It is now over a quarter of a century since the late Roy Porter made perhaps his most passionate call for a medical history seen not through the eyes of the medical practitioner but ‘from below’, that is, from the point of view of the patient. Medical history has been through a ‘cultural turn’ and many other theoretical acrobatics since Porter’s ‘The Patient’s View. Doing Medical History from Below’ (Theory and Society, 14, 2, 175–8) appeared in 1985, but the task remains pertinent and indeed still pressing. Philip Rieder’s La Figure du patient au XVIIIe siècle is an excellent addition to the tradition that Porter inaugurated. His focus is much more delimited than Porter’s – it covers the sickness experience of maybe a couple of dozen individuals who lived in the region of Geneva in the eighteenth century. Yet the tightening of the focus, which allows Rieder to place his study in the tradition of micro-history, is one of the great strengths of the book. We are allowed so close in to the health and sickness behaviour of his subjects that it becomes at times even slightly uncomfortable and embarrassing, as if we are getting to have really too much information about these historical figures. Rieder achieves this experience through systematic use of high-quality ‘ego-documents’, particularly diaries and (especially) correspondence. It helps too that he writes beautifully, with a sense of nuance in keeping with the sensibilities of his subjects.
Correspondence is in fact one of the forms of health behaviour that Rieder’s patients practised: listening, speaking and reading medical writings, especially popularising works, are others. The sick person, Rieder notes, was ‘rarely alone’ when faced by illness (p. 175). No work that I can think of testifies to the validity of the observation. The sick individuals in view here are in constant overlapping contact with fathers, mothers, siblings, children, cousins, neighbours, friends, carers, correspondents – and medical practitioners of every stripe. Much work in the late 1980s and early 1990 that took its inspiration from Porter was perhaps overly concerned with situating the patient in a ‘medical marketplace’, as a result of which the ‘patient’ could be metamorphised into the shopping-savvy twentieth-century consumer, a perspective which has its problems (not least anachronism). What emerges from Rieder’s monograph is the extraordinary density of relationships – some marketised, it is true, but most not – surrounding the sick person. The meanings of sickness simply cannot be mapped on such an economistic Procrustean bed.
When seeking to generalise from the conclusion of this study, we will need to note two significant aspects of it: the smallness and heterogeneity of his sample, and the apparent homogeneity of the ideas and practices here on view. The sample of individuals brought under the Rieder microscope is highly selective numerically as well as geographically, and it ranges from the famous (Isabelle de Charrière, Charles Bonnet) to the utterly obscure. And, partly because of this, it is very difficult to get a sense of what changed over the century. What seems to emerge is the continuing robustness of the humoral framework for understanding disease, and its ability to ingest new forms of understanding. Analysis in terms of nerves seems less to compete with humoralism, for example, than superimpose itself over it. Inevitably one wonders all the more how the eighteenth-century patient might then have differed from seventeenth-century or nineteenth-century comparators. Rieder offers us little to go on, save only for the thought that while there is no strong secularising trend in evidence, people no longer looked to the cosmos for valid astrological lore, but sought answers closer at hand, in the sub-lunar environment. If many big questions remain open, this is a call for further studies. Let’s only hope that they are as good as this one.
