "ecumenical"
synthesis Charas had started and established the
fusion of the two traditions in a single two-part unit :
the Pharmacopoeia, whose structure in three parts
(preparation of the substances, internal compositions,
external compositions) allowed one to integrate the
substances and remedies that came from chemistry into
the traditional categories – for example, an antimonial
"emetic wine," a diatartar powder with vitriolic tartar,
a trochiscus with lead, a pill with mercury or a
magnetic plaster or human blood plaster
; and the
Dictionary, which
presented on an equal footing all the vegetal, animal,
mineral and metallic substances and juxtaposed aloe with
antimony and human cranium with crocuses (while at the
same time going back to the alphabetical order that had
not been used since Nicolas’s antidotary).
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 futuro
(re-edited in 1548 and 1561), he elaborated (for the
benefit of students) "dividing tables" (in the form of
Porphyrus trees) presenting all the "differences"
(sorts) of diseases and their causes, as well as the
differences and causes of the symptoms, from the
treatises De differentiis et causis morborum et
symptomatum, then tables of all the signs of health,
neutral state or disease, from the treatises of the Ars medica (mainly), the
Temperaments, the Affected Loci, the
Pulse and the Commentary on the Hippocratic Prognosis. Of note,
Dubois gave a very restricted part to the treatise On
the Affected Parts, nor did he mention the method to
localize troubles enunciated in chapter 5 of Volume 1,
whereas both Argentorio (in his 1558 De morbis,
popularized in France by Le Thielleux [Methodus
dignoscendorum morborum, primum quidem tradita ab
Argenterio, deinceps autem exemplis multis ex veteribus
medicis et recentioribus desumptis adducta, 1581
])
and especially Fernel (Pathologia, 1554
)
considered this method to be essential to get to know
the disease affecting the patient.
The 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
). It
probably contributed to eclipsing the approaches of
Dubois, Argentorio/Le Thielleux and Rondelet, whose De dignoscendis morbis, associated with
the
Methodus curandorum omnium morborum corporis humani…
(1573), proposed an interesting method "facile omnes
morbos cognoscendos optimo ordine descripta" that
also resorted to Porphyrus trees [31], or of Du Port (De
Signis morborum libri quatuor, 1584, written in
verse, with annotations at the bottom of the page,
probably for the benefit of students). Excepting the
very Galenic Simiotice, sive de signis medicis
tractatus by Thomas Feyens
(1663, re-edited in 1664)
[32], the production of the 17th and 18th
centuries concerning semiology, diagnosis and prognosis
was extremely scant, and it was mainly devoted to the
question of crises and to the study of pulse and urines
[33]. For these three topics, which had been the object
of specific literatures since Antiquity, and on which we
will not further insist here [34], the production of the
early modern period did not feature any major work,
except maybe for the Dissertation on urines by
Thomas Willis
(1670, and 1683 for the French
translation) which incorporated the novelties of the
chemical analysis of salts obtained after evaporation
and distillation of urine, and the Recherches sur le
pouls, par rapport aux crises [Research on the pulse]
by Théophile de Bordeu (1756, re-edited in 1768
and
1779).
The line between practice
and theory: pathology and nosology, from Fernel to Pinel
Despite the large success of the
Medicina
and the numerous (Latin and French)
editions of its various parts (physiology, pathology,
therapeutics) in the 16th and 17th
centuries, Fernel’s separation of pathology from
therapeutics did not give way to the emergence of
a literary genre symmetrical to that of the
"therapeutics" which developed, as previously mentioned,
at the end of the 16th century, and one had
to wait for the second half of the 19th
century to witness the development of "medical
pathologies." The dynamics proper to etiological,
physio-pathological and semiological knowledge on the
one hand and to therapeutic knowledge on the other,
underlain by the differential interests of physicians –
and of the societies in which they lived – for these
parts of medicine, which Fernel might have intuited,
certainly did not favor the fast development of the
genre of "pathologies." By regrouping etiology and
semiology, which were separated in the traditional
categories, in order to create "pathology" or "discourse
on diseases," considering "their genres and […]
differences, their causes and the signs through which
they can be discerned," at the heart of the theoretical part of medicine, Fernel probably was
too innovative – or maybe too transgressive – to
have immediate followers, even if he was renewing a
tradition that had already been illustrated in Antiquity
by Aretaeus of Cappadocia [35]. The pregnancy of the dynamic conception of disease still opposed too
strongly the development of a science of diseases based
on the species and their distinction [36]. Very few
authors actually used the term ‘pathology’ as
Fernel did before the 18th century; Jean
Riolan (senior), though, defined pathology as the
"science of anti-natural things" and structured his
Universae medicae compendia
(1598, re-edited in
1606, 1610, 1618, 1626 and 1638) in three books:
physiology, hygiene and pathology.The main work by Joost Van Lom
(Lommius), Medicinalium observationum libri tres,
quibus notae morborum omnium et quae de his possint
haberi praesagia judiciaque roponuntur
(1560,
re-edited over 30 times – mostly in the 18th
century – and translated into French in 1712 under the
title Tableau des maladies où l’on découvre leurs
signes et leurs événemens
, re-edited in 1716, 1759,
1760, 1762, 1765 and 1792) was even more transgressive than that by Fernel [37]. It comprised
a first part devoted to the "reconnaissance" (Van Lom
Lom used the verb "animadvertere") of general diseases
(essentially fevers), a second part devoted to the
reconnaissance of specific diseases of the various parts
of the body (classified from the head to the foot, then
by pathological
process :
inflammation, gangrene, erysipelas, etc.), and a
third one devoted to prognostic signs. Van Lom, who
considered that identification of the genre of the
disease was the necessary step prior to its being
adequately cared for [38], did not address
the therapeutic aspects and said very little (contrary
to Fernel) of the etiological aspects of diseases, which
made his book quite atypical [39] – as did the use of
the phrase "medicinalium observationum" in the
title. It was certainly not chance that made Sydenham,
over a century later, choose a very similar title, i.e.
Observationes medicae
, for just as
atypical and transgressive a book. But Sydenham overtly
argued for an ontological conception of diseases, of
which he wanted to give the "history" in the manner of
botanists [40]. Sydenham, who laid the bases of medical
nosology with this book (as Boissier de Sauvages
explicitly mentioned in the title :
Nosologia methodica, sistens morborum classes, genera et
species juxta Sydenhami mentem et botanicorum
ordinem
), insisted on its importance for medical
practice, and he closely connected science (of diseases)
and practice again. 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
), followed by
that of William Cullen (Apparatus ad nosologiam
methodicam, 1775) and of Pinel (Nosographie
philosophique [Philosophical Nosography], 1797),
flourished until the middle of the 19th
century [41], when it was progressively replaced by
"pathologies," whose content was very similar (they
indeed presented signs, diagnosis and prognosis of
diseases, basic therapeutic indications – already
featured in Boissier de Sauvages’s nosology – and also
etiological and physio-pathological considerations –
present in Pinel’s).
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
Pauvres
in its various versions, attributed to
Arnaud de Villeneuve and to Petrus Hispanus (who became
Pope John XXI), also had a large diffusion. These books were essentially
comprised of collections of formulae (various remedies,
and how to prepare wines, liqueurs, balms, etc.)
for the main diseases and misfortunes (such as baldness)
in the a capite ad calcem order, and hardly gave
any details – or none at all – on the signs and
evolution of the diseases (on the contrary to Practicae). A few succinct notions of physiology
(the four humors, the temperaments, the six non natural
things) and basic dietary indications were usually given
as an introduction to these books, some of which could
also address non-medical issues.In 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
(1577,
re-edited until 1651) are perfect examples of the
continuity in titles and content for these
vulgarization books, which were
characterized, during the whole early modern period –
and still in the 19th century – by long
series of formulae for very little described (or not at
all) diseases and infirmities in the a capite ad
calcem order, sometimes preceded with basic
physiological and dietary developments, and combined
with other subjects, mainly agricultural or veterinary.
They were also and mostly characterized by
numerous re-editions over several decades, before being
included – for some titles – in the "Blue Library."
Within this mass production, often impossible to
differentiate from what was produced at the same time by
the enlightened profane (such as Madame Fouquet, or Dom
Nicolas Alexandre, etc.) [44], one can
nevertheless single out the work of some particularly
successful medical figures, some of whom durably
influenced later production – especially in their
titles, which may very well have been the most variable
feature in this literature. 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 1625
, published in a context of conflict between
Parisian physicians and apothecaries; these books
invited the public to do without apothecaries. Guybert’s
books were re-edited some 60 times until 1678 (and was
also translated into Latin and English [45]); they
initiated the trend of so-called "charitable" books,
subsequently illustrated by very diverse authors, from
the quite devout Marie de Maupeou, mother of
superintendent Fouquet (Les remèdes charitables… [The
Charitable Remedies…], 1678, re-edited until the
middle of the 19th century
!) to the protestant physician Constant
de Rebecque (author of a Médecin…, Apothicaire…,
Chirurgien françois charitable… [The Charitable French
Physician…, Apothecary…, Surgeon…] published in
1683).It is also the case of the Traité
des maladies les plus fréquentes [Treatise on the most
frequent diseases] by Jean-Adrien Helvetius
(1703,
re-edited numerous times until 1786)
; of
La médecine…, la chirurgie…, la
pharmacie des pauvres [Medicine…, surgery…, pharmacy…
for the poor] by the very Jansenist Parisian
physician Philippe Hecquet (published in 1740 and
re-edited until 1839), who was among the last authors to
use the old terminology when he referred to "the poor"
in the title of his book ; and finally the two major successes:
first the Avis au peuple sur sa santé ou traité des
maladies les plus fréquentes [Advice to people about
their health or Treatise on the most frequent diseases]
by Samuel-Auguste Tissot
(1761, 18 editions until 1797,
used as a school textbook during the Revolution
; in 1767 it was followed with an
Avis aux gens de lettres et personnes sédentaires sur
leur santé [Advice to literate and sedentary people
about their health], essentially comprised of
hygienic measures
) ; and second the
Médecine domestique
[Domestic Medicine] in five volumes by William
Buchan (1769, translated into French in 1775
and
re-edited numerous times until 1875) [46] with a much
more detailed hygienic content, quite frequently
imitated in the 19th century.
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. |
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