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5: Medical Attitudes toward the Care of Incurables
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VVVVVVVVVVV 90 5 Medical Attitudes toward the Care of Incurables Shortly before Christmas 1866, Auguste Runeau de Saint-Georges had his physician and his confessor join him for a sumptuous meal. He ate nothing . His condition, worrisome in September, had steadily worsened since. Beyond wanting to make a show of good graces, he had presumably invited his physical and spiritual doctors to thank them for their efforts at assuaging the “atrocious pains of a long illness.” The final course completed, a toast to the priest served as the prelude for a touching farewell to his grandchildren. There’s little doubt that, whatever the official prognosis might have been, de Saint-Georges had few illusions about the future. Foresight, in this case, was 20/20. He died fifteen days later, on December 29. That grief and sadness apparently didn’t give way to reproach suggests that all concerned had successfully risen to the occasion.1 We do not know how commonplace a scene like this was, but it clearly corresponded to a vaunted ideal. Throughout the nineteenth century, a series of behavioral norms dictated how the major actors in an incurable illness—patient, family, priest, and physician—were expected to behave. Often, however, one or more of the interested parties failed to do his part. This is not very surprising given the many barriers that impeded the translation of ideals into practice. Our exploration of the intimate and emotional world of chronic progressive illness and palliative medicine begins by examining physicians’ attitudes toward the care of incurables. While their motives were complex, some doctors clearly believed that their diagnostic and therapeutic skills were wasted upon hopeless cases, and their uninterest evoked charges of selfish indifference. The issue was generally more complicated, however , and a historical retelling must eschew simplistic pigeonholing that MEDIC A L AT T I T UDES TOWA R D T HE C A R E OF INCUR A BLES 91 discounts the complexities of doctors’ motives. Doctors’ perceptions and practices grew out of an intricate and often conflicting set of instincts, priorities, and experiences. More than anything, they reflected unease with suffering and death, two vivid and distressing symbols of medical “failure.” Equating them in this way was not, strictly speaking, chimerical; people were quick to criticize when things did not go as they hoped. Medicine’s impotence in the face of chronic progressive disease often bred hostility and distrust, feelings that strained an already fragile and emotionally intricate doctor-patient-family relationship. In response to a tangled web of influences and imperatives, the players in this drama often engaged in controversial behavior. On the one hand, observers denounced physicians and families for actions they deemed pointless and excessive. At the opposite extreme, many critics accused physicians of sinning by omission, a pattern of neglect referred to and experienced as abandonment. Certain striking continuities in rhetoric and behavior may leave the impression that this experience is somehow timeless, that nothing really changed over the course of the nineteenth century. This half-truth exposes one of the great challenges in tackling the history of palliative medicine. Historical forces—changing material and social conditions, developments in science and technology, broad cultural and ideological shifts—did have important, if sometimes subtle, effects. Doctors became more attentive to the needs of incurables in the second half of the nineteenth century. Medical discourses around palliative medicine also evolved, suggesting a greater complicity between physician and patient. Still, the available repertory of responses to suffering, physical decline, and slow death were not unlimited . Furthermore, some reactions—particularly personal and professional disinvestment—clearly came more easily than others. Understanding people’s lived experiences requires that one walk a fine line. In myriad ways, incurable illness was a culturally freighted and historically contingent life experience. Yet it also has important continuities. Engaging with these two tendencies, I believe, enhances the heuristic value of this narrative: though it is about a specific time and place, it allows us to better understand the timeless aspects of severe debility and death. Between Self-Interest and Philanthropy Reputedly incurable illness invariably elicited strong feelings among physicians ; sympathy, hubris, trepidation, and frustration ebbed and flowed, in lockstep with the disease and the mood of the patient and the household. Had physicians been free to choose, they may have avoided incurables altogether. That they regularly embraced the challenge of caring for them [18.221.146.223] Project MUSE (2024-04-17 21:15 GMT) 92 INCUR...