Med letters, not love letters

Text by Melanie Picard

Thanks to Pierre Choderlos de Laclos and his famous epistolary novel, The Dangerous Liaisons, we know a lot about love and passion in the 18th century. But what about the relationship between physicians and their patients back then? How were afflictions of the body, health, and skin perceived during the Enlightenment?


From 1999 to 2004, Swiss medical historian Séverine Pilloud researched these questions in depth. Taking a page out of Choderlos de Laclos’s book, Pilloud, a professor at the University of Applied Science, Western Switzerland (HES-SO) in Lausanne, sifted through letters from that time, and she shared her insights with swissnex San Francisco. Financed by the Swiss National Science Foundation, her aim was to create a database that shed light on attitudes toward medicine then and how they’ve changed over the centuries.

Of course, love letters were not Pilloud’s focus. Rather, she zeroed in on patients’ correspondence with a famous Swiss physician, Samuel Auguste Tissot, who lived from 1728 to 1797. She collected some 1,300 letters from all over Europe written in English, French, and Latin. They represented correspondence with 700 patients, with men and women about equally represented.


Reading these letters was not only crucial for understanding how biological phenomena have been interpreted differently through the ages, but it was also fun and captivating for Pilloud. As she puts it, it was almost like travelling through time.

She was able to follow all kinds of life stories through patients’ correspondence with their doctors. A deathly ill Duchess desperately tries to save her own life. A woman explains how she avoids touching her husband to control her chance of getting pregnant. People suffering from hallucinations are convinced that they were kings. Even though the modern situation is different—fewer people probably believe they are kings, for example, and effective birth control options are currently available—these stories sound strangely familiar.

Med letters, not love lettersSo what was so different during the Enlightenment? First, passions and emotion were seen as inextricably linked to physical health. The patient was treated as a person, not as a collection of cells. In diagnosing a condition, everything was important, from patients’ habits to their occupations, from their moods to what they ate. But that doesn’t mean that physical body was not important. Dr. Tissot and other physicians needed extremely precise descriptions of the afflictions because, in most cases, they were not able to see their patients. That’s why the letters that Pilloud dissected sometimes went on for up to 12 pages.

Second, little jargon was used. Have you ever left the doctor’s office with no idea what was wrong with you? According to Pilloud, that confusion did not happen in the 18th century, or at least not because you couldn’t understand what your doctor was saying. Pilloud says that physicians and patients shared the same vocabulary. After this period of history, medicine took a different path, and doctors began to treat patients more scientifically. The language became more technical, and patients slowly lost their role in their own treatment.

However, with the emergence of Internet, an aspect of medicine during the Enlightenment has returned: Patients are now more involved in their own diagnosis. Health websites and various forums allow anyone with Internet access to question the perception of health, the body, and the skin. Perhaps in another few hundred years, medical historians will look back at bits of web page code and online discussions for clues to how the practice of medicine once again changed over time.


Pilloud’s visit at swissnex San Francisco was part of our skin series, Feel the Skin: a Multidimensional Approach. On October 10th, she spoke at The Changing View of Skin Diseases with dermatologist Kieron Leslie and physician and UCSF Professor Victoria Sweet.

Do Fingerprints Tell the Truth? is our next event in this series and is part of the Bay Area Science Festival.