In recent years historians of nineteenth-century medicine have traced the development of physicians' professional interests, concentrating on the interplay of professional ambitions and reasons of state that have led to the medical profession's control over private life. In discussions of the complex triangle of the state, physicians, and patients, the concepts of professionalization, medicalization, and hygienization have become dominant. Undoubtedly, these concepts have yielded fruitful insights into the role of physicians and public institutions, but they have contributed very little to our understanding of the patients' role in these processes. The patient appears only as the victim, indeed, one who would have been much better off without the so-called progress that destroyed his or her traditional medical system, discredited lay medicine and family help, and ended with the expropriation of his or her body.

I would first like to make some critical observations on writing and researching the history of patients. Patients' history will always suffer from a lack of adequate and appropriate sources. The dearth of good historical material makes it easy to transfer our own sentiments toward medicine back onto history, largely because of our feelings of impotence in the face of modern medicine, our postmodern disbelief in progress, and our longing for an intact world, one unimpaired by the alienating forces of modern society. Moreover, viewing the patient as simply the victim of medicalization overlooks the fact that most of the people subjected to medicalization had already been uprooted from their traditional surroundings. As a result of the enormous social changes of the nineteenth century - particularly the great migration and urbanization processes - the traditional support of family, neighborhood, and village community gradually disappeared.