An Unusual Power: BECOMING THE RULING CLASS.
‘Although there was
much talk of a ‘profession’ in the eighteenth century (Wear, Geyer-Kordesch,
and French, 1993), medicine as a profession in the intellectual and moral
senses of the term did not yet exist. Before the eighteenth century physicians
and surgeons lacked a stable body of knowledge and they lacked an ethics to
guide the appropriate use of then nascent scientific knowledge that such
knowledge was about to create. In short, the concept of the physician as a
professional in the intellectual and moral senses of the term and therefore the
concept of the profession in its intellectual and moral senses did not exist,
at least in the English-speaking world, until the eighteenth century.’ McCullough, Lawrence B. John Gregory and
the Invention of Professional Medical Ethics and the Profession of Medicine.
Kluwer Academic Publishers. 1998: page 4.
Introduction:
According to research done at a
medieval graveyard outside London, there are no clear differences in health
between c950 and c1850. Although many new philosophical positions were
developed, the medical profession kept largely to a belief in humours, still
employing leeches and other tried, but rarely tested, procedures. This work
will dip occasionally into ‘An 18th Century Physician’s Handbook’
(Cockayne, Stow 2012) to demonstrate the profoundly conservative nature of
medical practice. Therefore this paper will not necessarily concern itself with
medical achievement but rather with how the profession ingratiated itself with
a disbelieving public.[1]
This paper will consider how physicians throughout Europe increased their
status, wealth and public presence without offering clear evidence of
efficiency,[2] focusing on the
professions increased power in comparison to the influence it had enjoyed
before through its intimacy with the court. The social complexity of care and
healing, involving lay patronage for example, prevented any clear,
authoritative distinction being established between orthodox profession and
fringe practitioners. This paper will also consider how lay people or those
claiming medical knowledge from other sources were ejected from practising
medicine, especially women, and how the medical profession became more
organised, becoming rapidly an elite male preserve. Was it in the end merely
the result of the professions drive towards professionalization, creating,
according to McCullough (1998), what amounted to corporate positioning,
exclusive rather than inclusive? Lastly, the actual nature of medical treatment
will be considered in an attempt, once again, to reveal the reality behind the
rhetoric.
In apparent contradiction of the
above, Adrian Wilson (The politics of medical improvement in early
Hanoverian London)[3] asserts that in
Britain the 18th century was one of medical improvement, that is,
people’s health became better. He demonstrates this by referencing improved
housing, hygiene, and more efficient police and prisons. Although not
immediately identifying perfected medical practice, he shows how society
improved, with the provision of voluntary hospitals, the first of which, the
Westminster Infirmary, was founded in 1719. Unfortunately for this viewpoint,
it seems that the general population fared no better, still suffering from
early death and plague, while the rich did, from 1850 living considerably
longer than their much poorer counterparts.
Developments in medical provision,
status and organisation were evident throughout the 18th century. In
order to clarify the processes of those developments, many of which did not
thereby involve better treatment for patients, several European countries will
be considered. This assumption underlying this investigation is that each
change influenced changes elsewhere. Certainly, during the 18th
century, the distinction between professional, in other words graduate and lay
healers remained blurred.
During the 17th century
until the early 18th century, there is greater evidence of state
involvement in ordinary lives and day to day activity. This varied from country
to country, state to state. Concern with the poor and their harbouring of
disease, incubators and distributors of plague and thereby their effects on the
elite, is one example, while the effects of centralised law courts and policing
activities are others. Although Great Britain remained largely free of
government control throughout this period, authoritarian examples throughout
Europe impacted on medical organisation. In Europe, inoculation against small
pox, which originated in the Middle East, began in the early part of the 18th
century. Wilson holds that its extensive use in Britain was the result of
approval from Crown and ministry.
I have raised doubts on the ordinary
medical practitioner’s involvement with the medical philosophies of the time
and that only a small number were engaged with the contemporary controversies.
Joanna Geyer-Kordesch (Whose Enlightenment? Medicine, Witchcraft,
Melancholia and Pathology, 1995) describes an 18th century
Europe little touched by enlightenment tropes, with medical practitioners still
caught up in metaphysical, spiritual and superstitious interpretations of
illness. Reason and science as colonising tools were yet to effectively
marginalise opposing forces and ideas. Not only did they affect the approaches
of a number of influential individuals inside and outside of medical practice,
but often provided the rationale for physician power. Nevertheless, the
predominant theories must be considered.
The concept of nature as a
representation of god, evidence of his workings and of his omnificence, was
held by the growing number of empiricists both within and outside of medicine.
Observing nature was increasingly preferred to learned perceptions of medicine
based upon Galen. But, nevertheless, there were differences between concepts of
nature, following individual thinkers and practitioners. Philosophies of nature
tended to involve the supernatural.[4]Atomists
might be considered an exception, believing that life and the universe were
formed accidentally, and therefore nature is simply chance, but few medical
practitioners were informed by such views. Pierre Gassendi (1592-1655),
although not an atheist like many atomists, was the principal component of this
viewpoint, separating body (corpus) and matter (material), thereby identifying
form and the potential of form. In fact, divine causality seemed then, at a
time before 19th and 20th century provided further
evidence of the apparent insignificance of human beings, a more logical
response. Robert Boyle (1627-1691) was a later atomists who declared that all
form, real or speculative, which occupied space and comprised the world, was
nature. Boyle accepted an immaterial world, consisting of souls and the supreme
deity, which he then made a separate issue from the material world. He also,
with conditions such as the primacy of god, the mechanical nature of human
bodies. Ralph Cudworth (1617-1688)
provided a Neoplatonist model of this view (King, pages 23-24), which involved
the word of god and nature as a receptive, plastic form that responded to his
bidding. Plastic nature therefore is a divinely acted-upon form, an element of
life itself, possessing recuperative, healing and transforming powers. It is
within instinct-driven animals and human bodies. The generally held position,
irrespective of direction, was that Nature required observation and
understanding, and by doing god’s workings are revealed.
Physicians and the Inquisition.
Social and
political change:
In Germany, broken up at that
time into many small states, learned physicians formed part of the power
structure, with some access to absolutist power and state finances,[5]
able therefore to control the process of professionalisation. As Geyer-Kodesch
asserts,[6]
the German universities were more subject to political influence than the
insular and elite universities of Oxford and Cambridge, allowing British
medical organisations to develop haphazardly.
In Prussia, state involvement in the determination of what legally
constituted a physician encouraged the professions institutionalisation and
also (Geyer-Kordesch, 1990), invested it later with scientific status. Practices remained nevertheless firmly within
the religious and cultural belief in the place of the body in the scheme of
things. In Prussia, Crown edicts of 1685 to 1725 separated learned medical
doctors from other healers. The state oversaw examinations, specifying the
character of a true medical doctor, linking university training to state power.
Under State imperialism, medicine became united with the sciences and from
thereon, with many detours along the way, expounded a reductive, mechanistic,
hierarchical view connected to the demands of State bureaucracy and power.
The above 1685 Edict justified state
regulation of medical practice in Brandenburg-Prussia through its attack on
mal-practice by non-physicians. It particularly referenced barber-surgeons and
surgeons, an approach that according to Geyer-Kordesch (1990) was largely the
result of court physician’s initiatives. The state proceeded to establish a collegium medicum bound to court authority,
run entirely by court physicians, and invested with enforcing powers. Systems
of control were developed for the inspection of apothecary shops, barbers,
barber surgeons and connected professions such as midwives and occultists.
This development was civilised compared
to events in Portugal during the same period.
As famously revealed by Timothy D. Walker[7],
investigating the activities of the Inquisition in Portugal at the turn of the
18th century, then a rich and stable country, he discovered (page 6)
that many of its victims were ‘folk
healers, peasant men and women who earned their keep in part by proffering
magical remedies for common illnesses.’ Further research indicated that
medical professionals were directly involved in the resulting persecutions,
providing expert witness or/and the initial denunciation. Senior physicians
attended the accused torture. In fact, although the involvement of Portuguese
physicians with the Inquisition appears to have been conspicuously
self-serving, in many parts of Southern Europe they colluded with the
institution by attending torture and procuring the corpses of those killed
under torture.
The inquisition started later in
Portugal but continued almost into the 19th century, dropping
quickly after 1772. Cases against popular healers (saludadores or curandeiros) continued
with considerable intensity throughout this period. This persecution coincided
with a period when medical professionals, physicians and surgeons, were
entering the paid ranks of the Inquisition in immense numbers (Walker, page 8).
According to Walker, medical professionals, in competition with popular healers
and also motivated by scientific medical ideas, employed the Inquisition to
discredit their rivals and spread doubt about traditional forms of healing. A
document from the Inquisition, Dos
Saludadores (On Healers), determined
that while some forms of healing were divine, others were inspired by the devil.
Of course, licensed doctors inhabit the area of divine healing and poor, often
uneducated, saludador inhabit the
realm of evil healers. The popularity of curandeiros
and saludadores was mainly due to
the lack of medicos in the country,
most drawn to the sea ports to deal with incoming seaborne diseases and greater
chances of employment. Education and power is seen as a cleansing force. In
this process, scientific application is ordained by god (Walker, page 12) and
anyone employing herbs, lotions (much used then and now by licensed doctors),
blessings, unguents, incantations, etc, is a charlatan and liar. Walker
stresses (page 13) that many of those tried for witchcraft in Early Modern
Europe and New England were cunning women-that is female folk healers. Walker
(page 14), in line with Roy Porter, identifies a European wide persecution of
folk healers in concert with the rise of medical professionals. It does appear
to be part of a normalising process involving elite agreement throughout the
region based upon a growing ideology of reason and behaviour. Concepts of the
natural world became fixed upon a rationalist agenda, run predominantly by
males. In Galicia (Walker, page 19), women made up the majority of those
accused of magical healing, a percentage found elsewhere prior to and during
the 18th century.
The inquisitions activities reached a high
point between 1715 and 1760 during the reign of Joao V, continuing with less
intensity into the Pombaline epoch (1750-1777). According to Walker (page 7),
although the first group focussed on by physicians was New Converts, Jewish
doctors who had accepted Christianity, shortly after popular healers were the
accused in 60% of Holy Office trials involving crimes of employing magic or
superstitions.
Curandeiros
and saludadores (Walker, 2005),
usually functioned amongst the peasantry, were both men and women, often
employed magical cures and did not elevate themselves above the poor groups,
usually peasants, they normally treated. Walker (Chapter 2) provides short
narratives of peasants prosecuted during this period, up to 1775, accused of
employing magic or recipes often used extensively by licensed doctors in the
previous century and still much used by medical doctors in the 18th especially
outside European urban centres. Some curandeiros
were denounced it seems out of professional jealousy, as their methods were
more efficient than that of professional medics (Walker, page 47). While many
popular Portuguese healers employed incantations and magic healing in their
treatment processes, medicinal preparations were widely used, including
beneficial folk medicine such as sap from the elder bush that contains (Walker,
59) anti-rheumatic and anti-neuralgic properties. In instances of fresh wounds,
olive oil was often employed to cleanse the wound before other treatments were
used. Walker (page 65) asserts that Parteiras
and cunning women possessed far greater knowledge of birth control than
licensed practitioners.
Although Walker asserts that the
Inquisition’s persecution of popular healers with the active assistance of
medical professionals was the result of the medical doctors desire to rid
themselves of competition, he stresses that it was also a way of the medical
profession introducing Enlightenment ideas into the general community. The
Faculty of Medicine at the University of Coimbra, the centre of medical
instruction in Portugal, where doctors were taught, was controlled by Jesuits
whose core beliefs were antagonistic to Enlightenment views. As a result of
religious domination, the medical curriculum had not changed for three
centuries with forward thinking physicians unable to instigate enlightened
reform. There, doctors were taught in the old fashioned way based upon Galen.
Enlightenment views entered the country via New Christians, by then living in
France and England, specifically London. In order to establish a conduit for
modern medical ideas into the community, that is materialism and empiricism,
doctors collaborated with the Inquisition to obtain power and to direct
oppressive measures against their medical rivals, practitioners of folk
medicine, and by so doing establishing science as the chosen medical method of
god.
New hospitals:
religion and politics.
As hospitals were probably more harmful
than beneficial to health, [8]it
seems that the use of medical services then as now was for a variety of
economic, social and emotional reasons outside of falling ill and the desire
for treatment. Hospitals appear to have been used extensively, but in some
European countries mainly for the dispossessed with curable illnesses (Valgarda,
1998), and mainly males in their twenties. They were primarily for the poor
who had no one to care for them. In this, hospitals throughout Europe early
simulated class structures, with the Upper Classes making decisions, the
Middle-Classes providing treatment, and the working or poorer classes receiving
treatments. In most of Europe, with the exception of Britain, hospitals were
mainly initiated, set up and overseen by governments. As most European states
held that large, healthy populations aided the production of wealth, it was
considered that the treatment of illness was essential for the state’s cultural
and economic health. Added to this, large armies had become the norm, therefore
state survival depended upon preserving the health of young men. Control of the
poor, a form of domestication, was another reason for the popularity of
hospitals.
United Kingdom:
According to Wilson (page 9), the Bills of
Mortality indicate not only the effects of improved environments but also of
medicine. He bases his judgement on the introduction of inoculation,
specifically for Smallpox, and the competitive establishment of hospitals
during the period of the late 17th century until 1750[9].
By 1745, general hospitals existed throughout the UK. In that year Guy’s
Hospital, St. Georges and Middlesex were all established in London. Although
blood-letting was still employed, in marvellous contradiction of Harvey’s
discoveries on circulation of blood, from the end of the 17th
century there were new cures for malaria, guanine from the bark of the Cinchona
tree from South America.[10]
Wilson identifies three types of voluntary
hospital. London general hospitals, provincial general hospitals, and London
specialist hospitals. None of the central drivers of these innovatory
institutions were physicians but subscribers, those who volunteered their
wealth to set up institutions. Subscribers appointed physicians and also
recommended prospective patients for admission. The initiative for each hospital
was entrepreneurial, a small group of subscribers gathering together to set up
an institution, with only one established by a doctor who then, it seems,
obtained financial backing.
According to Wilson, the original idea was
to infuse the Poor Law with Christian charity, medical practice based on relief
and care, not cure. It proceeded, like a number of societies and projects of
this period, from a coffee house. Wilson, in addition, demonstrates that the
model for these hospitals was based on the Society for the Promotion of
Christian knowledge, which had begun in 1698, also with four founders. Wilson
describes the founders as High Tory, closely involved with the Church of
England.
The founding of a number of workhouses
appears connected to the establishment of hospitals for religious and political
reasons. In Bristol, where a city workhouse was founded in 1696[11]described
by Mary Fissell as the result of ideological aspects of Interregnum approaches
to poor relief (page 7) and Low Church interest in the reform of manners.
Hospitals she describes as serving as arenas for the negotiation of social
power between elites. The Infirmary in Bristol embodied concepts of the
relationship between rich and poor, according to the dominant and male elite
who perceived themselves as stewards of the poor. It was nevertheless based
upon the reforming nature of the Bristol workhouse, concerned with improving
the behaviour and manners of the poor (Fissell, page 74). It involved therefore
a measure of gentrification.[12]
Its charitable duties were of greater concern than its medical care, and originally
doctor’s had limited power. The notion, still prevalent in modern day
hospitals, that all inhabitants of a hospital must abide by a strictly imposed
regimen within a structured environment appears to have come from medieval
monasteries, [13]certainly those which
engaged a physician and an infirmary for both monks and local villages.
Founded by John Elbridge, The Infirmary
was under the control of its committee, mainly Quakers and city merchants. It was funded also by subscribers, who paid
two guineas a year, allowing them to recommend one inpatient and two
outpatients at a time. Within hospitals, based upon notions of power being
negotiated within their walls, medical men gradually assumed the power of the
elite groups, often members of the aristocracy in other provincial hospitals,
who established these charitable institutions. [14]
The abiding rational for available
treatment was that only the deserving poor should benefit. That, as we have already seen, meant
those who worked and exhibited stable lives and behaviour. Its charity was not
to be dispensed randomly but only where it would do the most good. Assessments
and cures of the body, requiring close observations were necessary, involving
different processes from the workhouse. A hospital setting also enforced
passive and mannerly acceptance of charity, medical care, controlling demanding
behaviour, and established a clear relationship between ‘giver and getter’ (Fissell, page 77). From its inception, The
Infirmary, targeted on the working man, was concerned with returning
individuals to daily work, increasing the city’s wealth and the wealth of the
hospital’s benefactors, in effect, making, in the words of John Cary, a Bristol
Merchant, who established the workhouse,
“Multitudes of people serviceable who are now useless to the nation.”
The Infirmary accepted patients only
once their clothes were clean, thereby, according to Fissell (page 82),
simulating the deserving poor. Once inside, patients could not play dice or
cards, nor were they permitted to smoke. After breakfast, surgeons and their
pupils and apprentices made their rounds, tending to dressings and cleaning
wounds. Although Mary Fissell notes that the culture within The Infirmary
simulated ideas of primitive Christianity, it also appears to have replicated
nunneries and monks, with the apparently purposeless regimentation.
The growth of medical power within The
Infirmary appears to have followed a similar route to elsewhere, as in part the
consequence of doctor’s changed relationship to the body, whereby it was seen
as a machine, not harbouring a soul and the dignity that goes with such a
concept. Also, teaching became an essential part of the institution. In 1740
Joseph Shapland was apprenticed to the hospital apothecary, who was in charge
of the day to day running of the hospital. During the second half of the 18th
century, surgeons brought in apprentices and pupils.
The increased number of medical
practitioners throughout the century gradually altered hospital culture,
allowing for increasing domination by medical staff with professional rather than
charitable motivations, although lay people remained in overall charge. A
further consequence of the gradual rise of The Infirmary as an educational
facility, becoming by the 1770s the de facto centre of surgical education in
the city, was that many sons of the gentle folk went into The Infirmary to
train, and not into private practice. The Infirmary surgeons after all enjoyed
a constant supply of raw material to work on, thereby improving their skills.
The bodies of dead patients underwent autopsies, allowing greater understanding
of the body’s mechanisms. From 1728, burking increased, whole corpses or parts
of corpses taken away to be dissected.
The development and evolution of walled
facilities aided the development of physicians, from laissez faire operators to
that of an organised group with a fixed and powerful group identity. The ideal
of a super-efficient, all-knowing, scientific-minded physician was forged
within these medical monasteries separated from the rest of the community.
Here, medical treatment was contained and ideas of medicine, treater, treatment
and patient formed.
Monasteries and
Workhouses:
Hospitals of the 18th
century were informed by workhouses and monasteries. On the one hand containers
for human bodies, and on the other bodies to be cared for. Separation and
segregation emerged as an element of medical treatment, with that treatment
removed from both the community and those lay people who practised community
medicine. Although in medieval times hospitals were not solely about providing
medical care, also offering spiritual care, nevertheless the physician’s
practice was separate from areas of worship, with medical care and patients
segregated. As early as the ninth century a monastery consisted of an infirmarium
for monks, a paupers hospital, where pilgrims could also find shelter and care,
a place for guests, a leprosarium and a hospital for novices and nuns
(Lindemann, 2010). In later hospitals, the segregation was complete with
illness removed more and more from the general community.[15]Although
the medicalization model asserts that care not cure was the abiding role of
early hospitals, such a position tends to ignore the actual treatments on
offer. Before medicine became fixated on place, medical personnel were not
immediately identifiable, posing, in a way, also as priests and nuns
(Lindemann, 2010.) There was not until much later clear hierarchical structures
in place, with patients occasionally working as physicians or nurses.
Certainly, 18th century
hospitals made their mark on medical organisation and character, but also
created the patient. They were separate from the general community, often by
walls with gates. Beds, often used for more than one patient at a time, were
arranged in rows for the celebration of Mass and other religious occasions.
Within such institutions, physicians acquired greater power and control over
their patients, and also patients had less choice in their treatment.
Man-midwifery/accoucheur:
As during this period ‘accord
between patient and practitioner was broken as medical men arrogated
interpretations of the meaning of illness to themselves’ (Fissell, page 172), and sanctity and
ownership of the body became disputed, the further colonisation of health was
demonstrated by the rise of male mid-wives and the further exclusion of women
from medicine. Lindemann (2010) sees this process as one begun in the Middle
Ages, see previous papers, it increased during the 18th century and
formed part of the masculinisation of midwifery. The invention of obstetrical
forceps by Englishman Peter Chamberlen the Elder allowed his family to deliver
babies who might otherwise have died. Midwives were banned from using
instruments but nevertheless probably did (Lindemann, 2010). Contrary to
popular belief amongst both medical historians and laypeople, the rise of
man-midwifes was not, according to Lindemann, a consequence of male
colonisation of medicine, although that had been going on for centuries, but in
order to supervise and control women practitioners. Throughout the 18th
century many women remained as authorities in midwifery, such as Madame de
Coudray and Sarah Stone, who produced textbooks and generally acted as erudite
physicians attending lectures and exhibiting theoretical sophistication in
obstetrics.
Afterthought:
The above developments must be viewed
alongside actual practices, otherwise it all takes on an unnatural tinge, with
professional rhetoric posited once again as reality. The text forming ‘An 18th Century Physician’s
Notebook’ demonstrates, according to the editors, the day to day practices
of an unknown physician active in the early 18th century, influenced
by Sydenham (1624-1689), who believed in bedside observation of patients not
dogma, and Hermann Boerhaave (1668-1738), an influential physician of the time
who believed that sickness was caused by an imbalance of bodily fluids and the
excitation of fibres within it. He considered that the human body resembled a
machine, perceiving health in terms (Porter) [16]of
hydrostatic equilibrium. The editors
consider the unknown author of the handbook to have been a modernising exponent
of his profession. Nevertheless, as a physician he advocates bloodletting and wood soot for the treatment of pleurisy,
with references to alchemy for the treatment of Suffocating Catarrh,
bloodletting and mercury advised for continued hoarseness, and sulphur and
turpentine offered for impotence. These are just a few examples and do not
clearly indicate a scientific approach, whereby treatment and cures are
synthesised.
Such methods reflect the premise that
sickness is cured by stimulation and trauma, authorised and legitimised by the
physicians of the day. Clearly, the fact that many failed to work on the
various symptoms did not stop their use. Illnesses once identified were
accompanied by an identified cure, often passed down through generations, which
when established were rarely altered. Proportions were often the only part of
the treatment subject to change. The curative effects of sulphur, once defined,
encouraged sulphur to be administered for a number of illnesses that simulated
previous identified illnesses for which sulphur could be used. Usually, a
number of treatments and compounds were employed together. Formulae were created,
their efficacy established by the toxicity and invasive nature of the
ingredients. As I will demonstrate, this is often the case in modern medicine,
where formulae overwhelms observation and reason. Ideal bedside behaviour (Porter, 1999 page
257), how the physician appeared and behaved, was, as now, an essential part of
treatment.
Although Porter (1999) shows that
religion, magic, salves, prophylactics and remedial practices were commonly
used by the general population in the 18th century he fails to
acknowledge that these cures were also used by physicians. People made up their
own remedies, or used folk healers, preferring the experience of an elderly
woman, for example, than an inexperienced physician. Physicians cast their
cures under the magic of learning and science, investing toxic compounds with
non-existent curing capacities, occasionally (Cockayne, Stow 2012) through the
prism of alchemy. Day to day medicine remained in the hands of cunning men and
women and family members. Many of the
treatments they offered were, I suspect, effective.
Advancements
in medical treatment: from medieval times to the Enlightenment. From ignorance
to science. 
Bloodletting, involving venesection, was
employed by Galen for fever, either as a result of yellow bile, black bile or
phlegm (which Galen called cacochymia) or from blood excess (Plethora). It
continued to be extensively used until the well into the 19th century.
According to Porter (1999, page 313), it was employed by Broussais, chief
physician of the Paris Val de Grace military hospital, for everything in his
dispute with peers who localised pathological anatomy. He used leeches. His
disciple, Bouillard (1796-1881) continued this treatment, often, like his
master, to excess.
While nowadays we consider the above
practice pointless and often dangerous, many famous figures, such as Byron,
bemoaning their early deaths as the consequence of this treatment, it seems
mysterious that it lasted so long. While it may not have helped in fevers, it
certainly tipped many into the grave. I believe that this kind of professional
blindness remains with us, not just in medicine. Physicians believed that
bloodletting was beneficial, as they had been trained to believe so. In this
instance, evidence to the contrary counted for nothing. Bloodletting was an
essential part of the medical practice of surgeons and physicians, which often
set them apart from other healers. While it fitted in with the belief in a
single source for all illnesses, a large degree of wishful thinking was
involved, a flawed understanding of cause and effect existed then as now,
devolved upon medical authority. Patients’ improvement would have been seen and
recorded in changes in skin colouring, for example, or in other superficial
physical aspects. As these were held to denote a patients’ progress, although
there was no clear evidence of this, the treatment was considered advantageous.
We therefore have here a particular kind of knowledge, one that is not based on
evidence but on professional authority entwined with ancestor reverence. This
knowledge relies on material evidence being ignored or/and a different kind of
evidence, peer-reviewed if imasginary, fulfilling the requirements of cause and
effect.
Power.
Physicians were gaining greater power as a
consequence of the centralisation of authority within European states. In
France, many became servants of the King, in Britain they assumed managerial
roles within hospitals, in Portugal they acquired power through association
with the inquisition, and in the German states through again becoming an arm of
government. In addition, they marketed
their importance through identification with science, even though they failed
in most instances to practise the new intellectual discipline with their
patients. Most medical innovations came on the back of Harvey’s discovery and
were often variations of his breakthrough. In many instances their treatments
appear little more than combinations of magic and alchemy. The colonisation of
sickness by physicians reflected the groups developing sense of managerial
efficiency compared to the sloppy behaviour of lay healers, no matter how
experienced. The man-midwife, or accoucheur,
were after all graduates who had access to equipment. These reasons gave
impetus to physician’s involvement in child birth, as many claimed that
mid-wives required supervision.
Physicians diagnosed through the five
senses-feel the pulse, sniff for gangrene, taste urine, listen for breathing
irregularities and observe skin and eye colour (Porter, 1999 page 256).
Physical examination was unusual and diagnosis depended on ‘interpretation of
the patient’s own ‘history’ (Porter, 1999, page 257). In the early part of the
18th century, medical advances concerned patient/physician
interaction. Understanding of sickness
remained confined to personal factors such as diet and lifestyle, which was
often evident in the lives of the rich, whom physicians mainly treated, but
less so amongst the poor. Many of their patients suffered from gout, which was
recognised as a consequence of excess (Porter, 1999, page 258). Apparent change
was the order of the day, with physicians acquiring considerable power, while
actual medical practice moved crab-wise
[1]
Porter and Porter, 1989.
[2]
Barry, Jonathan, Publicity and the Public Good: Presenting Medicine in
Eighteenth-Century Bristol. Ed.Bynum, Porter. Medical Fringe and Medical
Orthodoxy. 1750-1850. 1987. Croom Helm. The writer declares: ‘No hard and fast lines are evident between
fringe and orthodoxy in the areas of therapeutic efficacy, choice or remedial
methods, or involvement in trade and marketplace.’
[3]
The medical enlightenment of the eighteenth century. Ed. Cunningham, French.
Cambridge University Press. 1990.
[4]
King, Lester Snow. The Philosophy of Medicine. Harvard University Press. 1978.
[5]
Geyer-Kordesch, Court Physicians and State Regulation in Eighteenth Century
Prussia: The emergence of medical science and the demystification of the body. Ed.
Bynum, W. F, Porter, Roy. Medicine at the Courts of Europe, 81500-1837.
Routledge. London and New York. 1990.
[6]
German medical education in the eighteenth century: the Prussian context and
its influence. Bynum, Porter. William Hunter and the eighteenth-century
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[7]
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