Medizin, Gesellschaft, und Geschichte. Beiheft : Jahrbuch des Instituts fur Geschichte der Medizin der Robert Bosch Stiftung最新文献

Reading letters depicting perceptions of the body, such as those addressed to the founder of homeopathy, Samuel Hahnemann in the 1830's, is one means to identify how gender influenced the self. Homeopathy produced specific writing situations for the patients. Taking into account the modern concept of privacy, this article demonstrates how patient's letters can express gender hierarchies, namely through different strategies used by patients in order to hide their own distress caused by illness. The expression and representation of experience and discourse are also analysed. In comparing women's and men's writings about their bodies, it is argued that women tend to disclose their knowledge whereas men typically offer names borrowed from different medical discourses in order to describe their illnesses. In short, women refer more often to experience and men to knowledge. One can therefore conclude that the way of representing body perceptions reflects a male or a female self, and suggests distinct constructions of the "nature" of male and female sexes of that time.

Letters represent the most important type of source where patients of the early modern period record their feelings, thoughts and behaviour. It is therefore crucial to put them into context and identify the author's reasons for writing. Consultation letters written to physicians can be distinguished from family letters or letters exchanged between members of the Republic of Letters. The way patients write about their illness is largely determined by the main reason for the letter. Family members want, for instance, to inform their relatives about the general situation of the household. News about the state of health of family and kin is an essential part of such accounts. Though usually sparse in detail, information about health is offered regularly in order to free addressees from uncertainty. Among learned men, accounts of sickness are mostly brief and described as "inconveniences", as distractions from the pursuit of learning. Neither in family letters nor in learned correspondence should superficial descriptions of illness be considered as a sign of superficial relationships.

It was common practice between the 16th and the 18th c. to submit a clinical case to a physician whose renown and prestige were generally acknowledged even outside academic circles. Patients could normally gain access to Antonio Vallisneri, who was then a famous physician, through their own physician. Vallisneri was regularly engaged in writing consultations and sending them by post, an activity which gave way to a peculiar kind of writing both in style and language level. The patient and his illness are the object of minute descriptions in order to secure an effective therapy. One of the best therapies, nevertheless, seems to be the written communication itself, written by the physician for the patient, which possibly reassured the patient that the best possible therapeutic measures were being taken in order help to retrieve his or her health.

Analysing the contents of letters exchanged by patients in the 18th century, this chapter aims to demonstrate the capacity of such sources to offer both contextual information on medical practices and first hand information on patient strategies to retrieve and maintain their health. The letter is sometimes closer to the events than other texts and hence, more precise. Series of letters sent by the same author to different addressees can be used to reveal something of the meaning construed around patients' choices. Letters sent over long distances reveal variations in medical practices in different spatial contexts. In short, the letter, as a historical document, is an important key to lay medical culture.

The private diary Diderot wrote every week for the benefit of his mistress, Sophie Volland, gives an insight into "illness in letters" in the XVIIIth century. Diderot inserts the long story of his wife's illness (September-October 1762) into his monologue. Indeed, in general, health related topics are commonplace in letters. The health of the author is better expressed in autobiographical writing since this type of text aims to ascertain the author's sincerity: modern scholars have emphasized the "exhibitionism" inherent to Rousseau's Confessions. Diderot was the author of the French translation of Robert James' Dictionary of Medicine, and his continuing interest in the human body is revealed by his depiction of everyday life. The intensely active mind of the philosopher is incapable of locking itself into a love cocoon and Diderot must constantly reassert his presence in the world whatever happens. His correspondence can therefore be considered as an anthropological document containing evidence of the state of medicine in the days when the Encyclopaedia was written.

Patients' letters are among historical sources that have been recently put forward in the history of medicine in order to shed light on the perspective of the sick and explore the dynamics of therapeutic relationships. They enable historians to focus on the active participation, initiatives and strategies of lay people in the handling of their health and illness. Based on the analysis of letters written by patients to the Swiss physician Samuel-Auguste Tissot in the second part of the 18th Century, this paper deals with the relative autonomy that sick people are able to claim in the process of interpreting and explaining of their medical trajectories. It is argued that they possess a "narrative authority", which can be defined as the possibility to defend one's own point of view in the organisation of one's narrative, thanks to the interpretative latitude due to polyphony and plurality of meanings inherent in the intersubjective construction of the illness experience.

The German writerJean Paul (Johann Paul Friedrich Richter, 1763-1825) and his friendJohann Bernhard Hermann (1761-1790) became acquainted with the thoughts of late Enlightenment at the University of Leipzig. They particularly appreciated the anthropology of Ernst Platner, who taught philosophy and aesthetics as well as medicine. Their confidential correspondence contains reflections on their respective situation and well being. Both write about feeling ill and label their illness "hypochondria". In the course of the correspondence Jean Paul's understanding of hypochondria evolves from an illness of the entrails as he follows Hermann, who supports the modern concept of hypochondria as an illness of the nerves. Two important themes from this correspondence recur in Jean Paul's novels and tales: firstly, his way of expressing comfort is related to his aesthetics, and secondly, the satirical way of portraying at least certain aspects of illness as imaginary reappears in his first successful novel "The Invisible Lodge" (1793).

Throughout his voluminous correspondence, Rousseau continuously exploits his bodily ailments. Staging illness serves as a specific strategy which can be understood through the concept of desire: a desire for the other, whose absence is ostensibly inscribed in the body of the writer, but also for the discourse of correspondents from whom Rousseau constantly shies away. In his case, the epistolary discourse of illness expresses as much an experience of suffering as a way of relating to the world, as if epistolary writing was the privileged place for a discourse on the suffering body before even becoming a social practice. A few exchanges of letters are analysed, such as the letters between Rousseau and the Duke and the Duchess of Luxembourg, who "gave him back his life" in Montmorenci, and that with Madame de la Tour and Madame de Verdelin, which is particularly revealing of Rousseau's strategies for dealing with the body in health, sickness and death.

Johann Gottwerth Müller, a so called "independent author", was one of the most successful novelists in the German Enlightenment around 1800. Educated as a scholar and trained as a physician, although not a practicing physician, Müller was sick throughout his life and constantly reflects on his diseases, and on what he considered to be an insufficient "medical system" and a socially "sick" society. This outlook is revealed by his library (in 1828: about 13300 volumes, of which 254 volumes of medical publications), his correspondence and his novels. Letters he exchanged with the publisher Friedrich Nicolai (74 letters between 1777 and 1796) about private and business affairs show that Miller uses statements about his sickness in order to win sympathy, to document his sufferings as part of an "independent" writer's identity, as a metaphor for social health, and as a means for excuses and compulsions in business connections. The didactic novels serve the author's transformation of individual suffering into the perspective of an enlightened humanitarian development of the government, the society, and the medical system within the structured society of his day.

In recent years, new patients' rights have been evolved, allowing them access to records of the state of their health. Many letters addressed by the public to physicians and to administrators are kept in hospitals' medical files. This chapter presents examples of such letters which are discussed from a linguistic point of view. It remains difficult to ascertain exactly what the patients expected of their letters and what exactly the medical and administrative staff answered. A typical letter contains two distinct themes: logistic or technical questions, and existential or affective issues. For the most part, doctors and administrators tend to answer the first type of questions only, as they feel unqualified to address or express an opinion concerning affective issues. This suggests that regular training in creative writing and reading could be interesting and useful for doctors and administrators, at least in helping them to be more sensitive to the subtleties and complexities of the patients and the patient's family's letters.