Upon analysing the thesis, The disappearance of the sick man from medical cosmology, written by Nick. D Jewson, concurrent links can be drawn between the era it was written in, 1970s, and the era it was written about, 18th and 19th centuries, with regards to the climate of medicine during these respective times. Throughout the history of medicine, medical breakthroughs have proven to help heal the sick man, but a lot of the time doctors did whatever it took to work out the disease and find a cure, disregarding the patient’s autonomy and using power to their advantage. The question arises as to whether the shift in power paradigm has happened yet again in 2017 and what this means for society today and in the future.
The thesis written by Jewson has aimed to provide the reader with the changes of medical cosmology over the centuries, and illustrates the way power has shifted between patients and medical professionals. Bedside medicine was the preliminary medical cosmology in the late 1700s in which the “patient’s self-report” was the main source of diagnosis. The patron was typically the patient, who hires the medical practitioner for their services. According to Jewson, patients were “drawn from the ruling class” and the physicians that analysed their illnesses did not hold this same social status. It was, therefore, up to the physician to please his patient and establish himself as being better than his competition by “clamouring for [the patients] favours” . Mary Fissle, to a degree, agrees with Jewson in her thesis. Fissle acknowledges the “eager to please” doctors who are trying to separate themselves from competition and that the power is in the patient’s hands, but, even the middle and working class had more power over the physician. The French Revolution caused a large stir in medical cosmology with the shift to Hospital Medicine. Doctors started to get more power and control and patients began to lose their autonomy as they merely “endured and waited” for their disease to slowly kill them, whilst the doctors tracked and recorded its process. Charles E. Rosenberg quotes American surgeon Alexander H. Stevens regarding his complaints on Western European medicine during 1836, claiming: “The French … are tearing down the temple of medicine… They are explaining how men die but not how to cure them”. This makes it clear that the medical system in Western Europe had lost value of human life. In 1811, a biographical recount of a mastectomy was written by Frances Burney who recounts the lack of autonomy she had and the humiliation she felt when she was requested to remove her gown that she “had meant to retain” whilst “7 men in black” observed her operation as though she was an experiment. Patients generally reassured themselves that this discomfort is “for their own good” and didn’t feel they had the authority to question the surgeons they trusted. Surgery was soon replaced with laboratory work where it was believed “observational anatomy would never explain the cause of disease”, but rather that cell theory held the answers. As a result, the sick man was just “a material” which meant that there was even less patient-doctor interaction. This more recent change put “the doctor at centre stage” removing all connection to patients.
Parallels can be drawn between Jewson’s analysis of the patient-doctor relationship during the 1870s compared with that of the 1970s, which is supported by Ivan Illich’s paper Medical Nemesis. Medical professionals, according to Illich, believe that their opinion on pain being a “technical problem” is the only orthodox one and it’s their duty to cure the sick man. Illich is implying here that these doctors see themselves as having a more superior role in society, compared to others around them as well as a “sickening power”. It is argued that there is a “powerlessness of the patient” and that the hospital is a huge figure of society during the 1970s. During the era of Hospital Medicine, unassuming patients would seek help for their ailments with little knowledge that the doctors they trusted would use them as a way to track disease progression. This is not unlike the Unfortunate Experiment conducted by Gyn. Herb Green, where women went to Dr Green to have the appropriate therapy to remove their carcinoma in situ, putting their trust in Green to cure them. Dr Green “had a fixed idea” that CIS did not lead to cancer in the cervix, and didn’t treat some of the women who asked for his assistance, yet treated others. The women without treatment eventually developed cancer compared to those who were treated conventionally, results similar to a controlled trial. It is argued by Charlotte Paul that these patients didn’t know about this trial and that this led to a revolt against the health system. The Cartwright inquiry had huge amount of publicity which lead to distrust in the medical profession. The attack on doctors is described as “undermining” and challenging the validity of their medical knowledge. As a result, this led to a change in the way doctors informed their patients of their medical treatment, as well as a development of a code of patient’s rights. We can see from this example, that slowly the power is being shifted onto the patient as they get more of a say into the way they were treated by doctors.
Jewson’s piece illustrates the way in which medical cosmology has shifted and changed throughout the centuries, and the role of the patronage influencing who had the most power. The 21st century proved no different, as the new age of technology shifted the balance of power in medicine yet again. 2017 depicts a world where patients have access to medical information readily through the internet, libraries, complementary, alternative and over the counter medicine, and so patients are active in the medical care that they obtain, holding also in their hands the responsibility to maintain their own health. This shift in power has created a level playing field for both doctors and patients, making us acknowledge that the Jewson classical view of the sick man is lost and in its place we see a “greater variation of sick men and women today” all with their own forms of medical knowledge. Jewson’s analysis of 18th and 19th century medical cosmology does not mirror the state of medicine today, but, as Sarah Nettleton states in her commentary of Jewson’s paper, he does “reveal a correspondence between broader socio-material changes, technological innovations and privileging of particular forms of knowledge” which can be likened to the cause of yet another change in medical cosmology, that is completely different to those documented throughout history. In today’s day and age, we see the rise of the Human Genome Project, where patients can access genetic information about themselves and their foetus. Parents now have the power to abort their child if they deem their genetic abnormalities too grave to follow through with a pregnancy. However, “to what degree should parents be given such choices?” and who has the authority to determine what defines a “normal” and “healthy” individual? The fear is that these medical breakthroughs will lead to ‘designer babies’ where foetuses are genetically engineered to possess the “ideal” qualities their parents desire. This huge amount of power that patients now have is so far from the fundamental medical cosmologies described by Jewson during the 18th and 19th century.
Strong links can be drawn from the medical profession illustrated by Jewson during 1770-1870 to the 1970s medical cosmology, in particular the way doctors and patients interact. 2017, on the contrary, has a medical landscape that is very different to the one Jewson described, however, the underlying balance of power between patient and physician has shifted throughout history. The future holds a new medical cosmology unlike those described in the past and undoubtedly the medical climate will change again.