The sick-man may be said to have disappeared from medical cosmology in two related senses during the period 1770-1870. Firstly, as control over the means of production of medical knowledge shifted away from the sick towards medical investigators the universe of discourse of medical theory changed from that of an integrated conception of the whole person to that of a network of bonds between microscopical particles. Secondly, as control over the occupational group of medical investigators was centralized in the hands of its senior members the plethora of theories and therapies, which had previously afforded the sick-man the opportunity to negotiate his own treatment, were replaced by a monolithic consensus of opinion imposed from within the community of medical investigators.