MEDICINE IN THE NEW TIME
Lecture Plan
1. Introduction to the New Time
2. Medical research and major breakthroughs. Hospitals and healthcare
3. 18-th century medicine. Inoculation. Practical measures
INTRODUCTION TO THE NEW TIME
Medical practice began to greatly improve during the 17th and 18th centuries. Professional societies were formed in all major European capitals, and scientists shared their research by publishing in journals.
The death rate in most towns remained extremely high. In London, perhaps one in five children died before their second birthday. In certain districts the infant mortality rate reached 75% of all births whenever epidemics struck. During the 1700s more people died in London than were baptized every year.
Due to the growing use of dissection as part of medical training, most doctors in the 1700s had a practical knowledge of the human body. Diagnosing and successfully treating disease, however, was often hit and miss. The connection between uncleanliness and the spread of diseases was not properly understood, and many people continued to die simply as a result of poor hygiene.
In many towns charitable hospitals and dispensaries also offered basic healthcare: to poor children and expectant mothers, for example, or to old sailors and soldiers. And as a last resort, dozens of quacks were on hand to offer an array of potions, powders to those most desperate for relief from pain or discomfort.
Many women died in childbirth because of infection. Even having your teeth pulled out could be fatal. Major surgery was particularly dangerous. Dirty surgical instruments caused wounds to be infected, and this caused the death of many patients. Flea and rat infestations were also common, even in wealthy households, and many diseases were spread this way in crowded urban environments.
A doctor’s consultation was costly and often inconclusive. Most doctors dealt with only the wealthiest members of society, and the poor were often left to seek alternative forms of help. Lower down the scale, barber-surgeons might be called on to perform a range of surgical procedures: the removal of kidney stones, the lancing of boils or setting of broken bones, or simply ‘letting the blood’ of patients for a whole range of ailments and conditions.
Yellow Fever was one of the many diseases that killed many people in the 1700s. It was very common to die from it because they didn’t have cures for it. The symptoms start with head aches, chills, and an ache in back , arms, and legs. Next comes a high fever for about 3 days. After 3 days, the person’s fever goes away, but only for a couple of hours. After that, the high fever returns and as red blood cells are destroyed the skin and eyes turn yellow. Next the person vomits black blood because of bleeding in the nose, gums, and intestines. As the person’s pulse grows weak they start to become confused and delirious. Also, tiny red bumps may appear on the skin. Death follows shortly after.
Doctors based their diagnosis of illness on the ancient beliefs of “humors”, bodily “tension”, or other cruder doctrinaire dogmas. The practice of “bleeding” with leeches to cure illness was common during the 18th century. In fact, the practice of medicine caused more harm than good. Doctors did not sterilize their hands, or instruments.
MEDICAL RESEARCH AND MAJOR BREAKTHROUGHS. HOSPITALS AND HEALTHCARE
Medical researchers made some astounding discoveries. William Harvey determined how blood circulated through the body.
William Harvey
When Harvey by his discovery of the circulation furnished an explanation of many vital processes which was reconcileable with the ordinary laws of mechanics, the efforts of medical theorists were naturally directed to bringing all the medical theorists were naturally directed to bringing all the departments of medicine under similar laws.
Anton van Leeuwenhoek used a microscope and discovered red blood cells, bacteria, and protozoa. Van Leeuwenhoek made more than 500 optical lenses. He also created at least 25 microscopes, of differing types, of which only nine survive.
Marcello Malpighi, a lecturer in theoretical medicine at the University of Bologna, has been pioneering the use of the microscope in biology.
One evening in 1661, on a hill near Bologna, he uses the setting sun as his light source, shining it into his lens through a thin prepared section of a frog’s lung. In the enlarged image it is clear that the blood is all contained within little tubes.
Malpighi thus becomes the first scientist to observe the capillaries, the tiny blood vessels in which blood circulates through flesh. They are so fine, and so numerous, that each of our bodies contains more than 100,000 kilometres of these microscopic ducts.
With their discovery, the missing link in Harvey’s circulation of the blood has been found. For the capillaries are literally the link through which oxygen-rich blood from the arteries first delivers its energy to the cells of the body and then finds its way back to the veins to be returned to the heart.
18-TH CENTURY MEDICINE
Unlike today, 18th century medical sciences were not as advanced in scientific knowledge because the body and its functions were still a mystery. In Europe, the doctors still adhered to the dogmas of vitalists, iatrochemists, and iatrophysicists. Each follower of these “brands” of medical practice argued over which of their single causes explained all human health.
Diseases were common during the 18th century and there was little medical protection against them. Death rates from certain diseases were high. In Europe, the close-confines of cities were breeding grounds for illnesses and disease. The lack of understanding of how such ailments were passed along and a subsequent inability to adequately prevent the spread of diseases many times resulted in epidemics of varying severity.
Diseases of the eighteenth century were a major part of daily life. Newspapers helped in providing necessary information to society for news on subjects that truly mattered to them. A vast number of colonists died from many horrible diseases including small pox, yellow fever, and diphtheria, just to name a few, because only a minute about of people had medical knowledge. If not for newspapers, these numbers would have been drastically higher. Even though many of the newspapers provided many quackeries and false information to its readers, the information that it did provide gave hope to many infected citizens.
Inoculation: 17th – 18th century
At some time before the end of the 17th century a bold procedure, possibly practiced already for several centuries in parts of Asia, becomes established in Turkish medicine. It is the use of inoculation to protect against the extremely infectious and frequently fatal disease of smallpox.
Inoculation is based on an easily observed medical fact – that those who contact an infectious disease and survive are protected against catching it again. Inoculation is a precautionary measure, though in the case of smallpox a dangerous one.
Edward Jenner invented vaccination after discovering the relationship between cowpox and smallpox. Jenner publishes his findings in 1798 in the splendidly titledAn Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the Western Counties of England, particularly Gloucestershire, and known by the name of Cow Pox.
Edward Jenner (1749-1823) tested the folk belief that cowpox, a mild disease, provided protection against smallpox. In 1798 Jenner published an account of his experiments. Despite the medical profession’s tendency to resist new ideas and methods, Jennerian vaccination spread throughout the world within a decade.
Smallpox took the lives of millions, killing at least 400,000 a year in Europe alone throughout the 18th Century – from peasant to king.
Clinical practice was revolutionized by Thomas Sydenham who developed a treatment procedure that recognized the importance of environmental considerations and included careful, detailed observation and record keeping.
Vitamins were discovered and their importance to health recognized. New drugs, including digitalis, were developed, and vaccination was perfected by Edward Jenner. Giovanni B Margagni founded pathologic anatomy, and Marie Francois Bichat created the field of histology.
Still, many of the old practices, like bleeding, continued, and several new and dangerous treatment theories, like homeopathy, flourished for periods of time.
As the practice of medicine became more professional, many folk healers were prohibited, and male obstetricians began to replace traditional midwives.
The progress of pharmacy was shown by the publication of Dispensatories or Pharmacopaeiae, such as that of the Royal College of Physicians of London in 1618. This, like the earlier German works of the same kind (on which it was partly founded), contains both the traditional (Galenical) and the modern or chemical remedies.
Practical measures: 1752-1785
The middle years of the 18th century are notable for practical advances in medicine, based on close observation by working practitioners. Some of those who record their experiences are at the academic end of the medical profession; others are country doctors paying attention to detail. Their efforts raise the scientific standards of medicine and introduce techniques and drugs of lasting benefit.
An early example is William Smellie, the first obstetrician to make a scientific study of the physical process of childbirth.
From 1741 Smellie gives midwives and medical students in London unprecedented practical lectures on childbirth. He achieves this by offering his services to poor women on condition that his students may attend the birth. In this way he is able to develop a scientific account of the mechanism of labour, describing previously unobserved details – such as how the child’s head is adapted for the passage through the pelvic canal.
William Smellie, A Sett of Anatomical Tables. This is Smellie’s engraving of twins in utero
Smellie publishes his findings in the three-volume Treatises on the Theory and Practice of Midwifery (1752-64). His text provides a new scientific basis for the ancient skills of the midwife.
Smellie illustrates a number of complications possible in childbirth and gives detailed directions for delivery. He was the first to use forceps to rotate the fetal head and the first to use them on the head in a breech delivery. He made important modifications to the “Chamberlen” forceps, included shortening and curving the blades and perfecting a locking mechanism.
A similarly thorough groundwork is provided for pathology in a book of 1761. Its author, Giovanni Battista Morgagni, is seventy-nine at the time of publication. He has spent nearly five decades as professor of anatomy at Padua (a post once occupied by Vesalius). During that time Morgagni has kept detailed notes of his dissections of corpses.
This is not new in itself, for there have by now been many published accounts of post-mortem examinations. Morgagni’s originality lies in his related notes, describing the symptoms of his patients before they died.
Morgagni’s book is De Sedibus et Causis Morborum per Anatomen Indagatis (On the Seats and Causes of Diseases, investigated by Anatomy). It describes 640 post-mortems with the related clinical records. Symptoms from now on can be interpreted as external signs of known internal conditions.
In the year of Morgagni’s publication, 1761, a book comes out in Vienna offering the general practitioner a useful new technique in the analysis of a patient’s internal condition. It is the work of Leopold Auenbrugger, an Austrian physician employed in a military hospital. Many of his patients have fluid in the chest. To discover how much, he adapts a technique learnt in his childhood.
As a boy Auenbrugger worked in his father’s tavern and learnt how to judge the amount of wine in a barrel by tapping on its top. He now finds that the same technique works well on a patient’s chest. Auenbrugger has stumbled upon the basic diagnostic technique known as percussion. He describes his findings in 1761 in Novum Inventum (New Invention).
Auenbrugger’s process is disregarded at first by the medical profession. It becomes of more evident use after an invention of half a century later – that of the stethoscope.
George Martine (1702-1743) was the first to perform a tracheotomy in Britain. Martine is recognized for having been the first to suggest the use of a double tracheotomy tube. The second inner tube could be easily removed and cleaned, thereby keeping the tube clear of mucus without having to remove the tracheotomy tube altogether
Everyone probably knows that cocaine is bad for your health. In the 1800s the people did not exactly know that cocaine was dangerous. Actually cocaine and other modern drugs were considered medicinal.
Back then a lot of substances were used as medicines. These medicines were called Patent Medicines. Patent medicines required no prescription which meant they were for sale by all druggists.
Women
Catholic women played large roles in health and healing in medieval and early modern Europe. A life as a nun was a prestigious role; wealthy families provided dowries for their daughters, and these funded the convents, while the nuns provided free nursing care for the poor.
The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God’s grace through good works—and thereby escape purgatory—by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering. Protestants generally closed all the convents and most of the hospitals, sending women home to become housewives, often against their will. On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.
In London, the crown allowed two hospitals to continue their charitable work, under nonreligious control of city officials. The convents were all shut down but Harkness finds that women—some of them former nuns—were part of a new system that delivered essential medical services to people outside their family. They were employed by parishes and hospitals, as well as by private families, and provided nursing care as well as some medical, pharmaceutical, and surgical services.
Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries, and enrolled their daughters as nuns who provided free health services to the poor. Nursing was a religious role for the nurse, and there was little call for science.
Age of Enlightenment
During the Age of Enlightenment, the 18th-century, science was held in high esteem and physicians upgraded their social status by becoming more scientific. The health field was crowded with self-trained barber-surgeons, apothecaries, midwives, drug peddlers, and charlatans.
Across Europe medical schools relied primarily on lectures and readings. In the final year student would have limited clinical experience by trailing the professor through the wards. Laboratory work was uncommon, and dissections were rarely done because of legal restrictions on cadavers. Most schools were small, and only Edinburgh, Scotland, with 11,000 alumni, produced large numbers of graduates.
Britain
In Britain, there were but three small hospitals after 1550. Pelling and Webster estimate that in London in the 1580 to 1600 period, out of a population of nearly 200,000 people, there were about 500 medical practitioners. Nurses and midwives are not included. There were about 50 physicians, 100 licensed surgeons, 100 apothecaries, and 250 additional unlicensed practitioners. In the last category about 25% were women. All across Britain—and indeed all of the world—the vast majority of the people in city, town or countryside depended for medical care on local amateurs with no professional training but with a reputation as wise healers who could diagnose problems and advise sick people what to do—and perhaps set broken bones, pull a tooth, give some traditional herbs or brews or perform a little magic to cure what ailed them.
The London Dispensary opened in 1696, the first clinic in the British Empire to dispense medicines to poor sick people. The innovation was slow to catch on, but new dispensaries were open in the 1770s. In the colonies, small hospitals opened in Philadelphia in 1752, New York in 1771, and Boston (Massachusetts General Hospital) in 1811.
Guy’s Hospital, the first great British hospital opened in 1721 in London, with funding from businessman Thomas Guy. In 1821 a bequest of £200,000 by William Hunt in 1829 funded expansion for an additional hundred beds. Samuel Sharp (1709–78), a surgeon at Guy’s Hospital, from 1733 to 1757, was internationally famous; his A Treatise on the Operations of Surgery (1st ed., 1739), was the first British study focused exclusively on operative technique.
English physician Thomas Percival (1740-1804) wrote a comprehensive system of medical conduct, Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks.
The practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more systematic analysis of patients’ symptoms in diagnosis. Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating theatres. Actual cures were developed for certain endemic infectious diseases. However the decline in many of the most lethal diseases was more due to improvements in public health and nutrition than to medicine. It was not until the 20th century that the application of the scientific method to medical research began to produce multiple important developments in medicine, with great advances in pharmacology and surgery.
Medicine was revolutionized in the 19th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology and virology. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology.
