© 1992 Duke University Press
A l l r i g h t s r e s e r v e d
P r i n t e d in the United States of America
o n a c i d - f r e e paper
o c
Chapter 5
i s a r e v i s e d v e r s i o n of a p r e v i o u s l y published a r t i c l e ,
“La
M e t t r i e ' s I n s t i t u t i o n s
de
Médecine:
A R e i n t e r p r e t a t i o n
of
1951–
p . cm.
Includes
bibliographical
references
and
index.
isBN 0-822.3-1204-2 ( a c i d - f r e e paper)
1 . La M ettr i e , J u li e n Offray de, 1709–1751.
2 . Physicians—France—Biography.
R5o7.L.193
W46
1992.
CIP
F r o n t i s p i e c e
i l l u s t r a t i o n : Engraving o f J u l i e n Of f ray d e La M e t t r i e .
 
Enlightenment: The Conflict
b e twe e n the Doctors an d the Surgeons
2
Medical
Satires:
The
Formation
3 Boerhaave: The Medical Heritage
4
La
Practice
of
Medicine
Reappraised
6
o f M et ap h y s ic s
7 La
P h i l o s o p h y
Applied:
The
Medicalization of Nature
8 Moral T h e o r y i n Medical Terms
9 From
to
of
the
M é d e c i n - P h i l o s o p h e
Conclu sion: The Legacy o f a M e d i ca l Enlightenment
ix
xiii
34
6o
85
Io7
I35
I69
2 .
I3
246
2.72.
Notes
Bibliography
Index
287
o f La Mettrie i n
the En l ig htenment b y studying h i s
medicine
as we ll as h i s p h i l o s o
phy.
I
b o t h
the m o s t convincing way to
understand
La Mettrie's p h i l o s o p h y and
that i t defines a
p r o m i n e n t s t r a i n
i n the
F re n c h m at e ri al
i s t s wh i c h distinguishes
t h e i r contribution to the French En l ighten
ment.
narrowly,
then,
that
medicine
makes sense of La Mettrie and to a s i g n i f i c a n t degree o f the other
French
m a t e r i a l i s t s
as
p h i l o s o p h y
adds a
c r u c i a l component to the
En l ig htenment as a wh o le . M ed ic in e, u n der st o o d i n i t s broadest
dimen s i o n s as
e n c o m pa s s i n g
physiology, philosophical discussions
o f nature,
concerns
t i o n e r , i s a
s i g n i f i c a n t
feature o f En l ig htenment c r i t i c i s m
of tradi
absolutist
i n s t i t u t i o n s an d o f arguments for
the
s c i e n c e .
Eighteenth-century medicine, as
an amalgam of
theory
and
p r a c t i c e wed d e d t o a broad p h i l o s o p h i c a l b a s e , played a
fundamental r o l e i n the evolution o f the Enlightenment, a movement
with a new sense o f the nature an d
p u r p o s e
o f philosophy, with new
tools
new
and
d e f i n i t i o n s
for
i n t e l l e c t u a l s . S p e c i f i c a l l y ,
medicine
integration
of
the
abstract and the u t i l i t a r i a n , afforded empirical evidence
f o r
a cri
tique o f metaphysics, allowed the d e v e l o p m e n t of a n a t u r a l i s t under
standing
existing
i n s t i t u t i o n s
and
t h e i r e f f e c t s
on
of
Mettrie i s
f i g u r e i n the
artic u lati o n and
evolution of
Because the compartmentalization
of d i s c i p l i n e s an d
the divi
between the
integration
of
medicine
and
p h i l o s o p h y no t only affords a c l e a r e r view
o f
the
mental landscape of the eighteenth century b u t also allows o n e to
integrate
the historiographic tr eat me nt o f the E n l ig hte nme nt an d
the history of s c i e n c e . These two traditions have followed
the
same
t h i r t y
years: f r o m a
discussion
to
the
involvement o f th os e f i g u r e s i n
p o l i t i c a l and
s c i e n t i f i c
i n s t i t u t i o n s ,
to
i n s t i t u t i o n a l h i s t o r i e s , to
the
impact
eighteenth
century medicine on p o p u lar c u l t u r e . A l l of these a p pr oac h e s have
b r o a d e n e d
o u r understanding of the
eighteenth
they
m u s t a f f e c t the way
i n
w h i c h history i s subsequently written. We
m u s t understand
great f i g u r e s within t h e i r context an d
b e
aware
of
the p o l i t i c a l d ime n s i o n s
of i n t e l l e c t u a l change;
the
ti o nal evolution
on i n d i v i d u a l s and
events
count. In gen eral , recent approaches to the Enlightenment have
impelled a heightened responsiveness to
the
context o f i d e a s , i n d i
viduals, events. Bu t we
learn more
abo ut
also
reexamine
what
we
take
for granted a b o u t i t s i n t e l l e c t u a l
dimensions. Does the t r a d i t i o n a l l y ack n ow l e d g e d muddle of New
tonianism and L o c k ea n i s m accurately
r e f l e c t
the i n t e l l e c t u a l i n h e r
itance w h i c h the
p h i l o s o p h e s
u s e d as a foundation for s o c i a l re
f o r m? This study argues that t h i s picture
needs to b e
for example,
Enlightenment studies written
f i f t y years ago, before the Enlightenment c o u l d b e u s e d to f o r e
shadow
Diderot
Encyclopédie, an d long before
the a c k n o w l e d g m e n t
of
anything
b u t
an e l i t e c u l t u r e . These studies a s s e r t a more p o s i t i v i s t i c En l ig hten
m e n t , a movement
with clear and
direct
c o n n e c t i o n s
to
American
almost s o l e l y
with
reform.
More
recent pictures ar e more diverse b u t l e s s
conclusive.
Enlightenment take
place
among
the
p h i l o s o p h e s i n salons
o r the
l i t e r a r y hacks on gru b s t r e e t ? The philosophes, nolonger g i f t e d with
p o l i t i c a l
omniscience,
are allowed a degree
of p o l i t i c a l i n s i g h t , al
b e i t
an d disdain
for
the
common man. Bu t they have also b e e n c a s t as diabolical
i n i t i a t o r s
of
s c he me s wh i ch
p r o d u c e d t o t a l i t a r i a n i s m .
And
o b v i o u s
t i e s
E n l ig hte nme nt
an d the French Revolution have a l l b u t
x |
 
dissipated, l eav in g th e connection between ideas an d events i n a
netherworld an d the question
of
the p o l i t i c a l
events o f the
Revolution,
as d i s t i n c t f r o m
centuries f
indeterminate.
T h e s e are j u s t a f e w
of
the
were no t
commonly
raised
when
e a r l i e r truisms a b o u t
the
i n t e l l e c t u a l
roots
Enlightenment
came into vogue. Just as o u r understanding o f
the E n l i gh t e n me n t has b e e n broadened, s o to o must as s es s me n ts o f
i t s important
i n t e l l e c t u a l forebears an d the r o l e s o f
certain
individ
b e
reexamined i n l i g h t o f evolving
perceptions
and
new
information
a b o u t the En lightenment an d
i t s ramifica
To
t h i s e n d I o f f e r t h i s study o f
La
medicalization o f the Enlightenment.
I n carrying o u t t h i s study I have made certain assumption s an d
followed c e rt ai n d i re c ti o n s which allow me
to
and,
plagued La
Mettrie scholarship. F i r s t , I have no t t r i e d to f o l l ow o u t l i t e r a r y
references
to
cant seventeenth-century
influences o n
h i s
wor k , some
have
b e e n well discussed elsewhere. Bu t instead of following
o u t these s o m e t i m e s
illuminating,
s o m e t i m e s t a n t a l i z i n g l y i n c o n c l u
s i v e comparisons, I have c h o s e n to take
La
Mettrie's l i t e r a r y , p h i l o
sophical, and
s c i e n t i f i c heritage
as h e e x p l i c i t l y
u s e d them.
Second, I
h av e b e e n c o nc e rn ed to
present La
sophical i s s u e s . This
i s
a
change o f emphasis f ro m m o s t
of the
h as
annotated editions
o f s p e c i f i c
t e x t s
with m o n o g r a p h i c introductions.
T h e s e editions
a s s e r t the importance
o f
a particular
i t
as a
d i s t i n c t i v e
evolution o r break i n La Mettrie's thinking. W h i l e s h i f t s
o f
present a striking
b y the short
writings,
17 3 5 –17 5 0 , an d b o r n e
o u t
to
the d e v e l o p m e n t o f
t h e m e s across La
Mettrie's writings. F i n a l l y ,
I have ch o sen
to
con
s i d e r only i n the f i n a l section the problematic q ue sti on o f La Met
t r i e ' s personality an d the reception o f h i s works, becau se s u ch
d i s c u s s i o n s u s u a l l y
degenerate
i n t o apologies or
d e n u n c i a t i o n s . I
am
attempting
an
mean
to
argue
corp u s
interpretation
of
x i
 
Enlightenmet ssues gave hm an mportant ole to pay the Elghtenment. While othe philosoes hae had ew epaions escued fom peous dsepute and neglect (conside, example the stking esugence n nteest n Dideot), La Mettie s appa ently in an almost unsalageable positon becase he had no co empoay defendes Recent scholashp has cast him into a ew knd of disepue as insane o as an ealy souce of totaltaa thoght, o has cased him to sue a ew kind of neglect, consd eed mportant o only one dea l'homme machine. y pupose is to pesent the whole of La ette's medcal and phlosophical wok, to clam hat the whole s stcued and infomed by he concens of eghteenth-cenury medical pactice and theoy, and to conicle hs applcaton of medcal conces to the undamental ssues of he Fench Enlghtenment
x I Prce
Acknowledgments
The
comp l eti on o f a f i r s t book
i s
s u c h
a l ong history
to o
edge. Friends and colleagues
at
the University of Chicago, i n P a r i s ,
at
Stanford,
the
University
Wisconsin
M i lwa u k e e , and So u t h er n M e th o d i s t University a l l f o r m p ar t o f t h i s
p r o j e c t .
They have pr ovided the s u p p ort an d stimulation of intellec
t u a l c o m m u n i t i e s an d made
scholarship b oth
This project owesa great deal to the Georges Lurcy Foundation,
w h i c h f u n d e d my research
i n
gave
e n t i r e attention to La Mettrie.
In
P a r i s , Jacques R o g e r made me
welcome i n h i s seminar, w h i c h he l p ed
me
to define certain i s s u e s i n
t he nat ural sciences o f the eighteenth century. To Marjorie Gr e n e
and
Humanities
seminar sh e directed, I owe a greater understanding of Descartes.
My e a r l i e s t i n t e r e s t i n the p h i l o s o p h y
of t h i s
period wasawakened
and nurtured b y N o r t o n Nelkin.
I am particularly indebted to members o f my dissertation com
mittee
my
i n t e r e s t i n the history o f s c i e n c e , and I appreciate h i s c o ntin ued
enth u siasm for t h i s p r o j e c t . Keith
M.
Baker
has
m o d e l o f
excellence
i n
eighteenth-century s t u d i e s , an d I
am
to
r ead in g o f
my material.
I would l i k e to thank Larry Malley an d Pam M o r r i s o n o f
Duke University Press for
manu
s c r i p t .
 
good cheer the demandso f my book t h e i r e n t i r e l i v e s . My h u s band,
D e n n i s Sepper,
h as
with
am
only
f o r his sustaining love and s u p p o r t b u t also
for h i s
This book
eighteenth
century was a period o f intense
i n t e l l e c t u a l
germination
the
movement reappraised
the
i n s t i t u t i o n s
an d conventions
things
enment i s i t s
t r e m e n d o u s
i n t e l l e c t u a l energy. With nocompartmen
t a l i z a t i o n of d i s c i p l i n e s , i t was
the
k n o w l e d g e was
a s s u m e d to
b e
accessible to
i n d i
vidual. As a r e s u l t , the philosophes, as the standard-bearers o f the
new movement
called themselves, f e l t f r e e to explicate Newtonian
p h ys ic s o r
popularize
They
that
th e p as t c o u l d b e recast i n terms w h i c h
would
to
address
no t only
the i n t e l l e c t u a l issues
of
also
and
concerns. Modest souls
of
the
reinterpretations
o f
the past h as b e e n admirably told i n w o r k s
of
the
i n t e l l e c t u a l
history o f the
The
evolution
f r o m the c las s i
c a l l i t e r a t u r e o f the s e ve n te e nt h c e nt ur y to the polemical, p h i l o
sophical l i t e r a t u r e
o f
of
the
seventeenth-century
r a t i o n a l i s t
to the
sciences o f the e i g h
teenth-century p h i l o s o p h e h as
come to
tional understanding
of
the Enlightenment. Bu t t h i s evolution i s
perhaps
and
l e s s c o n s i s t e n t
than
a
historio
g r a p h i c a l overview s u g g e s t s . An examination of t h e c a r e e r s and
writings
of s u c h diverse eighteenth-century i n t e l l e c t u a l s as
Montes
quieu, V o l t a i r e , Rousseau, an d Diderot suggest th at th ere were
many
d i s t i n c t routes to Enlightenment.
Julien
Offray
particularly
unconventional
b u t
f r u i t f u l ap p r oac h
to
the past
an d
the e m e rg i n g new i n t e l l e c t u a l
move
ment.
Both h is criticisms of the old and h is involvement i n thenew
were
understanding
o f me di ci ne . In e ss en ce , h e
medicalized the Enlightenment.
Medicalization h as b e e n cast b y historians l i k e M i c h e l Foucault
as a modern v i l l a i n , an authoritarian imposition b y the medical
p ro f es s io n o f i t s authority
at
the e x p e n s e o f r i v a l b u t l e s s powerful
p o p u lar
p r a c t i t i o n e r s .
Whether
or
charges can b e em
p i r i c a l l y substantiated, t h i s diabolical intention d o e s no t
s e e m
campaigne d
f r public health, or a control b y the pu bl ic of t h e i r own health
w h i c h would have challenged a l l medical a u t h o r i t i e s .
L Mettrie's
medicalization
m u s t also b e u n de rs to o d i n large part
as
an
attempt to
i n t e r p r e t the concerns
of
the
Enlightenment
medical
terms.
Hi s e n t i r e b o d y of w ork, b o t h
medical
sophical, i s
the
an d
theories of
the
l a t e seventeenth an d e a r l y
eighteenth c e n t u r i e s . Bu t
h e to o k those medical
concerns
with the
new i n t e l l e c t u a l
movement
public
k n o w l e d g e against corporate p r i v i l e g e . Hi s
medicalization
rein
on
the s o c i a l , s c i e n t i f i c , an d
i n t e l l e c t u a l i s s u e s
w h i c h p r o d u c e d the Enlightenment. Fo r example,
h e
nature
o f the
good
medical
theory
an d p r a c t i c e . In
the
b e
u n d e r s t o o d as
a movement
i n f o r m e d b y the principles
o f medical practice and
theory, a movement i n w h i c h the concerns o f the theologian had to
y i e l d
t o
p h y s i c i a n ,
d i s c u s s i o n s of nature
h ad
t o
an d
human
nature had t take into consideration the aberrant an d the deviant;
that i s
primacy was to
the evidence
o f d i r e c t o b s e r v a
tions of b o t h
s i c k
an d well
individuals. The p h i l o s o p h e
was
to
judge
b y the s tan dar ds o f medicine. The i s s u e s o f contemporary medicine
gave La M ettri e a c r i t i c a l perspective and a reformist stance. Hi s
analysis
an d
c r i t i c i s m o f the established
medical order
made him
to
tools and
o f
c o n t em p o rar y science i n the
cause
 
s o m e
r e c e n t s t u d i e s of t h e h i s t o r y of s c i e n c e and phi
losophy t h e e i g h t e e n t h century
take
s e r i o u s note
Mettrie t o d e d i c a t e
a few pages
t o him, g e n e r a l s t u d i e s i n
the
accord
m o r e than a few perfunctory
remarks, which s e r v e e i t h e r t o perpetuate s i m p l i s t i c notions of h i s
p h i l o s o p h y or to repeat the defamatory
remarks
of h i s c r i t i c s . Fo r
example, P a u l
Hazard mentions
La Mettrie
joke
a t La M e t t r i e ' s
expense.
“There
was mo re
matter i n him than i n the general ru n o f men   h i s ma c h i n e b r o k e
down,
indigestion
was
Cassirer t r e a t s La Met
t r i e , H e l v é t i u s , and d'Holbach a s a c o l l e c t i v e u n i t , denigrating
the
w r i t i n g s of t h e
m a t e r i a l i s t s
a s “having n o c h a r a c t er i s t i c s i g n i f i
cance” and a s a “ r e t r o g r e s s i o n i n t o t h e dogmatic mode of
thinking
l e a d i n g
s c i e n t i f i c minds of t h e e i g h t e e n t h century o p p o s e
and endeavor Because t h e y
r e j e c t e d
t h e c e r t a i n t y of
t h e mathematical
s c i e n c e s nd chose
i n s t e a d t o
o r i e n t t h e i r thought
around
b i o l o g i c a l and
p h y s i o l o g i c a l
c o n s i d e r a t i o n s , C a s s i r e r de
motes
t h e m a t e r i a l i s t s t o t h e
rank
of s c i e n t i f i c
d i l e t t a n t e s .
Although
that La Mettrie influenced d'Holbach,
H e l v é t i u s , and Diderot and mentions h i m i n connection with
eigh
t e e n t h - c e n t u r y s c i e n c e and the f i g h t a g a i n s t e x c e s s i v e r a t i o n a l i s m ,
h e
i s primarily c o n c e r n e d
with h i s
f l o c k , ” whic h
d o e s n o t
include La
n e g l e c t
of La Mettrie i n g e n e r a l d i s c u s s i o n s
of
problematic chronological
r e l a t i o n s h i p
t o
i t .
He wrote
1751.
On
works of
m a t e r i a l i s t
philosophy,
a philosophy m o r e
c h a r a c t e r i s t i c
of
h e
i d e n t i f i e d with
them,
t r i e
was a l i a b i l i t y t o t h e philosophes i n t h e
175os,
e s p e c i a l l y s i n c e
t h e i r enemies s i n g l e d h i m out a s
r e p r e s e n t a t i v e
of t h e e x c e s s e s and
t h e dangers
posed t o s o c i e t y
b y
and 1760s b y
philosophe
and antiphilosophe a l i k e and t a r r e d with a
thoroughly unsavory r e p u t a t i o n , La
Mettrie was
an u n l i k e l y candi
date f o r r e h a b i l i t a t i o n
b y t h e
philosophes i n t h e 1770s. I n d e e d ,
few
subsequent
h i s t o r i a n s
have
defamatory
remarks
about La Mettrie or h i s own outrageous statements
t o
i n v e s t i g a t e
t h e
c ontent o f h i s p h i l o s o p h i c a l
work.
More
or
h i s n e g l e c t i n g e n e r a l works o n
t h e
Enlighten
 
th
uses to w h i c h h s most outrageous remarks have b e e n
p u t by
some
modern h i s t o r i a n s .
The
m a t e r i a l i s t s as a
g r o u p
have
abused.
Jacob L . Talmon
have
decried
t h e i r p o l i t i c a l theories as res po ns ib le fo r th e r i s e o f the t o t a l i t a r i a n
s t a t e . ”
Marxist historians have distorted
t h e m into e a r l y ,
i f no t
p a r t i c u l a r l y p e r c e p t i v e , forerunners of Marx.” La Mettrie i n particu
l a r h as b ee n
r e s u r r e c t e d from
r e l a t i v e o b s c u r i t y
t o
considers
Sade t o
be t h e founder of n i h i l i s m
and
o f E nl i gh te nm en t
e f f o r t s
for p o l i t i c a l an d s o c i a l reform.
C r o c k e r
e x p l a i n s de
Sade
phy w h i c h
denied
man
a
the
cast
against
the
implications
of La Mettrie's e t h i c s . W i t h o u t God
and the Christian w o r l d order, the progression f r o m La Mettrie to
d e Sade
for
Crocker, i n e v i t a b l e . ”
Recent
studies
of
impor
tance an d i n f l u e n c e i n e i g h t e e n t h - c e n t u r y philosophy by studying
s p e c i f i c t e x t s . Aram Vartanian's edition o f L'Homme mac h i n e with
h i s
monographic i n t r o d u c t i o n has been
m o s t
i n f l u e n t i a l i n
pro
v o k i n g i n t e r e s t i n La Mettrie. Vartanian considers La Mettrie to
b e s i g n i f i c a n t
i n the
concept
o f béte m a c h i n e to
homme
h e
c a r t e s , and h i s
c r i t i c a l
e d i t i o n
of L'Homme machine
the evolution
o f that notion. By virtue o f h i s extensive
footnotes
to
demonstrate
the
connection between La M e t t r i e ' s t e x t and b i o l o g i c a l , p h y s i o l o g i c a l ,
and philosophical i s s u e s o f the seventeenth an d eighteenth
cen
t u r i e s . J o h n Falvey's
c r i t i c a l
edition
of
the Discours sur l e b o n h e u r
draws connections between La Mettrie an d seventeenth-century
m o ra l i s t s . AnnThomson'sintroduction toher critical e d i t i o n of t h e
Discours
préliminaire
discusses
the
the
text
and i n f l u e n c e s on i t . AndTheo Verbeek's r e c e n t
e d i t i o n
ofthe
Traité
d e l'âme has discussed th e s ou rces , e s p e c i a l l y i n
the
clandestine
l i t e r a t u r e , of t h i s fundamental work.” A l l of
these
important i n adding depth to o u r understanding
o f
La Mettrie, a
depth w h i c h h as taken him b e y o n d the s i m p l i s t i c c l i c h é s and d i s
paraging
remarks
w h i c h are
the basis o f h i s c r i t i c a l
reputation.
 
H owe v e r , these c r i t i c a l editions have
b e e n
most c on ce rn ed wi th
e s t a b l i s h i n g
t h e antecedents of La M e t t r i e ' s work. As a r e s u l t , they
invariably place him i n the
context
century rather
than t r e a t h i s c o n t e m p o rar y impact.
All of these uses an d abuses of La Mettrie's p h i l o s o p h y have
f a i l e d to t r e a t i t
as a
particularly
striking
i t s seamless
q u a l i t y .
Hi s e n t i r e p h i l o s o p h y
applies h i s s c i e n t i f i c k n o w l e d g e o philosophical questions s u c h as
the nature o f matte r an d human beings an d the relationship of
human beings to nature and s o c i e t y . La Mettrie investigated with an
ey e to
humanitarian reform, e s p e c i a l l y
to the a l l e v i a t i o n
of human
s u f f e r i n g , s p e c i f i c a l l y of
those unfortunates w h o s e
p h y s i o l o g i c a l
constitutions inclined them
to
n o n c o n f o r m i s m . R e f o r m i n g z e a l ,
rather
than n i h i l i s m , motivated some o f h i s most s h o cking remarks.
La works are
i n
of t h e i s s u e s t h e y d i s c u s s and t h e
examples they
they q u i t e
c l e a r l y follow o n e f r o m another. In h i s e a r l i e s t worksh e defined an
epistemology, then p r o vided empirical evidence for i t , an d
f i n a l l y
addressed i t s
an d man
Through h i s philosophy,
h e e x p a n d e d
h i s humanitarian
quest for
medical re f orm and public health to address broader i s s u e s
o f E nl ight enme nt. He intended to destroy m etap h y s i cal n oti o ns of
human beings and t o enforce a n a t u r a l i s t i c understanding of man s
that
s o c ial i n s t it ut i o n s could
b e t t e r
serve human n e e d s . His most
v e h e m e n t crusade was
for
o f the co
s t i t u t i o n a l l y maladjusted,
the
known
because
a
Bu t
b e y o n d the general outline
there i s s u c h a dearth o f d o c u m e n tar y evidence that the
main
source
information the delivered the Great.”
Some d e t a i l s of that éloge have been corrected o r questioned b y the
painstaking research
Saint-Malo
generation
o f p h i l os o p h es (Diderot, b . 1713, and Buffon, b . 1707), those whose
philosophic
began to
the
s o n of a well-to-do t e x t i l e merchant, who
wasab le t o
provincial
colleges o f C o u ta n c e
and Caen and
d u
P l e s s i s i n P a r i s , where
h e
was
very
 
much i n f l u e n c e d
b y
a t
according
to Frederick’s éloge, h e p r o d u c e d a Jansenist t r a c t , wh i ch u n fo rt u
n a t e l y
has
never
been found. I n 1725 he e n r o l l e d i n t h e Collège
d'Harcourt
philosophy and n a t u r a l
s c i e n c e . (The c o l l e g e
was
the
f i r s t academic
i n s t i t u t i o n to permit h e i ntr od uc ti on
of
Cartesianism
t h e F a c u l t y
of
P a r i s studying medicine. I n order t o
evade t h e
completing
a medical degree i n P a r i s ,
La
Mettrie
for
r e c e i v e d
h i s
Finding h i s medical
education an i n s u f f i c i e n t preparation f o r
medical
p r a c t i c e , he went
t o Leyden
before
home
i n Saint-Malo. He subsequently served
a s a personal physician t o t h e Duke
de Grammont
and a s p h y s i c i a n
t o a
b a t t a l i o n
of f r a n ç a i s e s . During t h i s period
t o
h i m a
t h e F a c u l t y
of
P a r i s an d to the orthodox—that i s , h i s medical s a t i r e s and h i s
m a t e r i a l i s t philosophy.
Because of
s a t i r e s
an d
philosophical
work,
L'Histoire
naturelle
d e
l ' â m e , he was e x i l e d
t o Holland. When L'Homme machine (1747)
p r o v e d to b e to o r a d i c a l even for the
tolerant Dutch,
La
Mettrie
s o u g h t refuge at the c ou rt o f Frederick the Great, w h e r e h e died i n
1751 a f t e r e a t i n g contaminated p â t é . ”
Th e f a c t s
of t h i s
s k e t c h
a r e
of La
l i f e
has proven
f r u s t r a t i n g l y
e l u s i v e .
Few
hav e b e en
found, and
n o
t o
man behind t h e
n o t o r i e t y . H i s t o r i a n s
have
been tempted t o
f l e s h out t h e persona f La Mettrie o n t h e b a s i s of h i s published
writings. This has b e e n a p o p u lar technique f o r b o t h those who seek
g r i s t f o r a defamatory m i l l and those who seek g r e a t e r r e c o g n i t i o n
f o r a misunderstood t h i n k e r . Th e s t y l i s t i c c o m p l e x i t i e s an d o bs cu r
ities
of
Others
have
i n h i s s e x u a l i t y
a s
prescient
a t t i t u d e s .
I n t r i g u i n g a s s o m e of
t h e s e
s p e c u l a t i o n s
a r e ,
they can
no t b e c o n c l u s i v e l y supported and d o not provide e n o ug h m a t e r i a l
to ad d
study
La Mettrie poses c e r t a i n d i f f i c u l t i e s not only because of t h e
l a c k
of biographical m a t e r i a l
b ut a l s o because of t h e nature of h i s
6
| La
 
s p e c i f i c context. I n t e l l e c t u a l h i s t o r i a n s , r e s p o n d i n g
to the
legitimate
c r i t i c i s m s of s o c i a l
h i s t o r i a n s ,
have s o u g h t
to
g r o u n d i n t e l l e c t u a l
f i g u r e s i n concrete contexts o f
t h e i r
c l a s s ,
profession,
c a r e e r , an d s o
f o r t h . However,
La Mettrie
i s also frustrating i n t h i s r e s p e c t ;
h i s
i s the w o r l d
of
w h i c h
places him
squarely within the i n t e l l e c t u a l context of the c o nt em p o rar y i s s u e s
o f p h ys i ol o gy an d phil o s o p h y . In
t h i s
study I therefore have s o u g h t
to contextualize La
Mettrie's
p h i l o s o p h y i n the w or l d
o f me di ci ne ,
b o t h theoretical and
p r a c t i c a l .
La Mettrie
i s s u e s o f
the p r o f e s
sion an d the practice o f m ed i ci n e while h e wasa
medical
student in
P a r i s . The primary i s s u e
o f that
b etween
no t
o n l y a b o u t the i s s u e s
o f
would control education, who
would h av e p re emi ne nc e among medical p r a c t i t i o n e r s , and how
m e m b e r s h i p i n t he p ro f es s io n would b e c o ntr o l l e d— b u t also a b o ut
s u c h crucial
questions
education
p r a c t i c e .
a Mettrie aroused the indignation o f h i s fe ll ow p h y s icians b y
e s p o u s i n g the
cause
surgeons
i n t h e i r p a m p h l e t war with the
doctors. He wasthe only doctor to dos o . He accepted the surgeons'
arguments
no t
for
the
i d e a l s . He
also apparently f o u n d the surgeons closer to h i s i d e a l medical prac
t i t i o n e r
than
the
h e
s a t i r e . Wit h i n
the
context o f the i s s u e s raised i n the
p a m p h l e t
war,
physician.
Hermann
and
p r a c t i c e .
Boerhaave's c l a s s e s revealed to him the poverty
of h i s own
medical education an d led him to
e x p o s e the
f a i l i n g s o f memberso f
he Parisian medical c o m m u n i t y . Boerhaave's medical theory
pro
o f the
p h i l o s o p h y of
nature. In f a c t ,
La Mettrie's
of Boerhaave's
medi
cine enabled him to develop fundamental perspectives f ro m wh ic h
h e l a t e r investigated
philosophical questions.
medical
thoroughly
discussed b e c au s e m ed i ci n e
was the d e t e r m i n
ing factor i n the
formation
of
h i s e n t i r e
p hi l o s o p h y . I t wasthe basis
o f h i s conception of nature, e s p e c i a l l y human nature, and was the
I n t r o d u c t i o n
7
an y metaphysical
examined.
Medicine thus
epitomized t h e t r u e method of s c i e n t i f i c
investigation and experimentation, and
vanquish metaphysics.
France,
La
Mettrie
considered
the c o m p e t e n t
medical practitioner
b e the
quintessential man o f h u ma n i t y an d s o c i a l r e s p o n s i b i l i t y . Where
medicine o f f e r e d a h o p e f o r a m o r e
n a t u r a l i s t i c
understanding of
nature,
the
méde cin - p h i l o s o p h e
m i g h t b e able
to
reform s o c i a l in
s t i t u t i o n s i n accord with
that understanding. This book w i l l exam
ine the d e v e l o p m e n t o f
La
Mettrie's medical
p h i l o s o p h y and
h i s
deliberate an d e x p l i c i t r e d e f i n i t i o n
o f c r u c i a l
Enlightenment i s s u e s
according to the concerns o f medicine.
8 La M e t t r i e
 
The Conflict
b e t w e e n the D o c t o r s
and
Surgeons
Medicine
was p a r t i c u l a r l y important t o the philosophes because of
t h e i r concern with t h e
s o c i a l
u t i l i t y of
t h e
As
has
n e a t l y summarized t h i s i n t e r e s t , “Nothing c ou ld b e p l a i n e r than
t h i s : Medicine
was philosophy
medicine
f o r t h e i n d i v i d u a l a d s o c i e t y . ” This i n t e r e s t i n s c i e n c e , p a r t i c u l a r l y
i n
should
provoke us t o seek an understanding of t h e p r a c t i c e and
theory
of s c i e n c e and medicine i n t h e e i g h t e e n t h century an d i t s
i n f l u e n c e o n Enlightenment
philosophy. La Mettrie provides a
par
t i c u l a r l y illuminating perspective f r o m w h i c h to e xami n e the in
t r i g u i n g r e l a t i o n s h i p between s c i e n c e , medicine, an d philosophy.
Bu t
p h il o s op h es wi th
medicine, con
c r e t e and e x p l i c i t connections between medicine an d t h e Enlighten
m e n t have not
r e c e i v e d a
g r e a t d e a l of a t t e n t i o n . H i s t o r i e s of eigh
t e e n t h - c e n t u r y
medicine q u i t e f r e q u e n t l y purport t o
t r e a t the e n t i r e
century
but
th en ru sh e a g e r l y from the chaos of e i g h t e e n t h - c e n t u r y
theory an d p r a c t i c e t o t h e m o r e
appealing
saga
of
medical
reforms of t h e Revolution an d t h e p r o f e s s i o n a l i z a t i o n of medicine
i n
t h e n i n e t e e n t h c e n t u r y . Perhaps t h i s n e g l e c t i s t h e
r e s u l t
of t h e f a c t
t h a t i n s o m e r e s p e c t s
e i g h t e e n t h - c e n t u r y medicine
does not lend
su p p ort to a W h i g g i s h
story
since
every turn with t h e
a r c a n e . Th e d e s c r i p t i o n s of d i s e a s e s
f o u nd i n
e i g h t e e n t h - c e n t u r y
medical t e x t s a r e
only sometimes
rec
ognizable to modern physicians. E v e n discussions of the treatment
of d i s e a s e s f o u nd i n t h e works of t h e best-educated medical practi
t i o n e r s a r e much m o r e l i k e l y t o h o r r i f y than
t o
( o r
a t
what seems
an i m p r a c t i c a l
education
 
dishearteningly i n e f f e c t i v e m e t h o d s
of treatment ( r e f l e c t e d i n
high
patient mortality r a t e s ) , bizarre an d arcane discussions of diseases
an d treatments, and vested s e l f - i n t e r e s t , v e n a l i t y , and chaos i n medi
c a l practice are factors that mig ht discourage
o n e
f r o m investigating
t h i s u n sav or y scene i n d e t a i l . In s u m , eighteenth-century medicine i s
b ot h b a f f l i n g i n i t s diverse manifestations and somewhat
unedifying
i n i t s lack o f e f f i c a c y . ”
In
practice o f
medicine i n
eighteenth-century
France mig ht lead o n e to think that the n atu re o f the relationship
b etween
on the
while the actual practices an d professional standards of eighteenth
century
medicine
e d i f y i n g ,
the records l e f t b y physicians i n
medical t e x t s and case studies p r o d u c e a more positive assessment
t h e r e o f . In other word s , r e m o v e d f r o m the
considerations
of
p r o d u c e d
decisive im
health,
medical texts t r e a t i s s u e s
i n ways
w h i c h can
b e correlated to Enlightenment concerns, e s p e c i a l l y to i t s c r u c i a l
quest to ameliorate the human condition. The p a m p h l e t war be
tween the doctors and the surgeons, w h i c h waswaged with
particu
l a r i n t e n s i t y
b etween 1724 an d
1750, o f f e r s a possible
source
for
r e f o rm which the p h i l o s o p h e s r e co g ni ze d as implicit i n the ap p l i ca
tion
o f s o c i e t y .
That
the
philosophes were d i r e c t l y inspired b y the
intense vituperative an d
s o m e t i m e s even
violent demonstrations
rancor
in
volved i t h i s p a m p h l e t war. (Indeed, the concerns o f philosophes
with
the
destructive te no r o f the p a m p h l e t war are e x p l i c i t l y
demon
Nonetheless, the
i s s u e s d ev e l o p e d
during
t h i s p o l e m i c
mig ht
the
p h i l o s o p h e s
reasons to b e h o p e f u l a b o u t what medicine offered
and mi gh t b e
able
war
the
professional i s s u e for the
doctors an d surgeons o f P a r i s i n the formative years o f the
Enlight
ization
for gauging pro
f e s s i o n a l i s s u e s . W h i l e the heat of p o l e m i c invited charges an d
countercharges an d
p r o m o t e d inflammatory rhetoric exaggerating
the
the
d e f i c i e n c i e s o f one's opponents, a
p a m p h l e t
war also provided the opportunity for developing
a
 
medicine
and
the s o c i a l
advantages g o o d medicine w o u l d produce. And t h i s p a r t i c u l a r pam
p h l e t war advocated a n e w c r i t e r i o n b y wh ich medical p r a c t i c e and
education s h o u l d b e judged. Some pamphlets were addressed to
the
king,
the
t r a d i t i o n a l adjudicator i n
disputes
and
surgeons,
but
arguments
o n
questions of
precedent an d m o r e o n t h e i s s u e o f p ub lic good, t h e surgeons i n
particular
s o u g h t
to present t h e i r case before a new b o d y , o n e
remote from
r o y a l
s t r i c t u r e s and a corporate h i e r a r c h y t h a t d e em e d
t h e m s u b s e r v i e n t
t o t h e
d o c t o r s ;
they
i n t e r e s t
o f the
to bring
undefined
and
u n s p e c i f i e d
a u t h o r i t y
of p u b l i c o p i n i o n . Thus
they s o u g h t to s h i f t authority f r o m the king an d the medical corpo
r a t i o n t o
p u b l i c
opinion an d t o r e d e f i n e t h e nature
of
t h e p r o f e s s i o n
as
independent
from t r a d i t i o n a l p r i v i l e g e , s u s t a i n e d
i n s t e a d
b y
the
pam p h l e t war suggests that the surgeons s u c ceeded
i n d e f i n i n g and implementing the agenda f o r medical
reform
i t i s a limited source f o r
the complicated
medical
Participants did
address
the s p e c i f i c i s s u e s of
medical education and
practice
o uts id e o f P a r i s , n o r
did
the
advo
cates on either s i d e see t h e i r positions as r e c t i f y i n g medical deficien
c i e s i n rural a r e a s . I t was instead a controversy b e twe e n
the
two
most e l i t e
medical g r o u p s i n France. And while they
had
influence
o u t s i d e of P a r i s and were c e r t a i n l y
i n t e r e s t e d
i n extending i t , they
did actually practice except among
the
Parisian s o c i e t y . (The practice o f e l i t e surgeons would h ave b ee n
somewhat more extensive i n b o t h s o c i a l and geographical terms.)
Thus
d i s p u t e s over
medical
p r a c t i c e and theory
would
have
l i t t l e immediate
impact b e y o n d t h e i r n a r r o w
c i r c l e . However, t h i s debate s e t t h e agenda and
d e f i n e d
t h e shape of
medical reforms t h a t were m o r e widely extended an d imp o s ed i n
t h e
n i n e t e e n t h
c e n t u r y .
Although
o f
French medical p r a c t i c e ,
i t
e f f e c t i v e l y
underscores
t h e
a f f i n i t i e s between
t h e
taken
b y
t h e surgeons of Saint-Côme” and t h e o p t i m i s t i c expectations
f o r
t he p h il o so p he s.
The barrage
o f
i n v e c t i v e , charges, an d countercharges p r o d u c e d
suggest that the
pam p h l e t war,
w h i c h raged i n P a r i s
b e twe e n
1724
1
1
e simply a
sional squabble.
H ow e v e r ,
the professional i s s u e s an d medical con
cerns w h i c h divided
the
c a t i o n s . Wit hin the
context of t h i s
war,
surgeons
came
to a r t i c u l a t e positions on medical practice and theory. From
those
attacks
on p r i v i l e g e and argument s
for
medical reform, c r i t i c i s m s o f existing i n s t i t u t i o n s an d systems o f
education, an d the beginnings of
a campaign
for public health.
W h i l e the i n i t i a l point o f contention was whether
the
surgeons
would
to throw
off
their s u b s e r v i e n c e to th e doctors,
e s p e c i a l l y
insofar
as
the
education
the debate had
far broader implications.
The surgeons o f Saint -Côme u s e d every l e g i s l a t i v e gain to
work
goal w h i c h
s e t
them d e f i n i t i v e l y apart f r o m the u n e d u cated em
p i r i c s . They also argued for reforms i n m e d ical e d u cati o n an d prac
t i c e ,
as th e 1720s
e m p i r i
c a l and the c l i n i c a l as
the
p r o p e r foundation o f me di ci ne . They
asserted
of p r a c t i c a l
education
an d
the incorporation
o f c hemi stry an d anatomy into m ed ic al e du cat io n an d p r a c t i c e .
Offering
bas e d on
b o t h
theory an d p r a c t i c e , and
identifying
the f r u i t s
o f
the
s c i e n t i f i c revolution, the surgeons also
d ef in ed th e
m ed i cal r e fo r ms
that
period i n France. T h o s e
reforms united the doctors an d the surgeons u n d e r th e s urge on s'
s tan dar d s o f medical
practice and education
the
physicians. In d i s t i n c t contrast
to
the
physicians,
the
surgeons
ar
new
w h i c h
wasto b e
b ot h
empirical
an d t h e o r e t i c a l . Their practice made extensive use o f
the
an d
the h o s p i t a l s . M o r e o v e r ,
the
s u rge on s o f the eighteenth
century p r o p o s e d to s e t themselves up as men educated i n the l i b e r a l
a r t s an d well studied
i n
t h e i r a r t an d
c r a f t ; the
s u rg e o n
was to b e a m o d e l of the Enlightenment
man
of
science n d a f or e s had owing
o f
the
surgeons may well b e a ke y to bridging b ot h
the differences i n medical
practice o f the
eighteenth an d nineteenth
differences b etween these periods
as
the
surgeons
to formulate
an d
Enlight
medicine
b e t t e r than t h e d o c t o r s .
Th e surgeons
empirical, pragmatic perspective
o f the
p h i l o s o p h e s
and
adopted
empirical
as
stance
c h a r a c t e r i s t i c
o f t e En l ight
enment,
because
i t c orre s p o n d e d
to
(No
connection e x i s t s
i n part because Locke's
Essay i s
t h o r o ug h l y colored
b y
his
close
contact with th e E ng li s h e mp i ri cal
physician, Thomas Syden ham.)7 Furthermore,
the
s u rg e o n s were
able to serve as a m o d e l of En l ig htenment h o p e s f o r
the
integration
l i b e r a l
a r t s ; for example, the E n c y c l o p é d i e
u s e d plates o f
surgical
instruments as outstanding examp le s o f the
b e n e f i t s derived f r o m the
c r a f t t r a d i t i o n . ”
Surgery
medi
cine a l s o served asa model of the utilitarian b e n e f i t s of medicine f o r
two
reasons.
The s u rg e o n s were more successful i n tying t h e i r goals
to the broader i s s u e s of the Enlightenment. And the
Faculty
of
Medicine, representing p r i v i l e g e , m o n o p o l y , and ignorance, and
thus
epitomizing
some o f the i l l s o f the ancien régime,
was to o
Conflict
The surgeons' s p e c i f i c concerns and projects for
r e f orm
g r ew i n part
o u t of the l o n g history o f t h e i r problematic position within the
medical c o m m u n i t y , particularly t h e i r relationship to the p owerf u l
Faculty
o f Medicine.” A guild o f s u rge o ns , whose
memberscame
to
b e e n established i n the
fourteenth century.
Altho ugh some
of these e a r l y s u rg e o n s
may
have been university educated, th ey did no t constitute an academic
body u n t i l 1533, when the surgical College o f Saint-Côme was
established. In 1544 Francis I granted t h e m the
r i g h t
to wear the cap
public
operations,
concessions
meant higher
f i n a n c i a l
p r i v i l e g e s for
the small
academic surgical
c o m m u n i t y . The
b a r b e r
surgeons,
as
the
a larger g r o u p who
t r i m m e d hair
an d p e r f o r m e d
m i n o r
opera
tions.10
A So ur ce o f Medical En l ig htenment
13
many agreements
deal only with
the
manual
operations
of surgery an d to t r e a t patients only a f t e r the doctors -regent o f the
Faculty o f
P a r i s had given t h e i r
approval.
e f f e c t
c o n c e d e d the doctors' superiority and control and p r o v i d e d them
with the
basis for t h e i r
arguments f r o m l e g a l precedent i n the
p am p h l e t war. In 1655 situation wasfurther complicated b y the
formal u n i o n o f the barber-surgeons an d the s urge on s o f the l o n g
r o b e . F o r the
eighteenth-century surgical polemicists,
the
i n f l u e n t i a l physiocrat, François Que snay,
t h i s
u n i o n
was the p r o d u c t o f
a conspiracy
surgeons and
p r o d u c e d the decline o f French
surgery. He described
the
relationship t h i s way: “On the o n e s i d e ,
o n e s e e s th e b arb ers , p u s h e d b y ambition, revolting against
t h e i r
masters, usurping
the
r i g h t s o f o u r
Art. I n league with the Faculty
of
M e d i c i n e to s u p p o r t t h e i r charges, they became the instruments of
the
hate
a l l
doctors against the surgeons. On the other s i d e , o n e
f i n d s
the surgeons completely
t h e i r profession, e n emie s
of
trouble, r e g r e t f u l l y
obligated
and
jealousy,
always
disposed
to s a c r i f i c e a p or ti on of t h e i r i n t e r e s t s for
the love
Toby Gelfand
h as
pointed to the e c o n o m i c factors that inclined the
surgeons
of
r o b e
surgical
a r t i n the sixteenth century c o u l d
n o t s u p p o r t an academic
surgical
principal
medical
function wasto p e r f o r m ma j o r operations. Given the pain, expense,
and
of
m a j o r operations, i t i s no t surprising
that
f o r them.”
h ad
reasons to
u n i t e , t h e i r expectations of the u n i o n were s t r i k i n g l y d i f f e r e n t f r o m
i t s actual r e s u l t s .
The
barber-surgeons wis h ed to unite with the
surgeons t o escape t h e c h a f i n g c o n f i n e s of medical
s u b j u g a t i o n .
Th e
t o share
s o m e
of t h e
m o r e
l u c r a t i v e p r a c t i c e s
the
to
e s t a b l i s h of
to r i v a l the medical f a c u l t y . Bu t
the
doctors quickly precluded these
p o s s i b i l i t i e s
an d u s e d th move
toward
for
ends. By
appealing to the king they gained the l e t t e r s - p a t e n t of 1655, w h i c h
granted
them
and supervise a l l
“mé d i ca u x se
c o ur s ,” i n cl u d in g
surgical operations;
 
o f physicians.” Instead o f ga ni ng a
surgical
faculty equivalent to the medical f a c u l t y , o r at l e a s t inde
p e ndent of
more
consistently
applied.
Whether
was
a misap pre h e n s i o n o f t h e i r
p a s t ,
the
theory
that the u n i o n o f 1655 was a c o ns p ir ac y on th e p ar t o f the doctors
allowed surgical polemicists o f the eighteenth century to portray the
pre-1655
of
the l o n g r o b e as a Utopian picture
o f
r o l e an d status
of
surgeons.
More r e a l i s t i c a l l y ,
i t gave
them a
h i s t o r i c a l precedent for an academic
company o f s u rge on s
w h i c h
they
to
r e e s t a b l i s h
t h r o u g h o u t
the course o
t he e ig ht ee nt h century.
M o r e o v e r , the doctors, not content with the subjugation of the
e n t i r e surgical profession, continued to l o b b y for an d to gain legisla
t i v e s t r i c t u r e s
agai n st t he
surgeons l a t e i n the seventeenth century.
Fo r
decreed that t h i s new
community
had
i t s e l f
to the
Faculty on
the same
basis
as
the barber-surgeons. This meant that a l l s i g n s o f academic status
were prohibited, an d p u b l ic t eac h in g an d the defense o academic
theses b y surgical students was forbidden. In 167o further legisla
tion required
render
f i n a n c i a l an d
honorific
nity.15
Alth ough these s t r i c t u r e s
were
teenth-century surgeons, they i n f a c t separated
the e n t i r e
s u r g i c a l
community
M e d i c i n e
and p r o vided
an oppor
i t s ow n .
Altho ugh the
the
s u rge o n s did not c hange f r o m
165o
to
1699,
t h i s
p e ri o d wi tn es s ed a strengthening of the surgical company and a
separation,
practice t h o u g h n o t
i n
l e g i s l a t i o n ,
o f the surgeons
f r o m
o f
thus those barber-surgeons who were
primarily barbers were q u i c k to take advantage o f the lucrative
s i d e l i n e of
wigmaking. A
forbidding
act
o f surgery an d the members o f Saint-Côme to s e l l
wigs. 7 The separation that h ad deve l o p e d b e tw e e n th e spheres of
practice o the academic surgical
community
 
was
recognized i n the s t a t u t e s o f 1699,
w h i c h
e x p l i c i t l y enjoined
t h a t
those surgeons who gave
b a r b e r s '
w o r k and l i m i t e d them
s e l v e s
to “the a r t o f
s u rg er y p u r el y and
simply
considered to
p r a c t i c e a l i b e r a l a r t
and
w i l l enjoy a l l t h e p r i v i l e g e s a t t r i b u t e d t o
t h e
liberal arts.” I t s h o u l d be noted that w h i l e
these distinctions
d e f i n e d i n
l a w ,
they were not
i n
P a r i s , an d i n the provinces s u c h distinctions tended
to
entirely.”
The
s urge ons o f the l o n g r o b e al so o ff er ed an alternative to the
doctors i n terms of medical
p r a c t i c e .
Even
l e g a l l y
r e s t r i c t e d to external s y m p t o m s , i n f a c t they
al so tr eate d
medical problems with i n t e r n a l s y m p t o m s because of t h e g r e a t
demand f o r medical s e rv i c e s
which
wh e r e
surgeons were the p r i n c i p a l medical p r a c t i t i o n e r s , provides a t e l l i n g
example. In the eighteenth century, the Faculty o f M e d i c i n e o f P a r i s
consisted
for
m i l l i o n .
The Faculty of M e d i c i n e maintained that number to ensure
t h e i r
control over the profession and the a b i l i t y of t h e i r members to
s u p p o rt themselves
and maintain t h e i r s o c i a l position.
At the same
time i n P a r i s t h e r e were approximately two hundred
and
t e r surgeons an d about
t h e
same n u m b e r
of “ p r i v i l e g e d
s u r
geons,” those who
rented the p r i v i l e g e of
w o r k i n g
u n d e r
a
master
t h e
r a t i o of surgeons t o doctors was about 5 t o 1 , i t i s
not
s u r p r i s i n g t h a t they encroached o n
t h e
p h y s i c i a n s '
p r a c t i c e of
medicine and were
l i c e n s e d
medical
practi
t i o n e r s of Paris.
S o c i a l f a c t o r s were a l s o involved
i n
t h e growing i n f l u e n c e of
s u r g e o n s .
Doctors belonged t o
t h e high
b o u r g e o i s i e
and
treated
members
the
many of whom acted
as t h e i r p a t r o n s . Doctors were a l s o f r e q u e n t l y m em b e r s of eigh
teenth-century salon s o c i e t y . Several physicians, notably Helvétius,
Chirac, and
ennobled
1720s,
i n d i c a t i n g t h e
r i s i n g
s o c i a l status o f p h y s i c ian s .” Surge o n s ,
on
the other hand, treated
m o s t other s o c i a l c l a s s e s , with t h e v e r y l owest seeking out
t h e
barber-surgeons. Surgeons rather than d octo rs th us served as the
ordinary
medical p r a c t i t i o n e r s
f o r t h e
bulk of
population. As
o n e s u rg eo n n o te d i n a charge against the
doctors,
o f
r e f u g e s of
p o o r c i t i z e n r y ,
contain
than
 
many c i t i e s of t h e kingdom; y e t n o p h y s i c i a n s l i v e i n
t h e faubourgs”;
w i l l
always b e t h e p h y s i c i a n s of t h e poor.”
And a doctor i n d i g n a n t l y claimed t h a t surgeons r e c e i v e d 90 percent
of medical revenues.”
f a c t
met a b u rge on in g d e ma n d
f o r
They
t h e
and
followed
Th e advent
of
t h e standing army i n t h e seventeenth
century
l a r g e medical
s t a f f , an d t h e s e p o s i t i o n s were
u s u a l l y f i l l e d b y surgeons. M i l i t a r y s e r v i c e gave t h e s u rgeo n n ot only
an opportunity to extend h i s a c t i v i t y to th e treatment o f w o u n d s ,
which w o u l d have been o u t s i d e h i s normal experience,” but a l s o a
l e g i t i m a t e way f o r h i m t o t r e a t a whole range
of
medical problems
d e s p i t e t h e t r a d i t i o n a l d i v i s i o n
of
medical
p r a c t i c e
i n t o i n t e r n a l and
external s y m p t o m s .
Most
importantly,
the s urge on s were i n a position to p r o f i t f r o m
an d p a r t i c i p a t e i n t h e renewed i n t e r e s t i n an at o my an d physiology
awakened b y
an d
b y
mechanism t o medicine. This prog
r e s s i n anatomy and i t s
d i r e c t
application to
greater
p r e s t i g e , and i n the
l a t e
seventeenth
cen
t u r y s e v e r a l
P a r i s i a n
surgeons
t h e Academy
of
Sciences.” I n general, the association o f s u rg eo n s wi th new d e v e l
o p m e n t s i n the sciences
gave
surgery greater c r e d i b i l i t y , undermin
i n g t h e
notion t h a t surgery
was
an d
ack n ow l e d g i n g the surgeons as standard-bearers of the new science
in
France.
were
a l s o a b l e t o c a p i t a l i z e o n
t h e g r e a t
popularity
i n t h e s even teenth c entu ry of a l l t h i n g s s c i e n t i f i c . As part of t h e
course a t
t h e
of P a r i s ,
a
doctor
l e c t u r e d while a surgeon
demonstrated anatomy
an d
s u r g i c a l t e c h n i q u e . Certain
surgeons
became s o renowned f or their a b i l i t i e s as d e m o n s t r a t o r s that sur
geons
could
reasonably argue t h a t t h e doctor was
superfluous t o
t h e
s u r g i c a l
c o u r s e s , y o u n g
surgeons also were
private
s u p p l e m e n t
t h e i r
income,
o f f e r e d
courses
public
i n s t i t u t i o n s .
For
c o u r s e s
i n s u r g e r y and
anat
omy
Jardin d u Ro i strik
ingly o v e r s h a d o w e d those of
the
premier
terms of at
l e c t u r e s were
gathered t o g e t h e r i n a popular
textbook.”
r e s u l t of
t h e p o p u l a r i t y
of t h e s e s u r g i c a l
demon
 
s t r a t i o n s , the Co ll ege o f Saint-Côme was authorized to construct a
public
amphitheater, an d
a royal e d i c t o f 1699 s p e c i f i c a l l y ordered
the s urge on s to continue t h e i r public demonstrations despite the
opposition o f the Faculty o f Medicine.28
The
surgical
community
wasalso
able
to
an important
educational niche. The separation o f the doctors an d the surgeons
l e f t a v o i d i n surgical
education, since the
Faculty o f M e d i c i n e ceased
to t r a i n barber-surgeons a f t e r they
merged
l ong ro be
and
did
n o t r e i n s t i t u t e a
course for surgeons u n t i l 1720.
The surgeons themselves attempted
t h i s void. They
had always
u n i o n
with
the
barbers
royal
1724,
o f
increasingly rigorous
T h e s e examinations effec
t i v e l y separated the s urge on s f r o m the barbers, raised the overalled
ucational l e v e l of the surgeons, an d created an educational e l i t e with
in the surgical
thus had
claim
surgeons,
system
o f f e r e d a p r a c t i c a l education
t h a t not
only
was
grounded i n
empirical investigation b u t also i m p l e m e n t e d the
most
an d
i n the
strengths o f
z e a l i n
the f i g h t to control
t h e i r
own education an d th e f er vo r of
the
righteous i n p re s si ng t he
claim
that
In
contrast to the s u r g i c a l emphasis on empirical investigation
an d p r a c t i c a l
e x p e r i e n c e ,
medical education i n France i n t h e eigh
teenth century remained staunchly
oriented
ar o u n d t he e xege si s
o f
ancient t e x t s and r i g i d l y r e s i s t a n t to innovation.”
Medical
students
were taught
b y p r o f e s s o r s
who were g e n e r a l i s t s . With r a r e e x c e p
t i o n s ,
there
was
no
notion
of
medical specialization within the
Faculty o f P a r i s an d very l i t t l e sense that research was worthwhile.
Instead,
was d o m i nat e d b y
the conviction
that e v e r y
thing to b e known ab o u t medicine was
to
b e f o u n d i n the t e x t s o f
Hippocrates, Galen, an d A r i s t o t l e . C o n s e q u e n t l y the requirement
for success as a medical student wasa
good grasp of
a
defense
of
medical
four
based
on
candidate's
to
show
i n
historian
who
has studied t h e s e t h e s e s concluded that “i t
would
to
these
works
o r i g i n a l i t y , a t a s t e for
research,
o r
i n t e l l e c t u a l
i n d e p e n d e n c e . ” The
education offered b y
 
t he Fac ul ty completely neglected midwifery, chemistry, and anat
omy; i n addition, i t offered
n o bedside instruction
c l a s s e s
annually. A c k n ow l e d g i n g the decline of standards
of French medical
1767
condemned
“the
relaxation
which
place
f a c u l t i e s of
medi
c i n e ,
b ot h i n regard to the duration and quality o f studies and i n
regard
to
the
to a degree.”
The decline of French medicine wasalso r e f l e c t e d i n the g r ow i n g
influence of
the king's f i r s t s u rg e o n at the e x p e n s e
of
the f i r s t p h y s i
c i a n . Traditionally,
the king
physician an d
barber-surgeon.
long
the pre
mier barbier to s e l l h i s “rights an d p r i v i l e g e s over
the
surgery
to the p r e m i e r chirurgien, François F é l i x . ”
The surgeons were particularly fortunate
i n
the a b i l i t i e s
o f
office.
increased
t h e i r p r o f e s
sional standing and t h e i r influence with the king. Fo r e xam pl e , i n
1686, Félix successfully operated on Louis XIV for an anal f i s t u l a .
Georges
Maréchal,
the
surgeon, also
the cause
o f the surgeons b y correctly diagnosing Louis XIV’s l a s t i l l n e s s an
rec ommending
Th e
f i r s t p h y s i c i a n , Guy-Crescent
Fagon,
had i n s i s t e d that
the king's health was
prevailed,
only
to
b e
dismissed upon the king's demise. Maréc hal wasalso i n goodstand
ing
with
the new r e g e n t , P h i l i p ,
Duke of
suc
c e s s f u l l y treated
him
s i g n i f i
c a n t l y , i n 17 11 M ar é ch al
de f ended
p o i s o n i ng
the h e i r s to the throne. Predisposed to favor the cause
of
the surgeons, P h i l i p s u p p o r t e d Maréc hal when
h e defied
the
doctors
b y ordering the surgeons no t to p ay the d e f e r e n t i a l f e e s to the
medical faculty.”
These
i n f l u e n t i a l f i r s t surgeons defined for
them
s e l v e s a r o l e as advocate for the surgeons, an d they lobbied to
u pgrade the
educational
l e v e l and s o c i a l status
of
the s u rge o n s .”
The history of the c o n f l i c t between
the
provides a
ba c k g r o u n d to a
discussion of
the p a m p h l e t war
but
i n d i cate s
critical d i f f e r e n c e s
in t h e evolution of th two
bodies, particularly the advances made b y e l i t e surgeons a t the
ex p e n s e
of the
o f M e d i c i n e . ”
The
the
doctors i n
t h e i r areas o f professional exclusivity s u c h as university education
A
o f
Medical
|
and
t r a i n i n g . Perhaps the m o s t i n t e r e s t i n g conclusion to b e drawn
f r o m th e his to ry
o f
i s that the new discoveries and
approaches to science o f the seventeenth century, for example,
anatomical discoveries and arguments for
empiricism,
worked
i n
favor o f the surgeons an d p u t t h e m i n a position to manipulate these
innovations
i n t h e i r own
i n t e r e s t s . I n the
co urs e o f
the p a m p h l e t
war t h i s i m p l i c i t p o s s i b i l i t y was
e x p l i c i t l y argued
and
b y
the surgeons. They did n ot simply claim that the new sciences
e n h a n c e d t h e i r professional status and reenforced t h e i r notions o f
p r a c t i c e ,
b ut rather
understanding
to
progress. These t a c t i c s allowed the s u r g i c a l
community
i n the course o f the p a m p h l e t war to e s p o u s e the new, to take
command
commitment to th e new
sciences legitimated themand authorized t h e i r control o f m ed ic i ne .
The m o s t concrete an d
immediately i n f l u e n t i a l
r e s u l t
o f
the in
crease i n surgical
v i s i b i l i t y , i n
the domain o f surgical
p r a c t i c e , in
educational
proximity to the crown
the ordinance
of 1724, wh i c h b e gan a l o ng
process
the
surgeons
to
claim that
they rather
than the doctors s e t the standards for medical p r a c t i c e . The pam
phlet warwh i c h e n s u e d i n the wake o f the
ordinance
i s s u e s
of professional preeminence an d control remained s i g n i f i c a n t , the
debate also p r o vided a f o r u m within w h i c h the surgeons presented
ideas f o r educational reform,
claimed to
c l u ng to outmoded an d
i n e f f e c t u a l
p r a c t i c e s . The
ordinance
i n
m ed i cal e du c at io n
an d practice were
more prominently
and the academic community of the surgeons asserted a new m o d e l
for the profession.
The royal
1724 v i o l e n t l y
re o p ene d the traditional
b a t t l e b e tw e e n the doctors an d the surgeons b y granting the College
of Saint-Côme
r i g h t
to appoint f i v e s u rg e o n
demonstrators
t
20
| La
 
give p u b li c c o ur s es i n
anatomy
ordinance i n e f f e c t
sanctioned the establishment of a surgical academic e l i t e and abro
gated
the
monopoly
wh i c h th e Fac ul ty of M e d i c i n e
claimed
over
medical
t h e i r c r a f t
an d thus
t h e i r
hegemony over the e n t i r e medical profession b y
questioning t h e i r expertise i n surgery. The
c o n f l i c t
became o n e
the
the
surgeons,
b e tw e e n the t r a d i t i o n a l , textually based
education o f
the doctors and the empirical, c l i n i c a l practice of the surgeons. The
doctors c o ul d n o t t o l e r a t e s u c h a challenge
to
authority
and
e x p e r t i s e , and they vented t h e i r indignation i n a p a m p h l e t war
wh i c h raged f r o m 1724 to 1750.
In
the
salvo, the
doctors protested
b y the
surgeons on t h e i r traditional preserves and c i t e d s p e c i f i c grievances.
Fo r
example, the
him
r i g h t s n d
to
argue
for
the
repeal
i t
was, t h ey c laime d , t o t a l l y unnecessary
b e cause they were
more than able to educate the surgeons. They pointed o u t that the
Faculty had
i t s
s u rg e o n s were no t
well
own
c o l l e g e , they would have to c o ntend with o v e r c r ow d e d
quarters an d to f i t t h e i r courses i n b e tw e e n a l l t h e i r e x e r c i s e s ,
d i s s e c t i o n s ,
an d
the
convenient arrangement.”
In another pam p h l e t a doctor c o n t e n d e d that the r i g h t o f th e f i r s t
s urge on to appoint the f i v e
demonstrators
p ower,
making him
surgeons b u t
also
placing
him
i n c har ge o f a l l instruction
i n
the art
o f
surgery. The
doctors w e r e voicing t h e i r c o ncern over the very r e a l change i n
power that
h ad
o c c u rr e d wi th i n the medical
pr o fe s s i o n” an d i n d i
cating
the
the authority
o f
As
profession,
the
was
able to e f f e c t greater centralization
and exercise
medical f i g u r e
c o u l d wield i n medicine. Although the f i r s t physician
h ad
tigious
influence
The
dean
of
had extensive
21
control
o ve r m ed i cal practice i n P a r i s b u t v i r t u a l l y n o n e
outside
h e c o u l d n o t
r e a l within
the
profession
because
for a term o f only
wo years.” I n
authority i n medicine,
was
able
to
further consolidate and extend h i s authority. The e d i c t
of
1724
revived the o f f i c e s o f lieutenant to the f i r s t s urge on i n regional
surgical communities. The s a l e
of
these o f f i c e s b oth
guaranteed
the
health
s urge on
Saint-Côme
an d considerably extended the f i r s t surgeon's control t hr o ug h
h i s
personal
a p p o i n t m e n t
o f four
h u n d r e d l o c a l
lieutenants
him.”
This
particular
p a m p h l e t expressed con
cern
the f i r s t
surgeon's
f i r s t
physician
that
t he o rg an izat io n o f the
surgical profession allowed
f a r
more
c e n t r a l i z a t i o n ,
and that the
b y reviving the o f f i c e
o f
only
centralization b ut also more e f f e c t i v e
continuing control f r o m P a r i s o v er provincial surgeons. The doctors
were incensed e n o u g h to claim i n o n e pam p h l e t that the r i g h t s
granted
to
i n
conspiracy against
the prerogatives o f the f i r s t physician.
The doctors
newly
acquired
to
teach
that they had
authority n o r
t h e a b i l i t y . Doctors, they
argued,
o p e r a t e ,
although they ordinarily c h o s e to o p er at e o n ly when a
surgeon
was
unavailable.
that
theory and
the physician.) Bu t
regardless
o f the a b i l i t y f the individual sur
geon, the profession o f the surgeon, the doctors claimed, was to
operate, an d h e wastherefore “sans qualité e t sans t i t r e” to teach.
Furthermore, they
argued,
there was no need to a l t e r the present
s y stem
the merits
o f
the public
courses
offered
at the Jardin du Roi. There, th ey c lai me d, La Pey
ronnie, o n e o f the m o s t noted o f c ontemporary surgeons, admirably
f u l f i l l e d
the pr o per r o l e
of
the s urge on b y acting simply as a demon
strator
The fundamental
t h e
doctors was to
t h e i r position of preeminence over the
surgeons. Therefore, they i n s i s t e d that doctors with o ut
training
m u s t
not b e allowed to teach, and th at th e
subordinate
position
hierarchy must
22 La M e t t r i e
 
outraged
physicians,
subordination which should e x i s t between the
doctors and the surgeons.”
Th o u g h t h e doctors conceded t h a t
t h e r e
were t h o s e r a r e
surgeons
La
they charged t h a t t h e education
of
They
f o u n d the s u rgeo n s' education
d e f i c i e n t
i n two
s p e c i f i c r e s p e c t s :
t h e i r
knowledge o f t h e o r y
was i n e v i t a b l y l i m i t e d
and o u t m o d e d because they did
not know
L a t i n , and, m o r e i m p o r
t a n t , t h e i r
education
the u n i f o r m an d
universal
and f i r s t reasons w h i c h
a r e ,
however, the source
o f
a l l the v a r i e t i e s whi c h are
f o u n d
i n the
bodies.”
These s o r t s of claims f o r c lear and
certain k n o w l e d g e gleaned through t h e i r conservative, c l a s s i c a l
mode o f education
s h o w s
the way i n wh i c h the Faculty was
o u t
s t e p
with t h e
e m p i r i c a l b a s i s
and the
e p i s t e m o l o g i c a l
modesty
which c h a r a c t e r i z e d t h e claims t o knowledge of t h e n a t u r a l scien
t i s t ,
surgeon.
The doctors also f o u n d f a u l t with the education of th e s urge on s
because i t n e g l e c t e d c h e m i s t r y . As r e s u l t , t h e
surgeons
“have n o
k n o w l e d g e o f elements o r
c o m p o u n d s ,
or moving forces an d
t h e i r
e f f e c t s ,
or of l i q u i d s an d
t h e i r d i f f e r i n g
proportions.
Nor
formation,
d e s t r u c
t i o n of m i n e r a l s , v e g e t a b l e s , or animals.” This charge seems
e s p e
c i a l l y ironic since the Parisian medical com unit had s o v i o l e n t l y
o p p o s e d th e intro du ctio n o f chemistry, e s p e c i a l l y chemical reme
d i e s , into French medicine. Fo r e xamp l e, Pierre Le Paulmier was
formally censured b y th e Fac u lt y
i n
1566 simply for consulting the
iatrochemist Joseph d e C h e s n e . ” And the Faculty o f P a r i s did
no t
even o f f e r courses i n chemistry u n t i l 1770.*7
The surgeons defended t h e i r
s y stem of education against
these
claiming t h a t t h e
advances made
i n
s u r g i c a l p r a c t i c e
and
b y
was not the
r e s u l t o f t h e i r education
b y
the
Faculty o f M e d i c i n e b u t was
instead
ways
education
o f f e r e d b y the
Faculty.” Furthermore,
according t o t h e
surgeons, i t was e s s e n t i a l
that
control o f surgical education b e
p l ac e d c o mp l e te l y i n t h e i r hands. O n l y then co u ld the educational
A Source o f Medical Enlightenment 23
 
l e v e l o f the s urge on s continue to r i s e and the public health continue
to
benefit
advances.
I n other words, they e x p l i c i t l y
connected
t h e i r
educational innovations with the i m p r o v e m e n t
of
right
o r control ( a s
they preferred o c a l l i t ) had t r a d i t i o n a l l y
b e l o n g e d
to the doctors,
i n
w h i c h
the
d oc to rs s o
p r ou d ly p r oc l ai me d
“had b e e n gained
on l y b y
i n t r i g u e ,
and had become
a r o u n d
the
the
ordinance
had
t h e m
natural li berty.”
r i g h t because the doctors h ad
p r o v e n
themselves to b e i nc ap ab le o f f u l f i l l i n g the r e s p o n s i b i l i t i e s i t en
t a i l e d . A
doctor's bonnet,
did n o t
a
good t e a c h e r . One particularly b o l d s urge on proc laimed that on l y
f o ur d o ct or s
i n
a h u n d r e d co u ld teach, a particularly acute p r o b l e m
because those doctorswhodid teach
had not been s e l e c t e d f o r t h e i r
pedagogical
The surgeons, h e
good
phasis o n empiricism
already
existed;
They
challenged
the
doc
tors to p r o d u c e o n e s u r g e o n they had t r a i n e d . Perhaps f a c e t i o u s l y ,
o n e surgeon suggested that the
doctors
t h i s
did
n o t know Latin, yet the
doctors had c o n d e s c e n d e d to teach i n French for only the past f i v e
years “Who then has r e a l l y
educated
the
surgeons
e n t i r e
l i f e t i m e
to “apply oneself to the cultivation and practice o f
t h i s a r t ” ; h owever,
the
the doctors
claimed
doctors themselves
s o
s c orned the practice o f s u rge ry th ey must also
have neglected
neglect
pr oc laimed that the
a r t of
surgery had made great s t r i d e s as a r e s u l t of i t s cultivation b y the
College o f Sai n t - Cô m e. Be cau s e
they
had fostered an d i m p r o v e d the
a r t
neglected i t ,
the
s u r ge o n s c lai m ed
to
to teach surgery.
the
 
deserving
wh i c h
leave
them
l a n g u i s h i n g ? ”
The surgeons attempted
the
doctors
that t h e i r education co ul d no t teach
them
tion
o f nature b y staunchly adopting a position o f epistemological
m o d e s t y and
arguing
for
the
surgeons noted,
k n o w l e d g e of f i r s t
causes
to surgeons.
“I wonder
wh et h e r
i t i s s u f f i c i e n t to b e a surge on to b e ignorant of t h i s knowl
edge, or i f i t i s e n o u g h to
b e a
queried a surgeon.
the
to
plumb
nature
made
i t much l e s s l i k e l y
that
learn
anything
s i g n i f i c a n t .
They
considered
made s o l i t t l e progress
i n
systems.” The surgeons
doctors that “b y aban
experience, y o u have nothing w h i c h can f i x
y o u r
astonishing that
the p r o d u c t of a l l
y o u r e f f o r t s can
b e reduced
mas s
because
the s u rg eo n s n ev e ceased to b e guided b y experience
and they
did n o t mai n tai n
the a r t i f i c i a l an d counterproductive d i s
tinction
between
theory
p r a c t i c e . I f
the
i n
t h e i r quest to r e e s t a b l i s h t h e i r control over surgical education, the
surgeons warned that the l e v e l of surgical practice would
inevitably
d e c l i n e . The s e surge on s were no t s i mp l y ar gu i ng that
t h e i r
practice
o f me di ci ne was as good as or better than that o f the doctors b u t
al so th at t h e i r understanding o f medical
theory
to
In formulating t h e i r arguments the surgeons
t o o k
positions
wh i ch we re l a t e r e s p o u s e d
b y
the p h i l o s o p h e s and have
come
to
b e
i d e n t i f i e d as c r u c i a l c h a r a c t e r i s t i c s o f the Enlightenment.
Fo r
exam
p l e , they adopted epistemological m o d e s t y
as th e
appropriate p h i l o
sophical position for the s c i e n t i s t . Just as v i r t u a l l y every p h i l o s o p h e
l a t e r d i d ,
the
surgeons
a ck n ow l e dg e d that o n e
can have no
causes.
th i nk er s a
firm
i n the
o f empirical
i n v e s t i g a t i o n .
Bu t b e y o n d
these philosophical a f f i n i t i e s ,
surgeons
shared
with
the p h i l o s o p h e s
an e x p l i c i t l y
r e f o r m i s t concern.
As
p r a c t i t i o n e r s of experimental
A S o u r c e
o f
 
p hil os op hy , th ey h el d o u t hope o f immediate
b e n e f i t
to mankind
f r o m
t h e i r p r a c t i c e . I n
other words,
p h i
losophes,
saw medicine as the m o s t o b v i o u s and concrete s ou rc e o f
the b e n e f i t s science
c o u l d
provide
for
o f
s o c i a l
conditions b y reforming i n s t i t u t i o n s . Th e surgeons d i r e c t e d t h e i r
reforming
z e a l s p e c i f i c a l l y t o
challenging
t h e c o n t r o l t h e
F a c u l t y of
Medicine exercised over them.
t o
t h e i r r e p u t a t i o n throughout
E u r o p e f o r excellence
i n b o t h surgical education an d p r a c t i c e , not
i ng th e “crowd o f foreigners who never s e t foot i n the Schools o f the
Faculty, who came to P a r i s to follow the exercises
o f
the school
French
surgery had attained a great reputation i n the l a t e seventeenth
century,
on
successful
techniques
maj o r operations an d
extensive anatomical work, w h i c h b r o u g h t surge on s and physicians
f r o m a l l over E u r o p e
to
P a r i s . An eighteenth
century pr overb that recognized t h i s p r e e m i n e n c e advised o n e to go
to
more
sympathetic hearing for
t h e i r arguments, the s urgeons s o u g h t to make t h e i r dispute
with
th e
doctors a public i s s u e b y d i r e c t l y addressing the reader f t h e i r
pam p h l e t s an d b y haranguing c r owd s on the s t r e e t corners o f P a r i s .
They
claimed
to
to every c i t i z e n
o f
i n
f a c t , the primary medical practitioners i n France. As the s urge on s
noted: “Doctors practice i n the c i t i e s , s urgeons practice i n the r e s t
o f
the country, f o l l ow he army, and
accompany
no t
the doctors
who best
served the
public well-being. They
pointed o u t to t h e i r readers that
the doctors, i n formulating t h e i r arguments, never claimed to serve
the pu bl ic i n t e r e s t . Instead they raised i s s u e s o f power and p r e s
tige.” The
as
a co ntro l on p r i v i l e g e because public o p ini on
represented a
ra
tional an d disinterested c o n sen s u s w h i c h would make reform p o s s i
ble and
address th e p ub lic good.”
W h i l e th e
s urge on s were c e r t a i n l y
r i g h t that th e
doctors’
pam
i s s u e
o f the public
g o o d ,
 
tended
to
p o lemics generally an d some
times deliberately do, certain
important i s s u e s .
The doctors m i g h t
have f a i l e d to argue for the p u b li c we l l- b e in g
e i t h e r
because they
saw i t as p er ip h eral to the i s s u e raised b y the ordinance, because
they
considered an appeal to the public an inappropriate f o r u m for
t he d is c us s io n o f professional i s s u e s , because they t o o k i t
as
axiom
o f
medical hierarchy,
would best
s erve th e public well-being, o r perhaps, as th e surgeons insinuated,
because they recognized that t h i s wasno t w h e r e the strength of t h e i r
position
t h e i r
own polemical s k i l l s ,
also
f a i l e d to a ck n ow l e dg e that
the doctors were legitimately c oncerned
about
profession b y
public
Although
defending the
t r a d i t i o n a l s y stem
o f e du cati on , they
occasionally
on
surgical p r a c t i c e s , challenging several
d o m a i n s t r a d i t i o n a l l y held
b y the surgeons.
o f medical practice between the doctors an d the
surgeons
wasbased
on
a
distinction b e twe e n diseases with external symptomsan d
those
with internal s y m p t o m s , a division o f practice dating f r o m the
incorporation of the barber-surgeons
the control o f the doc
tors
to
have
the
notion that a surgeon would b e abl e to resolve external p r o b l e m s
completely evident o the ey e b y means o f pragmatic, somewhat
mechanical s k i l l s . The doctors, with t h e i r theoretical a p p r oac h to
education an d p r a c t i c e , would b e better able
to
diagnose h i d d e n
s y m p t o m s . One o f
th e b o n e s o f
contention
p a m p h l e t war was
the treatment o f
d i s e a s e , which, according to
t h i s
distinc
t i o n , f e l l within the province o f the s u r g e o n s . ”
Because
venereal
disease
sixteenth
and
sev
enteenth c e n t u r i e s , i t was a
s i g n i f i c a n t s e gm e nt
o f the
of
c e r t a i n l y recognized
t h e
l u c r a t i v e nature
of t h i s
p r a c t i c e . Perhaps
they also r e a l i z e d that the surgeons' control over s u c h a prevalent
disease h ad carved f o r themselves
an important niche
another e n c r oac h m e nt
on
the
authority
they argued vehemently that the
n atu re o f the disease required treatment b y a physician.
A Source
o f
M e d i cal E n l ig h te n me n t
27
 
The doctors challenged th e s u rg eo n s'
r i g h t
to t r e a t venereal d i s
ease o n
two grounds. F i r s t , regardless o f t he e xt er nal
s y m p t o m s ,
venereal
disease
wassimply t o o c o mp l i c at ed
for surgeons to
b e able
Thesymptoms
were b o t h t e r r i b l e an d e qu i v
o c a l , and s o , the doctors contended, i t s treatment “unquestionably
merits th e m o s t serious attention o f the m o s t enlightened p h y s i
cian.” Secondly, the doctors claimed that even according to the
traditional
d i s t i n c t i o n between
external an d internal symptoms
they o u g h t to t r e a t venereal d i s e a s e , for the external symptomswere
on l y
m i n o r r e f l e c t i o n s o f a
great
i n t e r n a l disturbance o f h u m o r s ,
complications
cried
o u t
for t he e nl ighte ne d j u d g m e n t
of
a
again,
according to the doctors, the d e f i c i e n c i e s
of
incapable o f treating venereal
d i s e a s e . Doctors s u p p orted t h i s
claim
b y c a l l i n g into question the
value
o f experience. “ W i t h o u t speaking
of the
m o s t accomp li s hed
s o r t , experience i s nothing b u t an uncertain, no t to
say
routine
when
directed
b y p r u d e n c e
an d discernment. How
many unfortunate
vi cti ms ar e there o f experiments c o n d u c t e d
b y
In
the uned ucated surgeons,
e s p e c i a l l y
well
read
i n the b e l l e s
l e t t r e s . One doctor a c k n ow l e d g e d that t h i s sort o f e d u cat io n m i g h t
b e
th o ught i r r e l e v a n t to the
practice
h e c o nte nd ed
that “belles l e t t r e s wh i ch ad o rn the s p i r i t make i t more susceptible
to other learning.” Furthermore, t h i s f a m i l i a r i t y with
great