The transformation of the practice of medicine was the result of new ideas in treatment, attitudes and understanding to disease and the rise of hospitals. [1] Roy Porter has characterised the eighteenth century as teetering on "modernity".[2] It can be said that most of the participants in the conversations which were to change the face of medicine and its practices were prominent professors and lecturers within Universities such as Edinburgh, Montpellier, Halle and Leyden. They influenced hundreds of medical students attending the universities who transported ideas from these intellectuals back to their home towns. Lecturers were influential in encouraging students to believe that the antiquated humoral conception needed to be replaced with newer models of study drawing on ideas by David Hume and Adam Smith.[3]
John Brown (1735-88) established the theoretical scheme which focussed on one fundamental principle. He claimed excitability could determine the physiology and pathology of the human body; therefore, complicated disease classifications were needed. However, most physicians found this system impossible to apply, despite it looking promising in theory. The failings of such a system provoked further clinical observations by physicians and fact gathering through a hands-on approach was to be the vital ingredient to understanding the treatment of disease and the pathology of the human body. [4]
Discussions between those involved in scientific thinking continued as they placed emphasis on a model of "non-natural" elements. These were environmental factors such as food, drink, air and functions such as sleep, consciousness and psychological influences. All such factors were considered responsible for the health of the body. [5] Wear informs us of the French physician Arnulfe d'Aumont's works which states "There does not exist a definition of health applicable to everyone...each has his own state of well-being"[6] He believed that rest, control of non-natural factors and positive energy and thinking were the elements required for a healthy body. D'Aumont believed 'hygiene' to be the most vital factor in maintaining one's health and that there was no need for illness as society provided everything necessary for keeping well. Should an individual become ill, it was their own fault. This thinking provided the platform for further discussions on the actual treatment of disease and concluded disease could be eradicated once symptoms were better understood through "systematic observation and classification".[7]
On the back of D'Aumont's reasoning Proffessor Francois Boissier de Sauvages at Montpellier wrote the Treatise on the classes of diseases in 1731. He arranged the objects of diseases into classes, orders and genera as well as species. His most major work was 'Methodical Nosology', in which diseases are arranged by classes according to the system of Sydenham and the order of the Botanists'.[8] William Cullen responded with his publication of 'Synopis Nosological Methodical' in an attempt to guide his students. His theory was one which was a much more simplified index of clinical symptoms witnessed first hand by him. He believed students would be better served to have some knowledge of his own experiences. [9] Nosology became vital to the study and practice of Cullen in which he concluded "it would make the study of physics absolutely impossible for if we cannot arrive at some distinction of diseases, we must act at random".[10] As a result Nosological Treatises in 1760s and 1770s were being published in Edinburgh, Gollingen, Dublin, Vienna and Lyon.[11]
Mid- eighteenth century witnessed reforms in medicine due to subjects such as physics and chemistry being developed. Medicine became more about experiment and observation. Hermann Boerhaave emphasised the need for bedside observation as fundamental to understanding all diseases. Simmons quotes Lester King in saying that to understand Boerhaave "is to understand all the currents of medicine in the early eighteenth century".[12] However, Boerhaave was not alone in his thinking, Pierre Chirac believed medicine lacked philosophical foundations and because of this there was a rush to diagnose without a long enough look at the symptoms. He demanded Doctors followed the wisdom of Hippocrates and learn to observe the sick. He hoped to promote a network of physicians that would gather reports from tried and tested measures so that true cures and remedies could be established .[13] This theory was taken onboard at Montpellier where students were being taught and taking examinations in the bedside environment only. Observation and recordings of all diseases presented to them led to the growth of the importance of physical signs and to the diagnosis of diseases. [14]
Through the practice of properly observing patients presenting with illness, report gathering became vital to all those involved with science during the enlightenment. Enlightened thinkers began diminishing the myths that coincided with religious beliefs of the time, progressing the new philosophy of life, 'Reason'. "Reason, proclaimed Enlightenment propagandists, would create a better future; science and technology, as Francis Bacon had taught, would enhance man's control over nature and social progress, prosperity and the conquest of disease would follow"[15] In his writings Marquis De Condorcet argued that reason and science combined can and should be applied to develop intellectual and moral faculties of humanity. He believed that all aspects of nature should be re-evaluated and correspond to the needs of human intelligence. He also believed to apply reason and knowledge would be to eradicate issues of poverty, slavery, sexism as well as illness. [16]
It is vitally important to draw attention to those influencing such ideas as those of aforementioned. During the eighteenth century Britain and France appeared to have dominated the University system. Edinburgh was considered one of the most prestigious for medical training. Students from North American Colonies and Europe came to hear lectures by Joseph Black, Alexander Monro and William Cullen. Cullen lectured medicine in Glasgow University before going to Edinburgh in 1756 combining research and teaching in medicine and chemistry. He began teaching in the Edinburgh Infirmary and was president of the Edinburgh College of Physicians influencing chemist Joseph Black.[17] The century also saw the publications of William Buchan such as Domestic Medicine (1979) find its way into the households of citizens. He also promoted the rational, common-sense principles of Enlightenment which was the child of David Hume.[18] Other publications form Benjamin Rush, John Gregory and Thomas Percival all played a major role in influencing how medicine should and could progress.
Previously to this Edward Jenner gained recognition for his contribution to immunisation and the eradication of smallpox which was sweeping Europe at the time. After witnessing the method of variolation in Istanbul Lady Montague ordered the embassy surgeon to inoculate her five year old son. This proved to be a success. The term 'inoculation' was introduced in an account of the practice rendered to the Royal Society in London by Emanuel Timone in 1713. Lady Montague began a campaign in favour of inoculation. Most of Europe and America responded well to her campaign however, opposition from the Church in France resulted in acceptance of the practice being much slower. Throughout the Enlightenment there were considerable amounts of papers written on the subject both for and against. [19]
A short time later, John Hunter was bringing science into surgery and medicine working alongside Cullen. [20] He had been influenced by his lecturer James Douglas and continued his thinking lecturing on surgery and anatomy at St Georges' hospital. His dissections and experiments pushed forward his public lectures on the Principles of Surgery. He completely excluded all humoral concepts in all of his writings which in itself were proof of the advancements being made during the enlightenment. [21] Europe was witnessing a move forward in terms of old ways of thinking being completely abolished and new thinkers leading the way to the future of medicine.
Due to the growing numbers of experiments, the period also demanded the inventions of apparatus. Controversy soon erupted over the efficiency of many instruments being used, particularly those used in laboratories. Philosophers and lecturers were purchasing instruments at remarkable rates. Jean Hyacinthe de Magellan sold instruments from London, along with Gowan Knight's magnetic apparatus, to Spain, Portugal, France and the Netherlands. Following Knight's invention of the device capable of creating artificial magnets careers were being forged by those attempting to design apparatus for electrical and magnetic display. Amongst those highly recognised for their designs were engineers John Smeaton, George Graham and Edward Nairne. [22]
Portable devices introduced during the century allowed for Dr Thomas Beddoes of Bristol allowed the application of new airs in the treatment of endemic diseases such as consumption. He introduced the inhalation of "factitious airs" for the treatment of diseases. He established the Pneumatic Institution for Inhalation Gas Therapy in Clifton in 1798. Following which Antoine Lavoisier , important in advancing the chemical revolution, opened his home to gatherings for scientists with shared ideas. He was later to be recognised as the brain behind the discovery of oxygen which enabled general anaesthetics. However, both he and Beddoes were in contact and both were correspondents with Joseph Priestly, who has also claimed responsibility for discovering oxygen. [23] It is fair to say that during the research for this paper evidence would appear somewhat inconclusive as to which of the two actually did discover oxygen.
With the advances in medicine and medical practices growing at the rate they were in Europe, countries began examining how best to look after their citizens having recognised that diseases were prevalent regardless of class or gender. Germany introduced the 'Medical Police', a term coined by Wilhelm Rau in 1764. This was an attempt to end the back street quacks and to ensure government policy would ensure cradle-to-grave medical care. The most influential writer on this subject was Johann. P. Frank with his publication of A Complete System of Medical Police. Within which he determined the need for governments to take responsibility for the public regardless of class in order to maintain a population with the threat of diseases such as syphilis' typhus and smallpox.[24] Frank and other reformers encouraged governments to protect the most vulnerable in society. In particular, those subject to diseases due to industrialisation, overcrowding and poverty. They called for environmental reforms. [25]
Encouraged by Enlightenment ideas the British government began introducing Acts designed to maintain physical and emotional needs of children first and foremost. George Armstrong established the London Dispensary for the Infant Poor in 1769. This was the first of its kind in Europe. He has been considered the founder of paediatrics in Britain. Thomas Percival was successful also in expanding and improving facilities within the Manchester Infirmary. This was a charity movement, which aided in creating thirty-eight institutions based on the same idea by the end of the century. Establishments such as these were dependant on voluntary work of physicians, doctors and clergymen. "By 1803 the Manchester Infirmary included a lunatic asylum, an out-patient dispensary and a house of recovery or fever hospitals, additions created...by Percival and his Edinburgh- trained colleagues". [26]
Institutions like this were to mark the way forward for the care of diseases and those affected. Along with the new ways of thinking from those involved with the enlightenment participating either in discoveries of diseases, protection from and prevention of as well as treatment of diseases, the care of those in Europe was most definitely on the way to modernity as a result of those during the enlightenment period. During research for this paper it has been difficult to extend more praise to one country in particular with Europe and America. However, it has been brought to light that Britain and France worked very much together. It is even fair to say perhaps more so than any others in that communication and discussions between the two countries appears to have been more continuous than that of any others. This is not, of course, to diminish all contributions made by all European and American thinkers. It is apparent that those most related to within the literature referred to for this essay France and Britain most definitely stood at the forefront of the changes within the medical profession. It would be fair to suggest this is most likely due to industrial revolutions occurring within both countries and the establishment of renowned Universities as has been outlined earlier in the essay. It has been proven that the enlightenment was most definitely responsible for the modernisation of the medical profession.
Endnotes
N.D. Jewson, The Disappearance of the sick-man from Medical Sociology, Vol.10, 1976,pp.225-244
R.Porter, English Society in the 18th Century, Penguin, London, Revised ed, 1991,p.4
Andrew Wear, Medicine in Society, Press Syndicate of the University of Cambridge, UK, 1992,pp.163-165
Ibid; p.166
Ibid; p.150
Ibid; p.151
Ibid; pp.152,153
Tore Frangsmyr et al, The Quantifying Spirit in the 18th Century, University of California Press, Berkely, California, 1990, p.97
Andrew Wear, Medicine in Society, Press Syndicate of the University of Cambridge, UK, 1992,p.170
Ibid; p.171
Tore Frangsmyr et al, The Quantifying Spirit in the 18th Century, University of California Press, Berkely, California, 1990, p.97
John.G.Simmons, Doctors and Discoveries: Lives that created today's medicine, Houghton Mifflin Company, Boston, 2002, pp.131-148
Nicholas.J.Talley & Simon O'Connor, Clinical Examination: A Systematic Guide to Physical Diagnosis, 6th Edition, Reid International Books Australian Pty, Ltd, Elsevier, Australia, 2010,p.XV
F.N.LPoynter, Sydenham's Influence Abroad,
Roy Porter, The Greatest Benefit to Mankind, A Medical History Of Humanity From Antiquity to the Present Day, Fontana Press, London, 1999, p.245
Henry William Spiegel, The Growth of Economic Thought, Library of Congress Cataloguing publication data, 2002, pp.270-275
W.F. Bynun, Cullen and the Study of Fevers in Britain: 1760-1820, Medical History Supplement,No.1,1998:135-147,
Ibid
Lecture Notes
Leo. M. Zimmerman & Ilza Veith, Great Ideas in the History of Surgery, Norman Publishing, California, 1993, p.338
Ibid; p.344
Martin Fitzpatrick et al, Enlightenment World, Routledge, Oxford, 2004, p.241
Ibid; pp.241-263
Andrew Wear, Medicine in Society, Press Syndicate of the University of Cambridge, UK, 1992,p.173
Ibid; pp.174-180
Lisbeth Haakaonssen, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush, Editions Rodopi B.V. Amsterdam-Atlanta,1997, p.117
