Doctors and Their Patients in the Seventeenth to Nineteenth Centuries.

Abstract

How can these finings be interpreted in conclusion? Analysis has revealed firstly that, depending on the chosen period, the socio-geographical situation and the profile of the individual doctor's practice, the clientele varied widely in terms of gender, age and social rank. The consultation behaviour of men and women changed noticeably. Findings overall suggest that up until t8o the gender distribution varied in the individual practices. There was a trend for women to be overrepresented in urban practices during the earlier period. But in general, from the mid-nineteenth century they predominated - in towns as well as in the country in allopathic as well as homeopathic practices. The absence of children, which was bemoaned by many physicians, did not apply to the practices under investigation. On the contrary: the percentage is consistently high while older patients remained underrepresented right up until the end of the period under investigation, even though their proportion increased in the individual practices during the course of the nineteenth century In each of the nineteenth century practices investigated - and increasingly among the lower and middle classes - the physicians' services were used by several members of the same family. We have found no evidence to support the thesis that up until the nineteenth century academic physicians were mainly consulted by aristocratic or wealthy bourgeois patients. The theory probably applies only to early modern urban doctors. In the practices examined here, from the middle of the eighteenth century, patients from all social strata went to consult physicians. The participation of members of the lower classes or from an artisanal, (proto) industrial or agricultural background clearly increased over time 'despite ubiquitous economic and cultural barriers. That the annual numbers of consultations per physician increased - despite the growing number of physicians available - suggests that for economically disadvantaged social groups also, the consultation of learned physicians became more common: in towns from the first half of the nineteenth century and in the country from the middle of the century. In addition, the individual findings reveal that, prior to the introduction of statutory health insurance for salaried persons, patients of more secure social standing consulted a physician considerably more frequently in the course of the year than lower class patients. While the patient structure clearly changed around 1800, the relationship between physician and patient continued without major changes from the seventeenth to the nineteenth century. The therapeutic encounter up until the end of the investigated period can be summarized as a negotiation process. Patients were discerning in their choice of healer and did not refrain from using rival services. They sought help for unpleasant symptoms such as indigestion, pain or fever, and only rarely in cases of emergency Therapy was decided on after an exchange between a critical and autonomous client and the medical specialist who was generally willing to compromise. While the patient structure clearly changed around 1800, the relationship between physician and patient continued without major changes from the seventeenth to the nineteenth century. The therapeutic encounter up until the end of the investigated period can be summarized as a negotiation process. Patients were discerning in their choice of healer and did not refrain from using rival services. they sought help for unpleasant symptoms such as indigestion, pain or fever, and only rarely in cases of emergency. Therapy was decided on after an exchange between critical and autonomous client and the medical specialist who was generally willing to compromise.