Philip Alexander Rieder

Patients and Words: a Lay Medical Culture?

The chronology of medical history is generally organized around medical discourses and the evolution of ‘scientific’ knowledge. The position or role of the patient has long been ignored or, at best, inferred from medical knowledge, past or present. Roy Porter’s call, almost twenty years ago, for the development of a history of medicine from the patients’ perspective has done little to transform this way of considering the medical world of the patient in history.1 Events such as the invention of the clinic and the discovery of the world of the infinitely small, structure the way in which medical history and the history of the patient are written. In fact, a now-famous article written well before Porter’s call, Nicholas Jewson’s ‘Disappearance of the Sick-man from Medical Cosmology (1770–1870)’,2 offers a model explaining the evolution of the patient’s role through history and contributes to shaping the way patient’s history is thought of today. And yet, in the aftermath of Porter’s appeal, much was reported and published on individual or family relations to health in the past. Roy and Dorothy Porter have produced a particularly extensive book based on patients’ lives, strategies and stories.3 Through their research and that of many others, some knowledge about the general reality of patients’ situations, apprehensions and strategies has now been accummulated.4

The end of medical confidentiality? Patients, physicians and the state in history

Medical confidentiality has come under attack in the public sphere. In recent disasters both journalists and politicians have questioned medical confidentiality and claimed that in specific contexts physicians should be compelled to communicate data on their patients’ health. The murders of innocent individuals by a suicidal pilot and a Swiss convicted criminal have generated polemical debates on the topic. In this article, historical data on medical confidentiality is used to show that medical practices of secrecy were regularly attacked in the past, and that the nature of medical confidentiality evolved through time depending on physicians’ values and judgements. Our demonstration is based on three moments in history. First, at the end of the 16th century, lay authorities put pressure on physicians to disclose the names of patients suffering from syphilis. Second, in the 18th century, physicians faced constant demands for information about patients’ health from relatives and friends. Third, employers and insurance companies in the 20th century requested medical data on sick employees. In these three different situations, history reveals that the concept of medical confidentiality was plastic, modelled in the first instance to defend well-to-do patients, in the second instance it was adapted to accommodate the physicians social role and, finally, to defend universal values and public health. Medical secrecy was, and is today, a medical and societal norm that is shaped collectively. Any change in its definition and enforcement was and should be the result of negotiations with all social actors concerned.

Corps et subjectivité à l'époque des Lumières

Is there such a thing as an enlightenment body ? Over the past few decades, the multiplication of objectifying perspectives on the body in history tends to the extreme fragmentation of such a topic. This article defends an exploration of the body as a singular and experienced reality which remains situated in a given historical context. The case of Horace-Benedict de Saussure, studied thanks to a particularly rich set of archives (diaries, letters, various notes) bears witness to the fact that Saussure, as an individual, elaborates and affirms the meaning of his private body according to experiences and to intimate knowledge and conviction which are forever being revised during his life. The historian can thus analyse the relationship between the scale of the singular body and that of the Enlightenment body.