Medical advertising and trust in late Georgian England

Notes, Summaries & Reviews, Thesis Research

Hannah Barker, “Medical advertising and trust in late Georgian England,” Urban History 36, no. 3 (2009): 379-398.

Baker brings sociological theories of trust to bear on the proliferation of medical advertisements in the late 18th and early 19th centuries in four English towns. Using a statistical approach, she evaluates what sorts of rhetorical strategies were used to advertise patent medicines and asks what this can tell us about the people that were purchasing the tinctures and their construction of trust.

“The Most Difficult Part of Chemistry”

Notes, Summaries & Reviews, Thesis Research

Noel G. Coley, “Physicians, Chemists and the Analysis of Mineral Waters: ‘The Most Difficult Part of Chemistry,'” Medical History, Supplement no. 10 (1990): 56-66.

Coley approaches the historical practice of analyzing mineral waters as someone interested in the development and refinement of analytical chemistry techniques. This isn’t particularly useful for my research, but her work does provide a good historical account of what sorts of problems chemists have had in analyzing natural waters and what sorts of techniques they have used and developed.

“An adept in medicine”

Notes, Summaries & Reviews, Thesis Research

M. D. Eddy, “‘An adept in medicine’: the Reverend Dr William Laing, nervous complaints and the commodification of spa water,” Studies in History and Philosophy of Biological and Biomedical Sciences 39 (2008): 1-13.

Dr. Laing (1742-1812) wrote two works on a town with mineral waters — Peterhead, Scotland — and used his knowledge of medical chemistry (along with testimonials) to explain the therapeutic powers of the waters. Eddy employs this as a case study through which to acquire a better understanding of the development and deployment of medico-scientific knowledge in explaining the therapeutic powers of spa water and its relationship to therapeutic commodification.

This study is outside of the timeline and geographic constraints of my work, but it provides a good historical perspective, and Eddy’s approach and the language he uses to describe some of the things I’m seeing in Eureka Springs are very helpful.

Imperial Leather

Notes, Summaries & Reviews

Overall impression:

If you’re looking for an example of intersectionality — the idea that gender, race, and class are categories that create and reinforce on another — this book is an excellent example of a history where those issues are addressed without losing any of their complexity. I really get what people are saying about them all being hopelessly intertwined and complicated.

It’s also an excellent example of how different history looks when you take a gendered approach to something. It’s not a feminist history — McClintock spends as much time discussing masculinity as she does femininity — but because it focuses on the domestic sphere, it is able to get at women’s experiences in a way that most histories don’t.

Foucault: The Birth of the Clinic

Notes, Summaries & Reviews

Foucault’s is a history (if we can call it that) of discourse — of the way people talked about the body, particularly in its diseased state, and the way they’ve understood the doctor and the patient himself in relation to the disease.

« …commenter, c’est admettre par définition un excès du signifie sur le signifiant, un reste nécessairement non formule de la pensée que le langage a laisse dans l’ombre, résidu qui en est l’essence elle-même, poussée hors de son secret; mais commenter suppose aussi que ce non-parle dort dans la parole, et que, par une surabondance propre au signifiant, on peut en l’interrogeant faire parler un contenu qui n’était pas explicitement signifie. »

To comment on something is to assume that the ultimate meaning of what you’re getting at is more important than what you’re saying — that there’s something more, something left in the shadows of your words. I think Foucault is laying the foundations for the kind of work he will do in the rest of the book here, asserting that if we can read through the way that doctors talk about the body, the patient, the disease, and themselves in relation to it, we can understand at a deeper, more complex level how they saw and understood these concepts.

This is a history of reading between the lines, of seeing what was not explicitly stated and looking underneath for larger take-aways. I’m unsure how I feel about this, because it doesn’t seem to be based in anything tangible. It feels farfetched and difficult to substantiate, problems that Foucault does resolve, in my mind, in the remainder of the text.

I think it has the potential to be very powerful, though, and I love that Foucault states he is not arguing that this epistemic change in the late 18th century was doctors/scientists suddenly waking up and seeing what had really been there all along — rather, that a new kind of science (by which I mean what was considered scientific) emerged, and through its lenses, scientists and doctors saw different things. They were looking for different things.This way of looking at things, I think, is something a lot of historians of science don’t like. It’s the ultimate critique to the progress narrative and to positivism, to viewing the history of science, technology, and medicine as the story of how scientists eventually “got it right.”

Espaces et Classes

Primary (disease), secondary (disease + individual), tertiary (disease + individual + health infrastructure, or « l’ensemble des gestes par lesquels la maladie, dans une société, est cernée, médicalement investie, isolée, repartie dans des régions privilégiées et closes, ou distribuée a travers des milieux de guérison, aménages pour être favorables »). Big changes took place in the tertiary.

Une Conscience Politique

Begins by talking about epidemics, exploring how they were understood and why the concept of contagion was largely unimportant.

« On a discute beaucoup et longuement, et maintenant encore, pour savoir si les médecins du 18ieme siècle en avaient saisi la caractère contagieux, et s’ils avaient pose le problème de l’agent de leur transmission. Oiseuse question… »

Details growing « conscience collective » of medicine, as observations around France were being collectivized and disseminated through medical infrastructure.

« Le lieu où se forme le savoir, ce n’est plus ce jardin pathologique où Dieu avait distribue les espèces, c’est une conscience médicale généralisée, diffuse dans l’espace et dans le temps, ouverte et mobile, liée à chaque existence individuelle, mais bien à la vie collective de la nation, toujours éveillée sur le domaine indéfini où le mal trahit, sous ses aspects divers, sa grande forme massive. »

Discusses change in the doctor’s role being reinstituting an individual, idiosyncratic “normal” to, in the 19th century onwards, adhering to a common, popular normal as the standard for health.

Importance of the concept of healing the state — health as something the entire nation should be concerned about.

Le  Champ Libre

Account of the debates surround the reformation of medical education during the French Revolution;

Hospitals should be abolished; they shouldn’t be needed in the ideal state, because everyone will be healthy. They end up becoming the new “natural” place for disease, though, replacing the family.

Arguments over whether education/medical field should be regulated.

The Old Age of the Clinic

“Before it became a corpus of knowledge, the clinic was a universal relationship of mankind with itself; the age of absolute happiness for medicine. And the decline began when writing and secrecy were introduced, that is, the concentration of this knowledge in a privileged group, and the dissociation of the immediate relationship, which had neither obstacle nor limits between Gaze and Speech: what was known was no longer communicated to others but put to practical use once it had passed through esotericism of knowledge.”

Theory vs. seeing — to what extent do our theories dictate what we see? (“When Hippocrates had reduced medicine to a system, observation was abandoned and philosophy was introduced into medicine.”)

I’ve felt this way about learning history a lot. If I read so much theory, it’s going to change the way I do history. It’s going to change the way I read sources, the way that I understand them, and the way that I relate them to contemporaneous and modern-day situations and ideas. Is this less pure? Or merely substituting someone else’s bias for my own?

Details how the clinic is different from a hospital, one being that, while in a hospital, “one is dealing with individuals who might suffer from one disease or another,” in the clinic, “one is dealing with diseases that happen to be afflicting this or that patient: what is present is the disease itself, in the body that is appropriate to it, which is not that of the patient, but that of its truth.”

The Lesson of the Hospitals

Clinical hospitals became a space where “truth teaches itself… offers itself to the gaze of both the experienced observer and the naive apprentice; for both there is only one language…”

They made possible “the immediate communication of teaching within the concrete field of experience… effac[ing] dogmatic language as an essential stage in the transmission of truth.” (68)

Interesting, although I’d still argue there was a lot going on with medical language at this time. Someone didn’t just walk in and know how to talk about the body. The body still wasn’t speaking for itself.

“What makes medicine, thus understood, a corpus of knowledge of use to all citizens is its immediate relationship with nature; instead of being, like the old Faculty, the locus of an esoteric, bookish corpus of knowledge, the new school would be ‘the temple of nature’; there one would learn not what the old masters thought they knew, but that form of truth open to all that is manifested in everyday practice…” (70)

Signs and Cases

Begins by discussing similarities and differences between natural history and this new brand of medicine; continuing conversation distinguishing classificatory medicine and clinical medicine. Instead of just classifying everything by their differences and similarities, clinical medicine embodied “a gaze… not bound by the narrow grid of structure (form, arrangement, number, size), but that could and should grasp colors, variations, tiny anomalies… it must make it possible to outline chance sand risks; it was calculating.” (89)

Discusses signs and symptoms — actually kind of defines something for once — and the changing amount of space between what was a signifier and what was signified. Symptoms, instead of being a sign of something, become themselves part of the whole of the disease.

Fascinating discussion of the rising importance of statistics in medicine (WISH THERE WAS MORE SUBSTANTIAL EVIDENCE), which “gave the clinical field a new structure in which the individual in question was not so much a sick person as the endlessly reproducible pathological fact to be found in all patients suffering in a similar way; in which the plurality of observations was no longer simply a contradiction or confirmation, but a progressive, theoretically endless convergence…” (97) “The only normative observer is the totality of observers…’Several observers never see the same fact in an identical way, unless nature has really presented it to them in the same way.’” (102)

Seeing and Knowing

Difference between experimentation and observation

“The observing gaze manifests its virtues only in a double silence: the relative silence of theories, imaginings, and whatever serves as an obstacle to the sensible immediate; and the absolute silence of all language that is anterior to that of the visible.” (108)

The setting of the hospital is important, permitting “pathological events to be reduced to the homogenous; the hospital domain is no doubt not pure transparency to truth, but the refraction that is proper to make possible, through its constancy, the analysis of truth.” (110)

“…by saying what one sees, one integrates it spontaneously into knowledge…” (114)

This is a really important point for Foucault, I think. He’s writing about discourse as a way of knowing. How we put into language what we see is how we construct knowledge.

Long-winded analogy between disease and languages:

“Disease, like the word, is deprived of being, but, like the word, it is endowed with a configuration.” (119) – nominalistic (denies the existence of universals and abstract objects, but affirms the existence of general or abstract terms and predicates)

Open Up a Few Corpses

Argues that the histories of anatomy that posit dissection was not common until the mid-19th century are false, constructed to explain why pathological anatomy (the correlation of lesions with symptoms) wasn’t a thing earlier.

Historical narratives constructed as “retrospective justifications.”

Foucault: Madness and Civilization

Notes, Summaries & Reviews

This book read a lot like Orientalism to me. It is a history of The Other and how it has been defined in relation to what is normal, what is reasonable. In Said’s work, the opposing ideas were Western and Oriental. In Foucault’s, they are reason and folly. I think the two overlap a lot, however; the Oriental was often associated with emotion, spiritual ways of understanding the world, and unreason. Equally parallel in both works is how one of the opposing binaries — the Oriental and the Mad — is made to embody all that is undesirable and the operative results of being understood that way. I understand why this book would probably be important for anyone in colonial and post-colonial studies to read.

It’s a very deep history that definitely falls firmly in the camp of constructionism. Like The Birth of the Clinic, Madness & Civilization is looking at how the discourse (knowledge-base) around something informs how it is viewed and dealt with in society.

Posits that madness was handled via confinement starting the 17th century, “the moment when madness was perceived on the social horizon of poverty, of incapacity for work, of inability to integrate with the group; the moment when madness began to rank among the problems of the city.”  (64)

“The new meanings assigned to poverty, the importance given to the obligation to work, and all the ethical values that are linked to labor, ultimately determined the experience of madness and inflected its course.” (64)

Interesting for my research is the change in conceptions of madness Foucault outlines in “The Great Fear,” summarized well in the following excerpt:

“In the second half of the eighteenth century, madness was no longer recognized in what brings man closer to an immemorial fall or an indefinitely present animality; it was, on the contrary, situated in those distances man takes in regard to himself, to his world, to all that is offered by the immediacy of nature; madness became possible in the milieu where man’s relations with his feelings, with time, with others, are altered; madness was possible because of everything which, in man’s life and development, is a break with the immediate.” (220)

This reminds me of neurasthenia and makes sense given contemporaneous therapeutic recommendations — a return to nature, to the natural state of man. Modernity, it was believed, was overexciting and led to mental problems.

Airs, Waters, Places

Notes, Summaries & Reviews

W. F. Bynum in Science and the Practice of Medicine in the Nineteenth Century traces early ideas about the social ecology of diseases to this important piece within the Hippocratic corpus. Of its importance to the history of community health, he says: “…the Hippocratic authors of this work (there were undoubtedly at least two) yoked together medicine, physical geography, and ethnology so persuasively that subsequent medical speculations on why epidemics occurred, and why certain diseases were prevalent in particular regions, made frequent reference to features such as wind, climate, temperature, soil, and humidity.” (59) Reading it today in preparation for Aparna’s History of Public Health class, I’m inclined to agree with this assessment.

I can see a basic proto-epidemiological approach; the authors are trying to understand the prevalence of certain kinds of diseases among particular populations in distinct locations. They take into account many potential “determinants”: climate, winds, water source and quality, habits, and base constitutions. Sudden changes in anything — temperature, humidity, air flow, etc. — are understood as unhealthful. Climates that vary tend to breed ecologies that are also varied, which in turn breeds unbalanced flora, fauna, and humans. In this sense, the theories in Airs, Waters, Places are incredibly ecologically deterministic.

The authors also discuss “distribution.” An example will clarify this assertion. Part 22 deals with Scythians and attempts to explain the high number of eunuchs in their ranks. They are a nomadic tribe in which horse-riding is the primary method of movement, and wealthier citizens are more likely to be able to afford a horse. A higher proportion of eunuchs are wealthy. From this information, the authors deduce that it is the frequent horse-riding that is the root determinant; it causes inflammation of the joints, which is treated via bloodletting behind the ears, which, according the authors, causes impotence. Realizing that they can no longer perform sexually, these men don the clothes and social roles of women, becoming eunuchs. After establishing an abnormal incidence rate in a population and subsequently combining culture-specific behaviors with the physiological effects they have, the authors come up with an environmental explanation for a disease.

This does feel a bit whiggish — looking to the past and cherry-picking methods that look familiar to modern-day epidemiology — but if we are looking for the history of basic public health strategies, I can see why historians have understood this work to be of importance. I’m hoping we discuss how its ideas were or were not used contemporaneously and whether or not it was read and followed by later individuals concerned with community health.

Another interesting bit — the authors’ thoughts on the supernatural character of diseases are of note. Though not ready to throw the possibility of divine will completely out, they were certainly sure that the cause of illness was natural and knowable;

"...no one disease is either more divine or more human than another,
but that all are alike divine, for that each has its own nature, and
that no one arises without a natural cause." (Part 22)

A Science of Impurity

Notes, Summaries & Reviews, Thesis Research

Christopher Hamlin, A Science of Impurity: Water Analysis in Nineteenth Century Britain (Berkeley: University of California Press, 1990).

In a case study of the political, social, cultural, and newly scientific conversation surrounding concerns about water quality in 19th century England, Christopher Hamlin shows that through the powerful claim at absolute, unbiased, and natural knowledge, science (especially chemistry) was used as a way of arguing for different standards and policies.

Hamlin points out something very interesting in his introduction. The 19th century is often seen as home to “the great watershed in environmental medicine, separating a pre-scientific period in which medicine could offer little more than a false cultural authority from the contemporary period of scientific precision where the authority is real,” an idea he takes as “unsatisfactory.” (3)

His first argument against the above narrative was the precarious financial situation of scientists, who often couldn’t count on their professorships to pay the bills if they weren’t already independently wealthy (a situation probably even more common in the US than in Britain). He cites chemists specifically, who often felt the need to accumulate side acts; “as consultants, witnesses, authors, entrepreneurs, as well as teachers.” This may help explain the historical record I’ve uncovered of Dr. Juan H. Wright, who seemed to have made a career (or at least part of one) by providing chemical analyses of springs around the midwest.

Chapter one deals with the chemistry behind mineral water analysis, breaking early- to mid-19th century strategies down into three contemporaneously recognized categories; physical examination (smell, taste, color, observed medicinal properties), “qualitative examination through the use of reagents, and a quantitative analysis of the evaporative residue.” (24-27) All were generally employed, although the last two were considered more scientifically telling. Hamlin makes clear that there was much debate within chemistry itself as to which tests were the most useful, when they should be employed, and how accurate they were. There seems to have been a lot of concern about how the tests themselves might alter the water and about whether certain combinations of chemicals in the water could affect a test’s outcome.

Interestingly, due to the way chemical reactions were understood before the late 19th century, when discussing medicinal benefits of waters chemists did not often take into account how the water’s contents may interact chemically within the human body. Physicians (and by extension spa proprietors and customers/patients) were used to working under the assumption that it was the salts, not ions, contained within mineral waters that were responsible for their medicinal value. The uncertainty-driven debates within the community of analytical chemists were not comfortable or economically valuable for those seeking water analyses, so they were generally glossed over and older conventions (tables of salts instead of ions) used. (36-37)

Chapter two, “Water Analysis and the Hegemony of Chemistry, 1800-40,” contains a lot of work that helps to clear up some of the stuff I’ve been seeing in my primary sources. Hamlin begins by briefly describing the rise of “trained ‘practical’ chemists” who did not limit their work to exploration and discovery but applied chemical techniques to “industry, commerce, government, law, and education.” (47) A more prominent role in society meant that these men were gaining authority, but how? Hamlin argues it was not because of “the progress of pure chemistry,” but rather due to “a combination of social needs and aggressive marketing…” (48)

Hamlin contends that a new kind of chemist — embodied by his two examples, William Thomas Brande and Alfred Swaine Taylor — emerged at the beginning of the 19th century whose contributions to original research were scanty but whose public presence and ability to sell chemistry as the answer to many of society’s most pressing problems was impressive. “…with decent laboratory skills, passing familiarity with the contents of the journals, tolerable lecturing talents, good connections, and untouchable confidence, one could make a decent living in London as a practical chemist.” (50) Oftentimes these men were hired by people with a vested interest in the medicinal benefits of the spa, and they would publish their results in both scientific journals and pamphlets for the springs. Many “pure” chemists (i.e., Humphry Davy) found these men problematic and quackish, but Hamlin is careful to state that the modern distinction between pure and applied science was in its infancy. Not every chemist and certainly not every layperson would have recognized this as bad chemistry, which helps to explain why the conflicts of interest were not seen as horrendously problematic. Another consideration is the kind of science these men thought they were doing; if they could gather enough analyses, payed for by whomever and for whatever reason, they may be able to draw larger conclusions from the data. Hamlin terms this “Baconian” science and argues that it helps to explain the willingness for chemists and doctors to accept what we would consider biased information as probable fact.

Though he does not explain in detail how these men made themselves visible to spa proprietors or physicians, Hamlin does argue that chemists became an important vehicle for providing scientific legitimization to the medical claims being made about mineral waters. It allowed comparisons to be made between mineral waters (OUR springs contain similar elements to Baden-Baden, and they’re found in your backyard!) and “symbolized that someone knew what was going on, that the medicinal environment one was to encounter was comprehended and would be applied in a precise and rational way.” (54) Chemists would often provide an analysis, then immediately below state possible medicinal benefits of the waters without explaining how the two connected; Hamlin argues that this is because it would have been understood by wealthy client or physician, and for the rest, that “it was the appearance of thoroughness that was to impress the reader.” (54)

The next section deals with attempts at synthesizing mineral waters, which is interesting but not immediately relevant. Maybe come back to this later?

Another facet of the relationship between chemists and doctors in the testing of mineral waters was which set of knowledge to begin from. Doctors and some chemists believed that it was the chemist’s job to take the observed medicinal effects of the water and explain them with an analysis. If the analysis yielded results that didn’t make sense, it must be a problem with the chemist’s method. Some, however, thought that “chemical composition was the only thing that could be empirically determined.” (60) Claims about medical benefits were unfounded assertions based on testimonial, and so it must be that medical benefits should be deduced from the chemical composition of the waters. We see again that the patient’s narrative is taken out of the equation in an attempt at an objective, scientific truth.

This context helps to explain some of the analyses in pamphlets and government documents alike that read like advertisements at times and situates the chemistry these men were doing in the context of practical and analytical chemistry. I wonder to what extent Hamlin’s conclusions carry over to the American situation and plan on supplementing this book with one about American chemistry. In reading the quotes he provides from his primary sources and seeing the format of the tables, however, it seems to me that the situation I’m working with is very similar to 19th century England.

The Great American Water-Cure Craze

Notes, Summaries & Reviews, Thesis Research

Harry B. Weiss, The Great American Water-Cure Craze: A History of Hydropathy in the United States, (Trenton: The Past Times Press, 1967).

Harry Weiss’s work provides an excellent starting point for anyone trying to grasp what hydrotherapy was, when it was prominent, and who practiced and promoted it. The book is full of facts, images, dates, publications, and names that prove very useful for expanding on Weiss’s work. It was a bit strange to read a work of history that did not put forth a clear argument, but frankly, I sometimes wish more books were written this way. I suppose once the conversation has been started, however, it’s difficult to continue to produce more meaningful scholarship in this format.

Weiss makes an interesting and useful distinction between “hydropathy” and “hydrotherapy.” The former he associates with the earlier movement, commonly thought to be initiated by Austrian Vincent Priessnitz and characterized by strict adherence to routines (often involving a lot of exercise and various kinds of baths at strange hours), abstinence from stimulating food/drink, the exclusion of therapeutic drug use, and a vehement opposition to mainstream medicine. The latter, which emerged in the last decades of the 19th century, was less radical; most proponents were not only hydrotherapists, and they did not espouse a therapeutic strategy that relied exclusively on water. There was also more of an effort put forth by its main practitioners to provide a scientific foundation for the water’s efficacy and less of a tendency to denounce allopathic medicine. Instead, many of these men (and most of them were men — it seems the closer a sect associated with mainstream medicine, the less women were allowed in their midst) published in standard medical journals and associated with regular physicians.

Simon Baruch, M.D., provides an excellent example of this new kind of scientific hydrotherapist. He studied in Vienna under W. W. Winternitz, which is telling; I have seen in a couple of other places (Valenza, Taking the Waters in Texas and Weisz, “Spas, Mineral Waters, and Hydrological Science in Twentieth-Century France”) the contention that the effort to “scientize” hydrotherapy was far more prevalent in Europe than in the United States. In 1898, Baruch published The Principles and Practice of Hydrotherapy, A Guide to the Application of Water in Disease in New York.

“[It]…was written for students and practitioners of medicine, and represented the observations of Baruch who had gathered material for a third of a century from his private and hospital practice, together with the observations of other investigators. It includes a discussion of the application of water in its various forms, both internally and externally, and its mechanical and thermic action in disease. He thought ‘the nerve fibers and endings furnished a clue to that remarkable sensitiveness of the epidermic layer which opened to hydrotherapy a free gateway to the central nervous system,’ and believed in the ‘existence of active contrastibility upon the part of the muscular walls of the arteries and arterioles, and in a less degree of the veins and lymphatics, and of the capillary epithelium.’

“…Baruch studied the effects of hydriatic applications upon the distribution of the blood, upon blood pressures, upon changes in corpuscular elements, upon respiration and muscular systems, both in man and animals. Many case histories of cures by hydrotherapy are described. He deplored the neglect of the application of water in disease in America, characterizing it as ‘vague and timid until recent times.'” (66)

He evidently succeeded in his goal of bringing medical acknowledgement to hydrotherapy, as he served as professor of hydrotherapy at the College of Physicians and Surgeons at Columbia University. (See if I can find the years of this, as Weiss does not give them?)

Dr. John Harvey Kellogg also conducted extensive research into water’s use as a therapeutic agent, publishing a book on the subject — Rational Hydrotherapy. A Manual of the Physiological and Therapeutic Effects of Hydriatic Procedure, and the Technique of Their Application in the Treatment of Disease — in 1901. Kellogg operated a laboratory beginning in 1883, where he “began to make hundreds of observations with the aid of the calorimeter plethysmograph (for measuring variations in size of an organ or limb), ergograph (for recording work done by muscles), and other devices.” He classified the effects of water extensively — “excitant and sedative,” which were then “subdivided into primary and secondary, and then into general and local effects. The general effects he labeled as restorative, tonic and caloric, and the local effects as sudorific, diuretic, cholagogic, peptogenic, emmenagogic, revulsive, derivative, resolutive, alterative, and caloric.” (66-67) Kellogg also did not believe that water should be used exclusively in medical treatment, and he held that each disease required experience and knowledge on the part of the practitioner before a therapeutic strategy (water-based or otherwise) should be attempted.  (I have read elsewhere that Dr. Kellogg had a bit of an odd reputation toward the end of his life. Could this have affected the reception of his hydriatic studies?)

As hinted at earlier, Weiss provides a very helpful summary of water-cure journals, some of which I was pleased to find were published on into the late 1890s. I need to check out the “Herald of Health,” which ran from 1863-1892, and the same journal under a different title, “Journal of Hygiene and Herald of Health,” which ran from 1893-1897. It’s unlikely I’ll find anything related to Arkansas in the journal, seeing as the state is completely excluded from Weiss’s book, but maybe I can get a feel for the periodical’s  relationship with mainstream medicine.

I do want to talk about how Arkansas was absent. I’m used to seeing only Hot Springs mentioned, but for the entire state to be absent is a bit strange. The entire last half of the book (the “Appendix”) is a state-by-state breakdown of what was going on with the water-cure. States covered include: Alabama, California, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas Territory (really?), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota Territory, Mississippi, New Hampshire, New Jersey, New York City and vicinity, New York State, Ohio, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Wisconsin, and Canada. This is an old book — published in 1967 — but Weiss read a lot of primary source material, and it worries me that he didn’t run across Arkansas once. Either my subject area is more isolated than I thought or I’ve found an oversight… I guess either way, it’s an interesting little lacuna I’ve stumbled across.

 

The patient’s narrative & hospital medicine

Notes, Summaries & Reviews, Thesis Research

Mary Fissell, “The disappearance of the patient’s narrative and the invention of hospital medicine,” in British medicine in an age of reform, eds. Roger French and Andrew Wear (London: Routledge, 1991).

In this piece, author Mary Fissell traces the changing nature of the doctor-patient relationship in the 18th century through the narratives doctors and patients used to understand illnesses. As the century wore on, physicians’ notebooks contained fewer patient voices. Where once lay vocabulary, only slightly filtered through the doctor, had been the source for both parties’ understanding of an ailment, a new, professional language emerged and began to eclipse that of the patient. The hospital facilitated this development, changing the landscape in which the patient and doctor interacted from one where the patient retained interpretive authority to one where he or she came to be examined. In this new setting, his or her physical characteristics spoke to the authoritative doctor trained to interpret them. “The body, the disease,” Fissell argues, “became the focus of the medical gaze, not the patient’s version of illness.” (100)

The testimonial is a difficult source to include for the historian because of its proclivity for exaggeration and potential issues with its authenticity. Fissell uses testimonials to discuss patient narratives, and her strategy for mitigating these issues is, I think, both elucidative and adequately tempered. “The veracity of some of these puffs is open to question; but whether ‘genuine’ lived experience or not, these tales followed similar narrative conventions about illness.” (97) She traces the commonalities between the content of the testimonials, concluding that all used a hot/cold, wet/dry framework for understanding the cause and cure of ailments. This gave patients some command over the what would otherwise seem to be random and uncontrollable health problems they encountered.

Next time I read through a set of testimonials, I plan on looking for narrative patterns — similarities and differences between what patients and doctors understood to be the reason for the springs’ efficacy. Did this change over time, as the claims in other parts of the ads become more scientifically oriented?

Fissell also discusses the use of what I have seen termed as “heroic therapies” — “an anti-phlogistic regimen that featured bleeding, purging, blisters, and a bland diet” — in silencing the patient’s narrative. In these regimens, it was the body’s response to treatment that aided in diagnosis and the evaluation of therapeutic efficacy. A fast pulse and red complexion called for bleeding, while a “languid” one indicated that the patient was “contraindicated.” (105)

I have seen in many of the works I have read on hydrotherapy that a major reason it became so popular was due to the fact that people were becoming increasingly skeptical about and weary of allopathic therapeutics. Obviously patients were growing tired of draining (literally) and ineffective treatments; I think, after reading this, they were probably also exasperated by the lack of agency they had in their relationships with their doctors. If their bodies always spoke for them, what control did they have over their health? Add to that the evidence (and it was piling up) that these kinds of treatments were ineffectual, and you have a scientifically-informed populace that is looking for an understandable health system in which they have a voice. A big part of the hydrotherapeutic movement was its emphasis on the importance of the doctor-patient relationship, the sharing of experiences between patients, the social outings, dances, clubs… You went to resorts to heal, but it was a communicative, socially stimulating practice as well. Where an allopathic physician had little interest in communication with his patient, hydrotherapeutic regimens and resorts were constructed with the importance of communication in mind.