Othmar Keel. L'avènement de la médecine clinique moderne en Europe, 1750–1815: Politiques,institutions et savoirs .L'avènement de la médecine clinique moderne en Europe, 1750–1815: Politiques, institutions etsavoirs. (Bibiliothèque d'Histoire de la Médicine et de la Santé.) by Othmar KeelReview by: Reviewed by Martin S.   StaumIsis, Vol. 99, No. 3 (September 2008), pp. 622-623Published by: The University of Chicago Press on behalf of The History of Science SocietyStable URL: http://www.jstor.org/stable/10.1086/593245 .

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lin’s new watchdogs who was then sent along toLondon to police the activities of the Sovietdelegates. It was under these constraints thatHessen wrote his paper. He chose Newton’sPrincipia as an uncontroversial precedent of ab-stract mathematical physics, aiming to show thatit was deeply relevant to contemporary materialneeds and that Newton’s worldview directly re-flected the concerns of his class. Hessen’s pointwas that abstract science need not be merely theproduct of bourgeois idealism; it could serve theneeds of any class, including the proletariat.Initially, Hessen’s account seemed to haveworked in assuaging concerns about his loyaltyto the communist cause, since he received nomore threats for the next few years. But whenStalin tightened his grip at the end of 1934 theaccusations resumed, probably again via Kol-man. In 1936 Hessen was arrested, “tried,” tor-tured, and finally shot, becoming one of the firstvictims of Stalin’s Great Terror. Years later,Needham recollected how “delighted” he hadbeen to meet Kolman, one of the Soviet dele-gates who had shown him the political signifi-cance of the history of science, for a second timein 1965. But Kolman had known that politicalsignificance all too well—as had Boris Hessen.

Guerout’s new edition rightly stresses thesewider historical and historiographical dimen-sions. His translation and the accompanyingtexts are a timely invitation to take a fresh lookat Hessen’s famous paper.

GEERT SOMSEN

Othmar Keel. L’avenement de la medecineclinique moderne en Europe, 1750–1815: Poli-tiques, institutions et savoirs. (Bibiliothequed’Histoire de la Medicine et de la Sante.) 542pp., bibl., index. Montreal: Les Presses del’Universite de Montreal, 2001. $59.95 (cloth).

For more than thirty years Othmar Keel hasquestioned the traditional history of the ParisClinical School of the early nineteenth century.The established view appeared in the classichistory by Erwin Ackerknecht, Medicine at theParis Hospital, 1794–1848 (Johns Hopkins,1967), and in Michel Foucault’s Naissance de laclinique (Presses Univ. France, 1963). For theseauthors, the Paris school was the linchpin of themajor transition from “bedside” to “hospital”medicine and from a humoral theory of diseasefeaturing observation of symptoms to a local-ized concept of disease based on the evidence ofdissections and pathological anatomy. Foucaultattributed to Xavier Bichat a highly significantrole in changing the medical gaze from the ex-

ternal to the internal and in advancing the studyof lesions in cadavers.

Urged by one of his mentors, Georges Can-guilhem, to compare clinical medicine in Franceand Austria, and inspired by the work of ErnaLesky on the Vienna Clinical School, Keeleventually directed much of his comparativestudy to the rise of pathological anatomy inBritain. In particular, he found sensational evi-dence that Philippe Pinel, a proponent of a noso-logical approach based on pathological anatomy,had plagiarized the Scottish physician JamesCarmichael Smyth (La genealogie de l’histo-pathologie: Une revision dechirante: PhilippePinel, lecteur discret de J.-C. Smyth [1741–1821][Vrin, 1979]). The present comprehensive workaspires to hammer nails into the coffin of theinterpretation asserting the unique importance ofthe Paris Clinical School.

On the whole, Keel builds an impressive casethat clinical medicine and pathological anatomyboth arose in medical milieus all over Europe atleast from about 1750. Certainly the book isnoteworthy for its scholarly range and linguisticvirtuosity. The conclusion is that the FrenchRevolution, despite its amalgamation of medi-cine and surgery in France, was not the neces-sary catalyst for significant change in medicalconcepts and practices. While Keel does notprovide an alternate explanation as to why thistransition occurred earlier, he aggressively re-futes any special status for Paris.

The first part of L’avenement de la medicineclinique moderne en Europe, 1750–1815, seeksto demolish Foucault’s view that eighteenth-century clinical instruction was merely “proto-clinical”—a theater of species of disease. Heshows, like Toby Gelfand, that even in Franceitself surgical institutions and several Paris hos-pitals contributed to the “gestation of the clinic.”Yet he criticizes Gelfand for confining the ac-count to France. Keel asserts that Edinburgh andVienna, as well as an assortment of institutionsin London, Berlin, and Italy, were significantsites both for the emergence of the clinical ap-proach and for the “anatomo-localist” view ofillness. Military hospitals in Britain and France,with their captive populations of the wounded,provided another clinical arena. In short, therewas no discontinuity between mid-eighteenth-century and early nineteenth-century clinical in-struction.

The second part of the book, on the origin ofconcepts and techniques, shows that, long be-fore the eminence of the Paris school was estab-lished, there were pioneers elsewhere in thephysical examination of patients, palpation, andpercussion. Keel’s principal goal here seems to

622 BOOK REVIEWS—ISIS, 99 : 3 (2008)

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be to deflate the reputations of the leading fig-ures of the Paris school. Jean-Nicolas Corvisartbecame famous, for example, for translating anddeveloping the work of the Viennese physicianLeopold Auenbrugger on thoracic percussion.Keel argues that Corvisart mistranslated Auen-brugger’s representation of the sounds heard bypercussion and was more retrogressive than in-novative. In fact, John Hunter in London, Alex-ander Monro secundus and Matthew Baillie inEdinburgh, and Maximilian Stoll in Viennawere more astute pioneers of percussion.

Having previously shown the questionablepractices of Pinel in appropriating the work ofSmyth, Keel here attacks the contributions ofPinel’s disciple Bichat in classifying membranesand tissues within organs. Keel’s accolades herego once again to John Hunter, who studied peri-toneal inflammation, arrived at the concept ofdistinct tissues, and confirmed his pathologywith the microscope and through animal exper-iments, disdained by Bichat. While other histo-rians of medicine have stressed barriers betweenmedicine and surgery in Britain that no longerexisted in France after the revolution, Keel in-sists on the interpenetration of medical and sur-gical education in Britain.

Bichat’s study of membranes did not high-light his awareness of Andreas Bonn’s classifi-cation of membranes, dating back to 1763. InKeel’s view Bichat merely systematized previ-ous knowledge. Even the master physiologistAlbrecht von Haller had a more useful tissueclassification system than the excessive differ-entiation and dogmatism of Bichat’s categories.In this respect Keel’s argument is opposed toRussell Maulitz’s interpretation of the innova-tions in French pathological anatomy and per-haps more akin to John Pickstone’s assertion ofcontinuity between the era of Giovanni BattistaMorgagni and Bichat. Keel asserts that the an-alytic philosophy of Condillac and the Ideo-logues impelled Bichat to excessive subdivisionof tissues. However, one wonders if the merefact that he adopted an analytic approach fromPinel is enough to characterize the resolutelyvitalist and conservative Bichat as inspired bythe monist and moderately prorevolutionaryIdeologues.

While the developments in British pathologywere continuous and independent, Keel showsthat the Parisians massively exploited the workof foreigners. If British surgeons sometimes pre-ferred to acknowledge the French as pioneers,they were unaware that the French filtered Brit-ish ideas. Reformist surgeons also may haveresented the preeminence given to followers of

Hunter in the Royal College of Physicians andRoyal College of Surgeons.

Keel’s work leaves the vaunted Paris schoolas largely a product of eloquence, mythmaking,and the easy availability of cadavers for stu-dents. But would so many foreign students haverushed to Paris had there been no substancebehind the collective reputation of the leadingfigures? At what point in time did students failto see through the mythology? Keel promises asequel on the period 1815 to 1850. No doubt hewill continue to produce impressive scholarshipas well as to introduce provocative arguments.

MARTIN S. STAUM

Ursula Klein; Wolfgang Lefevre. Materials inEighteenth-Century Science: A Historical On-tology. (Transformations: Studies in the Historyof Science and Technology.) x � 345 pp., figs.,index. Cambridge, Mass.: MIT Press, 2007. $45(cloth).

Ursula Klein has ruffled some feathers thesepast few years by referring to chemistry duringthe long eighteenth century as a “technoscienceavant la lettre” (“Technoscience avant la let-tre,” Perspectives on Science, 2005, 13:227–266). Some have been critical of what theycharge is an anachronistic claim on her part. Ilike to see it instead as part of a larger effort byKlein and like-minded historians to take aim ata historiography organized around the artificialand anachronistic poles of “science” and “tech-nology,” which has done so much to cloud ourunderstanding of chemistry during the crucialperiod covered by this challenging book. Mate-rials in Eighteenth-Century Science is a tributeto Klein and Wolfgang Lefevre’s interactive in-telligence, intricately built as it is on their inter-woven insights into the practical and philosoph-ical issues that inform their topic.

Many have commented recently on the grow-ing popularity of “geographies of science”; thisbook presents us with a double geography. Thefirst attends to the places in which chemicalanalysis and application took place. Such a ge-ography, however, does not constitute a map ofthe application of (scientific) theory to (techni-cal) practice. The authors convincingly showthat mental and manual labor often inhabited thesame spaces and that they were more likely to befound in workplaces related to activities such aspharmacy, metallurgy, and manufacture than ina scholar’s library or laboratory. The book’ssecond geography depicts the ontological land-scape of eighteenth-century chemistry, mappingits modes of identification and classification.

BOOK REVIEWS—ISIS, 99 : 3 (2008) 623

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