Ira Rezak

Sarah Elizabeth Freeman, in the course of introducing her catalog of medical medals in the collection of the Johns Hopkins Uni­versity, quotes Warwick Wroth as saying (c 1892) that medals "are the mirrors which the men of the past delighted to hold up to every momentous event, or to every event which seemed to them momentous; and they are mirrors, which have the magic power of retaining the images they originally reflected." Freeman noted, however, that "these images are often indecipherable, or at least blurred, if one is not familiar with the events and personalities which gave rise to them."

We too believe that all artifacts and sources from the past, medals included, reflect what people then wanted to say to themselves and to their posterity and, of course, we know better than to impute meaning to a text or image before us without reference to their original context. But medals, perhaps because they are so "material," so undeniably weighty in the hand, so reassuringly regular in their circular or quadrangular form, each so seemingly independent as objects, are commonly experienced as self-evident, inherently ''factual." We are tempted, with Wroth, to understand them as presenting images directly from former times, frozen before us. Furthermore, in looking at a temporal sequence of medals, as at any sequence of so-called "facts," there is a certain tendency to see them collectively, as presenting a coherent narrative. My subject today, medical subject medals in 19th and 20th century France and how they might reflect the modernization of medicine in this period, may serve to probe the above considerations.

To compress the traditional narrative about medical progress in post-­Revolutionary France: at the demise of the Ancient Regime medicine was archaic, hierarchical, hidebound and of relatively little benefit to its patients; but under the influence of scientific insights and social reorganization during the succeeding 200 years the science of medicine became progressively more rational and coherent, and its practice demonstrably more effective. So, the medallic question I propose to discuss is: Does the array of medals produced over the period during which medicine is reputed to have been advancing in France, a country especially renowned for self-confidence, cultural cohesion, and the sophistication of its medallic tradition, support this narrative of progress? And, whether it does or not, what may be learned by studying the iconographic and textual content to be found in a review of this medallic series?

A complete corpus of French medals relating to medicine and science, its institutions and practitioners, from the Revolution onward has not, to my knowledge, ever been attempted. As a collector over the past few decades, however, I have had the opportunity to acquire some 750 such medals and plaques, and have become aware of at least as many more, so that the present discussion is based on a survey of perhaps 1500 medals. (I have also formed the impression that France has produced as many, if not more, medically ­related medals over the past 200 years than other European countries.)

Prize medals of the Ecole Pratique
Fig. 1: Prize Medal of the Ecole Pratique (Ecole de Medicine) Paris, 1797, by N. Gatteaux. 60 mm. Bronze.

Medals used to commemorate significant medical events before the French Revolution—the foundation of a hospital, the establishment of an academic medical power and grace of the sovereign. Likewise, the recovery of the king or of other royals from illness was considered a "medical event" often to be memorialized on a medal. Saints and ancient divine figures were displayed and by implication credited on medical medals, further indication of the idea that healing derived not from medical skills per se, but by the grace of "higher authorities." Much of actual day to day medical care in pre-Revolutionary France was in fact in the hands of ecclesiastical institutions whose symbols were evocative of faith, but not faith in the physician. Individual practitioners of medicine were rarely if ever honored on medals in their own right, being so commemorated when they were mainly in the capacity of academic heads of royally sanctioned institutions or societies, and then garbed as officials rather than as practitioners. Such physician medallic portraits were normally paired with reverse devices such as royally granted coats of arms rather than with symbols of their own professionalization. Virtually absent in pre­revolutionary medallic usage were illustrations of the physician, or even of the surgeon, caring for patients in a clinical setting, as independent operatives. It is, however, noteworthy that, apart from the depictions of King, saints, ancient gods, and their related institutions and symbols of beneficent concern, also occasionally displayed on medals were some few of "modern" tools, particularly those of surgical or chemical techniques, which lend themselves to direct depiction.

The Revolution had a tremendous impact upon the conception, practice and teaching of medicine. The tumultuous social and institutional disorganization which revolution produced, especially in the wake of relatively ineffectual royal and ecclesiastical institutions which had previously been responsible for dispensing public medical and custodial care, led to the suggestion, and indeed initially the consequence, that hospitals and medical schools be shut down entirely. On the other hand, the new concentration of populations and power within towns, and in the hands of their governments, especially in Paris, produced the opportunity and soon the demand and political will to reorganize medical, particularly hospital, care in a state-funded and highly centralized way. Simultaneously, the influx of bright young men of the middle classes from the provinces into the cities mobilized a fresh body of talent for the medical enterprise. The twenty years of war that followed the Revolution also compelled the state's immediate attention to the military necessity for system, efficiency, and hygiene. New hospitals and schools were established from 1794 onward often, like Val-de-Grace and St Antoine, in confiscated monasteries and other church properties. These brought together large numbers of patients, newly philosophical and practical medical men freed of earlier traditions and habits of thought, ample sources of public funding, and the state­ generated concern for success. In this setting systematic observation and human research produced disciplined physicians soon to be the educators of the next generation.

18th and 19th century medical medals
Fig. 2 (clockwise from upper left): Jeton of the College de Pharmacie, Paris, 1778; Prize of the Ecole de Medicine, Paris, 1805; Prize of the Faculte de Medicine, Paris, 1809; Prize of the Societe de Medicine Pratique, Paris, 1808.

The messages on early official medallic issues often convey the severity and rationality of the revolutionary period. Gone were references to king and saints and Apollo, but an impulse to identify relevant antecedent figures was fulfilled by reference to the ancient healing gods who were also seen as quasi-human professionals, Aesculapius and Hippocrates, and to their symbols, the caduceus, the serpent, the calyx and the rooster. Greek allusions in particular were valued tropes because the Hippocratic tradition of medicine, similarly to the new French method, was based on direct patient observation in contradistinction to the scholastic tradition of authority which had been established in the Middle Ages and was prevalent until 1789. The message was that medicine was reviving ancient truth even as it broke newer ground.

Another trend, the depiction of individual physicians and surgeons on medals, some few of the past as models and authorities, but chiefly those of the present, became established in the 19th century. Such medallic portraits are not necessarily those of the physicians we would today pick out as the "greats" of that age. As with many other commemorations, personal status at the time, political influence, occupation of a prestigious office, even notoriety all counted for more than achievement as might later be judged in the light of history. It is pertinent at this point also to note the usual tendency, the bias, for later collectors (the author not excluded) to acquire or even within random collections to highlight and preserve the medals of physicians who were subsequently held to be distinguished or otherwise noteworthy. The portraits of Mesmer and Hahnemann, of Gall and Broussais, were and remain of interest even to a non-medical audience, while those of the retrospectively less acclaimed, understandably, receive less attention today. Many giants of French medicine, prominent even in their own time, Corvisart, Louis, Laennec, Pinel, Broca, were not honored by contemporary medals however much they have been commemorated post hoc in the 20th century. In imitation of early Greek and Roman coinages the most serene and abstract form of portrait, and hence the most broadly authoritative in the early 19th century among physicians and other public figures, was that of the nude head or bust, an affectation today much less used. A second fashion on medical medals specifically highlighting the academic achievement, or the officialdom —of professors, deans, or members of the institute—portrayed the honoree in formal robes and decorations and was common by the late 19th century. A third and the most typical format is the portrait bust or half figure showing a doctor in his work attire, a frock coat, a modern suit, or the smock used in clinics and operating rooms. As the 19th century gave way to the 20th, this range of portraiture format was available to encode part of the identity of the honoree—as a mythic being, an institutional official, or, most commonly, as a beloved practitioner and/or educator.

19th century medical medals
Fig. 3 (clockwise from upper left): A. Mesmer, 1846, by Lassagne. 45 mm. Bronze; F. J. Gall, 1828,by J. J. Barre. 46 mm. Bronze; J. V. Broussais, 1836, by A. F. Michaut. 50 mm. Bronze; S. Hahnemann, 1835, by E. Rogat. 50 mm. Bronze.

The reverses of medals offered considerable flexibility as counterpoint to the obverse portraiture just described but, in practice, the choices made over the hundred years from 1850 to 1950 tended to cluster about relatively few types. Note was taken of the simplicity and severity of the earliest obverse portraits, those of the revolutionary, Napoleonic and Restoration periods. On the reverses of these medals simple texts were initially most common—describing the institution, school or hospital, the prize being awarded, the achievements of the doctor being honored. Such texts could be brief or extensive but did not typically invoke metaphor or allude to the distant past, emphasizing, rather, the immediate present or events in living memory. Also prominent on medallic reverses as the 19th century unfolded were the caduceus, serpent and calyx, or mythological figures as abstractions of agency. Hygeia later morphing into Science, Charity or Nature as the opponents of disease, Athena and Aesculapius, the personalized geniuses of cities or of France itself, putti and angels: all make appearances on the reverses of French 19th and early 20th century medical medals, emphasizing the grandeur of the honoree's achievement, and the generality of his fame. Strikingly, however, there was hardly any realistic depiction of modern physicians at their work, or of the setting of modern medical practice, on French medical medals before the 20th century, with the occasional exception of chemistry laboratory apparatus. Most remarkable is the specific absence throughout most of the 19th century of realistically depicted diseased patients, of autopsies, of hospital interiors, and of those new instruments—the microscope, stethoscope, reflex hammer thermometer, and sphygmomanometer—which were revolutionizing contemporary French medical praxis and making France a center of medical achievement and education.

As is well known, a great flowering of French medallic art occurred in the last decade of the 19th and first of the 20th centuries. Typical individual specimens of the medical medals by some of the finest artists of this period show exquisite tech­nique and the then-fashionable beaux art style but also what can only be called a determinedly unmodern presentation of the actual medical situation. Allegory ruled, with healer and patient alike abstracted from reality. One is also struck by the extreme similarity of the reverse types of many medals. Whether this has resulted from the predilection of the artist or the fashion of the times, the reverse motives on medals of many contemporary honorees may be said often to obfuscate rather to define their specific achievements. Why might this have been so?

Virtually none of the medals and plaques in honor of the persons we have been discussing were self-commissioned but, like most encomia of the period, were the outcome of a committee process.

Louis Pasteur honorific medal presentation
Fig. 4: Souvenir pamphlet of Louis Pasteur honorific medal presentation. 1882.

The custom, from middle of the19th century to the present day in France has been, as many hundreds of struck medals and plaques testify, that at retirement, or on election to an academy, or perhaps at a significant anniversary, of birth or of graduation into the medical profession, a group of eleves, former and present students, friends, colleagues, more rarely, patients, gather to celebrate the event with a formal dinner or colloquium as part of which a medallic presentation is to be made to the physician being celebrated. The honoree receives the medal in gold or silver while the subscribers typically receive copies in bronze as a souvenir of the event. This mechanism, formulaic in its initiative, planning phase and desired outcome, and with the need to accommodate a diverse audience, fosters a conservative approach to the selection of the artist, theme and modeling of such commemoratives. Thus, the conventions of such celebrations, like those of weddings, inaugurations, memorial events, etc., set an agenda which may have been more determinative of the event and of its manifestations (the dinner, the range of people who attend, the nature of the obligatory speeches, the post hoc collection and publication of medal and speeches in pamphlet form) than the personality or achievement of the individual being honored. Such a process goes far to explain the conservatism of many French medical medals. It also supports the idea that they in must be viewed as part of a larger social dynamic, as individual example of a relatively homogeneous class or series of medals. Not individual mirrors of the occasions exactly, such artifacts are more like fashionable studio photographs, fairly consistent in appearance over time, given similar locality and circumstances. The above described custom also accounts for the fact that fairly large numbers of such objects survive and fairly regularly appear in groups in the marketplace when the "collections" of individual doctors, who may have attended dozens of such events, are dispersed after their retirement or death. I have the impression that between 100 and 300 examples were typically struck of such honorific souvenirs for physicians of mostly local fame. More famous persons, medical heroes, the Pasteurs and Claude Bernards of France, of course merited larger original production runs, and their medals have often remained in production for years after their initial offering.

Samuel Pozzi, Professor and Academician
Fig. 5: Samuel Pozzi, Professor and Academician, 1905, by J. C. Chaplain. 68 mm. Bronze.

Returning to the discussion of iconographic programs, and carrying the story forward into the 20th century, especially after the social upheaval of World War I and the artistic diversification that immediately preceded and followed it, the patterns previously outlined began to undergo considerable change. Specifically, what we may readily identify as indications of "modern" medicine now became regularly visible on medals. To say that realism had triumphed would be too strong a judgment; within the modest module of the medal perhaps realism is really too much to expect. But it is fair to say that scenes of actual medical practices, however idealized, now became a common trope. Images of science, the great engine of modern medical advances, also came to be graphically represented with increasing frequency on French medals. With this shift the physician at work finally became the primary focus of attention, powerfully but serenely going about his business, diagnosing disease, toiling in the laboratory, teaching students, though only more rarely comforting patients. Often the centrality of the physician was so dramatically highlighted as to appear to us somewhat theatrical. This focus on the doctor as performer was not necessarily unintentional, nor unrealistic, for the modern healer was often seen in the 20th century as a singularly potent and beneficent being. On the other hand, patients were characteristically depicted as passive, even hopeless; nurses and students were often arrayed on medals as mere appendages of the star performer.

Ernest de Massary
Fig. 6: Ernest de Massary, 1931, by G.Prud'homme. 78x56 mm. Bronze.

The patient as sufferer, as a person whose pain per se compels the doctor's concern, is infrequently found in the early part of the 20th century though there are exceptions. Only still later were the distinct features of actual diseases and distortions suffered to appear on the medallic scene, contrasting with abstract, unblemished though fearful, patient of earlier views. 20th century French medical iconography also broadened the palette of symbolic imagery used to evoke the scientific and social aspects of medicine. The use of Art Deco, for instance, with its tendency to distance images both from reality and from the pseudo-reality of classicism, illuminated the notion of medicine as a social enterprise, inevitably larger than any individual doctor-patient relationship. Other formats too now revisited older themes but in a fresh new fashion. Indeed, by the mid to late 20th century, the now long established confidence of scientific medicine allowed a swing of the pendulum, a return to referents that earlier had been specifically rejected as decidedly unmodern: radiology could be evoked by use of the ancient mirror and serpent motive, albeit modernized by the addition of wires; orthopedics was, as it had been in the 17th century, represented by traditional arborial techniques; a specialty in peripheral blood vessels might appropriate an ancient symbol of continuity and inevitability.

It is important to emphasize in closing that in fact the tribute to many medical practitioners was never really based upon their "modernity" or their scientific prestige. Rather it was their loyalty to institutions, towns, and patients, their faithful service over a long period which was valued so highly, and consequently rewarded with a medallic tribute. This less elite reward tradition, based on longevity of service, has produced a very substantial proportion of French honorific medals for physicians, as for pastors, civil servants, and many other professionals of strictly local renown.

What might we conclude from this extremely condensed survey of 200 years of medallic reflections on medical progress in France? Here are a few tentative generalizations:

Science Fighting Disease
Fig. 7: Art Deco medallic reverse: Science Fighting Disease, 1932, by P. Turin. 72 mm. Bronze.

First, despite the early and irreversible modernization of medicine in France and especially its growing intimacy with science, the content, the message, of the great majority of contemporaneous honorific medals has been conservative, indeed one might say anti-modern. Continuity with the past rather than novelty in the present has been emphasized. Immediate relationships and loyalties—to patients, students, friends, institutions, to the nation—rather than integration within a modern international arena of scientific scholarship has been the predominant theme. Second, most of the iconography to be found on French medical medals has also tended to be traditional. Serene portraiture and many ancient symbols hallowed, perhaps one should say abstracted, by long usage remain stalwart features of the medical medal even to our own day. But thirdly, that said, it is also true that in the first 50 years of the post revolutionary period there was a revolution of sorts in the appearance of honorific medical medals. Icons of divine and royal patronage suddenly gave way to the images of physicians and direct citations of their personal intellectual and clinical achievements, situating physicians as the heirs of a newly recollected and respected mythic antiquity, and also subtly restatirng the doctors' ancient claim to priestly sta tus. At the same time the state was reconfirmed as a beneficent but now rational guarantor of medical care for the people. The mid to late 19th Century presentation of "medicine" in formulaic, abstracted, allusive, terms began to give way to a predominantly "realistic" depiction of medical practice only in the early 20th century, and then only partially, long after the transformations, first of hospitals, bedside care and teaching, and later in scientific investigation, had modernized medicine and placed France in a leading position.

Lastly, one might comment on the impact of specifically French artistic traditions in the recording of medical development on medals. Certainly, the long standing medallic heritage of a centralized state in France gave impetus to the format and style, indeed to the very conception of medals as public votives that underlay the efflorescence of medicina in nummis we have been reviewing. Not surprisingly, depictions mimicked the officially favored modes and tropes, including classical grandeur and serenity. The established artists typically commissioned by committees and institutions in turn imposed their own preconceptions and approaches on the iconography of a field with which, anatomy excepted, they themselves had little familiarity.

Medicine is at once a complex social activity, a self-defining profession, a mythology, and more besides. Existing in many forms, personal, institutional, governmental, it probably cannot and certainly should not be reduced conceptually to a single entity. Ultimately, what is mirrored best in the medals is that which was at each particular time and circumstance held to be most important, representative, authentic, and worthy of honor. It is this diversity that we find best preserved and mirrored in medals for, contrary to any unitary notion of "modernity" in medicine, it turns out that there have been remarkably varied perspectives on the progress of medicine, even within a country of such undoubted singularity as France.


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