Western Civilization_ Volume B_ 1300 to 1815 - Jackson J. Spielvogel [265]
The World of Medicine
In the eighteenth century, medicine was practiced by a hierarchy of practitioners. At the top stood the physicians, who were university graduates and enjoyed a high social status. Despite the scientific advances of the seventeenth and eighteenth centuries, however, university medical education was still largely conducted in Latin and was based primarily on Galen’s work. New methods emphasizing clinical experience did begin to be introduced at the University of Leiden, which replaced Padua as the foremost medical school of Europe in the first half of the seventeenth century, only to be surpassed in the second half of that century by Vienna. A graduate with a doctorate in medicine from a university needed to receive a license before he could be a practicing member of the physicians’ elite corporate body. In England, the Royal College of Physicians licensed only one hundred physicians in the early eighteenth century. Only officially licensed physicians could hold regular medical consultations with patients and receive payments, already regarded in the eighteenth century as outrageously high.
Below the physicians were the surgeons, who were still known as barber-surgeons well into the eighteenth century from their original dual occupation. Their primary functions were to bleed patients and perform surgery; the latter was often done crudely, without painkillers and in filthy conditions, because there was no understanding of anesthesia or infection. Bleeding was widely believed to be beneficial in reducing fevers and combating a variety of illnesses.
The surgeons underwent significant changes in the course of the eighteenth century. In the 1740s, they began to separate themselves from the barbers and organize their own guilds. At the same time, they started to undergo additional training by dissecting corpses and studying anatomy more systematically. As they became more effective, the distinction between physicians and surgeons began to break down, and surgeons were examining patients in a fashion similar to physicians by the end of the century. Moreover, surgeons also began to be licensed. In England, the Royal College of Surgeons required clinical experience before granting the license.
Other medical practitioners, such as apothecaries, midwives, and faith healers, primarily served the common people in the eighteenth century. Although their main function was to provide herbs and potions as recommended by physicians, apothecaries or pharmacists also acted independently in diagnosing illnesses and selling remedies. In the course of the eighteenth century, male doctors increasingly supplanted midwives in delivering babies. At the same time, the tradition of faith healing, so prominent in medieval medicine, continued to be practiced, especially in the rural areas of Europe.
Hospitals in the eighteenth century seemed more a problem than an aid in dealing with disease and illness. That conditions were bad is evident in this description by the philosophe Denis Diderot, who characterized the Hôtel-Dieu in Paris, France’s “biggest, roomiest, and richest” hospital, in these words:
Imagine a long series of communicating wards filled with sufferers of every kind of disease who are sometimes packed three, four, five or even six into a bed, the living alongside the dead and dying, the air polluted by this mass of unhealthy bodies, passing pestilential germs of their afflictions from one to the other, and the spectacle of suffering and agony on every hand. That is the Hôtel-Dieu. The result is that many of these poor wretches come out with diseases they did not have when they went in, and often pass them on to the people they go back to live with.13
Despite appeals, efforts at hospital reform in the eighteenth century remained ineffectual.
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