Suchergebnisse

The sick-man may be said to have disappeared from medical cosmology in two related senses during the period 1770-1870. Firstly, as control over the means of production of medical knowledge shifted away from the sick towards medical investigators the universe of discourse of medical theory changed from that of an integrated conception of the whole person to that of a network of bonds between microscopical particles. Secondly, as control over the occupational group of medical investigators was centralized in the hands of its senior members the plethora of theories and therapies, which had previously afforded the sick-man the opportunity to negotiate his own treatment, were replaced by a monolithic consensus of opinion imposed from within the community of medical investigators.

Medical knowledge in eighteenth century England was characterized by the growth of numerous often contradictory theoretical systems, founded upon a common underlying analogy of bodily processes. This foundation of metaphor was derived from the ancient humoural model of classical medicine, attenuated by the introduction of concepts imported from contemporary mechanical philosophy. Medical theory may be viewed as a form of social interaction between physicians—the elite of the eighteenth century profession—and their aristocratic patients. The phenomenological conceptualization of disease, the speculative and systematic character of pathology, the psychosomatic interpretation of illness and the swingeing use of heroic therapies may be ascribed to the pre-dominance of the upper class patient in the consultative relationship. Furthermore the contemporary career system constrained physicians both to establish their credentials as members of the upper class and to advertise their services by individual display. Fashion provided a form of social behaviour which reconciled these demands, but also generated a profusion of medical theories. In addition the structure of relationships between patients and practitioners, and among medical men themselves, prohibited the emergence of a scientific community dedicated to the analysis of medical problems.