Adrian Wilson

On the history of disease-concepts : The case of pleurisy

INTRODUCTION It is, I believe, uncontentious to suggest that concepts of disease — both in general and with respect to particular ailments — have changed and developed historically in the long history of the Western medical tradition. And it is obvious, too, that diseases (taking that term in its widest sense, to embrace illnesses at large) were-and-are precisely the distinctive concern of medicine. On principle, therefore, we might expect that the history of disease-concepts plays a central part in the historiography of medicine, just as the histories of celestial, physical and vital concepts do in the historiographies of the respective natural sciences; yet paradoxically, this is far indeed from being the case. That strand of medical history which focuses on medicine’s cognitive content has devoted far more attention to anatomical and physiological knowledge than to pathology; the history of medical practice is often written without reference to the disease-categories by which past practitioners apprehended the illnesses of their patients; and as we shall see, histories of actual diseases have tended to treat their objects as timeless entities, thereby blocking off the very possibility of considering disease-concepts historically. This paper proposes that the history of disease-concepts deserves far more attention than it has traditionally been accorded, not least because this theme is relevant to the full range of medical history’s existing concerns, from anatomy to medical practice. I shall proceed in three stages. Part 1 sketches the historiographic state of play with regard to disease-concepts. Part 2, which makes up the bulk of the paper, seeks to illustrate the possibility of treating such concepts historically by means of an example, namely the disease of “pleuritis” or “pleurisy”; I shall trace the shifting meanings of this term first amongst the ancients and then, on a very selective basis, in the early-modern period. Finally Part 3 will meditate briefly on the results of this case-study, returning to the general historiographic theme and suggesting some points of wider application.

Illegitimacy and its implications in mid-eighteenth-century London: the evidence of the Foundling Hospital

Dieser Beitrag untersucht die Herkunft der Londoner Findelkinder im Zeitraum 1749–60. Auf der Grundlage der Aktenbestande des ‘Foundling Hospital’, erganzt durch Material der wochentlichen ‘Bills of Mortality’ wird nachgewiesen, das die Findelkinder tatsachlich uneheliche Kinder waren, wie bereits von den Zeitgenossen vermutet. Dagegen waren der Verlust der Eltern oder deren materielle Verarmung kein Grund dafur, das Kinder ins ‘Hospital’ geschickt wurden. Es zeigt sich, das das Illegitimitatsniveau Londons uber dem nationalen Durchschnitt lag – ganz im Gegensatz zur Situation um die Mitte des 19. Jahrhunderts. Daruber hinaus wurde die Zahl unehelicher Kinder (abzulesen an der Zahl der Findelkinder) stark von okonomischen Bedingungen (gemessen am Brotpreis) beeinflust. Die zeitlich verzogerte Bewegung beider Faktoren legt fur London ein spezifisches Verhaltensmodell der Brautwerbung nahe, demzufolge die Heirat als durch das ‘Hofmachen’ bestimmt erscheint, wahrend umgekehrt dem landlichen Modell eine Form der Brautwerbung entspricht, die von der nachfolgenden Heirat bestimmt ist. Eine Bestatigung dieses Modells ergibt sich aus der Untersuchung des Einflusses der Preisentwicklung auf die in London geschlossenen Ehen. Anschliesend wird das Modell im Zusammenhang mit den im 18. Jahrhundert auf dem Lande zu beobachtenden Veraanderungen des Hofierens, der Heirat, der vorehelichen Schwangerschaft und der unehelichen Geburten diskutiert. Daraus ergibt sich die These, das London als Schnittmacher gesamtgesellschaftlicher Veranderungen in den Verhaltensmustern der Brautwerbung angesehen werden kann.

Porter versus Foucault on the ‘Birth of the Clinic’

It is well known that Roy Porter’s oeuvre in the history of psychiatry was partly stimulated by, and in no small measure pitched against, Michel Foucault’s Madness and Civilization (Folie et deraison). But what was Porter’s response to Foucault’s Birth of the Clinic (Naissance de la clinique)?1 By the ‘birth of the clinic’, let us recall, Foucault referred to the remarkable change in medicine that took place in the Paris Ecole de Sante between 1800, when Xavier Bichat’s Traite des membranes initiated his new doctrine of tissues, which rapidly invigorated pathological anatomy, and 1817, when Rene-Theophile-Hyacinthe Laennec (1781–1826), one of the most influential pupils of the new school and himself a master of pathological anatomy, invented the stethoscope. Foucault himself, as we shall see, regarded this as the most important transformation in Western medicine’s entire history, and although not all commentators would go this far, none would deny that pathological anatomy made giant strides in the Paris school, or that the stethoscope gave an unprecedented impulse to physical examination, with permanent effects. Thus we are dealing here with a momentous set of events, which means that Porter’s view of Birth of the Clinic is of considerable interest.

Hayden White’s “Theory of the Historical Work”: A Re-examination*

Abstract Hayden White’s Metahistory is best known for its “theory of tropes”; but Metahistory also put forward a distinct “theory of the historical work”, which has received rather less attention, and indeed has tended to be swallowed up by White’s tropology. This is a symptom of a wider problem, that the theory has been apprehended in paraphrase and synopsis rather than in the terms in which it was actually articulated. This paper seeks to redress these oversights through an exegetical analysis, embracing the structure of the theory, its rhetoric, and its relationship to the “theory of tropes”. The results bring several surprises, not the least of them being that Metahistory’s well-known relativism was accompanied by a hidden naive realism; and it is shown that the book’s anti-epistemological stance was unfounded. Nevertheless some of the theory’s main concepts remain fertile, and even its limitations are instructive.

Midwifery in the ‘Medical Marketplace’

The quotation marks in my title have been carefully placed: I shall be discussing not ‘midwifery in the medical marketplace’ but rather the way in which a model of the medical marketplace has been applied to midwifery in early eighteenth-century England. Specifically, it has been suggested that the rise of man-midwifery — that remarkable new form of medical practice in which the medical man came, by around 1750, to play the role of midwife — can be attributed to competition between medical men for a limited pool of patients. This model has been applied in three somewhat different ways, which nevertheless all invoke the ‘medical marketplace’ as an arena of competition, and see such competition as the universal currency of relationships between early modern practitioners. These claims are interesting in allocating to the ‘medical marketplace’ a dynamic role, as an agent of change; but I shall suggest that this particular application of the concept is not persuasive. After developing this argument, I shall go on to suggest some points of wider application, whose common burden is that the concept of the medical marketplace needs to be sharpened and refined.