The metastatic theory of pathogenesis and the professional interests of the eighteenth-century physician

Malcolm Nicolson

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History of Science and Medicine Medical History and Innovations History of Medicine Studies

Abstract

In two papers published during the mid-1970s, N. D. Jewson proposed a sociological explanation for the character of eighteenth-century medical knowledge.'He argued that medical knowledge was then produced by a particular form of social interaction between patients and their physicians, who competed for customers in an open and pluralistic market-place.This competition was not controlled by rigorous academic or professional criteria.Economic authority rested wholly with the customer-the patient.Jewson argued that the patient's power of patronage structured the social dynamics of the consultative encounter, with the patient playing a much more active part than in the nineteenth or twentieth centuries.Physicans had to exert themselves, in primary social interaction with their patients, to gain and retain employment.If the patient was not convinced or impressed by one practitioner, he could summon another.It was thus necessary for the physician to provide the patient with acceptable rationales for his diagnostic pronouncements and proposed therapeutic procedures.Likewise, the patient's subjective experience of his disorder constituted the primary reality on which the understanding of disease was based.2The most favoured therapeutic agents and procedures generally had effects directly perceivable by the patient.Jewson's stimulating but largely theoretical analysis has only recently begun to receive the attention it deserves.Historians of medicine are assembling materials that allow the accuracy of the model to be assessed.3The three major premises on which Jewson based his argument-shared vocabulary, easy lay access to alternative forms of

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1985The patient's view 1973The Female Animal: Medical and Biological Views of Woman and Her Role in Nineteenth-Century America 1977The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America 1950An Introduction to the Study of Experimental Medicine 1839Oeuvres completes d'Hippocrate /1985Lay medical knowledge in the eighteenth century: The evidence of the Gentleman's Magazine 1953Greek Medicine as Science and Craft 1974From mechanism to vitalism in eighteenth-century English physiology

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