American medicine in transition 1840–1910

The Revolutionary period did (after some hesitation by those who dreamed of a society without hospitals) bring about the conversion of the main houses of Christian care for the sick poor in the large urban centres (Hotels-Dieu, Charite's, and Hopitaux Ge'neraux) to medical institutions concerned with the study and treatment of disease. The process of medicalization of Paris hospitals has been well documented by Michel Poucault, Erwin Ackerknecht, and others. The medical revolution has tended to overshadow the "medical old regime". As a result of this perspective (as well as the destruction of many of the relevant archives at Paris), our knowledge of hospital medicine in eighteenth-century France, as it was lived by patients, religious, medical and administrative personnel, and perceived by the rest of society, remains obscure. Unfortunately, the present collection of eleven papers does not present any new insights or interpretations. The proceedings of a colloquium, the collection is poorly organized, repetitive, and palpably in need of editorial attention. This is especially evident in the prolix introduction by Pierre Huard and M.-J. Imbault-Huart, and, to a lesser extent, in three other papers by the same team. Their discussion of the hospice of the Paris Royal College of Surgery, for example, dwells on previously published material while missing an opportunity to consider patients or diseases. They accuse "American authors", singling out this reviewer, of mistaking the small hospice for "la grande ecole chirurgicale parisienne". Suffice it to say that I never made such a claim. (Ironcially, it is the French authors who grossly mistake the scope of the small model surgical hospital by stating that it received ten times as many patients as it in fact did.) Vincent Comiti's brief discussion of the distribution of patients and disease categories is the only paper to address these central questions. Pierre Niaussat (French naval hospitals) and Marcel Baudot (archival sources) provide facts, lists, and hints for further research. Adrien Carre's sketch of English naval hospitals argues for their inferiority to French counterparts. Jean Filliozat reproduces an eyewitness description of Paris medical institutions left by a Swedish visitor in 1770-71. Jean-Pierre Kerneis's 'J.-B. Cassard and the birth of hospital medicine at Nantes in 1717' is the only piece of research based on hospital records in this disappointing collection. Toby Gelfand History of Medicine (Hannah Chair) University of Ottawa