The body politic: splitting gender medically in eighteenth-century Philadelphia

Before the rise of clinical medicine, Western medicine was undergoing several prerequisite shifts in epistemology and methodology - moving from an eighteenth-century practice of spaces and classes, wherein the symptom is synonymous with the disease, toward a nineteenth-century science of signs and cases, in which symptoms are symbols, or products, of a deeper disease (Foucault 1973). During the former age of classes, about mid-century, a particular shift in the medical perception of sex differences appears in the literature, without any great advances or revisions in human anatomical knowledge or treatment methods. This thesis looks at hospitalization of in-patients at Pennsylvania Hospital spanning 50 years during which this shift in medical body concept took hold in European medicine, and was transmitted to American medical students educated in England and Edinburgh. A correlated change in medical practice is expected after major changes in either medical knowledge or in medical body concept occur. Generally, no significant difference is found in the records of the kind of treatment administered or length of hospitalization of in-patients during the time period analyzed. However, women did experience longer hospitalization for most diagnostic categories. A correlation exists between men hospitalized for increasingly longer periods while a much higher proportion (by 45 percent) of pay patients to poor patients were being admitted after 1783. More research on pay and poor patient demographics is needed before a conclusion on this point may be drawn. This thesis suggests that the lived patient experience may not reflect the image presented by contemporary medical literature. The patient records do appear to indicate that a contrastive view of anatomical sex differences was influencing lengths of hospitalization between men and women. This difference is most visible among lunacy cases, in which the author shows patient autonomy is reduced while the physician\u27s power is inversely increased, and thus the medical body concept more strongly affects the course of treatment. Future research at Pennsylvania Hospital may need to extend into the nineteenth century when hospital records begin to include more complete and detailed information about individual cases. Similar studies at other contemporary hospitals in America and Western Europe may also shed light on the links between patient experience and medical practice advocated in literature