Experiencing Illness and the Sick Body in Early Modern Europe

296 Pages·2011·2.002 MB·English

by  Michael Stolberg (auth.)

Experiencing Illness and the Sick Body
in Early Modern Europe

Experiencing Illness and
the Sick Body in Early
Modern Europe
Michael Stolberg
Chair for the History of Medicine,
Director of the Institut für Geschichte der Medizin, University of Würzburg, Germany
Translated from the German original by Leonhard Unglaub and Logan Kennedy
© Michael Stolberg 2011
Softcover reprint of the hardcover 1st edition 2011 978-0-230-24343-9
Orig. published in 2003 as Homo patiens. Krankheits- und Körpererfahrung
in der Frühen Neuzeit, by Böhlau-Verlag, Cologne-Weimar, Germany.
Research for this book and the translation of the German o riginal were made
possible by the generous support of the Deutsche Forschungsgemeinschaft
and Wilhelm H. Ruchti Stiftung, Würzburg.
All rights reserved. No reproduction, copy or transmission of this
publication may be made without written permission.
No portion of this publication may be reproduced, copied or transmitted
save with written permission or in accordance with the provisions of the
Copyright, Designs and Patents Act 1988, or under the terms of any licence
permitting limited copying issued by the Copyright Licensing Agency,
Saffron House, 6–10 Kirby Street, London EC1N 8TS.
Any person who does any unauthorized act in relation to this publication
may be liable to criminal prosecution and civil claims for damages.
The author has asserted his right to be identified as the author of this work
in accordance with the Copyright, Designs and Patents Act 1988.
First published 2011 by
PALGRAVE MACMILLAN
Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited,
registered in England, company number 785998, of Houndmills, Basingstoke,
Hampshire RG21 6XS.
Palgrave Macmillan in the US is a division of St Martin’s Press LLC,
175 Fifth Avenue, New York, NY 10010.
Palgrave Macmillan is the global academic imprint of the above companies
and has companies and representatives throughout the world.
Palgrave® and Macmillan® are registered trademarks in the United States,
the United Kingdom, Europe and other countries
ISBN 978-1-349-31837-7 ISBN 978-0-230-35584-2 (eBook)
DOI 10.1057/9780230355842z
This book is printed on paper suitable for recycling and made from fully
managed and sustained forest sources. Logging, pulping and manufacturing
processes are expected to conform to the environmental regulations of the
country of origin.
A catalogue record for this book is available from the British Library.
A catalog record for this book is available from the Library of Congress.
10 9 8 7 6 5 4 3 2 1
20 19 18 17 16 15 14 13 12 11
Contents
Introduction 1
Some Thoughts on Theory 4
Sources 10
Part I Illness in Everyday Life
The Concern for Oneself 21
Disease and the Self 23
The Experience of Pain 27
The Search for Meaning: Religion, Witchcraft and Astrology 33
The Search for Meaning: Illness, Way of Life and Biography 41
The Narrative Reconstruction of Personal History 46
Anxieties 48
The Physician’s Audience: Illness and the Bedside Community 53
Nursing Care 55
The Medical Marketplace 58
The Doctor–Patient Relationship 64
Part II Perceptions and Interpretations
Medical Popularization 79
The Cultural Framing of Disease 82
From Temperament to Character 85
Plethora and Apoplexy 89
Fluxes, Gout and Rheumatism 95
Gichter (Convulsions) 100
Acrimonies 101
Skin and Rashes 105
Red Murrain (Erysipelas) 109
Scurvy 110
The Therapy of Acrimonies 114
Miasms and Contagia: Plague, French Disease and English Sweat 115
Indigestion, Winds and Slime 122
Obstruction and Disrupted Excretion 126
v
vi Contents
Stagnation and Deposits 134
Cancer 135
Pathological Heat 139
Vapors 142
Fever 144
Consumption and Consumptive Fever 147
Expenditure and Exhaustion 149
Dropsy 152
Seminal Economy 153
Part III Dominant Discourse and the
Experience of Disease
The Sensible Body 161
A New Disease: The Vapors 164
Historical Roots: ‘Vapores’, Hypochondria and Hysteria 165
The Rise of the Nerves 170
Embodiment 173
Critique of Civilization 178
The Sensible Woman 179
The Cult of Sensibility 181
Illness as Protest 185
Ennui and Narcissism 191
Masturbation and Disease 195
A New Crusade 196
Readers’ Response 203
The Social Construction of the Anti-Masturbation Discourse 209
Conclusion: A New Bourgeois Habitus 213
Notes 219
Manuscript Sources 278
Printed Sources 280
Index 289
Introduction
This book explores how ordinary people in the early modern period
perceived, experienced and interpreted illness and how they dealt and
coped with it in everyday life. In this sense, it is an attempt to write a
history of medicine from the patient’s or layperson’s point of view.1
This approach to the writing of medical history is a comparatively
recent undertaking.2 For a long time, medical historians were primarily
interested in the ‘great physicians’ and their contributions to medical
‘progress’. Patients usually appeared as little more than faceless inmates
of medical institutions or as the collective target of public health poli-
cies. The sole major exceptions were famous patients – rulers and artists
above all – whose diseases and causes of death frequently gave rise to
lively debates. Since the mid-1980s, however, in the wake of renewed
interest in the social history of medicine,3 historians widened the view
to include patients’ experience of disease and medical care. A number of
studies have since produced valuable new insights.4 Even studies on the
history of public health and medical institutions have come to accept
the need to pay attention to the needs and experiences of patients.5
Thanks to this work, we know much more today about how people
dealt with diseases in the past, about the importance of self-treatment,
for instance, about the wide range of curative approaches patients
could choose from, about the relationship between patients and heal-
ers, and about people’s attempts to find meaning and orientation in
the face of their suffering. These issues have, in particular, been stud-
ied for the early modern period. Yet even in recent work about this
period, the perception and subjective experience of the sick body and
the interpretation and assessment of different symptoms and diseases
by patients and their relatives are – if they are addressed at all – usually
characterized only briefly and in a sweeping manner.6 Some recent
studies have opened valuable insights into the cultural meanings of the
early modern body and its diseases from literary works of the period.7
But we still know very little about how laypeople of those days perceived
and i nterpreted the most important and common diseases such as, in
contemporary terms, fever, fluxes, cancer, consumption and scurvy.
Frequently and very misleadingly the lay understanding of all kinds of
diseases is boiled down to the notion of a disturbed humoral balance.
1
2 Introduction
Largely uncharted are the images, sensations and experiences that lay
people associated with the disease terms commonly used at the time.
One major exception must be named: in her book The Woman Beneath
the Skin, Barbara Duden, drawing on the Eisenach physician Johann
Storch’s case histories, has created a vivid picture of the female body
in the 18th century; it is the fascinating image of a body shaped by a
permanent flow of humors within and across its boundaries, a body
that was always endangered by obstructions and congestions. Her study
has rightly been acclaimed. But Storch’s case histories deal specifically
with ‘women’s complaints’. As a result, menstrual irregularities and the
many complaints which contemporaries associated with them play a
paramount role, while many other images and concepts which were
crucial for the contemporary lay understanding of the sick body find
little mention, because they did not in some way relate to the female
reproductive system. Further, it is questionable to what extent Duden is
able to access the personal experiences of the afflicted women relying
solely on a physician’s descriptions. A closer look at Duden’s sources
shows that, though the case histories often extend over several pages,
the women’s voices are usually expressed only in an occasional sen-
tence or half-sentence; and even then, we do not know how truthfully
Storch relayed their words and whether he perhaps gave preference to
statements that supported his own interpretations.8
In what follows I will pursue a different path. I will rely primarily on
personal testimonies in patient letters, personal correspondence, auto-
biographies and similar sources. As I hope to show they provide a very
rich and nuanced account, even though it would be naive to assume
that they offer an immediate, truly authentic picture of lay experiences
of the body and its diseases.
This book is divided into three parts. The first part will give a prima-
rily descriptive overview of how laypeople experienced and interpreted
the body and its diseases and how they dealt with illness in everyday
life. It will begin with the question of how assessment of health, illness
and pain were described, assessed and given meaning. From there it
will move to the fears that became associated with certain diseases and
purportedly pathogenic influences from the environment and lifestyle,
and it will close with issues surrounding nursing, medical care and the
doctor–patient relationship.
The second part will focus on the perceptions and interpretations of
individual types of disease. It will present the most important explan-
atory elements which framed contemporary lay perceptions and the
ways different kinds of disease were dealt with. These explanatory
Introduction 3
elements, it will be argued, not only were decisive for the interpreta-
tion and choice of treatment; they also determined the vocabulary
which patients used to describe their complaints and indeed shaped
their physical, bodily perceptions, spawning descriptions of symptoms
which patients in modern Western societies no longer experience. In
particular, the doctrine of ‘morbid matter’ will be given considerable
space, but also the fear of obstructions and the fear of a disruption of
the flow of humors past the body’s boundaries. A more detailed study of
the most widespread and/or most feared diseases, such as fever, cancer
and consumption, will show the concrete application and interplay of
these explanatory concepts.
At the center of the third part will be the complex relation between
the subjective body and disease experience on the one hand and the
‘dominant’ medical discourse and the values and interests that found
expression in it, on the other. I will trace this relation by looking at
the impact of two highly influential medical concepts of the 18th cen-
tury. The rapid rise of ‘nervous complaints’ to the status of a fashion-
able disease shows how quickly – and creatively – medical laypeople
adopted the new medical concepts of ‘nervous sensibility’ and ‘nervous
complaints’. Physicians combined the new model with a contemporary
critique of civilization and also brought it to bear on the intense debate
around the nature and social position of women. Looking at the recep-
tion and adaptation of the new model among the population, however,
reveals that nervous complaints could also serve as a medium of self-
fashioning or somatic protest. A look at the great campaign against the
health hazards of sexual self-gratification, which began in the late 17th
century once more shows clearly that the sole analysis of dominant
medical discourse provides only limited access to the ways in which
ordinary people actually experienced their bodies. At the same time,
the confessions of patients who ascribed a wide range of diseases to
the sins of their youth offer impressive empirical evidence for Michel
Foucault’s notion of a ‘regimen of truth’ which colonizes the individual
not by repression but by offering a welcome source of meaning.
Since the original German edition of this book was published, in
2003, under the title Homo patiens. Krankheits- und Körpererfahrung
in der Frühen Neuzeit a number of works on various aspects of the early
modern experience and interpretation of illness have appeared, most of
them based on a specific source or body of sources. Their findings have
not substantially altered the picture at which I arrived in 2003. I will
include references to the these works in the notes and will in some cases
discuss their results in greater detail. I have resisted the temptation of