Medicine-by-Post: The Changing Voice of Illness in Eighteenth-Century British Consultation Letters and Literature (review)

In this scholarly, interdisciplinary study, Wayne Wild provides a valuable analysis of the shifting rhetorical styles that typically characterized epistolary exchanges between eighteenth-century physicians and their patients. Medical consultation through the medium of letters was a service offered by physicians of this period to their more wealthy patients, and, as Wild argues, such exchanges provide an important insight not only into the patient experience of illness and how sickness was understood and narrated but also into the ethical and social dynamics of such doctor–patient relations. Responding to the call of Piloud, Hachler, and Barras to not simply treat such medical correspondence as mere "background material," Wild considers how—in an era when physicians typically offered a fairly standard range of treatment regimes and prescriptions—the rhetoric of the doctor– patient relationship changed significantly in response to shifts in theoretical language, notions of embodiment, and popular medical culture. Attention is also given to questions of discretion, the emergence of a more codified medical ethics toward the close of the century, and to related novelistic representations of doctor–patient relations.

An opening chapter, offering a cogent overview of the professional and social contexts in which epistolary medical exchanges were enacted, pays particular attention to the medical correspondence of Samuel Johnson. Arguing against the notion of a "single rhetoric of sensibility," Wild goes on to posit a number of significant paradigm shifts in the rhetoric of what he conveniently terms "medicine-by-post." In a series of well-focused chapters, these shifts are illustrated through the informed examination of a number of exemplary exchanges of letters, some of which have hitherto remained unpublished. The early decades of the century are characterized by the absorption of iatro-mechanistic and fashionable Newtonian concepts of the body and the language of the "New Science" as promoted by the Royal Society, which sought detachment and objectivity. This voice is represented by the partly unpublished private practice correspondence of Dr. James Jurin (1684–1750).

The chapter following Dr. Jurin's correspondence addresses the colorful, influential figure of Dr. George Cheyne (1671–1743) who, as the most successful early Georgian physician, dietician, and medical author, played a crucial role in promoting a new, more subjective language of nervous sensibility. Cheyne has recently received considerable attention from both medical and literary historians, and Wild offers an astute evaluation of the importance of Cheyne's distinctly confessional style—in which he cast himself as a fellow nervous sufferer—as well as Cheyne's deft manipulation of the literary marketplace to render private medical exchanges public property.

A subsequent chapter draws upon the remarkable archive of Dr. William Cullen (1710–90) who, in his professorial role at Edinburgh, was to become the leading academic physician of the Scottish Enlightenment. Cullen left over two thousand letters recording his private practice in which, somewhat rarely, we have both sides of the correspondence (thanks to Cullen's employment of a copyist and, latterly, a prototype copying machine). Examining these exchanges, Wild argues convincingly that contemporary notions of sensibility and sympathy offered an enabling dramatic framework within which both male and female patients felt able to offer remarkably candid accounts of their bodily ills. A final chapter examines the related fictional representation of medical encounters in the novels and journals by Defoe, Fielding, Sterne, Smollet, and Burney.

Wild pays attention throughout to questions of gender difference as well as to the broader philosophical, theoretical, and social contexts within which medicine by-post was enacted. His engaging study will be of value to medical historians concerned with the rhetoric of illness as well as to literary scholars engaged with medical culture and the body.