History of Science December.Indb

Volume 46 Part 4 Number 154 December 2008 CONTENTS Pillow Talk: Credibility, Trust and the Sexological Case History Ivan Crozier . 375 Galileo, Bruno and the Rhetoric of Dialogue in Seventeenth-century Natural Philosophy Stephen Clucas . 405 Liars, Experts and Authorities Graeme Gooday . 431 Science, Scientifi c Careers and Social Exchange in London: The Diary of Herbert McLeod, 1885–1900 Hannah Gay . 457 Notices of Books . 497 Notes on Contributors . 499 Index to Volume 46 . 500 HISTORY OF SCIENCE Editor: Iwan Rhys Morus, Department of History & Welsh History, Hugh Owen Building, Aberystwyth University, Ceredigion SY23 3DY, UK (e-mail: irm@aber. ac.uk) Advisory Editors: Pascal Brioist, Janet Browne, Hal Cook, Serafi na Cuomo, Igor Dmitriev, Jan Golinski, Anna Guagnini, Trevor Levere, David Miller, William Newman, J. D. North, Lewis Pyenson, Larry Stewart, Andrew Warwick Publisher: SCIENCE HISTORY PUBLICATIONS LTD, 16 Rutherford Road, Cambridge CB2 8HH, UK Copyright: © 2008 by Science History Publications Ltd SUBMISSION OF ARTICLES. By e-mail attachment to [email protected] COPYING. This journal is registered with the Copyright Clearance Center, 21 Congress Street, Salem, Mass 01970, USA. Permission to photocopy for internal or personal use or the internal or personal use of specifi c clients is granted by Science History Publications Ltd for libraries and users registered with C.C.C. subject to payment to C.C.C. of the per-copy fee indicated in the code on the fi rst page of the article. This consent does not extend to multiple copying for promotional or commercial purposes. SUBSCRIPTIONS. History of Science is published quarterly in March, June, Sep- tem ber and December. A subscription to Volume 46 (2008) is £125.00 (US $255.00 in the Americas and Japan) for institutions (paper plus online access via www. ingentaconnect.com), £41.00 (US $82.00 in the Americas and Japan) for individuals subscribing direct (paper only), including postage. Single parts cost £28.00 (US $56.00 in the Americas and Japan), including postage. The prices of previously published volumes may be had from the publisher on request. ISSN: 0073-2753 (print), 1753-8564 (online) Web Site: www.shpltd.co.uk Printer: Cambridge Printing, the printing business of Cambridge University Press Hist. Sci., xlvi (2008) PILLOW TALK: CREDIBILITY, TRUST AND THE SEXOLOGICAL CASE HISTORY Ivan Crozier University of Edinburgh INTRODUCTION In the last part of the nineteenth century, a new fi eld emerged within psychiatry and psychology that was specifi cally concerned with human sexuality. This fi eld — sexology — developed theories of sexual behaviour and recorded observations of sexual activity based on case histories of various ‘perversions’ (initially homosexu- ality, but soon afterwards sadism, masochism, fetishism, etc.). These case histories were enrolled in sexological texts as the basis for scientifi c speculation. To use Ian Hacking’s formulation, sexology “made up” the “kinds of people” who can be found in these case histories.1 It is the uses of these cases, and the sociological issues that surround the construction of sexological knowledge based on them, that will be addressed in this paper. Sexology differs from other types of medicine. First, there was much trouble with defi ning what is to be counted as sexual: Desire? Lifestyle? Penetration? Other forms of stimulation? These issues are often not as important in, say, oncology or internal medicine, when the patient is either sick or well, has cancer or not. Furthermore, unlike when a sick patient goes to his or her doctor with certain symptoms caused by an illness that the doctor can interpret from the body through intensive testing, the doctor is rarely there when the subject has sex. And even on the odd occasions when the sexologist was there during intercourse — such as with the people who had sex on a clinical bench with William Masters and Virginia Johnston poking about and taking scientifi c measurements, resulting in the best-selling Human sexual response (1966) — the doctor had to trust the patient’s report about what they were thinking and feeling during the act. Sexologists want this information, as many are interested not only in what people do for sex, and how people’s bodies respond physically, but also in the psychological aspects of sexuality. There are very few meaningful physical signs of sexuality that can tell sexologists much about people’s sexual desires and practices, so psychological information is the basis of sexological knowledge.2 This information gathered from the patient is converted into a case history, and is then circulated in the fi eld of sexology. APPROACHES TO MEDICAL CASE HISTORIES Case histories are central to medical writing. They are the raw material for medical knowledge claims, acting rather like the data appendix in a scientifi c paper from another fi eld. Cases are such a familiar trope in medical writing that they are 0073-2753/08/4604-0375/$10.00 © 2008 Science History Publications Ltd 376 · IVAN CROZIER unproblematically presented in medical journals and textbooks without needing any form of justifi cation. But this unproblematic status does not mean that cases are identical. As Harriet Nowell-Smith notes in her survey of cases in Canadian obstetric medicine, “Nineteenth-century case histories transformed individuals’ bodies into something statistically regular and understandable”.3 The practice of making perversions “regular and understandable” was the central aim of sexologists in the late nineteenth century, and more recently whenever something new has appeared (I will use examples of both below). It is the use of case histories in this way that makes sexology a medical discipline, rather than simply musing about sexuality. In clinical medicine, cases were important to everyday work. For example, Charles Lyman Greene, Professor of Clinical Medicine at the University of Minnesota College of Medicine, emphasized in 1910 that “case-taking, reading and reporting should be carried into everyman’s practice. Old casebooks well kept are wells of knowledge, and the science of medicine would be greatly enriched were the workers in the city and hamlet alike to give to it reports of the unusual cases now for the most part allowed to pass without record”.4 Likewise, Noble Chamberlain, Lecturer in Clinical Medicine at the University of Liverpool in the 1930s, stressed the centrality of the case to practice, writing: When the history of the case is complete, the physician should have a mental picture not only of the patient’s present symptoms, but of the manner in which these developed and of the type of background of personal and family life upon which they have been grafted. Too often we have been rightly accused of study- ing the disease rather than the patient.5 This standpoint can be seen in current medical writing when cases are written up, and they take a codifi ed form nowadays known as the S.O.A.P. method: Subjective (history) data; Objective (clinical) data; Assessment; Plans for treatment. Julia Epstein argues that by writing in such a disinterested, objective style, the S.O.A.P. method of case reporting allows for a reading which ignores all personal issues, and instead focuses on the medically ‘relevant’ issues.6 This reduction of the patient to their salient medical features is criticized by Katheryn Montgomery Hunter, who argues that medicine should do more to think about the individual in the case, rather than merely construct a reductionist history of a disease process. She protests that “The medical case is not the patient’s story”.7 Hunter, like Oliver Sacks, is keen to put the person back into the case study. For Sacks, medical case histories are a form of natural history — but they tell us nothing about the individual and his case history; they convey nothing of the person, and the experience of the person, as he faces, and struggles to survive, his disease. There is no ‘subject’ in a narrow case history; modern case histories refer to the subject in a cursory phrase ... which could as well apply to a rat. To restore the human subject at the center ... we must deepen the case history to a narrative or tale.8 PILLOW TALK · 377 Nevertheless, there are reasons that medical case histories do not refl exively address the case history as a literary form; it is assumed that all medical writing will be written in a passive, unbiased voice. This voice-without-compassion was not always a feature of medical writing. As the cultural historian Thomas Laqueur has shown, the modern medical case developed initially as a form of humanitarianism, which was interested in the human details expounded in the narrative.9 But as a number of medical historians have demonstrated, such humanism declined in the context of clinical medicine.10 One of the key ways of writing the history of medicine that addresses individual lives has come from ‘historians-from-below’, a part of the Marxist and, more recently, cultural and feminist historiographical lineage.11 Medical historians-from-below examine some of the ways that patients have reacted to the differing interpretations of their cases, or focus on the doctor/patient relationship as a power relation. A central way of accessing cases from below is to consider patients’ voices. One of the earliest proponents of this (medical) historiography was Barbara Duden, who reconstructed the lives and experiences of women, rather than contemporary medical ideas, from a doctor’s casebook.12 Roy and Dorothy Porter pioneered this approach in England,13 following the axiomatic programme set out by Roy Porter in 1985.14 In the history of sexuality, attention to the patients’ voice over and against doctors’ writing comes from Harry Oosterhuis, Alice Dreger, and Joy Dixon.15 This work on the patient in a medical text is important, as often in these texts, patients’ ‘confessions’ were rewritten by the medical practitioner, thus removing the bulk of the patient’s voice from the account (usually excepting minor quotations).

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