How is the effectiveness of drugs assessed? This question, which is now central, is not new, as shown in this work on the practices of medical electricity in XVIIIe century. By studying the popularity and effectiveness of a treatment, he asks a more disturbing question: What “works” in a remedy?
The issues of medical innovation and the evaluation of the effectiveness of drugs have become central in our society, which is among the largest consumers of drugs. Recurring questions weigh on some of the most popular molecules, whose commercial expansion has sometimes been artificially supported by the transformation of risk factors into “diseases”. They are accompanied by increasingly massive doubts among citizens towards the manufacturing companies and the marketing processes. An entire society is wondering about the way in which the popularity and effectiveness of these remedies could have been built.
A new medical consumption
These questions are not new. This is what historian François Zanetti shows in a book devoted to the history of medical electricity practices during the Enlightenment. From a salutary approach that aims to understand the springs of a new medical consumption, whatever its status, he reduces to nothing the overly simple arguments appealing sometimes to the credulity of patients, sometimes to the greed of practitioners to explain the emergence of a new therapeutic fashion. If the medicine – by definition “that which is suitable for healing”, that is to say the practice or the remedy – is popular, it is because something works.
But this “something” is not necessarily to be identified only with a gesture, a machine or a potion; it is a set of social interactions built around these remedy-objects and which produces a relationship of trust between caregiver and patient. It is to reconstruct this tangle of complex relationships which, once dislocated, leaves room for misunderstandings and doubts, that the historian devotes his work in a particularly documented manner.
The interest of doctors in the wonders of electrical energy revealed in the 1730s was not immediate. The amusing physics experiments that it allowed—even the most spectacular ones like those of Abbé Nollet—were more a matter of theater than science. The use of electricity for therapeutic purposes was all the more difficult to envisage since it presupposed, like the Leyden jar, the use of a complex device designed to accumulate the fluid and administer it. However, in a medical world belonging to elites of the Ancien Régime who were rather prejudiced against the “vile mechanics”, a frequent attribute of surgeons, electricity was long marked by the seal of infamy.
Old and new knowledge
Why, from the 1770s onwards, did electricity become, quite quickly on the scale of the history of therapeutics, an effective medicine? This is where F. Zanetti’s hypotheses take on their full interest. Electricity did not become a remedy because of its remarkable healing potential, this would have been underlined before, but because it had a function in the history of medicine at the end of the 17th century. XVIIIe century.
First of all, electricity thought of as a means of action intended to help the penetration of existing remedies into the body by the action of the nervous fluid allows, in a sense, to reconcile two different representations of the body, humoral and anatomical. The end of the XVIIIe century is precisely the moment when, in Western Europe, the new anatomo-clinical model emerged, based on knowledge born from the convergence between clinical observation of symptoms and research into organic lesions through dissection.
Before it became established as official knowledge in medical schools at the beginning of the XIXe century and that it does not spread in mentalities by means of popular representations (such as traveling anatomical museums), this way of understanding the body coexists durably with the Galenic representations which give humors a central function in the economy of health.
Medical electricity, modeled on the analogy of a machine body as much as on the image of a permeable body, based on the circulation of nervous fluids, therefore makes possible the coexistence between the old and the new on the level of anatomical knowledge.
The first experiences
Then, the new practice comes at a time when doctors are organizing themselves and asserting themselves as a new authority linked to the demographic concerns of the State. The Royal Society of Medicine was born in 1778 from the merger of two commissions: the Royal Commission of Medicine, to keep in touch with provincial doctors for everything that could be related to epidemic diseases, and the Commission for the examination of secret remedies. With the support of the royal government, an expert system was set up which concerned in particular the effectiveness of medicines.
It is in this context that the first experiments in medical electricity are organized, the publicity of which serves the appropriation of the technique by professionals. The effectiveness of the medicine is thus forged in its academic exclusivity. It is by an identical process and at the same time that the animal magnetism of Doctor Mesmer is examined. The considerations on the therapeutic effectiveness of the mesmerian tub are mixed with lower competitive concerns emanating from Parisian doctors and against the very popular Austrian doctor.
The definition of the right remedy does not only obey scientific criteria, but also professional defense interests. In the case of medical electricity, it is as much a question of consolidating the corporation in the face of competition from renowned European doctors as of making the boundary between amateurs and health professionals impermeable. The history of XIXe century shows that, despite the legislative effort to establish this monopoly, the discourse on healing and the effectiveness of the remedy has hardly been crowned with success. This is demonstrated, for example, by the strength of the medical and democratic counter-project of François Vincent Raspail.
It is in this historical framework that the construction of the electric fluid as an effective medicine becomes possible, which supposes defining the diseases for which the remedy is useful and detailing the methods of administering the treatment. Again, the thing was not obvious, because the notion of disease covered a reality very different from ours: it was thought of as a state, and not as an entity.
But it is time for classification, in botany as in medicine. The “luck” of medical electricity is that it can be part of a new effort to construct a scientific nosology of diseases: paralysis, epilepsy, madness will be the most common indications of the fashionable practice.
Moreover, so-called “specific” remedies, that is, those that correspond precisely to a disease, are rather at this time the attribute of a quack medicine, doctors on the contrary taking pride in adapting any treatment to the subject being treated. The medicalization of electricity participates in this still embryonic movement of constructing correspondences between medicines and diseases.
Impress, focus, shake
The methods of administration are well established. From the end of the XVIIIe century, medical electricity is deployed in three canonical forms. The first, in the form of an electric bath, surrounds the subject with a saving fluid. The second, in the form of sparks, directs the remedy to more precise locations. The third, in the form of a violent concussion, hopes to provoke a salutary shock to the body.
This three-form typology — impress, concentrate, shake — is well established. It is still perceptible to anyone interested in the techniques of faradization of hysterics at the end of the XIXe century, to the methods of torpedoing soldiers in the Great War or to the vogue for electroshock in psychiatry in the 1940s.
It is particularly interesting to note that the question of the violence and danger of electrical treatment was immediately raised during the experiments of XVIIIe century (some, like Jean-Paul Marat, were already warning against the violence of certain uses of medical electricity). Far from disqualifying the remedy, this force on the contrary gives it increased credibility. It is also this dangerous character that is put forward to legitimize the medical monopoly on the practice, reserving harmless and amusing uses for non-professionals. Its use required precautions and sometimes correctors that could prevent its side effects.
Did patients play a role in this story? Obviously, yes. Regularly subjected to invasive and painful practices, such as bloodletting, cautery or seton, many patients wishing to be cured turned more readily to electricity, the treatment of which was, however, long and restrictive, except for those who, by chance, were able to have machines at home.
The practice of medical electricity was also reinforced by a new social function, that of giving back to bodies damaged by the work of proto-industrial times a new productive utility. Because the practice emerged in a time of reflection on occupational diseases. The sources of XVIIIe century are full of descriptions of suffering and trembling limbs, of bodies affected by metal diseases, which electricians will offer to repair as a priority. As if in a form of climax, it has even become a metaphor for revolution: the electric spark of freedom overthrowing corrupt thrones, unless it has already become an uncontrollable energy in people’s minds.
The decline of medical electricity, if it is one, remains somewhat in the shadow of this beautiful study of a therapeutic fashion of the Enlightenment. Would the specialist of modern times have had some qualms about going beyond the French Revolution? Historians are always more inclined to describe the birth of phenomena than their death. Whatever the case of this end which remains somewhat mysterious, F. Zanetti shows well how, in a short time, the last decades of the XVIIIe century, a medicine was able to become “effective” thanks to the combination of interests of professional doctors, the academic institution, scientists, but also of patients affected by new suffering and aspiring to a less painful cure.