University-trained Physicians Research Articles

Notes from the Front: The Casebook of a Renaissance Hospital Surgeon.

This essay uses the unpublished casebook kept by the Tuscan surgeon Giovanbattista Nardi to examine the provision of urgent medical care in sixteenth-century Italian hospitals. Most major hospitals on the peninsula maintained separate therapeutic spaces known as medicherie for this purpose. Written in the 1580s while Nardi worked as a staff surgeon at a Florentine civic hospital, this rare surgical casebook provides insight into the types of institutional resources devoted to acute medical problems; the clientele seeking immediate assistance and the situations that brought them there; the treatments used to achieve short-term "cures"; and the clinical experiences of hospital surgeons who served as frontline healers. A close analysis of the seventy-nine cases recorded sheds new light on everyday surgical treatments for conditions ranging from serious head injuries requiring trephination to syphilitic lesions and genital trauma. Casebook entries also reveal Nardi's deep engagement with the composition and use of topical remedies as both practitioner and experimenter. Intended as a memory aid for future reference, the casebook shows material traces of the author's shifting occupational identity as he matured from hospital surgeon to university-trained physician. Viewed through multiple lenses, this richly layered source expands our understanding of both the practice and profession of early modern surgery.

The Anatomy of a Medico-Legal System. Medical Practitioners and the Investigation of Suspicious Deaths in Early Modern Flanders

During the early modern period, medical practitioners came to play an increasingly important role in criminal proceedings throughout continental Europe. Nevertheless, medico-legal procedures in the Southern or Habsburg Netherlands have hardly received any attention from historians of forensic medicine. The present article aims to address this issue by studying how suspicious deaths were investigated in the early modern County of Flanders. More specifically, three major aspects of the Flemish medico-legal death investigation system are analysed: the composition of the corps of medical practitioners on which the judicial authorities relied to conduct post-mortem examinations, the content of post-mortem reports, and arrangements for the remuneration of medical experts. Although surgeons initially constituted the principal group of medical examiners, university-trained physicians were increasingly required to participate in death investigations over the course of the seventeenth and eighteenth centuries. Furthermore, this period also witnessed a gradual increase in the number of internal autopsies. However, arrangements for the payment of medical experts remained largely unchanged throughout the early modern period.

The Poison Trials: Wonder Drugs, Experiment, and the Battle of Authority in Renaissance Science by Alisha Rankin

Reviewed by: The Poison Trials: Wonder Drugs, Experiment, and the Battle of Authority in Renaissance Science by Alisha Rankin Frederick W. Gibbs Alisha Rankin. The Poison Trials: Wonder Drugs, Experiment, and the Battle of Authority in Renaissance Science. Syntheses. Chicago: University of Chicago Press, 2021. 330 pp. $35.00 (978-0-226-74485-8). When thinking about the nature of early modern experiment and knowledge production, the relevance of administering pulverized unicorn horn to condemned [End Page 416] criminals doesn't necessarily spring to mind. Alisha Rankin deftly shows why it should. In Renaissance Europe, poison was a very real threat to those in power (or wanted to be), making effective antidotes to poison a prized possession. But how could one know if a particular antidote actually worked—that it was a truly "authentic" substance naturally endowed with anti-poison properties, or a complex drug that was correctly prepared? What kind of evidence constituted proof of a drug's efficacy? Whom should one trust to make such a determination? While provocatively exploring these questions, Rankin immerses her readers in the early modern world of variegated medical practice, contested medical authority, and competing kinds of evidence. Efficacy of a drug or poison could be known from a number of sources: reasoning through medical theory, written testimony from physicians who had witnessed a drug's effects on patients, deceitful curative demonstrations in public markets, and of course personal experience. In showing how all these interfaced with each other, Rankin also brings to light the particular experience of performing contrived experiments with poisons and antidotes on criminals condemned to death as a way of establishing authoritative medical knowledge. Although focused on the sixteenth century, Rankin carefully situates poison trials in a long medical tradition. The first chapter provides a thorough overview of how thinking about poison and antidotes developed from antiquity through the Renaissance. The concluding seventh chapter shows how interest in poison trials persisted into the seventeenth century and remained significant for the burgeoning field of toxicology, even as poison trials moved from human to animal subjects. The book's three main sections—Authorities, Experiments, and Wonder Drugs—provide a helpful thematic heuristic, but what makes the book so exciting is how these boundaries are constantly blurred within and especially across the various chapters. The chapters at the heart of the book proceed chronologically, each focused on a different trial or antidote. Chapter 2 describes the advent of the early modern poison trials with Pope Clement VII and Caravita's oil, emphasizing how physicians framed trials of antidotes on condemned bodies not as a revolutionary new practice (although there was no recent precedent), but as an extension of the learned medical tradition. Chapter 3 highlights how university-trained physicians (including the well-known Andrea Mattioli) asserted their authority to create medical knowledge by carefully detailing the gruesome effects of poison on the human body and explaining any success or failure of an antidote in order to minimize the legitimacy of public spectacles by charlatans hawking fraudulent drugs. Chapter 4 examines the concerns about using living bodies to test antidotes given the potential disruption to the important social and religious function of providing a pious death to a repentant criminal. Taking a more global approach, Chapter 5 investigates the burgeoning interest in wonder drugs—remedies for basically any malady and especially poison—including bezoars, unicorn horn, terra sigillata, and tobacco—and how medical debates increasingly intersected with growing international commerce and private collections of these supposedly powerful new substances. Chapter 6 uses competing versions of terra sigillata from two rival medical empirics, Andreas Berthold and George am Wald, to illustrate [End Page 417] ow alchemical panaceas further muddied the waters of medical authority and credible evidence in the late sixteenth century. Readers will quickly cherish the vividness that Rankin brings to early modern texts, their authors, and medical debates. Specialists and nonspecialists alike will appreciate Rankin's energetic and conversational prose, as well as the fluidity with which she moves between micro and macro analysis. She weaves together, for instance, careful attention to the language used to describe poison trials—sometimes meticulously descriptive, sometimes curiously imprecise—with the broader cultural contexts of how...

Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage by Todd H. J. Pettigrew

Reviewed by: Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage by Todd H. J. Pettigrew Carol F. Heffernan (bio) Todd H. J. Pettigrew. Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage. Newark: University of Delaware Press, 2007. 197 pages. $85.00. Todd Pettigrew's Shakespeare and the Practice of Physic studies the medical practitioners that appear in Shakespeare's plays in the context of tracts and vernacular medical texts that were part of the debate on medical practice sparked by the establishment of the College of Physicians of London in the early sixteenth century. The College of Physicians attempted to establish a hierarchy of medical practitioners with themselves at the top. Pettigrew argues that "Shakespeare's drama consistently questions and challenges the elite physicians' claim on absolute authority in medical matters" (30). His introductory chapter (chapter 1) focuses on the rhetorical question the king in Cymbeline puts to the physician who delivers the news of his wife's death, "Who worse than a physician/Would this report become?" (5.5.27-28). Pettigrew suggests that the question "is the subtle medical refrain of the most sophisticated drama of the age" (30). The next five chapters each takes up one kind of practitioner of the healing arts: "the empiric," with no formal training but with practical experience (usually a woman); the university-trained physician; apothecaries and friars; surgeons; and, finally, those who heal with magic. Left unsaid is that most of the sick in Shakespeare's day, as in the late fourteenth and early fifteenth centuries, did not have the good fortune to be treated by a doctor of physic such as Richard Napier, mentioned several times by Pettigrew. Napier was a physician and clergyman whose medical records, kept from 1597–1634, are the source of Michael MacDonald's study of madness in seventeenth-century England, Mystical Bedlam. Napier's patients were exclusively dukes and duchesses and other members of the highest ranks of [End Page 161] the aristocracy. Patients were usually treated by barber surgeons who performed such operations as bleeding, tooth-drawing, and cauterization; midwives; apothecaries; and members of the clergy who were long in the habit of curing men's bodies together with their souls. Except for the clergy, these other leeches were unlatined and, therefore, unversed in the Latin medical authorities that formed the basis of university medical training. This reality makes more striking Pettigrew's assertion that Shakespeare challenges the establishment physicians. Chapter 2 presents Helena's cure of an ailing king in All's Well that Ends Well as Shakespeare's "case for greater tolerance in medical practice" (60). The king at first rejects Helena's offer of help because, as a woman, she lacks the formal training of the "learned doctors" of "the congregated college" (2.1.115-16) and, therefore, he groups her with "empirics" (2.1.121) who were thought to privilege experience over formal training. Helena, however, is no mere female empiric; she has inherited remedies from her father, Gerard de Narbon, a famous physician. In the end, the king calls Helena a "sweet practiser" of "physic" (2.1.183-84) and declares himself her "resolved patient" (2.1.203). Chapter 3 is primarily concerned with Macbeth and demonstrates the powerlessness of physicians—the establishment practitioners—to heal conditions beyond the physiological. Called in to treat the madness of Lady Macbeth, the physician seems to judge her condition in need of spiritual rather than medical treatment: "This disease is beyond my practice" (5.1.60). Timothy Bright's A Treatise of Melancholie would seem to concur: "the affliction of soul through conscience is quite another thing than melancholy." Chapter 4 takes up marginal practitioners: the apothecary and friar who appear in Romeo and Juliet, the one play that does not challenge the elite physicians' claim to absolute authority in medical matters. Both the apothecary and the friar exceed the limits of their profession, and thus lead to disaster. The apothecary breaks the laws of Mantua when he sells Romeo the poison because of his poverty; Friar Laurence's potion concocted for Juliet would have been forbidden by the College...

Hoaxes, Humbugs, and Frauds: Distinguishing Truth from Untruth in Early America

This essay examines two cases of deception and fraud in Early America to explore the way knowledge was socially constituted in the first half of the nineteenth century. The first concerns a heated debate over the authenticity of a fossil sea serpent that was exhibited and then offered for sale by a specimen dealer and dime-museum operator from St. Louis named Albert Koch. The second revolves around Samuel Thomson, a better-known figure from the history of "quack" or "alternative" medicine. These cases furnish an intriguing and symmetrically inverse relationship: In the case of Koch's fossil sea serpent, the community of learned naturalists deliberately and consistently desisted from making an accusation of fraud. But in the case of Thomsonian medicine, established and university-trained physicians made every effort to characterize their rivals as dangerous charlatans who were more likely to injure a patient than cure their disease. Taken together, both cases reveal that to accuse someone of fraud was to seek their expulsion from the community of knowing subjects, whereas to defend someone against such an accusation was to vouchsafe and uphold the value of their contributions to that community. Hence, one of the uses to which knowledge was put was to serve as a powerful sorting mechanism for delimiting membership in what might best be described as a knowledge community.

Medical Practice, Urban Politics and Patronage: The London 'Commonalty' of Physicians and Surgeons of the 1420s.

Medical practice in fifteenth-century England is often seen as suffering from the low status and unregulated practice of which Thomas Linacre later complained. Unlike in many European cities, the provision of physic was uncontrolled, and while urban guilds oversaw surgery as a manual art, no comprehensive system of medical organisation or regulation existed. However, in a remarkable episode of the 1420s, a group of university-trained physicians and elite surgeons associated with Humphrey, Duke of Gloucester, briefly established just such a system. While their efforts initially secured approval for a national scheme, it was only in the City of London that they succeeded in implementing their plans. The detailed ordinances of the collegiate ‘commonalty’ they founded provide a unique insight into their attitudes. Drawing on continental models, they attempted to control all medicine within the city by establishing a hierarchy of practitioners, preventing illicit and incompetent practice, and offering treatment to even the poorest Londoners. Yet they failed to appreciate the vested interests of civic politics: achieving these aims meant curtailing the rights of the powerful Grocers and the Barbers, a fact made clear by their adjudication of a case involving two members of the Barbers’ Company, and the Barbers’ subsequent riposte—a mayoral petition that heralded the commonalty’s end. Its founder surgeons went on to revitalise their Surgeons’ Fellowship, which continued independently of the Barbers until a merger in 1540; in contrast, the physicians withdrew from civic affairs, and physic remained entirely unregulated until episcopal licensing was instituted in 1511.

The professionalisation of Irish medicine in the generations before Charles Lucas.

The educational opportunities and qualifications, corporate structures and regulation that had become accepted features of the Irish medical profession in the era of Charles Lucas were the fruits of a slow process of professionalization initiated by a handful of Irish medics who, from the 1620s, began tackling poor standards of medical practice in an era of medical pluralism. This paper begins by reviewing the standard of practice in early seventeenth-century Ireland. Through the examples of Thomas Arthur, M.D. and John Clavell, a self-styled medic, differences in the approaches adopted by university-trained physicians and unorthodox practitioners are highlighted. The succession of significant steps taken in this professionalization process are traced, with particular emphasis on the failed attempt to establish a Royal College of Physicians in Dublin during the mid-1620s and the importance of the influx of English physicians in the 1650s for the creation of permanent corporate structures and regulation.

Witchcraft and Inquisition in Early Modern Venice by Jonathan Seitz (review)

Reviewed by: Witchcraft and Inquisition in Early Modern Venice by Jonathan Seitz David Lederer Jonathan Seitz. Witchcraft and Inquisition in Early Modern Venice. New York: Cambridge University Press, 2011. xi + 286 pp. Ill. $99.00 (978-1-107-01129-8). While the title of Seitz’s analysis of Venetian inquisitorial records adverts to an explication of witchcraft persecutions, the contents and results of his research are substantially germane to medical history. Theoretically, the author explores the boundaries between natural and supernatural phenomenon with particular reference to mentalities, the role of the material and demonic in magic, and, importantly, the delineation of competency over accusations of maleficium. The vast majority of the study is dedicated to the role of medical experts—the clergy as spiritual physicians and university-trained natural physicians—in the determination of the natural or supernatural etiology of illnesses popularly attributed to witchcraft. Therefore, while trial records and inquisitorial procedures frame his analysis, Seitz focuses on contemporary understandings of illnesses and treatments. The book itself is broken down into nine chapters, though these become progressively uneven depending upon the amount of material available to support individual points. The main body of evidence derives from 600 trials brought before the Venetian inquisition from 1550 to 1650 (housed in the Archivio di Stato, with almost all records missing from 1593 to 1610), of which 120 involved maleficia, that is, magic intended to inflict physical (and occasionally mental) harm. Seitz expands upon these through a laudable investigation of related materials made available to the public since the recent opening of the Archive of the Congregation for the Doctrine of the Faith in the Vatican. In addition, he consults an array of contemporary printed sources on demonology, medicine and exorcism, organized under the rubric of “libraries.” The theoretical introduction lays out the central ideological problem: the delineation of natural from supernatural phenomenona and the gray areas in between, particularly della Porta’s realm of natural magic and the popular understanding of nature. Throughout, Seitz goes on to demonstrate how Venetians at all levels of society saw both natural and supernatural causes at work in accusations of witchcraft. Chapter 1 will be familiar territory to those familiar with Ruth Martin’s study of the mitigating influences of inquisitorial procedure on witch trials, usually arising from an illness purportedly caused by magic. Seitz hones in on inquisitorial skepticism, limited use of torture, and the rarity of executions. He outlines procedures, denunciations, testimony of eye witnesses, the interrogation of the accused (constitutus), the defensive phase, and sentencing when the accused was occasionally found guilty. Chapter 2 considers afflictions and material evidence presented as proof of maleficium: reminiscent of allegations from the anti-Cathar inquisition of Le Roy Ladurie’s Montaillou, these included feathers, wax statues, bits of bone, and other objects described as sporchezza (literally “filth”) hidden about the household or corruption vomited as poison. The remainder addresses Gentilcore’s tripartite concept of medical pluralism, examining the role of experts in healing and testimony. Evidence on wise women as popular healers is scant, and the inquisition viewed their activities [End Page 197] with skepticism. Spiritual physic by ecclesiastical exorcists and university-trained physicians takes center stage. Although the inquisition even harbored misgivings about clerical medical practitioners, lay people viewed them as integral to the diagnosis and treatment of disease. Over time, natural physicians gained prominence and their testimony was rarely questioned. However they operated within religious constraints (e.g., the requirement for patients’ auricular confession) and deferred to clergy in all matters supernatural with the laconic protestation, “not my profession.” Seitz lays out four chapters on spiritual and medical physicians, providing archival evidence and an overview of standard handbooks. Although the inquisition privileged medical healers, the population at large (including medical practitioners!) could not be disciplined into a similar set of beliefs. At the end of the day, professional experts, material evidence, and natural causes gained influence in Venice and Italy more generally, while jurisprudence continued to dominate cases for maleficia in the empire to the north. Overall, Seitz provides a detailed reconsideration of Venetian witch trials, focusing on medical understandings rooted in inquisitorial procedure and popular mentalities. More recent literature on witchcraft and exorcisms...

Transforming Matter, Refining the Spirit: Alchemy, Music and Experimental Philosophy around 1600

Although tracing its origins back to antiquity, a distinctly new kind of alchemy emerged in mid-16th-century Europe. This new tradition developed out of the teachings of Paracelsus (1493–1541), a German medical practitioner who challenged the authority of university-trained physicians. He sought to establish a reformed kind of medicine based on first-hand experience of the natural world rather than dry scholastic texts. Alchemy was at the heart of this new medicine, a body of experimental practice and theory that not only held out the promise of improving the health of individuals but could also be applied to wider sicknesses of society.

Lotions, Potions, Pills, and Magic: Health Care in Early America by Elaine G. Breslaw

Reviewed by: Lotions, Potions, Pills, and Magic: Health Care in Early America by Elaine G. Breslaw Susan Hanket Brandt Breslaw, Elaine G. — Lotions, Potions, Pills, and Magic: Health Care in Early America. New York: New York University Press, 2012. Pp. 236. News reports are awash with debates on the “healthcare crisis” and strategies to reform the ailing medical care system in the United States. In Lotions, Potions, Pills, and Magic, Elaine Breslaw takes an intriguing backward look at the history of healthcare in early America and finds parallels between the current disillusionment with physicians and the former “gloomy picture of the early state of health care and the medical profession” (p. 193). Breslaw offers an accessible [End Page 537] synthesis of scholarly works on the history of medicine. Her overarching goal is to chart the longstanding tensions between doctors and the public. According to Breslaw, doctors experienced a period of prestige during the colonial years, but their medical authority then declined from the early national period through the mid-nineteenth century. While European physicians were on the forefront of nineteenth-century scientific advances, Breslaw asserts that doctors in the United States resisted change and clung to familiar but outmoded therapies. Breslaw begins with Alfred Crosby’s classic “Columbian Exchange” paradigm that underscores the devastating depopulation of American Indian groups caused by the transfer of pathogens between the Old and New Worlds. European colonists also fell prey to diverse epidemics. Breslaw analyzes publically-enacted early eighteenth-century therapeutic conflicts between medically-savvy ministers who advocated smallpox inoculation and physicians wary of unorthodox practices. Doctors in all colonies faced continued challenges from numerous authoritative non-physician healers in an unregulated medical marketplace. Breslaw concludes that these struggles between practitioners over “traditional” versus experimental treatments “gradually dissolved the magical aura” that had long surrounded physicians (p. 41). In the pre-Revolutionary period, physicians reasserted an aura of authority by employing “heroic” therapies, including extensive bleeding and purging. Breslaw argues that the colonial culture of deference allowed socially prominent, university-trained physicians to claim preeminence in healing hierarchies. Physicians’ authority was also bolstered by the placebo effect—the phenomenon in which the patient’s belief in the efficacy of a drug or therapy prescribed by a reputable practitioner causes physical healing despite the remedy’s lack of actual therapeutic effect. Breslaw’s arguments though intriguing, raise questions regarding the nature of colonial deference and historians’ ability to assess the placebo effect retrospectively. During the American Revolution, public rivalries between Continental Army medical officers dampened public confidence in physicians. In the post-war Republic, doctors’ acrimonious debates over the etiology and treatment of yellow fever during the devastating 1790s epidemics further undermined patients’ trust in the medical community. In the early nineteenth century, “medical nationalist” physicians achieved consensus by arguing that the American health environment was exceptional, causing Americans to experience different medical issues from those in Europe. According to Breslaw, this mentality prevented U.S. doctors from taking advantage of European advances in statistics, clinical studies, and pathology. Medical nationalism devolved into medical sectionalism, as southern physicians argued for a differentiation in southern physiology and remedies, including differences in African American bodies. Breslaw considers themes of personal agency and institutional coercion in chapters on gynecology and mental health. Although male midwives secured obstetrical practices among urban middle-class women by the late eighteenth century, female midwives presided over most American women’s childbirth into the mid-nineteenth century. For enslaved women, childbirth was a site of resistance to [End Page 538] slaveholders’ coercive healthcare practices and sexual abuse. Coercion also shaped alterations in psychiatric care. Leading American physicians like Benjamin Rush promoted humanitarian treatment based on new notions of rational, secular causes of mental illness. However, therapies included physical restraint and incarceration in asylums. By the mid-nineteenth century, asylum-based psychiatric physician specialists asserted professional authority to determine the boundaries between normality and deviancy. In Jacksonian America, the celebration of the common man fostered a popular health movement in which numerous “sectarian” practitioners, including Thomsonian herbalists, homeopaths, and hydropaths challenged “regular” physicians’ authority. In the face of failed regulatory efforts to block competition, “regular” doctors clung more fiercely to their “heroic” therapies. According...

Love Cures: Healing and Love Magic in Old French Romance (review)

LAINE E. DOGGETT, Love Cures: Healing and Love Magic in Old French Romance. University Park, PA: The Pennsylvania State University Press, 2009. Pp. x+291. isbn: 978-0-271-03530-7 (cloth), 978-0-271-03531-4 (pbk). $75 (cloth), $39 (pbk).The idea of love as a healing force permeates Old French literature. Laine Doggett's book examines several instances of the curative strength of love and the privileged role that medieval women play in a number of Old French romances. Doggett's thesis goes further, however, than simply giving examples of the healing arts. By contextualizing her readings in the history of medieval medicine, Doggett aims to show that Old French romance reflects a real social phenomenon-the woman without formal training who achieves social status through her extraordinary giftof healing.Love Cures begins with an overview of medieval magic and medicine within the context of marriage and courtly love in twelfth-and thirteenth-century northern France and in particular regarding untrained (usually female) practitioners whom she calls 'empirics.' Along with other scholars, Doggett challenges the strict divide between magic and medicine for this time period, noting the difficulty in determining when a practitioner was practicing 'medicine' and when it crossed into 'magic.' In this excellent overview, she writes clearly and covers the territory with confidence. I am one of the readers to whom this overview seems tailored; I often encounter medieval magic in reading, but without this summary I would not know enough to follow Doggett's analyses of literary sources. I am not altogether sure that she needed to debunk the work of Duby, Frappier, Bloch, and others. Much scholarship has been done (as she notes) in past years to correct this older work, and I imagine those who read this book are aware that the field has continued to evolve. The chapter seems to just glance at the surface of several problems since she cannot devote much space to a thorough review of magic, the marvelous, marriage and courtly love in a single chapter. However, her dialectical method of contrasting past theories with more recent work situates her work and provides a quick review of the scholarship.In contrast to the rapid overview of love and gender in the introduction, the chapters that follow treat love magic in specific works in great detail through close readings, referring back to the historical framework established in the opening chapter. Chapter two treats the figure of Thessala in Chretien de Troyes' Cliges. Doggett interrogates the role that has been ascribed to Fenice's servant and confidante. Thessala is referred to by Chretien as 'mire,' which was rendered by David Staines in his translation of Chretien's works as 'physician.' Doggett goes on to show that 'mire' had not been equated with university-trained physicians by Chretien's time, and the word could clearly encompass informally trained empirics like Thessala. Doggett shows how Chretien's descriptions of Thessala's work offer a colorful and detailed look at the training and role of a twelfth-century female healer.Chapters three and four treat the romance of Tristan and Iseut, making this story the lynchpin of Doggett's argument. Through close readings of the various versions of the story, Doggett aims to make two points:1) Iseut and her mother are talented healers who alone know how to counteract certain poisons and save Tristan's life. While trained doctors attend to Tristan's wounds, they are repeatedly unable to save him as they lack the knowledge the women have of poisons and their herbal antidotes. The potions and poultices fabricated by these women succeed because of the particular and unique skill of these women who do not have formal training. Thus those reading the story of Tristan and Iseut cannot fully understand it without attributing this special talent to Iseut, a talent that gives her equal footing with Tristan, whose own special talent is his prowess as a knight. …

Confronting the Elephant in the Room: Can We Transcend Medical Graduate Stereotypes?

As a US medical graduate, I was not exposed to the travails of international medical graduates until 1993. That year, having just completed critical care training at the University of Chicago, I joined the faculty of a program where international medical graduates made up most of the trainees. I made this choice because I sensed an opportunity to have a positive impact on education and a community's health outcomes. At the time, some admonished me that I would be throwing away my career on “missionary work.” While this elitist comment sealed the deal, my choice was also prescient. My impact in a place that had not had formal critical care education and team coordination was instant and substantial.1 Eventually, I became program director of internal medicine and was charged with the task of building a top-tier residency. This journey has been simultaneously edifying, frustrating, and inspiring. Demographics of 21st Century Graduate Medical Education Data compiled by the National Resident Matching Program (NRMP)2 show that the percentage of international medical graduate (IMG) residents has remained relatively stable during the past decade at 17% to 20% overall and 28% to 36% for internal medicine programs (figure). While the NRMP publishes national specialty-specific match results, it excludes positions offered outside the match, which are often filled by IMGs. Thus, the number of IMGs in residency programs is unknown. Despite the sizeable proportion of IMGs who fill training programs, relatively little scholarly work has examined their demographics, distribution, and performance compared to US medical graduates (USMGs). A few studies and anecdotal data suggest that university programs train a greater percentage of USMGs, and community hospitals may have a higher percentage IMGs.3,4 A single large study of internal medicine residents examined aggregate examination scores over time finding that medical knowledge scores of IMGs compared favorably to those of USMGs.5 Between 1995 and 2000, IMGs “scored higher than graduates of US medical schools on every internal medicine in-training examination at every PGY level.”5 Although overall rates of internal medicine board certification are less in US-born international medical graduates (US-IMGs) than in non–US-IMGs and USMGs,6 no study has reported pass rates for first-time test takers in medicine or other disciplines. FIGURE NRMP Statistics Describing Percentage of IMGs Matching to All Residencies and Internal Medicine Residencies.

Laura J. McGough, Gender, Sexuality and Syphilis in Early Modern Venice: The Disease that Came to Stay, Early Modern History: Society and Culture (Basingstoke: Palgrave Macmillan, 2010), pp. x + 202, £50.00, hardback, ISBN: 978-0-230-25292-9.

Laura J. McGough’s study of the ‘French Disease’ in early modern Venice is a much-welcomed addition to both the history of women and gender, as well as the history of medicine.It is also an example of comparative history at its best, for McGough not only offers valuable insights about the Venetian past but also about present-day Africa, where she resides. Mining several rich archival collections in Venice, McGough offers us a variety of contemporary perspectives on syphilis, ranging from public health officials and Holy Inquisitors to physicians and popular healers, and from the custodians of women’s asylums to the afflicted themselves. The author finds that over the course of the sixteenth to eighteenth centuries, perceptions of the ‘French Disease’, whose symptoms ranged from syphilis to gonorrhoea and elude post-modern categorisation, changed. First introduced in virulent form by the French armies invading late fifteenth-century Italy, its familiarity, by the sixteenth century, reduced its stature to something characterised by contemporaries as endemic, familiar, and curable. McGough carefully outlines the social, cultural, and institutional processes that helped transform these perceptions. The onset of this sexually transmitted disease was initially attributed to the liaisons of soldiers and prostitutes. But the lagoon also attracted many unmarried migrants, and eventually syphilis became endemic, infecting every neighbourhood and social class in Venice, clergy and lay people alike. Venice’s response to the disease, McGough astutely shows, was gendered. A badge of honour for men, the ‘French Disease’ was a source of stigma and shame for women. Venetian authorities strove to contain afflicted females in various asylums, while men were given more attentive medical treatment. The women’s asylums, in part a product of the Counter Reformation wave of charitable causes, were destined to be venues of lifetime institutionalisation, a kind of punishment for licentiousness. However, perceptions of the purpose of women’s asylums changed over the two centuries under study as well: once a place to confine women of beauty, authorities realised, by the eighteenth century, that the real source of peril was the poverty that forced the indigent to become sex workers. Thus, unlike the Convertite, which housed a mix of former concubines, as well as the pretty daughters of merchants and artisans in danger of losing their virginity, the eighteenth-century Pentiti offered their wards vocational training and then reintegrated them into Venetian society. McGough treats us to insightful cases about the travails of these women. As the Convertite did not retrain sex workers, women hesitated to join them, for they required severing relationships with men they loved, and there was no replacement of earning potential. McGough’s book is also about the treatment of disease. Guaiacum, known as Holy Wood in Italy, was ground into sawdust and soaked in water, then boiled and reduced. The foam was then dried and used as a medicine. However, while the disease was considered curable, university-trained physicians viewed it as a moral failing and attached great stigma to it, a deterrent to patients needing treatment. Moreover, they blamed their patients if treatment failed, or suspected witchcraft if natural remedies proved ineffective. Popular healers were more accessible, and self-treatment was even more attractive because it assured anonymity. The most unique aspect of McGough’s work involves her comparisons of early modern Venice with Africa in the twenty-first century. People in both settings were guided by religious authorities as well as practitioners of witchcraft. Guilt-ridden, they sought to hide their afflictions because of the stigma, allowing the disease to thrive. Furthermore, stigma got in the way of mapping out a course of planned prevention. For Africa there is still time to overcome such obstacles, and McGough’s fascinating study of sexual contagion and treatment in Venice is an instructive means of understanding how societal attitudes can shape the course of disease.

The Professor of Secrets: Mystery, Medicine, and Alchemy in Renaissance Italy (review)

Reviewed by: The Professor of Secrets: Mystery, Medicine, and Alchemy in Renaissance Italy Pamela O. Long William Eamon . The Professor of Secrets: Mystery, Medicine, and Alchemy in Renaissance Italy. Washington, D.C.: National Geographic Society, 2010. 314 pp. Ill. $26.00 (ISBN: 978-1-4262-0650-4). The prospective readership for this study is the general public and undoubtedly also students being introduced to Renaissance history and the history of medicine in Renaissance Italy. Eamon focuses on the figure of Leonardo Fioravanti, a [End Page 500] medical practitioner, experimenter, alchemist, "professor of secrets," and prolific author. Leonardo traveled throughout Italy during the mid- and late sixteenth century, practicing medicine according to his own original regimes, advertising balsams, emetics, and other medicaments that he concocted, treating a variety of illnesses and wounds, promoting his own miraculous cures, participating in small academic societies and groups of experimenters, and eventually writing books to garner fame and advertise his spectacular successes. Eamon's method is to follow Fioravanti's travels and to contextualize the particular locales and cultural situations in which he operated. As a result, the book provides a vivid introduction to the culture of Renaissance Italy, focused particularly on empirics and other nontraditional medical practitioners, and "professors of secrets." Fioravanti favored "natural ways of healing" and opposed Galenic medicine based on the balance of the four humors that was the mainstay of university medicine. In describing the views of Fioravanti and others, for example in the 1540s in Bologna, and then in other cities that Fioravanti visited—Palermo, Naples, Rome, Venice, and Madrid—Eamon provides a richly nuanced view of a medical culture that ranged from university-trained physicians to a multiplicity of empirics, barber-surgeons, apothecaries, midwives, and "charlatans" who sold their concoctions from makeshift platforms in the piazze of Italian cities. He graphically describes diseases, such as bubonic plague and syphilis, as they must have been experienced by the people who suffered from them in the sixteenth century; and he describes patient reactions to Fioravanti's medicines, such as violent vomiting of putrid material and worms. The Professor of Secrets contains lively descriptions of empirical and experimental academies, especially in Naples, including a small group surrounding Fioravanti. Eamon underscores the wide dispersion and importance of empirical cultures at this time. He portrays the excitement of the experimenters and underscores their view that their work would benefit humanity as a whole. Alchemy was very much part of this culture, but in this particular context was utilized more for distilling medicines and other practical remedies than for discovering the nature of material reality or ascending to higher philosophical realms. Fioravanti moved to Venice because it was a great center of printing. He became a highly successful surgeon and empirical healer as he also began to write and publish his many books. Eamon describes the city itself, its role as an emporium with over fifty apothecary shops and numerous printers and print shops. He describes Fioravanti's own activity in making, advertising, and selling a variety of medicines, even developing a mail-order business and writing tracts and books. Fioravanti expounded a theory of disease that derived from corruption centered in the stomach, which could be expelled with a variety of purging medicines. He also branched out into various nonmedical schemes, persuading the Venetians to allow him to rejuvenate the city of Pola (now Pula) on the Dalmatian coast (a failure). In another effort, he wrote numerous letters to Cosimo di Medici with ideas for various inventions involving ships and various types of military apparatus, none of which persuaded Cosimo to give him a position in the Florentine court. [End Page 501] Not unsurprisingly, given his vociferously open criticism of academic medicine, Fioravanti antagonized traditional physicians who eventually managed to get him expelled from Venice for practicing without a license. He immediately went to Bologna, amazingly requested and received a doctorate in arts and medicine from the university there, and then returned triumphantly to Venice to continue his practices legally. Nevertheless, after some time he is found in prison in Milan (following the complaints of Milanese physicians), is released, moves to the court of Philip II in Madrid, again comes to loggerheads with...

JEBCAM: Rebirth Brings New Life to an Old Journal and Scientific Scrutiny to the Field

Beginning with the dawn of human consciousness, disease and death have perplexed mankind and resulted in a variety of mystical, religious, and mythological explanations. Stories such as ‘‘Pandora’s box’’ helped provide a reason for disease and other human afflictions. As human societies appeared, certain individuals claimed to be endowed with a special knowledge concerning disease and death, and such personages are evident in early writings from communities in Asia, Africa, and Europe and in the oral traditions of other groups. With advancing civilization, knowledge concerning disease and death became codified and treatises were developed, such as the various papyri attributed to Imhotep in Egypt, the Corpus Hippocraticum from ancient Greece, the writings of Galen of Pergamon in Imperial Rome, the alQ an un fi’l-tibb (Canon of Medicine) by the Central Asian Islamic physician Ab u ‘Al i al-Husayn ibn ‘Abd All ah ibn S in a (also known as Ibn S in a or Avicenna), the Nei Ching Su Wen attributed to the Chinese Yellow Emperor Huang Ti, and the Hindu texts Atharvaveda, Caraka Samhita, and Sushruta Samhita. Over centuries, various adherents came to view these writings as hallowed texts. Although scientific inquiry provided stuttering advances in a variety of disciplines such as mathematics, chemistry, and physics (particularly after the European Renaissance), medicine tended to adhere to the ancient wisdom of these sacred teachings. For example, even though the Dutch scientist Antonie van Leeuwenhoek could see microorganisms with his microscope as early as the 1600s, the germ theory of disease did not reach ascendency until the late 1800s. Until science finally insinuated its way into medical thought in the 19th century, more harm than good generally resulted from care by the supposed healers. Even during the American Civil War (1861-1865), the accepted medical therapy for injuries and illness that could not be treated by amputation was either bloodletting or administration of calomel (mercurous chloride) purgatives, and not unexpectedly most patients receiving such treatments did not survive. Although by the 1800s university-trained physicians in Europe and America could finally begin to categorize and diagnose diseases based on some scientific understanding, the results of their treatments were generally no better than that of any other healing discipline. In fact, the famous 1891 painting The Doctor by Sir Luke Fildes depicted the ‘‘physician in our time’’ who could offer no effective therapy but instead could only sit in vigil until the child either miraculously recovered or died (Figure 1). Thus, from the early-1800s until the mid-1900s (through World War II), there was an explosion of health care theories and disciplines, many offering treatments that were less gruesome and equally effective (or ineffective) as compared with those advocated by the universitytrained medical establishment. Unfortunately, this was also a period of exponential growth for charlatanism and quackery. Even following reforms to medical education as a result of the famous 1910 Flexner report, there were still few successful treatment options for most diseases. Interestingly, despite the relatively poor therapeutic options, death rates had actually fallen and longevity had increased, presumably in part due to improvements in public health as a result of better understanding of infectious disease. Astonishing breakthroughs during the heady half-century from the 1930s to the 1980s brought medical science to the forefront, and the public came to believe that all disease was finally conquerable and that the modern medical therapies dispensed by physicians were ‘‘magic bullets.’’ This period saw the introduction of effective antibiotics, which led the Surgeon General William Stewart to tell the US Congress in 1969 that it was time to ‘‘close the book on infectious diseases. The war against pestilence is over.’’ Medications to treat mental illness obviated the need for asylums and associated barbaric procedures such as shackling, shock therapy, and frontal lobotomy. Surgical procedures became safer and more routine, including open heart surgery and organ transplantation of kidneys, heart, and liver. Vaccinations were developed that basically eliminated the threat of childhood scourges such as poliomyelitis, measles, and mumps. Women who would otherwise have been childless could be made fertile with drugs or

Empirics, Physicians, and Wonder Drugs in Early Modern Germany: The Case of the Panacea Amwaldina

This essay examines the conflicting approaches towards marvelous cures in sixteenth-century Germany As pharmaceutical substances flooded in from both east and west, they brought with them a market for "wonder drugs" that would cure any ailment. In this climate, university-trained physicians felt threatened by the rising popularity of cures hawked by empirical practitioners, while at the same time endorsing certain wonder drugs. Using the example of one particularly controversial empiric, Georg am Wald, and his wonder drug, the Panacea Amwaldina, this article parses the various factors that made the medical elite embrace certain cures while deriding others.

A Philosophical Path for Paracelsian Medicine: The Ideas, Intellectual Context, and Influence of Petrus Severinus (1540-1602) (review)

Reviewed by: A Philosophical Path for Paracelsian Medicine: The Ideas, Intellectual Context, and Influence of Petrus Severinus (1540–1602) Dane T. Daniel Jole Shackelford . A Philosophical Path for Paracelsian Medicine: The Ideas, Intellectual Context, and Influence of Petrus Severinus (1540–1602). Copenhagen: Museum Tusculanum Press, 2004. Pp. 519. Cloth, $83.00. The Paracelsian and Danish royal physician Petrus Severinus complained, "If we can make more potent [drugs], extracted from metals and minerals, . . . I ask, what age except this one will oppose our efforts?" (115). Indeed, early modern attempts to prepare and prescribe drugs forged in the alchemical laboratory often faced vehement opposition by the university-trained physicians who were weaned on the humoral theory and herbal materia medica of Galen. The orthodox Galenists disdained not only the "chemical poisons" of the Paracelsians, but also their theoretical speculations. After all, the Paracelsians dismissed the belief that disease was the result of humoral imbalances, and promoted both the analogy of microcosm (the human) and macrocosm (the natural world, including the stars), and the idea that diseases were essences or actual beings. Severinus was prescient in his prediction that chemical medicine would become popular, but—as Jole Shackelford notes in the introduction to his A Philosophical Path for Paracelsian Medicine—the concepts of Paracelsus and his followers continue to remain peripheral to the grand narratives of early modern intellectual history. This remains the case despite the illuminating studies of such scholars as the late-Enlightenment medical historian Kurt Polycarp Sprengel, Walter Pagel, and Allen Debus. Thus, Shackelford sheds much needed light on this significant strand of sixteenth- and seventeenth-century science and medicine. Via text-oriented study, particularly of Severinus's Idea medicinæ philosophicæ (Ideal of Philosophical Medicine), Shackelford provides a long-awaited and meticulous biographical account of Severinus and explains with refreshing clarity the sources and speculative theory behind his brand of chemical medicine. Like such recent scholars as Michael Walton and Charles Gunnoe, Shackelford presents Paracelsianism as an ideology, duly noting that the ideas of Severinus, reflecting the reception of Paracelsus in general, were frequently accepted or rejected on religious grounds. To begin, Shackelford establishes Severinus's importance, noting that the medical author and Wittenberg professor Daniel Sennert wrote in 1619 that most iatrochemists followed in the steps of Severinus, who had molded Paracelsus's ideas into a coherent philosophy. Shackelford then traces the story of how Severinus—after studying at such universities as Padua and Paris—joined his friend Pratensis (a recognized Paracelsian) and Tycho [End Page 488] Brahe in bringing an increasingly eclectic Denmark up to continental cultural and intellectual standards. Unfortunately, Severinus's appointment as physician to the king distracted him from completing most of his research projects, but he had already left for posterity his Idea medicinæ, published in 1571. As Shackelford writes, the Idea medicinæ promoted Severinus's belief that Paracelsian medicine was not only an alternative to humoral medicine, but also promised to cope better with "new" fevers. Also, Severinus invested Paracelsianism with authority by emphasizing its ancient forebears and by arguing that Paracelsus was the latest in the line of prisca theologia—one of the few to "ascend to the inner chambers of the Mosaic mysteries" (57). In his amalgamation of Neoplatonism, the Hippocratic tradition, and Paracelsus, Severinus's featured doctrine was efficient causation, or "semina theory." Unlike Robert Boyle's inertial, material corpuscles and their active principles, Severinus's semina were "intrinsically formal and immaterial, and were logically and ontologically prior to matter" (17). The characteristics of these "loci," which accounted for all change in the subvisible world, could be observed through chemical analysis, and they were uniquely attractive to Christians, who were drawn to Severinus's Paracelsian interpretation of Genesis and his idea that when the predestinations contained in the semina are completed, the world will reach its end. Shackelford engages the reader with such fascinating topics as why Tycho—who was not just an astronomer, but also a student of alchemy—departed Denmark, and how Paracelsians were involved in the effort to improve the Danish Bible by "cleansing" it of non-Lutheran elements. Very welcome too is Shackelford's discussion of the neglected topic of Paracelsian therapeutics, especially his evaluation of...

Roy Porter (ed.), The Cambridge history of science. Vol. 4: Eighteenth-century science, Cambridge University Press, 2003, pp. xxx, 912, £65.00, $95.00 (hardback 0-521-57243-6).

Although best known for his prolific writing on the history of medicine, the late Roy Porter's reputation among general historians and a generation of Cambridge graduates was first and foremost as the author of the outstanding Penguin paperback, English society in the eighteenth century (1982). He was therefore the obvious authority to edit the fourth of eight volumes synthesizing our knowledge of the history of science. The Cambridge history of science has been planned since 1993 as a complement to Cambridge University Press's fourteen volume Cambridge modern history. It is intended to be an up-to-date account of science “from the earliest literate societies in Mesopotamia and Egypt to the beginning of the 21st century that even nonspecialist readers will find engaging” (p. xxx). In Eighteenth-century science, Porter masterminds thirty-five contributors in a sweeping survey of the longue duree (curiously a temporal category not used by any of the contributors) between Newton's Principia (1687) and the defeat of Napoleon in 1815. Although Porter did not live to see the volume through the press, he contributed a vintage twenty-page introduction that seamlessly links the authors' papers together. He observes that while Enlightenment sciences lacked the drama of the scientific revolution in the seventeenth century or the Darwinian revolution of the nineteenth, the century was anything but dull. During it natural philosophy became part of Western culture and “public knowledge”, and natural philosophy itself underwent what Porter terms “balkanization” as the unified nature of tradition broke up into specialist disciplines. It is unfortunate that Porter chose not to contribute a chapter. As it is, Thomas H Broman's essay on the medical sciences (pp. 463–84) is confined to a treatment of medical theory as articulated by university-trained physicians. It is a fine chapter, but its account of a world without surgeons, apothecaries, patients and the medical market place is hardly representative of the scholarship of the last twenty years. (Indeed, readers interested in eighteenth-century medicine would be better directed to Porter's rumbustious chapter in his Greatest benefit to mankind, 1997.) The bulky but sturdily-bound volume is organized into five sections. Eight preliminary essays on science and society cover the Enlightenment, universities, institutions, science and government, popular science (an entertaining and perceptive essay by Mary Fissell and Roger Cooter), the image of the man of science, women, and how historians have deployed prosopography. Part 2 has a dozen essays on scientific disciplines; besides the obvious sciences collateral to medicine, these include treatments of the classification of natural knowledge and of the marginalization of sciences such as animal magnetism, physiognomy, astrology, alchemy and Hutchinsonianism under the twin pressures of Enlightenment reason and social attitudes. A shorter section of five essays follows on special themes such as instrument making, printing and the book, scientific illustration, and the significant subject of scientific voyages during the century. The book then looks at non-Western traditions in Islam, India, China (over brief, and strangely achieved without a single reference to the work of Joseph Needham) and Spanish America. Each of these, but particularly the last by Jorge Canizares Esguerra, pays particular attention to medicine. Science in the Ottoman empire, Africa and Australasia are not covered except by default in scattered references by several authors to exploration during the century. A final section of five excellent essays surveys some of the ramifications and imports of the century's events and concerns in religion, literature, the philosophy of mind, commerce and Empire, and technological change. The latter two chapters, by Larry Stewart and Ian Inkster, are the only ones that deal explicitly with industrialization. Porter admits to having had difficulties in commissioning non-British or American contributors, but given the global reach of the volume Anglo-American bias is minimized and the treatment of French and German sources is excellent. The comprehensive indexing required in such an encyclopaedic survey seems reliable and helpful, though it is puzzling why some, but not all, footnotes are indexed. While the volume does not offer a comprehensive survey and analysis of the medical sciences in the eighteenth century (the lack of a chapter on pharmaceutical developments is a serious omission), historians of medicine will undoubtedly find this a useful reference book for help in contextualizing their teaching and research. It achieves Porter's intention of providing a stable platform upon which scholarship on the nineteenth-century can be built. At the same time it shows how the eighteenth century was much more than the consolidation of the revolutionary changes that had taken place in the century before.

Women's little secrets: defining the boundaries of reproductive knowledge in sixteenth-century France. Society for the social history of medicine student essay competition winner, 1999.

Although there has been much recent work on the contribution of midwives to early modern medical practice, there has been less investigation of the participation of other women outside of the corporative or professional medical arena. This article seeks to examine how élite women were involved in medical discussion of reproduction, using the sixteenth-century correspondence surrounding the reproductive health of Elisabeth de Valois, Queen of Spain. Letters passed between the courts of France and Spain demonstrate that control of Elisabeth's reproductive health became a source of conflict between the Spanish and French. National rivalries created possibilities for women to be authoritative contributors in medical discussion with the support of university-trained physicians.

The consilia attributed to Arnau de Vilanova.

Four of the works attributed to Arnau de Vilanova may be considered consilia, which is the name of the genre of texts that expound medical treatments for illnesses suffered by specific individuals. In this paper, I first address the problem of their autheticity within the framework of the so-called "Arnaldian question". The evidence presented here confirms that Arnau de Vilanova was the author of the Regimen podagre and the Epistola ad Bremundum Montisferrarii, while the question regarding the authorship of the Regimen quartane and the Cura febris ethice remains unresolved. This article furthermore documents the degree to which the actual cures prescribed by the physician in the consilia agreed with the doctrinal works of the Galenic tradition. It is explained how medieval university-trained physician had to compete with other practitioners and how they tried to outrival them by applying the doctrines of learned medicine to the individual cases at hand.