Although the professionalisation of medicine has been one of the most important themes in the history of medicine, scholarship has tended to separate the generation of scientific knowledge from the function that science plays in society. Recent studies on the history of science and medicine during the nineteenth century, however, are beginning to pay more and more attention to the ways in which what was considered ‘science’ and proper scientific conduct was linked to broader values of the new liberal and civil society of the nineteenth century, especially as it was defined by the growing urban bourgeoisie. Joris Vandendriessche’s study into medical societies and scientific culture in nineteenth-century Belgium, therefore, forms part of a growing field that seeks to overcome the dichotomy of science-as-ideology and science-in-society by paying attention to the relationship between science and civil society, which was characterised by ‘a desire for civil participation and social engagement by the urban bourgeoisie’ (p. 283).
In order to achieve this aim, Vandendriessche focuses on medical societies in Belgium’s major cities, namely the Society of the Medical and Natural Sciences of Brussels (established in 1822), the Medical Society of Ghent (1834) and the Medical Society of Antwerp (1834). While these places have generally been understood as sites of professional organisation, which served to lobby the government for more autonomy, Vandendriessche approaches them as spaces of scientific practice. In other words, he conceives them as something more than generators of discourse: they were also places in which expertise, codes of conduct and scientific sociability were constructed, contested and reproduced. Among other sources, he analyses the monthly journals, meeting reports, obituaries and correspondence between the societies and the Belgian authorities to uncover the performative dimension of medical sociability. As he explains, ‘[c]ustoms and codes of conduct, the ways in which they were set and imposed, lie at the heart of the book’ (p. 6). The aim of the book is therefore to uncover the changing norms of nineteenth-century medical sociability and scientific culture. In doing so, he shows that the history of medical societies is ‘a history of written and unwritten procedures, and of succeeding generations bending these to their advantage’ (p. 3). While he pays attention to moments of rupture in which those norms were debated, he also analyses how medical sociability sought to define itself through tradition and a sense of continuity. As such, he shows how change was a slow and steady process that took place over the nineteenth century.
Vandendriessche explores this change by paying attention to discourse, practices, networks and institutions throughout seven chapters organised thematically, following a broadly chronological structure from the 1830s to the end of the century. The first chapter, titled ‘Sociability and Medical Reform’, situates the origin of medical societies in the early years of the new liberal society. The establishment of new institutions after the French Revolution and the abolition of those associated with the Ancien Régime reflects a change in the role that medical societies were expected to play in the process of reforming the medical field. By the mid-nineteenth century, the eighteenth-century model of the learned society was replaced by that of a civil institution that reflected contemporary liberal ideals. Although they continued as elite institutions that struggled to establish their relationship to the state, a process of ‘democratisation’ took place in which medicine and surgery were unified under one field, and younger physicians were introduced to more scientific work.
Chapters 2 and 3, titled ‘Debate and Controversy’ and ‘Publishing and Editing’, respectively, focus on the scientific inner-functioning of these societies. Vandendriessche analyses the traditions of debate and publishing in order to argue that successful claims to authority depended on how well physicians were able to navigate these rules. Failing in their oratorical skills and scientific demonstrations during meetings, for example, meant that they ran the risk of losing scientific authority. Part of this process also involved questions of credibility and identity debates that contrasted the physician with the charlatan. After the 1840s, tighter publishing criteria and the demands of publishing a scientific article created a shift in which debates regarding professional criteria were preferred over the production of original scientific studies.
Chapter 4, titled ‘Networks and Collections’, offers a valuable insight into the relationships that societies had with other institutions – namely universities – and with rural physicians who did not have access to the urban medical societies. It focuses on the networks of anatomical collections and how these objects travelled from rural spaces to universities, with medical societies acting as an intermediary. Vandendriessche therefore successfully situates the functions of these societies within the broader process of the professionalisation of medicine.
Chapter 5, titled ‘Expertise and Advice’, deals with the construction of the figure of the expert and the ways in which their profile changed in the field of public health throughout the nineteenth century. As the field of public health became increasingly recognised as a speciality in its own right, the figure of the expert began to change from elite practitioners to paid professionals who worked for the state. Reconciling the diverse ideological and professional interests of experts and medical societies with those of the Belgian state proved difficult, however, and was the cause of recurring tensions throughout the century.
Chapters 6 and 7, titled ‘Celebrating and Commemorating’ and ‘A New Scientific Landscape’, open up new perspectives on the types of practices that formed an integral part of scientific culture, but have gone largely ignored by historians. The first pays attention to obituaries and articles celebrating predecessors. These ‘commemorative practices’ served to create a collective memory from which members of the medical society could confirm their shared beliefs and reify their values. The second analyses the institutional changes of medical societies as universities increasingly began to dominate the scientific landscape as places of scientific debate and practice throughout the second half of the nineteenth century. In the face of this loss of power, medical societies had to refashion themselves in the urban scientific landscape. By the final decades of the nineteenth century, medical societies no longer held their central role as arbiters in the process of determining the course of the medical sciences.
Vandendriessche’s study successfully demonstrates that the remit of the practice of science – understood as both scientific knowledge and the ways in which scientists created their identity in line with the bourgeoisie values of civil society during the period – is in fact far broader than what has generally been considered to date. His inclusion of rural doctors in this regard is particularly welcome, since histories of medicine tend to focus on centres of knowledge production rather than peripheries; as is the way in which he charts the tensions between science and politics during the nineteenth century through the figure of the expert, pointing to the historical origins of technocracy. The only critique I would make of the book is that it could have benefitted from a gender analysis – specifically, the way in which changing norms of medical sociability were tied to middle-class notions of respectable masculinity. Although Vandendriessche addresses how personal and professional honour was constructed in line with the values of the urban bourgeoisie within civil society, he does not analyse the way in which these were shaped by wider gender ideals, or how changing norms within medical societies also contributed to the redefinition of what was considered acceptable masculine behaviour outside of them. In the nineteenth century, the notion of honour was strongly tied to ideals of respectable masculinity; exploring the relationship between science, honour and masculinity would have offered yet another layer to understand how scientific practice was shaped according to norms of civil society. Nonetheless, this does not detract from the overall value of the book: Vandendriessche’s study is a useful and welcome contribution to the history of the professionalisation of medicine throughout Europe.
