English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

The juxtaposition of the word cosmology with medicine might appear as somewhat discordant to medically trained professionals. It is an odd word; suggestive as it is of a theory of everything. Not surprisingly, perhaps, Jewson goes to considerable lengths to define the term in his opening paragraphs. Thus, cosmologies are referred to as conceptual structures; as metaphysical attempts to define the nature of medical discourse; as intellectual frames in terms of which people make sense of their worlds; as ways of knowing; and things that function as a medium within and through which perceptions of self and other are expressed, and institutionalized. They might be regarded, suggests Jewson, as akin to Foucault’s notion of a ‘discursive formation’. Suffice to say that the language and preliminary content of Jewson’s 1976 paper inevitably reflect the concerns of the age. Thus, the reference to cosmology, in particular, is characteristic of a sociology that was closely focused on the content and role of belief systems (religious and secular) and the place of ideology in social and economic affairs. Equally, characteristic of the age are Jewson’s use of Marxian terminology—especially his deployment of the concept of the ‘mode of production’. Yet, despite the passing years, it is easy to detect the pressing relevance of this style of analysis to an understanding of the ways in which patients and their relationships with their doctors and systems of health care are structured in the modern world. Above all, by applying Jewson’s mode of analysis to the period since 1870 we can see more clearly how and why ‘sick’ men and women became first transposed into patients and thereafter into independent consumers of health care in market-based systems. As I have just remarked, the strength and originality of Jewson’s analysis bears little relation to the definition of cosmology. Rather, the pivotal concept is drawn from Marxist discourse, and turns on the aforementioned notion of the mode of production: in particular, the mode of production of medical knowledge. In that respect Jewson’s work stands at a juncture where an interest in the content of ‘belief’ was developing into a concern with the ways in which knowledge, including scientific and medical knowledge, was produced rather than ‘discovered’; and the ways in which positions (such as those of patient and doctor) were reproduced in and through everyday social practices. Above all, by drawing upon the resources of classical Marxist theory, Jewson proves able to connect changes of medical practice and medical thinking during the period 1770–1870, to the social and economic relationships in terms of which doctors and patients interacted. By extension, his analysis offers fundamental insights into features of more familiar, twenty-first century systems of health care. So how does the ‘sick-man’ fit into such a schema? Essentially, Jewson identifies three phases of medical practice—or, in his words, three types of medical cosmology. The first he calls bedside medicine. This is medicine as practiced on those wealthy enough— during the late eighteenth century—to employ the services of a physician. It is built around a speculative pathology; around ‘disease’ that travels through airs, bodies and systems, around a morbidity that is mercurial and defiant of location. Yet, it is also a medicine—and a form of medical practice—that is specifically tailored to the patient (sick man) considered as a Homo totus (if not in the religious sense, then at least in a modern secular sense). Such practice is, however, supplanted during the earlier part of the nineteenth century by hospital medicine. A key feature of this latter is the connection of disease and pathology to bodily organs—for every disease there is a site, for each pathology there is a lesion. Department of Sociology, School of Sociology & Centre of Excellence for Public Health, Queens University, Belfast BT7 1NN, UK. E-mail: l.prior@qub.ac.uk Published by Oxford University Press on behalf of the International Epidemiological Association

Commentary: From sick men and women, to patients, and thence to clients and consumers--the structuring of the 'patient' in the modern world