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16 2 Medical Conversations and Medical Histories The medical practice that the first women physicians entered was one which valued talk. The body’s story was not read from diagnostic images or test results but composed from information provided by the patient and con- firmed, if need be, in direct examination by the physician. Medicine was therefore a heavily discursive practice, worked out patient by patient in a series of conversations. Conversation initiated treatment, and conversations marked its progress. The doctor would inquire about the patient’s symptoms, the history of his or her illness, and daily habits and hygiene. The accompanying physical examination might be limited to a cursory glance at the tongue and survey of the pulse or include careful palpation of organs, auscultation of the chest, and rudimentary laboratory work. Treatment almost always included a prescription but possibly also minor surgery or (more and more rarely after midcentury) bleeding or cupping, cautery, or blistering. The doctor ’s talk to the patient, however, was always a feature of treatment; hygienic counsel, medical information, and calm encouragement were seen as essential to the cure. Since the patient was seen regularly until a cure was certified, the conversation between doctor and patient would be protracted, often over years. Given the uncertain efficacy of so many nineteenth-century treatments and the growing rejection, especially in the middle of the century, of such heroic measures as purging and bleeding in favor of therapies that concentrated on strengthening the system, the medical interview was the central discipline of therapy rather than ancillary to it. In the later decades of the nineteenth century, when techniques of physical diagnosis developed, these conversations diminished in importance. Diagnostic devices such as x rays and laboratory tests more complex than basic studies of blood and urine became available at the end of the century, and microscopic investigations became common. At midcentury, it was a rare physician who, after medical school, looked through a microscope. Also, although pulse and respiration rates were counted, only the most scientifically advanced physician used thermometers, and stethoscopes were optional.1 17 Medical Conversations and Medical Histories Moreover, there was an extremely close correlation between medical conversations and the most common genre in nineteenth-century medical writing , the patient history. Even today, the patient history is so closely connected with the initial doctor-patient conversation that patients who can accurately narrate the course of their illnesses are called good historians.2 The case history is a venerable and durable medical genre; from Sigmund Freud’s to Oliver Sachs’s, case histories have also been read by a lay audience . Contemporary medical histories offer concentrated, formulaic accounts of patients’ experiences, sometimes produced by relatively inexperienced physicians, intended to communicate with dispersed professionals and to direct future investigation and treatment. In the nineteenth century, case histories were a staple of medical education but quite diverse in form; standard conventions for collecting and reporting case histories developed, quite unevenly, during the last half of the century. The nineteenth-century case history might orient the attention of students, project a course of treatment, or record a significant therapeutic advance; the form and structure of the history varied with the interests and status of the writer. Doctor-patient conversations and patient histories are and were important sites for the linguistic performance of gender and so were especially problematic for women. Women patients faced contradictory constraints both to speak frankly and to maintain a decent silence. Many illnesses we see as having nothing to do with gender were, for nineteenth-century physicians and patients, gendered experiences. Women sought treatment during pregnancy , childbirth, or menopause, but conditions such as eye infections and general fatigue could be understood by both doctors and patients as reproductive illnesses. For women patients, the medical interview was a conversation on potentially delicate subjects with a member of the opposite sex, even when her symptoms were located far from her reproductive organs. When the doctor was a woman, gender was even more salient to the conversation: women doctors understood themselves as having conversations with their patients that no male doctor could have had. As physicians and writers of medical histories, women negotiated the cultural expectation that they be empathic; they also developed institutional forms that supported distinct medical conversations and encouraged the writing of distinct texts. At these sites, women’s discursive performance of their gender inflected the nondiscursive medical treatment they were likely to provide or receive; an ideology of unorthodox...

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