The Day the Universe Changed - James Burke [97]
However, as the eighteenth century ended, various factors combined to bring about improvement in medical science. To begin with, the new political fashion was to regard England, with its rising population, burgeoning industrialisation and urban growth, as the ideal model. In a strongly mercantilist atmosphere it was felt that national strength lay in numbers. The bigger the population, the wealthier the country.
In emerging nations the emphasis began to switch to health. If the population were to be capable of working productively in the new factories, then ‘the health of a nation [ was] the wealth of a nation.’In Prussia, under Frederick II an enlightened despot capable of effecting speedy reforms, order was brought to medical confusion. As early as 1764 Wolfgang Rau introduced the idea of a state health policy, arguing his case from the economic point of view. The state, he claimed, needed healthy subjects so as to succeed in war and peace, so it should legislate against quackery and develop administrative skills to enforce such legislation. Public health was an economic resource to be safeguarded, therefore the education and competence of doctors should be a matter for regulation.
’How merrily we live, that Doctors be. We humbug the public and pocket the fee.’
Johann Peter Frank of Vienna was the first great practical exponent of the new approach. As a hospital administrator, clinician and teacher, he travelled extensively throughout Europe, teaching at Pavia, Vienna and Vilnius in Lithuania. In each country he worked for the absolute rulers of relatively small states who wanted the means to control the productivity of their populations.
Frank produced his major work in the years following 1790. It was principally directed at administrators rather than the medical profession. The series of seven volumes, which bore the general title of A System of Medical Police, was translated into the principal European languages. In it Frank concentrated on the public aspect of health. His despot rulers wanted to be able to supervise even the most personal of their subjects’activities. Frank provided them with the means to do so.
Since increase in the population was keenly desired, Frank included guidelines on everything from procreation to marriage. He advised that women should stay in bed during and after childbirth, with state support for up to six further weeks. Great attention was given to child care, the policing of schools, lighting, heating and ventilation regulations. Frank included detailed programmes for the state provision of food, the distribution of which would be supervised at every stage from field to mouth. Housing, sewage, garbage and water supply were also to be controlled.
Frank dealt with the roots of the problem, medicine and the general environment. Poverty should be rooted out, he said, and the doctors forced to undergo new kinds of training, in hospitals. Here they should learn practical medicine with live patients, follow cases through, and carry out post-mortems. Teaching and practice should go hand in hand, so there should be provision in the hospitals for many students to be at the same bedside, for having many patients of mixed sex and age, and for treating the maximum variety of illnesses. Treatment should be prescribed, observation should continue through convalescence and, above all, the practice of regular dissection after death should be established. The motto Frank put on the cover of his great work was ‘To serve and magnify the state’.
Further advance in Germany was to be forestalled by events in France. By the late eighteenth century European philosophy was dominated by the