The Day the Universe Changed - James Burke [96]
Although doctors were gentlemen, qualifying as physicians at Oxford or Cambridge where the course lasted six years, they were not, in general, drawn from the aristocracy. Many of them imitated their aristocratic patients in wild clothing and stylish manners. Their overblown vocabulary was spiced with the Latin tags used by their superiors with a classical education. As soon as a doctor made any money he bought land, in order to progress up the social ladder.
A medical career flourished or foundered according to the relationship the doctor managed to strike up at the bedside. It was for this reason vital for any doctor to compete successfully with others who might be called to replace him in his highly lucrative position. For these very good reasons he presented himself as a man wrestling with the forces of nature, triumphing over disease by his skill and ‘curative powers’through the use of heroic and secret remedies known only to him. This free market in physicians’services and remedies produced much expensive and vituperative advertisement, in which one doctor would claim that all other doctors were quacks and their remedies ill-advised and dangerous.
A wide number of competing and mutually exclusive theories of illness and therapy flourished. The more exotic the approach, the more the patient would feel he was benefiting from personal treatment. The patient had the ultimate veto on diagnosis or treatment, and his own view of what was wrong with him was the basis on which curative measures were recommended. Hypochondriasis was the most commonly diagnosed ailment in the eighteenth century. Each patient regarded his own suffering as unique, and demanding unique remedies.
The two faces of eighteenth-century medicine. Left, the doctor who spends time and money healing the poor. Right, the more typical profiteering quack, who takes a side of bacon from patient without the cash to pay him.
In this ‘bedside’era of medicine little scientific progress was made, thanks to the competitiveness and lack of interchange of experience and ideas among doctors. Professional advancement depended on the successful recommendation of such dubious aids’as patent stomach brushes or electro-medico-celestial beds or life-generating cordials, which remained jealously guarded secrets of the trade. Any real research pursued by individual practitioners remained unshared, but for the most part research was regarded as irrelevant anyway.
The only group of medical practitioners who made routine observations on the anatomy was the surgeons, who were classed as manual workers and, as late as 1745, were still ranked socially with barbers. Surgeons were not permitted to attend patients and never mixed with physicians, so their anatomical knowledge was rarely of use to the sick. Dissection was permitted only on the poor and destitute, from whom no profit was to be gained, so little interest was taken in their diseased corpses. As one of the great doctors of the day in England, Thomas Sydenham, said, the job of the doctor was ‘to cure disease and do naught else’. No secrets were shared, no common advances made.
The self-taught French country surgeon wields his scalpel. In the eighteenth century, this was the only medicine available to the majority of the population. Note the instruments in a pouch at his waist and hooked in his hat for ease of access.
The women’s ward at St Luke’s hospital for the insane, London, 1800. Untypically, beds are being cleaned and made. The most fashionable treatment of the day was the new electric shock therapy.
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