The reappearance of the sick man: a landmark publication revisited.

Abstract

There has been much cause to celebrate Leicester in the recent past, but this year marks a little-noted academic anniversary. Forty years ago, in the second of two seminal papers, Nicholas Jewson helped to recast medical historiography. Earlier historians of medicine focused on scientific developments, the origins of theories and treatments. Hitherto, intellectual progress had been regarded as the inexorable driver of therapeutic and institutional advance. A sociologist at the University of Leicester, Jewson was one of a new wave of researchers for whom medicine was a social phenomenon, shaped by wider political, economic, and cultural influences.1 Jewson was concerned in this paper with what he called ‘the disappearance of the sick man’ from medical cosmology in the period from 1770 to 1870.2 He used the term ‘medical cosmology’ as shorthand for the prevailing theories and practices that defined the nature of medical discourse at that time. He sought to demonstrate how the social relations underpinning 18th-century medicine had been supplanted — with major consequences for knowledge and practice that endure to the present day. Until the late 18th century, a system of ‘bedside medicine’ had prevailed in the Western world. In the Galenic tradition, diseases were thought to result from an imbalance of humours. Health was restored through various therapeutic actions and interventions devised to restore the disrupted equilibrium. Thus the sick man (or woman) was not viewed in isolation. Rather, an individual’s psychological and social circumstances, behaviours, and life history were central to diagnosis and treatment. In a paper published 2 years earlier, Jewson sought to show how this system was influenced by the economic power exercised by patients.3 The fee-payer could choose the doctor who met their needs. The clinical encounter was also influenced by what Jewson called ‘epistemological parity’ — the extent of …