Doctor-Patient Correspondence in Eighteenth-Century Britain: A Change in Rhetoric and Relationship

Doctor-Patient Correspondence in Eighteenth-Century Britain: A Change in Rhetoric and Relationship WAYNE WILD The language of doctor-patient correspondence in British private practice medicine changed over the course of the eighteenth century. In the first decades of the century, patients seeking medical advice by post adopted a formal rhetorical style influenced by the prescriptions and proscriptions of new science discourse. It was a rhetoric characterized by an unadorned prose suited to reporting in great detail on the objective facts of an illness while discouraging personal opinion or subjective feeling. In return, what patients expected from their doctor was a prescription-by-post, a medical receipt with detailed instructions on regimen. Around the 1740s, coincidental with the development of the sentimental novel, epistolary medical communication became more of a dialogue, one in which the patient insisted on the particularity of his or her subjective experience with illness and, in so doing, hoped to elicit a more urgent and sympathetic response from the doctor. A shift in medical theory, from a Newtonian-inspired mechanical model of the body to a physiology based on the nervous system— a new model stressing sensibility and sympathy—provided a bridge for this change in communication style. The language of sensibility in doctorpatient correspondence began as a fashionable mode of discourse, but over time this studied prose paved the way for upper- and upper middle-class patients to address their doctors in a more personal and direct voice, invit47 48 / WILD ing physicians themselves to respond in a more individual and sympathetic manner to both the physical and psychological needs of their patients. Medicine-by-post was both convenient and practicable in the eighteenth century.1 The hands-on physical examination was far from an established diagnostic tool, and the patient's account of his or her own particular medical problem, and constitutional make-up, served as the cornerstone for therapeutic decisions.2 By the first decades of the century, the public had become well-versed in medical matters through a flood of commercial literature on health and disease. Furthermore, as Roy Porter has shown in the case of the extremely popular Gentleman's Magazine, lay persons were frequent and confident contributors to the flurry of medical articles.3 Although there was, as of yet, no prohibitively specialized medical jargon, new science rhetoric had become most influential in configuring medical discourse. The rhetorical etiquette of the new science, as elaborated by Thomas Sprat for the Royal Society in 1667, has been considered elsewhere,4 but in the context of doctor-patient letters of the early eighteenth century the adoption of Sprat's rhetorical prescriptions took a distinct form. Patients seeking consultation (or family members who wrote on their behalf) strove to write about illness in a dispassionate, unadorned prose, eschewing fanciful metaphor or simile, but with almost obsessive clinical detail—what Frederick N. Smith has described, referring to articles in The Philosophical Transactions, as a "nervous factuality."5 Surprisingly, in letters to their doctors patients largely refrained from self-diagnosis, seeming to defer to professional authority—much as early contributors to The Philosophical Transactions left interpretation of their observations to readers of the journal .6 Such epistolary behavior seems paradoxical in a medical system built on patronage, a system in which doctors were entirely dependent on client satisfaction and regularly deferred to the opinions and whims of their upper -class patients.7 Indeed, the discrepancy between rhetorical form and actual medical practice highlights the importance of stylistic considerations in private medical correspondence.8 The influence of new science rhetoric in personal medical correspondence in the early eighteenth century is typified in patient letters to James Jurin (1684-1750), a prominent English physician as well as Secretary to the Royal Society 1721-1727. In the following letter, Mordecai Cary, Bishop of Clonfert (d. 1751), a close friend of Jurin, provides a fastidious medical history of a pain which his wife has developed in her breast.9 Dear Doctor Above a month ago my wife took cold by going into new rooms where the walls were damp, after a walk that had heated her. Thereupon her left Doctor-Patient Correspondence in Eighteenth-Century Britain / 49 breast. . . has...