natural philosophy and laws of nature, so as to

combat scepticism and irreligiosity by proving

the existence of God through demonstrations

of the laws of the mind.

Two other essays focus on images of

anatomy, and natural history and materia
medica in late seventeenth- and eighteenth-
century Netherlands. Rina Knoeff

comparatively analyses the conceptions and

moral lessons of perfection in the anatomical

atlases by the Mennonite Govard Bidloo

(1685) and the Calvinist Siegfried Albinus

(1734). Benjamin Schmidt focuses on the

peculiarities of the ideological strategy

(exoticism, universal knowledge, priority of

pleasure and delight) followed by authors,

illustrators and publishers of naturalistic works

from the non-European world under Dutch

control (mostly the East Indies).

Iberian Enlightenments are targeted by two

more essays. Timothy Walker emphasizes

Portuguese state-licensed medical

practitioners’ conspicuous role as experts in

the service of the Inquisition, and the

paradoxical convergence between their fight

against popular healing culture and the

Catholic Church’s struggle against magic and

sorcery. While the essay by José Pardo-Tomás

and Àlvar Martı́nez-Vidal discusses secular

and regular clergymen’s moralist contributions

to the Spanish debates on birth care (including

performing baptism on a dying infant), and

their support for the professional

legitimization of the emerging practice of

male midwifery surgeons to the detriment of

that of traditional midwives.

The remaining essays are focused on case

studies of miracles, exorcisms and sanctity

that illustrate Enlightenment interactions of

new medicine and its practitioners with

Catholicism in the context of Europe where

religious division was still relevant. Robert

Jütte revisits the French and German

Enlightenment debates on the medical miracle

of the “golden tooth” that was allegedly grown

by a Silesian boy in 1593. Through the case of

a Franciscan friar who levitated during his

ecstasies and was beatified by Benedict XIV,

Catrien Santing shows the limits of the

modernizing and rationalizing agenda of an

“Enlightenment pope” who aimed to use new

medical and natural philosophical scholarship

for purifying and reinforcing the Catholic

Church. Claudia Stein explores the

peculiarities of Bavarian Catholic

Enlightenment by dealing with an apparently

successful healing through exorcism (1774)

performed on a daughter of Johann Anton von

Wolter—the favourite physician of

Maximilian III Joseph of Bavaria—and the

reactions of a variety of witnesses. And Ole

Peter Grell focuses on the spiritual journey

from Lutheranism to Catholicism of the

Danish anatomists Nicolaus Steno and his

grand-nephew Jacob Winsløw, by

emphasizing the seminal role played in both

conversions by Jacques-Bénigne Bossuet in

the fervent intellectual atmosphere of Counter-

Reformation Paris.

In sum, this valuable volume underlines

firstly, the persistence of the religious

rationale in Enlightenment Europe and its

relevance for medicine and medical

practitioners; secondly, the plurality of

meanings and registers of this cultural

movement, from its radical version to the

multiplicity of more moderate Protestant and

Catholic Enlightenments; and thirdly, a

number of features (miracles and conversions,

mostly) that fed religious polemic between

both sides of the major early modern Christian

schism.

Jon Arrizabalaga,

CSIC-IMF, Barcelona

Marion Maria Ruisinger, Patientenwege.
Die Konsiliarkorrespondenz Lorenz Heisters
(1683–1758) in der Trew-Sammlung Erlangen,
Medizin, Gesellschaft und Geschichte, Beiheft

28, Stuttgart, Franz Steiner, 2008, pp. 308,

e43.00 (paperback 978-3-515-08806-0).

For more than twenty years medical history

has been paying greater attention to the people

for whom medical thought, action and effort is

carried out—the patients. Primary sources,

459

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especially for the early modern period, have

posed a comparatively difficult problem. Over

the course of time, more or less prominent

representatives of academic medicine have left

behind printed works that are easily located,

yet those who consulted them have generally

remained silent. Gaining closeness to

historical patients has proved challenging,

sometimes happening only indirectly or by

chance. The sources usually consulted thus far

have revealed little about how patients felt and

interpreted their physical circumstances and

medical restrictions. It has been equally

challenging to investigate how sick people

perceived their own interaction with the

providers of medical services.

Recently, the use in German medical history

of a type of source that must be seen as a central

means of communication in the eighteenth

century for various social strata of European

society has allowed for a qualitative leap—the

private letter (Michael Stolberg, Homo patiens,
Cologne, Böhlau, 2003). Not only did

physicians and learned people interested in

medicine and natural science carry on

academic and professional correspondence,

sick people also used their quills to write to

medical experts far away. They wrote about

their illnesses and asked for advice. If the

person to whom the questions were addressed

answered with an extensive letter interpreting

the medically related problems, a “practice by

post” could be established.

Marion Maria Ruisinger is the first medical

historian to analyse an extensive German

consultative correspondence from the

eighteenth century. Her Habilitationsschrift,
published in 2008, deals with topics in internal

medicine as well as the field of surgical

treatment, carried out at that time in the

German speaking territories almost

exclusively by artisan-practitioners. At the

centre of this written exchange is the medical

professor from Altdorf and later Helmstedt,

Lorenz Heister (1683–1758), who enjoyed a

European reputation for pragmatic authority in

both areas of medicine.

Lorenz Heister carried on an extensive

correspondence. The Trew Collection in the

University Library in Erlangen contains 1,295

pieces of writing from the learned physician

with 356 correspondents, including relevant

third parties. In addition, Ruisinger has

evaluated Heister’s casuistic works as well as

influential teaching manuals. She has

succeeded in interpreting the rich

correspondence in a highly convincing

analysis that is well conceived and carried out.

Her study can almost be seen as a reference

work on patient history that, in addition,

retrospectively corrects the medical and

scientific historical picture of surgery in the

eighteenth century and lays it out in a more

nuanced manner.

Ruisinger begins her close examination of the

patient’s course of action before the person

actually becomes a “patient”, at a time when he

has perceived in his unspoken feeling a change in

health and has construed it as part of his world

view. (Women made equal use of this type of

treatment, for ease of reading, however, the

masculine form has been used in this review.)

The person first becomes “ill” after he has begun

to see the sickness in himself. Thereafter he can

take refuge in medication or other therapeutic

measures, receive medical aid in his private circle

and finally enter the contemporary market of

healers where he can act in a relatively self-

determined manner. If he feels that the

indications and suggestions for treatment are too

confusing or contradictory or if an invasive

surgical measure is being discussed, the person,

perhaps having already been declared a “patient”

by a local healer, finally calls on Heister for his

written external medical authority. At this point a

“practice by post” can begin.

Ruisinger’s approach proves of value

especially in the elaboration of the great

variety of functions that such a consultative

correspondence could have for the participants.

By using the highly productive term “self-

fashioning” (Stephen Greenblatt, The
improvisation of power, Chicago University
Press, 1980), the author succeeds in describing

a broad spectrum of demands, instrumental-

izations and self and third-party ascriptions

made by the patient and the distant medical

expert that are interdependent and overlapping.

460

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In her analysis of the consultative

correspondence of Lorenz Heister, Ruisinger

construes the continued “practice by post” as a

win-win situation for the patient as well as the

distant expert. For both protagonists, it

represents an essential moment in the

strengthening and preservation of both

positions in the discourse on health in the

eighteenth century. The patient plays a strong,

self-determined role, even in the event that the

distant medical authority and the patient

actually meet and the patient is examined. The

symmetry is not broken until the patient goes

under the knife. This surgical measure, as

shown most impressively in Ruisinger’s study,

is the last option in a therapeutic process that

always started conservatively by applying

internal measures of treatment. For a short

time, during surgery, the patient and physician

are on differing levels. Yet the patient always

agrees voluntarily and explicitly to the

operation. Informed consent is a reality in

Heister’s surgical practice.

Ruisinger’s study stands out on account of

its rich array of sources and the exceptionally

concise evaluation of these sources that are

also interpreted on a gender basis wherever

possible. The work’s analytical structure is

well thought through and the style is a pleasure

to read with its good dosage of original

quotations from both patients and their

physicians. This monograph opens the door for

international comparative studies on the worlds

of patients in the eighteenth century.

Thomas Schnalke,

Berliner Medizinhistorisches

Museum der Charité

Sean M Quinlan, The great nation in
decline: sex, modernity and health crises in
revolutionary France c. 1750–1850, The
History of Medicine in Context, Aldershot,

Ashgate, 2007, pp. xi, 265, £55.00 (hardback

978-0-7546-6098-9).

The central aim of this book—to rewrite,

and to some extent redefine, the history of

French hygiene between 1750 and

1850—should be welcomed by all historians

of French medicine. Even William Coleman,

who acutely observed both the “bourgeois

medical doctrine” of the 1750s and the public

health movement of the nineteenth century,

never linked these two hygienic projects.

Quinlan, by contrast, makes an ambitious

attempt to demonstrate the continuities in

hygienic writings over this period: they were a

forum for middling medical practitioners to

critique both their social superiors and

inferiors, and they increasingly addressed the

effects of industrialization upon the urban

poor, explaining away its adverse

consequences by a variety of naturalizing

strategies, culminating in theories of heredity.

Quinlan divides the period into three: an Old

Regime phase which rested on meliorist

models and portrayed nervous diseases as

evidence of the decline of civilization; a

Revolutionary phase characterized by Utopian

programmes for achieving social and political

harmony through hygiene; and, lastly, a more

pessimistic phase, lasting from 1804 until the

1848 revolution, underpinned by an appeal to

statistics and concerned to cure, cleanse and

decriminalize the working class.

Methodologically speaking, Quinlan

asserts, “this study has moved beyond

sociological explanations of medical power

and the social constructionism associated with

the new cultural history”. This claim is

supported by a second assertion: to have

shown that doctors exercised their public roles

by means other than a blatantly “unified

ideological front”, instead working in

collaboration with a range of public

authorities and “patients” to accomplish

certain social, moral and political agendas

(pp. 217–18). It is here that Quinlan’s

argument falls down, for me, since this

dimension—the relationship of doctors to the

formation of public authority over French

bodies—is one of the least well-supported

parts of the book. There is little attempt to

show whether the books discussed actually

had any outcomes in terms of changes in

public policy, by whom they were read and

461

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