Patients/Practitioners Flashcards
Outline Jewson’s model about the disappearance of the sickman
three part schematic model, in which each process increasingly silences the patient
- bedside
- hospital
- laboratory
What is the best way to use Jewson’s model?
A three horizontal schemas/categories of analysis, rather than a hierarchical progressive model of change over time
How many times does Samuel Pepys mention health
439
42 times- consults help, not always with medical men.
What is the social history of the patient?
History from below- recover the dynamics of illness and healing- interactions betwen practitioners and patients through practice and institutions
What is the cultural history of the patient?
Recover socially embedded meanings of illness and healing through attentiveness of language and discourse and issues of subjectivity and representations.
What is the Christian doctrine of the flesh
Flesh is tainted- soul is immortal.
What is the Foucaldian turn?
Foucault = body becomes the site in which the state enacts power
History of the body = corrective to history of the mind- don’t just focus on things/products of intellectual activity (ie. Galenism and the history of the body often less compatible in reality)
What are Kassell’s four ways of looking at the body?
- Social/cultural history
- Learned definitions (theology and medicine)
- Gendered bodies (Duden)
- Fluid bodies (emotions and excrement)
What were three things believed to cause sickness?
1) unhealthy environment
2) result of maleficum
3) fallen condition of mankind (original sin)
What does Roy Porter argue was primary care for early modern patients?
Primary care = self-care: self-medication part and parcel of comprehensive lay medical culture.
Did self-care complement or countermand?
Complement: humanist physicians commonly recommended relatively non-medical remedies, and within this framework, patients were required to be active rather than passive.
Did the expansion of professional medicine in the 18th century stimulate or suppress lay medication?
Stimulate - flood of self care literature was printed. It’s a mistake to regard amateur self medicine pre 19th century as radically opposed to regular professional mediicn.e
How many of Napier’s case studies cited conflict over courtship or marriage as a reason for insanity?
40%
what was the case of Joannes Gronevelt
Groenevelt - Dutch doctor- educated Leiden - moved London 1674-75
1694 case of Suzannah Withall: claimed Groenevelt had prescribed her a dose of cantharides that had left her more seriously ill than before she consulted him - taken up by the College of Physicians, Groenevelt consigned to Newgate jail, lost much of his practice.
Case = patient power, but also weakening of the College of Physicians authority - illustrated disagreement within the ranks, illustrated the inappropriateness of college having the power to impose penalties on the basis of therapeutic judgements where there was no unanimous informed decision.
What was the impact of the reformation on childbirth?
Pre-Reformation: pregnant women taught to identify with the Virgin Mary
Post-Reformation: this option was no long open to them officially. Reformation turned devotional practices associated with childbirth into politically sensitive topics.
How did the Tudor and Stuart governments respond to concerns about insanity
Refurbished traditional institutions to help families bear the burden of ‘harbouring a madman’.
What did King James I instruct about lunatics?
That they are freely committed to their best and nearest friends -> court usually appointed relatives or friends of mad landowners to their care and property preservation.
What were parishes obliged to do with the insane after 1601?
Treat impoverished madmen as ‘deserving poor’ who like orphans and cripples were unable to work.
What were the methods of explaining insanity?
- divine retribution
- diabolical possession
- witchcraft
- astrological influences
- humoral imbalance
Cure = remove cause of the disturbance, lunacy as a temporary state.
How does Porter argue sick in EMP viewed their illness
A bodily malfunction caused by unhealthy environment, or result of malefic, or fallen condition of mankind
What did diet or regimen help prevent?
dis-ease
Why is Foucault irrelevant?
Idea of the medical gaze presupposes a role scripted by the scenario of the medical system - by wary of retrospectively imposing current sociological models on the past- patient practitioner relationship rarely a two way system - involvement of wider community and kinship.
Who were the Protomedicato
Judicial brand of the Bolognese College of Medicine
An academic oligarchy, who heard and ruled on complaints brought by patients against medical practitioners.
Double mandate to protect a) patients and b) their own authorities.
How was European medical practice governed by contracts?
Oral or written- fixed the obligations of practitioner (to provide services) and patient (to follow instruction and pay fee upon improvement.)
In the contrast system, how were breakdowns of the patient-practitioner relationship conceived?
As breaches of contract, not failure to adhere to professional norms.
Why did elite practitioners begin to reject the contracts?
They privilege patient’s judgements of efficacy not physician’s professional expertise.
Practitioners view vs. patient view
Physicians: saw the tripartite hierarchy of practitioners
Patients: saw a vast array of healers offering different services, who could be consulted under particular circumstances.
Healers vs. protecters
Healers: horizontal contractual relationship of equality, looked for simple, efficacious medical services
Protectors: high ranking practitioners with whom they were in relationships of defence and looked to for counsel and direction about conduct and lifestyle
How are healers and protectors associated with two models of illness?
1) obstruction- healer- aided body in excretory functions
2) flow- protector- emphasised balance and regimen.
How does Duden explain the patient encounter
‘the subject…was not a disease, isolable body as a physical entity, but the patient’s felt self in terms of the interior movement of fluids.’
Who did Barbara Duden study?
Johann Storch, physician in Eisenach, Germany, created a document recording symptoms of 1800 women, along with ideas about their illness and prescriptions, in many cases using their own words.
What can contemporary thinking be influenced by?
Anatomical information not available in the past.
What does Stollberg’s study of George Handsch show about medical knowledge?
Handsch’s notes show how physicians were prepared to learn from ‘common folks’ - friends, family, patients, unlicensed empirics. They valued their ideas and observations as useful to their own practice.
Rise of empirical approaches in learned medicine- had to improve as a result of competition.
Explain Stollbergs ‘common medical cosmos
Degree to which learned physicians and medical laypersons lived in a common medical cosmos, shared the same medical ideas, trusted the same diagnostic and therapeutic practices.
Frequent exchange of medical knowledge and practice across EM society.
How do Webster and Pelling define the medical practitioner
any individual whose occupation is basically concerned with the care of the sick.
Stollberg case study: Monsieur Debely
[Experiencing Illness 2011]
As a result of mistrusting medications prescribed by physicians, found his ‘panacea in an onion’ and used the same remedy for every ailment
-> Individual sets their own rules for health and diagnosis
Role of the patient
- Setting own rules for health and diagnosis
- Choosing a form of treatment
- Deciding whether their cure was successful
- Challenging medical practitioners
- Defining medical care
What has Pomata shown about information networks?
- Several patients could file joint complaints against the same healer
- Common to choose medical practitioner on advice of a friend/neighbour
- Patronage system where friend of a high social standing might provide money for treatment
Pomata: Patient social status and choice
not a factor in choice between licensed or illicit healer - unlicensed could include upper classes, urban middle classes employed regular doctor.
Case of Andrea Bossie wife 1691
Swelling in left arm treated by Dr Oretti, College Doctor, and later by a barber who practice illicitly as a physician when it worsened -> official and illicit shared same patients- not two worlds but a pool of medical resources.
Two conclusions from the decline of uroscopy
1) it was a threat to physicians professional authority
2) Patient power prevailed on the marketplace, despite decline in learned medicine
Three factors which inadequately explain the decline of uroscopy in EM learned medicine
1) Theoetical inconsistencies
2) new medical empiricism
3) humanistic opposition to Arabic medicine
-> above all, it challenged physician authority.
Humanism
A Renaissance cultural movement which turned away from medieval scholasticism and revived interest in ancient Greek and Roman thought.
Started in Italy and spread North with the adoption of large scale printing, where it became associated with the Protestant reformation.
What was Orvietan
medical panacea said to protect against poisonings, amongst others. Popularized in France and England.
Why does Gentilcore believe we need to broaden the explanation of Charlatan success?
Success has been explained in commercial terms- while economic models explain appeal, they don’t explain frequent denouncement, nor Charlatan’s place in period’s therapeutic network.
‘La medicine charitable’ 1625
Self help guide which aimed to put Parisian apothecaries out of business [pamphlet war]
John Archer 1671
every man must be a physician or a fool by the age of 40
Archbishop under Charles II
Reward of £1000 for anyone who could not treat his gout -> even he did not fully trust God to heal him [religion and medicine in tandem]
Toulon France under the plague
Heads of houses had to pray 3 times a day
Ambroise Pare
Physician - ‘I tended him, God cured him’.
William Holland 1827
Head was sweating so much, thus believed excess blood must be flowing there - ‘cause of the pains in my face’
Huisman: Gronigen Case Study
- Netherlands
- No strict hierarchy until early c.19th
- individual power- medicine organised on a local level
- help: self -> neighbourly -> practitioner
- Officials stigmatised itinerants as outsiders but locals still went to them.
Bakhtin’s grotesque vision of the body
Obstruction epitomises the dieased condition. Healthy body = in constant fluid motion. Sick body = flow interrupted
What plays a secondary role in learned medicine?
Evacuation
Galenic doctrine = hygienic, preventative role of medicine: exercise, diet, rule of living, rather than therapeutics.
Laura Diola case study
Asked protomedicato 1595 for a refund of three ducats from a Neapolitan man practising medicine
-a man had crippled her rather than treated her, and she wished the money returned, especially since she had heard of further bad practice
- Appeals for justice thus:
a) punished bad practitioners
b) recovered money spent on ineffective treatment.
Stollberg George Handsch study: three reasons for openness between ‘common folk’ and ‘academic’ physicians
1) rise of empirical approaches to learned medicine
2) need to improve outcomes in view of the competition from unlicensed healers
3) physicians own upbringing in the medical lay culture of their time.
