The Day the Universe Changed - James Burke [95]
It is often said that the miracle of modern medicine is best exemplified by the number of old people alive today. Thanks to medical advances the percentage of the population over the age of retirement will shortly exceed those young enough to work. Every day, it seems, a new discovery extends life.
The real miracle, however, is that the rising population of the industrial nations has not suffered from a major epidemic since the last century. The modern world supports millions who come into close contact with each other every day, in offices and shops, on public transport, in crowded streets. Each one of us is a potential source of wholesale death, but through medicine and pharmacology any explosive spread of disease is stopped before it begins.
Medication prevents minor symptoms from developing into serious and contagious conditions which could threaten the community at large because of the overcrowded and confined demographic circumstances in which we live today. Sophisticated public health measures maintain overall control of the situation. All this is possible only because we attack disease at source by striking at the micro-organism which causes it.
Only two hundred years ago the view of disease was radically different. Then, each individual’s illness was a unique condition, to be treated as the patient’s situation demanded. One of the doctors in an eighteenth-century French play, Le Malade imaginaire, summed it up thus: ‘The trouble with people of consequence is that when they’re ill they absolutely insist on being cured.’It was this control by the patient of the doctor’s efforts in eighteenth-century Europe that prevented an already ignorant community of physicians from making any scientific headway.
Medical theory at the time had advanced little beyond the system worked out by the second-century Alexandrian, Galen. Some improvements had been made in the sixteenth and seventeenth centuries which improved anatomical knowledge: the circulation of the blood, for example, and very primitive theories of respiration. But virtually none of the other general scientific advances of the period were reflected in medicine.
The late eighteenth-century pharmacy of Michael Schuppach. His success in diagnosing ailments by analysis of urine made him famous throughout Europe, bringing as many as a hundred cases a day to his rustic Swiss laboratory.
Disease was viewed as a generalised condition of the whole body deriving from a lack of balance among the essential elements of the human constitution, the four humours - blood, phlegm, choler and black bile. These humours controlled different aspects of the character of the individual and were a subdivision of the general cosmogony in which everything was made up of earth, water, air or fire. Normal health was defined as a balance among the four humours.
As there was no way of viewing the inside of the living patient, medicine relied on a series of taxonomic systems, listing conditions according to their exterior symptoms. These were the only data available to the doctor for use in his diagnosis. Medicine consisted of phenomenological disease lists and speculative pathology based on guesswork. Disease was seen as a single entity, manifesting itself in different symptoms according to which part of the body it struck, in which person and under which circumstances. It was thought therefore that there must be some single irreducible first cause for disease. Patients might have an underlying predisposition to ill-health, since each individual had a unique pattern of bodily factors which the doctor was supposed to identify. The body was a microcosm, obeying its own laws of growth and decay, comparable to the macrocosm revealed by Newton in the previous century. For these reasons the practice of medicine was hopelessly confused. Doctors sought a cure for disease which would cure all symptoms.
The remedies for this ‘disease’were at best idiosyncratic and at worst dangerous. In a Clinical Guide of 1801 published in Edinburgh remedies included digitalis, crabs’eyes,