Historia ciała : Lekarz i jego pacjentki w osiemnastowiecznym Eisenach

The Woman Beneath the Skin was originally written by Barbara Duden as her PhD dissertation which she defended in the Institut für Neuere Geschichte at the Technische Universität in Berlin, advised by professor Reinhard Rürup.

The book is divided into two equal parts. The first includes the discussion of publications and research methodology of studies into the history of the body. The author discusses the findings of publications focusing on the body, wondering if the subject could be problematized. Duden’s selection of authors was guided by their perspective on the subject and its epistemology, and not by secondary texts on the time period of her source material or by the historiography of medicine. Her main premise was to compile an overview of contemporary research in the field of social sciences on the experience of the body. The first chapter includes the results of these explorations. The literature is presented in a manner which makes its influence on the second part of the book apparent for the reader. The second part, in turn, is a commentary on the descriptions of women’s ailments and diseases provided by the physician Johannes Storch, the author of the analyzed work.

In the second chapter the author discusses doctor Johannes Pelargius Storch (1681-1751) and the idea behind the creation of Diseases of Women (original title Weiberkrankheiten). Johannes Storch was born as a son of a local healer and barber who sold medicines and herbs. When he grew up, his family decided to send him to studium medicum so that he could continue his father’s practice legally. From 1698 he studied medicine in Jena and Erfurt. In 1702 he began to practice in Weimar with permission from the local duke. In 1708 he moved to Eisenach where he became town medic, and in 1720 he became town physician. At first, Storch treated craftsmen and poorer townspeople. But he developed his practice gradually and quite successfully. He began treating the ladies of the court after gaining the good opinion of their servants. In time, he assumed the role of the duke’s personal medic and held it until the year 1741 when the duke died. In 1742 he was accepted into service by the duke of Saxony-Gotha as his personal physician. Storch spent his entire life in the service of provincial ducal residencies, first as a town medic and later a court physician. His position as well as his reputation, privileges and upkeep were all dependent on the duke. He persistently continued his education, and his medical practice was also his research, as it was a source of material for his journals and a way into the world of the scholars of nature. Storch was not interested in collecting natural oddities. His interest was in the real course of illnesses noted down at a sick person’s bed.

Diseases of Women was not written by a scholar for other scholars, but by a practicing doctor for young future doctors. He did not wish to create an eminent text, but rather to offer the world unembellished notes for everyday use of his younger colleagues. This aim determined not only the style, but also the language he used. Storch decided to write his journals in German, as he wished to create them in a language his patients used, so that he could faithfully convey what they were experiencing.

Storch published his journals at the age of 60. They contained cases covering over 40 years of his practical work. The source text includes eight bulky volumes divided according to the “conditions of female nature”: unmarried women, pregnant women, prostitutes, women in labour, etc. Each volume covers approximately the time period between 1721, when Storch assumed the role of town physician, to 1740, when he closed his practice in Eisenach. The volumes include 1816 histories of illnesses experienced by 1650 different women. Each case includes a short description of the patient, the date of the first consultation, a summary of symptoms and information on prescribed medication.

Although the individual stories differ significantly, the construction of the descriptions is schematic and based on an unchanging pattern. After describing the patient’s complaints Storch always included information about the prescribed medicine. The unchanging element of each volume is a woman as a casus, with individual descriptions differing in contents and length. Each volume is thus characterised both by the women’s personal chronologies and the chronology of his practice—a vertical and diachronic order. This kind of structure of individual cases combined with an unclear system of cross-references makes the process of horizontal ordering of the source material quite difficult, so it is uncertain how many women Storch treated at a given time (during a month or a year).

The status of the woman (unmarried, pregnant, etc.) remained the ordering criterion for the medical histories. Storch also added stories which he collected elsewhere, but which supplemented and modified the already vast histories of his Eisenach patients. His aim was to create a compendium of all “histories” available to him that were similar to his cases from Eisenach.

In the third chapter Duden discusses the situation of a doctor practicing in a small town. She tries to reconstruct aspects of conversations between the physician and the women that are visible form a historian’s perspective. Her main objective is to describe the relationship that was built between the patients and the doctor. The author is aware that her source is only a sample and presents one of many possible methods of treatment.

A large part of the chapter is devoted to home remedies described by Storch in his journals. He wonders what caused his patients to reject their doctor’s opinion and ponders over the factors which determined their choices. It is interesting that Storch, as town physician, was not the only person who the sick turned to for advice. Eisenach residents often sought help in their ailments from family and friends, and next from illegitimate but regular practitioners, such as wart-cutters, urine examiners, barber-surgeons or “empiricists.” In the end, all such cases returned to the doctor’s office. What is interesting is the fact that the patients often knew what was wrong with them and treated themselves without the help of a qualified medic. Duden gives many examples of such self-treatments illustrated by specific cases from Storch’s journals. The most common of these remedies were those that caused bowel movements, cleansed the body or strengthened it. Storch wrote many descriptions of home remedies used by mothers and female neighbours which, since they were included in his writings, most probably led to medical interventions. The author concludes that female patients were motivated by a unique and complex logic which was not determined by the cost of treatment or the knowledge, experience or qualifications of the physician.

Duden pays much attention to the way the doctor conducted examinations and interviews. In most of the cases Storch did not see the patients, at least not in the decisive moments of their illnesses. In some cases he never met the patient and only exchanged letters—sometimes for years. A doctor’s visit to a patient’s house or a patient’s visit to the doctor’s office was only one of many ways to make a diagnosis. Most often, the diagnosis was based on information conveyed through intermediaries. The task could be given to anybody—a messenger, a pastor, or a husband. Such form of contact was both a consequence of large distances between the doctor and his patients, and a standard manner of communication between doctors and women. A kind of personal sphere surrounded the body and invading it to perform palpation was allowed only in rare, justified cases and with the permission of the patient or a mandate from the authorities.

In the next chapter Duden focuses on the ideas that guided practicing physicians and women in formulating their complaints. Storch and his contemporaries did not know the rules behind internal processes and had only some hypotheses that were mainly based on the secretions of the body. The author begins with an analysis of the ideas on the interior of the body and the processes taking place within it. She briefly summarises the thinking connected to the belief that the body cannot be opened and examined as long as a person is alive. One can only speculate basing on signs, the so called “discharges” that appear on the body or escape it. Apart from discharges form basic orifices, a diagnosis was also based on all lesions such as tumours, ruptures, wounds and other injuries that could enable the discharge of matter. Many medical interventions were also caused by an “influx” of various ailments such as headaches, tinnitus, fading sight or hearing, etc. The lack of knowledge on internal processes combined with real pains experienced by patients led to a conviction that not only the flow of the visible, tangible and repulsive discharges posed a threat, but also lack of thereof, seen as a sign of a blockage in internal outflows which inhibited the cleansing of the body. What caused fear were not unpleasant secretions, but the inner body as a space susceptible to the blockage of these secretions. Healing was synonymous with freeing the body of its internal obstructions.

In Diseases of Women, Storch wrote primarily about women, but he sometimes described men and children. His descriptions suggest that the similarities between women and men were based on the monthly regularity with which the body cleanses itself. In the case of women it was their menstruation, or more precisely the regularity with which a woman’s body cleansed itself through blood flow. Monthly bleeding was not limited to mature women, as it was also experienced by children. In men, the flow of semen or haemorrhoids were seen as phenomena analogous to the “regularity of women” in which the body spontaneously healed itself through the evacuation of unnecessary substances. The author concludes that no morphological element or physiological process, such as ejaculation or monthly bleeding, was seen at all times and everywhere as an indication of gender.

Duden pays much attention to events which cause various women’s diseases. These were most frequently random incidents not linked to everyday work, which could cause fear, stress or injury, for example falls, walking in cold water, storms. Nevertheless, these random events required certain predispositions in the body which were often the product of the patient’s biography, her surroundings or her ancestry. It was a physician’s job to conduct a detailed interview that would include a complete biography as well as family history, including grandparents and siblings, as all diseases were rooted in predispositions. It is interesting that heredity did not cross the gender line.

Interestingly, when ill people started displaying signs of impending death, they were no longer patients and the physician stopped treating them. Instead, he focused on preparing their families for their passing and teaching them about useful home remedies which could ease their final hours. If possible, the physician performed an autopsy to search for (and usually find) the cause of death.

The chapter ends with an analysis of pregnancy described in Storch’s writing as a state of “balancing on the edge.” A woman enters a new phase when entering into marriage—a fertile time which begins with her first menstruation and has a vague ending. The period of pregnancy was then seen as a time in between, in which the presence and absence of menstruation could mean a pregnancy or infertility. Being pregnant was like balancing on edge, as on the one hand it was linked to the desire to create new life, but on the other to the fear of inner stagnation and the body not being able to cleanse itself. Lack of menstruation was not equalled with conception until the sixth month, when the size of the belly explicitly proved pregnancy or when the woman felt the baby’s movements. That is why, among other reasons, inducing an early miscarriage was a normal practice seen as an act of cleansing the body.

In her book, Barbara Duden analyzed the phenomenal work which is a source of notions about the female body. She presents the image and the experience of the body revealed through a day-to-day medical practice. She portrays the body as an object of complaints, care and fear as well as the doctor’s response to his patients’ grievances. The book includes many fascinating examples drawn from the analyzed source which will certainly encourage the reader to continue their exploration of the subject.