Medicine-by-post in eighteenth-century Britain: The changing rhetoric of illness in doctor-patient correspondence and literature (James Jurin, George Cheyne, William Cullen)

The experience of being sick is, in crucial ways, a social construct shaped by rhetoric. Popular conceptions about particular kinds of illness conjoin with prevailing medical discourse to generate a rhetoric that simultaneously informs the patient's experience while describing it. Furthermore, the patient's acceptance of established medical rhetoric is critical for a successful doctor-patient encounter and therapeutic intervention to take place.; In literary criticism of the eighteenth-century novel, and other literary genres, the patient of extreme sensibility—whether pictured satirically or sympathetically—has figured so prominently as to give the impression of a uniform eighteenth-century view of the disease. However, the rhetoric of eighteenth-century doctor-patient consultation letters, or medicine-by-post, shows that the patient's self-image was far from uniform. Rather, the experience of being sick—and expressing that illness in writing—changed dramatically several times over the century, in keeping with shifts in medical speculation on human physiology that have been well documented by modern historians of eighteenth-century medicine.; Three periods of medicine-by-post letters are examined, focusing on the doctor-patient correspondence from three large private practices of the eighteenth century: Drs. James Jurin, George Cheyne, and William Cullen. These letters reflect the modulation in medical rhetoric as medical speculation changed from an iatromechanical system (based on Boerhaave's adaptation of Newtonian hydraulics) to a physiology based on the nervous system and sensibility, and the further refinement of the physiology of “sensibility” and “sympathy” by doctors of the Scottish Enlightenment.; The evidence of medicine-by-post letters of the eighteenth century is that medical rhetorical style developed from a highly impersonal, formal, and objective, tone (adopted from the “new science”) to a rhetoric that encouraged self-expression, subjectivity, and a metaphorical view of illness by the patient. The medical rhetoric of sensibility eventuated in extroverted and dramatic expressions of illness—of irritability and melancholy. In the final decades of the Enlightenment, the rhetoric of sensibility was joined to utilitarian purpose to produce a less stylized but more varied and individual patient voice.; The appreciation of such fundamental shifts in doctor-patient rhetoric significantly refines, and redefines, the interpretation of illness for authors of the novel and writers of other literary genres in the decades between 1700 and 1800.