X. MEDICINE

The strongest stimulus to the biological sciences came from the needs of medicine. Botany, before Ray, had been the handmaiden of pharmacy. Health was the summum bonum, and men, women, and children sought it through prayers, stars, kings, toads, and science. One physician, before prescribing, “went to his closet to pray,” says Aubrey, 67 so that at last “his knees were horny” with orisons. Astrology still took a hand in medicine; the surgeon in ordinary of Louis XIV advised that the King be bled only in the first and last quarters of the moon, “because at this time the humors have retired to the center of the body.” 68 Defoe thought that the money spent upon quacks would have paid off the national debt. 69 Flamsteed, the astronomer royal, traveled miles to have his back stroked by the famous quack Valentine Greatrakes, who proposed so simply to cure scrofula. Perhaps Flamsteed was among the 100,000 whom Charles II touched for scrofula—the “King’s evil.” In the one year 1682 the complaisant ruler touched 8,500 sufferers; in 1684 the press to get to him was so great that six of the sick were trampled to death. William III refused to go on with the play. “It is a silly superstition,” he exlaimed when a crowd besieged his palace. “Give the poor creatures some money, and send them away.” On another occasion, when he was importuned to lay his hand on a patient, he yielded, but said, “God give you better health and more sense.” The people denounced him as an infidel. 70

Defects of personal hygiene and public sanitation co-operated with the resilient ingenuity of disease. Prostitution spread syphilis in cities and camps. It was especially rife among actors and actresses, as we gather from a subtle story in Mme. de Sévigné of “a player who, being resolved to marry though he labored under a certain dangerous disorder, one of his companions said to him, ‘Zounds! can’t you wait till you are cured? You will be the ruin of us all.’” 71 The French general Vendôme appeared at court without a nose, having sacrificed it to the spirochetes. 72 Cancer was on its way; Mme. de Motteville describes a cancer of the breast. 73 Yellow fever was first described in 1694. Smallpox was especially widespread in England; no cure was yet known for it; Queen Mary died of it, and Marlborough’s son. Epidemics, particularly of malaria, ran through whole countries; in 1657, reported Thomas Willis, almost all England was a hospital treating malarial fever. 74 Plague devastated London in 1665, killed 100,000 in Vienna in 1679, and 83,000 in Prague in 1681. 75 Occupational diseases increased with industry: Bernardino Ramazzini, professor of medicine at Padua, issued in 1700 a classic treatise, De morbis arttficum, on the damage done to painters by the chemicals in their paint, to workers in colored glass from antimony, to masons and miners from tuberculosis, to potters from vertigo, to printers from eye troubles, to physicians from the mercury they applied.

Amid ignorance and poverty the science of medicine slowly advanced. The thirst for money hampered the profession; some doctors who had made successful cures refused to reveal to other doctors the treatment they had used. 76 The medical members of the Royal Society rose above this greed, and zealously shared their discoveries with their fellows. There were now good medical schools, led by those at Leiden, Bologna, and Montpellier; and generally a degree from a recognized institution was required for the legal practice of medicine in Western Europe. The teachers of the art continued their division into two schools of treatment. Borelli defended “iatrophysical” therapy, proposing to deal with diseases as derangements of the body’s mechanism. Sylvius, developing the arguments of Paracelsus and Helmont, advocated the “iatrochemical” method of using drugs to counteract disturbances in the “humours” of the body; most of these, he thought, were due to hyperacidity. More fruitful than these general theories were discoveries in the causes of specific diseases; so Sylvius first described tubercles in the lungs, and related these morbid growths to consumption.

One of the most basic discoveries of this age was the work of that remarkable Jesuit, Athanasius Kircher of Fulda, mathematician, physicist, Orientalist, musician, and physician, and apparently the first to use the microscope in investigating disease. 77 With this aid he found that the blood of plague victims contained numberless “worms” invisible to the naked eye. He saw similar animalcules in putrefying matter, and ascribed putrefaction and many diseases to their activity. He reported his findings in Scrutinium pestis(Rome, 1658), which first stated in explicit terms what Fracastoro had only suggested in 1546—the doctrine that the transfer of noxious organisms from one person or animal to another is the cause of infectious disease. 78

Medical treatment lagged behind medical research, for those who excelled in research tended to form a class distinct from those who practiced, and their communication was imperfect. Some medieval cures were still prescribed. Aubrey records an untimely success: “A woman . . . endeavored to poison her husband (who was a dropsical man) by boiling a toad in his potage; which cured him; and this was the occasion of finding out the medicine.” 79 Some new drugs entered the pharmacopoeia in the second half of the seventeenth century: ipecacuanha, cascara, peppermint . . . Dutch physicians, favoring Dutch commerce, prescribed tea as almost a panacea. 80

Two Dutchmen were the greatest medical teachers of the age: Sylvius and Boerhaave, both at Leiden. Hermann Boerhaave taught chemistry, physics, and botany as well; students came to him from all northern Europe; and he raised the status of clinical medicine by taking his maturer pupils with him on his daily rounds of the hospital beds, instructing them by direct observation and specific treatment of each individual case. His works were translated into all major European languages, even Turkish; his reputation reached to China itself.

In England clinical medicine had its finest exponent in Thomas Sydenham. After two stays at Oxford, separated by terms of service in the army, he settled in London as a general practitioner. With little theory and much experience, he came to his philosophy of disease, which he defined as “an effort of nature striving with all her might to restore the health of the patient by eliminating morbid matter.” 81 He distinguished “essential” symptoms as those caused by the foreign substance, and “accidental” as those caused by the body’s resistance to it; so fever is not an illness but a device of the organism in its self-defense. The problem of the physician is to help this process of defense. Hence Sydenham praised Hippocrates because the “Father of Medicine”

required no more of art than to assist nature when she languished, and to check her when her efforts were too violent. . . . For this sagacious observer found that nature alone terminates distemper, and works a cure with the assistance of a few simple medicines, and sometimes even without any medicines at all. 82

Sydenham’s distinction lay in recognizing that each major disease has many varieties; he studied each case with its clinical record, in order to diagnose the special form of the disease involved; and he adjusted the treatment to the specific differences of the ailment. So he separated scarlatina from measles, and gave it its current name. He was known to his profession as “the English Hippocrates,” because he subordinated theory to observation, general ideas to particular cases, and drugs to natural cures. HisProcessus Integriremained for a century the English practitioner’s manual of therapy.

Surgery continued to struggle for recognition as a reputable science. Its ablest representatives found themselves pressed on either side by the hostility of physicians and the envy of barbers—who still performed some minor operations, including dentistry. Guy Patin, dean of the faculty of medicine in the University of Paris, could not forgive surgeons for assuming the dress and manners of the medical profession, and he denounced all surgeons as “a race of evil, extravagant coxcombs who wear mustaches and flourish razors.” 83 But in 1686 the surgeon Félix operated successfully upon Louis XIV’s fistula; the King was so pleased that he gave Félix fifteen thousand louis d’or, a country estate, and a patent of nobility. This elevation raised the social status of surgeons in France. In 1699 surgery was decreed to be a liberal art, and its exponents began to assume a high rank in French society. Voltaire called surgery “the most useful of all the arts,” and “the one in which the French excelled all other nations in the world.” 84

English surgery, however, had at least two credits in this age: in 1662 J. D. Major made the first successful intravenous injection in man, and in 1665–67 Richard Lower succeeded in transfusing blood from one animal into the veins of another; Pepys noted this latter event in his diary. 85 From that private gossip sheet we gather that operations were usually performed with only feeble anesthetics or none: when Pepys was operated on for stone in his bladder he received no chloroform and no antiseptics, but only “a soothing draught.” 86

Satires of the physician continued as in every generation. People resented his fees, his pompous dress in gown, wig, and conical hat, his grandiloquent speech, and his sometimes mortal mistakes. Boyle said that many people feared the doctor more than the disease. 87 Molière’s caricatures of the great profession were for the most part the good-natured fun of a man who nevertheless took care to keep on amiable terms with his physician. After all darts had been thrown it remained that the seventeenth century had seen a creditable advance in medical science through a hundred discoveries in anatomy, physiology, and chemistry, that the international exchange of medical knowledge was increasing, that notable teachers were sending out able pupils to all parts of Western Europe, that surgery was improving its methods and status, that specialists were developing greater knowledge and skill, and that more measures were being taken to promote public health. Municipal governments legislated sanitation. In 1656, when plague appeared in Rome, Monsignor Gastaldi, papal commissioner of health, made mandatory the cleansing of streets and sewers, the regular inspection of aqueducts, the provision of public facilities for the disinfection of clothing, and the requirement of health certificates from all persons entering the city. 88 As wealth rose, men built sturdier houses that could keep rats at a respectful distance and so reduce the spread of plague. Better supplies of water—the first necessity of civilization—enabled the willing body to be clean. For more and more people it was becoming physically possible to be civilized.

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