Insight and industry: on the dynamics of technological change in medicine

BARBARA DUDEN, The woman beneath the skin: a doctor's patients in eighteenth-century Germany, transl. Thomas Dunlap, Cambridge, Mass., and London, Harvard University Press, 1991, pp. viii, 241, £19.95 (0-674-95403-3). Readers of German will already be familiar with Barbara Duden's pathbreaking study of the female patients of an eighteenth-century provincial medical man of Saxony (it was published as Geschichte unter der Haut: Ein Eisenacher Arzt und seine Patientinnen um 1730 in 1987). Thomas Dunlap's translation will ensure that this book reaches the wider audience it deserves. Duden has analysed an eight-volume work on the diseases of women compiled by Johannes Storch from his notebooks of twenty years' practice. She peels back the medical theories and learned references with which Storch filled his work to reveal what his female patients told him about their bodies. And very startling bodies these were-at one point Duden remarks that Storch's work can be read as a decades-long attempt on his part to inscribe his understanding of the body upon the tales his patients tell. However, she resists the temptation to cast Storch as a Halle-trained Stahlian in opposition to his patients, and instead suggests that some of Storch's most important concepts were those he shared with them. The most striking aspect of these women's bodies is their fluidity in every sense. What characterizes women's bodies is flow, especially blood flow-body substances changed into each other, ailments moved around, the inside of the body was characterized by invisible but experienced flows. These extended beyond the body, both in space (external causes like dancing could alter them) and in time (like other early modern accounts of illness, these emphasized the logic of the life story rather than that of the body). Nor did these women possess modern bounded bodies; Duden suggests that the modern highly-individuated person did not yet exist-and therefore neither did such a body. She links this unboundedness to forms of social organization, arguing that social relations extended to innermost flesh. On this point, a more nuanced argument which explicitly connected particular social forms to historical bodies would have been an asset. One of Duden's most important discussions of Storch's casebooks concerns early modern constructions of gender. She shows that womanhood was not located in sex characteristics as we know them; there were no unequivocal signs of difference. What defined femaleness was periodic blood flow-men bled too, but not regularly. Nor, of course, given the fluidity of the body, did female blood flow automatically equate with menstruation; women bled or discharged other fluids from a variety of orifices. In sum, gender was a relative category. Such claims, of course, fit well with recent studies by Thomas Laqueur and Londa Schiebinger which address the construction of sexual difference. However, where the latter primarily use writings by socially-elite men, Duden shows us this system of sexual difference as it was lived by ordinary women. Although this book is an outstanding achievement, it has to be said that it is frustratingly uneven. The third chapter is the best description I know of the day-to-day realities of early modern medical practice, accomplished through intermediaries and letters, subject to shifting patterns of patronage and reputation. However, the conclusion is extremely sketchy. For example, Duden writes, "The synthesis of the bourgeois body was accomplished only after its care was monopolized by medicine" (p. 184), but does not pursue the implications of this remark. Such quibbles aside, it is to be hoped that Harvard University Press publishes this book in paperback. Duden's chapter on "The Perception of the Body" is a superb way to persuade students that the body has a history. The book will be read with great interest by historians of medicine and by feminist scholars.