The patient's view

Conclusion

It is time to draw the threads together. I have been arguing that we should lower the historical gaze onto the sufferers. “Banish money,” wrote John Keats, “- banish sofas - Banish wine - Banish Music - But right Jack Health- Honest Jack Health, true Jack Health - banish Health and banish all the world.”¹ Health is the backbone of social history, and affliction the fons et origo of all history of medicine. For whereas one could plausibly argue, a history of crime should start not with the criminals but with law and police-because these define criminality - the sick cannot possibly be regarded as a class apart, conjured up by the faculty. Moreover, it is especially important to get under the skin of the sufferers, because most maladies have not in fact been treated by the profession but by self- or community help, or in the paramedical marketplace where the sufferers' own initiatives, confidence, and pockets are critical. In addition, lay medical power has also been crucial in a sphere I haven't touched upon here, since I have been concentrating on the sufferer as an individual - in other words, lay-instigated social, civic, and institutional strategies for sickness, above all, in earlier times, for coping with epidemic pestilences such as plague. For what emerges, for example, from recent studies of civic health arrangements in the Italian Renaissance is that physicians regularly had to play second fiddle, in the teeth of various lay interests, to city fathers, philanthropic patrons, and, of course, the Church itself.²

Medicine has never enjoyed full monopoly or police powers, and most healing, like charity, begins at home. The upshot is that doctors traditionally had to remember that he who paid the piper called the tune. George Bernard Shaw was well aware of this:

The doctor learns that if he gets ahead of the superstitions of his patients he is a ruined man; and the result is that he instinctively takes care not to get ahead of them. That is why all the changes come from the laity.³

I do not intend to conclude by offering a set of theoretical models for understanding sick person-doctor interaction in times past. That would certainly be premature, and probably also counterproductive, by creating the illusion of patterns of typicality and uniformity. But I should like to tabulate certain strategies and broad interpretive guidelines for future investigations.