18th Century Medical Experts and Medical Expertise

A brief overview of three fantastic historical papers on eighteenth century expertise and experts:

Steven Shapin, “Trusting George Cheyne: Scientific Expertise, Common Sense and Moral Authority in Early Eighteenth-Century Dietetic Medicine,” Bulletin of the History of Medicine 77(2): 263-297.

What gives a physician his expertise, and how does one trust that expertise? Shapin addresses this issue, by focusing on eighteenth century dietetics, an area that encompassed common sense, and yet was an aspect of medical authority; for Shapin, George Cheyne is a prime example of medical authority of the common culture between patients and physicians. Early modern dietetics and therapeutic self-knowledge was a result from habit and constitution; one became an expert on his own body merely through trial and error. This of course, derived from the ancient “Rule of Celsus,” whereby “a man in health, who is both vigorous and his own master, should be under no obligatory rules, and have no need, either for a medical attendant or for a rubber and anointer. His kind of life should afford him variety.” Dietetics was essentially management of the non-naturals, and the common culture between physicians and patients gave physicians authority, but only as long as their advice counted as common sense. This cultural sharing also undermined medical expert authority, a problem which did not change until the emergence of the mechanical philosophy of Descartes, Boyle, and Newton, which emphasized the invisible corpuscles. Shapin argues that this new philosophy led to new grounds of medical expertise (iatromechanism), as physicians spoke their authority from the invisible realm, and promoted the maintenance of health, the cure of disease, and the prolongation of human life, which was factored in Cheyne’s works. A fashionable physician, Cheyne was acclaimed for his dietetics, particularly his “lowering” diet, which emphasized moderation in food and drink, and advocated vegetarianism (especially his weird milk-and-seed diet). As an expert of authority, Cheyne counselled many members of high society, and a large number of letters survive from his correspondence with Samuel Richardson, and Selina, countess of Huntingdon, which are the case studies Shapin focuses on during the third half of his paper. Cheyne was a trusted physician, not only due to his expertise and knowledge of the invisible world, but because he was a patient of his dietetics as well, an aspect which became a strategy in gaining a patient’s trust.

Shapin’s paper wraps up by analyzing two kinds of experts: the prudential, who bases his expertise based on an accumulation of experience, and whose judgements are informed by those experiences, and the ontological, whose authority is derived from the possession of a special kind of knowledge. Of course, we see instances whereby the polarization is diffused, but it seems that the ontological expertise may distance the patient, due to lack of trust – why should the patient trust the physician, especially in cases where the physician’s advice seems contrary to common sense (think of being given antibiotics and being told that this will make you feel better)?

Andrea Rusnock, “The Weight of Evidence and the Burden of Authority: Case Histories, Medical Statistics and Smallpox Inoculation” in Roy Porter, Medicine in the Enlightenment (Rodopi, 1995), pp.289-315.

One of the chief architects of the use of statistics into medicine was the physician James Jurin, who sought to quantify the benefits of smallpox inoculation, by collecting and evaluating case studies through correspondence. Jurin’s numerical rations eventually became a feature of expertise, through the accuracy and trustworthiness of testimonies. The first step in Jurin’s statistical research was to establish a correspondence network, which in turn, presented complete, faithful and accurate case histories of cases of smallpox inoculation (to be compared with cases with natural exposure to smallpox, or cases without inoculation); it was the details, and Jurin’s questioning character, which presented accurate information for him to analyze. Any odd cases of inoculation were privy to Jurin’s judgement, as he challenged cases that did not fit with his research. Jurin also downplayed difficult cases (such as if the inoculation did not lead to a case of smallpox) by reducing the variety of inoculation experiences to a limited number of categories for statistical analysis. The individual case histories became powerful tools for convincing others, and at the same time, they questioned the validity of authority and trustworthiness (e.g. how do we regard the case histories as accurate information?). Rusnock points out that although many agreed with Jurin’s application of a numerical approach to medicine, many in turn questioned the validity of his correspondence research, particularly in regards to the use of inoculation.

Rusnock notes that only the healthy and wealthy were inoculated, while most deaths attributed to smallpox were recorded among the poor. How does one advocate the numerical approach when there are obvious demographic constraints to the research? Does this in any way deter the validity of the statistical approach for providing medical authority?

Roy Porter, “Consumption: Disease of the Consumer Society?” in John Brewer & Roy Porter, Consumption and the World of Goods (Routledge, 1994), pp.58-81.

“Did the wealth of nations secure the health of nations?” The paradox of health and wealth was captured by early modern economists, who viewed the wealth of the nation not in measure of dollars, but by “money in motion,” the labor and consuming populations. Placing the body politic upon the body human, “high living” became a means for preventive medicine, a way to ward off the diseases in an age where hunger stalked the land. Essentially, the health of the people was defined by the consumption of rich food and drinks, which in turn, reflected the wealth of the nation. However, as the experience of George Cheyne demonstrates, high living erodes health, as Cheyne’s diet and obesity led him to question the relationship between civilization and health; he argued that despite England’s increase in wealth, a large portion of her people became vulnerable to the “English Malady,” which was a result not just of the high living, but the disproportioned spread of wealth. Further, Porter outlines three features that allowed Cheyne to become such an authoritative figure: Cheyne set himself up as a dietary apostle, challenged the popular “high diet,” and he advanced a lifestyle designed to refine the grossness of waste by “lightness” of the body. In the second part of his essay, Porter argues that the consumer revolution led doctors to judge the new consumption patterns as threatening to health, as the consumption factors led to deeper pathological forms contrary to the advice set out by Cheyne. Thomas Beddoes was a foremost critique to the light and lowering diet arguing that the rise of chronic diseases was not due to any dietary factor, but rather the result or the new snobbish aspirations to sensibility. Propriety and the fashionable created a deficit (as opposed to Cheyne’s excess) of health, as the body was disregarded for a sort of “fetishism of culture.”

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