A few doctors dared to undermine their income by spreading a knowledge of preventive medicine. Dr. John Arbuthnot of London, in an Essay concerning the Nature of Ailments (1731), argued that diet would do almost all that medicine could accomplish. He anticipated later complaints in a treatise, The Cost of Preserving Health (1744). The instruction of medical students improved slowly, with the Italian universities (Padua, Bologna, Pavia, Rome) still in the lead, and with Vienna, Paris, and Montpellier following; but even in these there were only four or five professors. Each teacher collected fees for his own course, and issued tickets of admission, sometimes on the back of playing cards.27 Certain hospitals now began to teach clinical medicine. Legal practice of medicine, or of midwifery, required a diploma from an accredited institution.
Just as Georg Stahl’s theory of fire as “phlogiston” dominated chemistry in the century before Lavoisier, so his concept of “animism” dominated medicine. Rejecting Descartes’ view of the body as a mechanism, Stahl pictured the soul as an immaterial principle of life molding the body as its instrument. Consequently (he held) nature, in the form of this life force, is the chief agent in curing disease; sickness is an effort of the anima to re-establish the normal tone, operation, and harmony of disordered organs; heightened temperature and quickened pulse are means that nature uses to overcome disease; a wise doctor will rely chiefly on such processes of auto-detoxication, and will be reluctant to administer drugs. Stahl left unanswered the question of the cause that produced the disorder. One answer was given by Marcus Antonius Plenciz, who in 1762 revived Athanasius Kircher’s conception of disease as due to infection by a microorganism; for each disease, said Plenciz, there is a particular invading organism, with a definite period of incubation. This remarkable prevision of the germ theory left no mark on eighteenth-century therapy, and had to be revived a second time in the nineteenth century.
Some new methods of diagnosis were advanced. Stephen Hales advocated the measurement of blood pressure; Leopold Auenbrugger introduced percussion of the chest as a way of detecting fluid in the thorax. Two Scots, George Martine and James Currie, developed the use of the clinical thermometer.
Drugs, surgery, and quackery competed for the money of the patient. Bloodletting was still the standard panacea; one physician calculated in 1754 that forty thousand deaths were caused each year in France by excessive withdrawal of blood.28 Toward the end of the century protests mounted, and found an effective voice in Wolstein’s Annotations regarding Venesection (1791). Drugs multiplied. The official London Pharmacopoeia of 1746 discarded prescriptions made of spider webs, unicorn horns, and virgin’s milk, but it retained theriac, crab’s eyes, wood lice, vipers, and pearls as forming curative mixtures. The Pharmacopoeia of 1721 gave official standing to paregoric (containing opium), ipecac, tartar emetic, spirit of sal volatile, and other new drugs; the edition of 1746 added valerian, sweet spirits of niter, and “balsam” (tincture of benzoin); the edition of 1788 sanctioned arnica, sarsaparilla, cascarilla, magnesia, tincture of opium … Castor oil came into use in modern Europe about 1764, arsenic toward 1786; colchicum was introduced for gout in 1763. William Withering, a Shropshire lad, learned from an old granddame that foxglove (digitalis) is good for dropsy; he earned a niche in medical history by discovering its usefulness in ailments of the heart (1783). Many reputable physicians made and sold their own drugs, and charged rather for their prescriptions than for their visits. “Proprietary medicines”—from secret and patented formulas—made some individuals rich. So England absorbed tons of “Stoughton’s Elixir,” “Betton’s British Oils,” “Hooper’s Female Pills,” and Ching’s “Worm Lozenges.”
Quacks were an appealing element in the medical scene. “Count” Alessandro di Cagliostro, whose real name was Giuseppe Balsamo, sold an elixir of long life to wealthy ninnies in several lands. “Chevalier” Taylor, armed with his cataract needle, proposed to cure any disorder of the eyes; Gibbon and Handel heard him hopefully. Joanna Stevens persuaded Parliament to pay her five thousand pounds for divulging the secret of her cure for the stone; when her recipe was published (1739)it proved to be a compound of eggshells, snails, seeds and soap; and in each of the cases which she claimed to have cured, stone was found in the bladder after death.
The most famous quack of the eighteenth century was Franz Anton Mesmer. The thesis that earned him a doctor’s degree at Vienna (1766) renewed the old claim of astrological influences on man; these he explained by magnetic waves. For a time he tried to cure diseases by stroking the affected parts with magnets; later, having met a priest who seemed to cure merely by laying on of hands, he discarded magnets, but announced that an occult force dwelt within him, which could be transmitted to others under financial stimulation. He opened an office in Vienna, where he treated patients by touching them—as kings had done for scrofula, and as faith healers do today. The police declared him a charlatan, and ordered him to leave Vienna within forty-eight hours. He moved to Paris (1778), and began afresh by publishing a Mémoire sur la découverte du magnétisme animal (1779). Patients came to him to be “mesmerized”; he touched them with a wand, or stared into their eyes until he produced a semihypnotic submission to his suggestions; in this hypnotizing process his ugliness was a terrifying asset. He set up magnetic tubs (baquets) containing a mixture based on hydrogen sulfide, and provided with iron projections which the patients touched as they joined hands with one another; to make the cure more certain Mesmer himself touched each in turn. His patients included the Marquis de Lafayette, the Duchesse de Bourbon, the Princesse de Lamballe, and other persons prominent at court. Louis XVI offered him ten thousand francs if he would reveal his secret and establish a Magnetic Institute open to all; he refused. Within six months he took in 350,000 francs.29 In 1784 the Académie des Sciences appointed a committee, including Lavoisier and Franklin, to investigate Mesmer’s methods. Its report admitted some of his claims and cures (especially of minor nervous ailments), but rejected his theory of animal magnetism. The French Revolutionary government denounced him as an impostor, confiscated his tempting fortune, and banished him from France. He died in Switzerland in 1815.
In London James Graham opened (1780) a “Temple of Health” on Mesmer’s principles, but with improvements. He provided a magical wedding bed for married couples, which was guaranteed to ensure beautiful offspring; he rented it at a hundred pounds per night.30 His assistant as “Goddess of Health” in his procedures was Emma Lyon, destined, as Lady Hamilton, to hypnotize Lord Nelson himself.
Confused by the proliferation of quacks and their miraculous cures, both the public and the medical profession took nearly all of the eighteenth century to accept prophylactic inoculation as a legitimate form of therapy. The transfer of weakened virus from a smallpox-infected human being to another person to make him immune to smallpox had been practiced by the ancient Chinese.31 For the same purpose Circassian women pricked the body with needles touched with smallpox fluids. In 1714 a communication from Dr. Emanuel Timoni, read before the Royal Society of London, described “the procuring of the smallpox by incision or inoculation, as it has for a long time been practiced in Constantinople.”32 In a letter sent from Constantinople on April 1, 1717, Lady Mary Wortley Montagu wrote:
The smallpox, so fatal, and so general amongst us [British], is here [made] entirely harmless by the invention of ingrafting.… Every year thousands undergo this operation … There is no example of anyone that has died of it. You may believe that I am very well satisfied of the safety of the experiment, since I intend to try it on my dear little son.33
The boy, six years old, was inoculated in March, 1718, by Dr. Charles Maitland, an English physician then in Turkey.
In 1721 a smallpox epidemic spread through London, proving especially fatal to children. Lady Mary, who had returned from Turkey, commissioned Dr. Maitland, also repatriated, to inoculate her four-year-old daughter. Three prominent doctors were invited to see how little the future Lady Bute was disturbed by the results. They were impressed, and one of them had his son inoculated. Lady Mary propagated the idea at court. Princess Caroline agreed to have it tested on six criminals who had been condemned to be hanged; they submitted on a promise of freedom if they survived; one suffered a mild attack of the disease; the others showed no ill effects; all six were released. In 1722 the Princess had the operation performed on the orphan children of St. James’s Parish, with complete success; in April she had it performed on two of her daughters. Acceptance of inoculation spread among the British aristocracy, but the death of two inoculated persons in their households arrested the movement and gave a hold to the opposition. One critic complained that “an experiment practiced only by a few Ignorant Women … should on a sudden, and upon slender Experience, so far obtain in one of the Politest Nations in the World as to be received into the Royal Palace.”34 Lady Mary felt the stab, and published an anonymous “Plain Account of the Inoculating of the Small Pox by a Turkey Merchant.” Most English physicians rejected inoculation as unsafe, but in 1760 Robert and Daniel Sutton introduced inoculation by puncture, and reported that in 30,000 cases they had had 1,200 fatalities—four per cent. As late as 1772 Edward Massey, an English clergyman, preached against “the dangerous and sinful practice of inoculation,” and stood stoutly by the old theological view that diseases are sent by Providence for the punishment of sin.35 (Perhaps, like many old religious doctrines, this could be profanely rephrased: disease is often a punishment for ignorance or negligence.)
Other countries took up the idea. In America Dr. Zabdiel Boylston, during the sixth epidemic of smallpox in Boston, inoculated his son (1721), and performed 246 additional inoculations despite an excited opposition that threatened to hang him. Most of the Puritan clergy defended him and shared the obloquy brought upon him.36 Benjamin Franklin and Benjamin Rush gave their influential support to the inoculation movement in Philadelphia. In France the Regent Philippe d’Orléans, with his usual courage, led the way by having his two children inoculated. The Faculty of Medicine at the University of Paris opposed the practice till 1763. Voltaire, in his Lettres sur les Anglais, praised Lady Mary’s campaign, noted the universality of the practice among the Circassians, and ascribed it to the monetary value of beauty: “The Circassians are poor, but have handsome daughters, who accordingly are the principal article of their foreign trade. It is they who furnish beauties for the seraglios of the Grand Seigneur and the sufi of Persia, and others who are rich enough to purchase and maintain these precious commodities.”37 An Italian physician, Angelo Gatti, spread the inoculation experiment in France, and Théodore Tronchin in Switzerland. Catherine the Great and Grand Duke Paul of Russia had themselves inoculated on the urging of Voltaire (1768); and in that year Jan Ingenhousz inoculated three of the imperial family in Vienna.
All these experiments, using smallpox serum from a human being, left much dissatisfaction, for the rate of mortality from inoculation, though down to four per cent, was still disagreeably high. An English surgeon, Edward Jenner, noticed that dairymaids who had contracted cowpox (a relatively mild disease) rarely contracted the often fatal smallpox. About 1778 he conceived the idea of conferring immunity to smallpox by inoculating with a vaccine made from a pox-infected cow (vacca is Latin for cow). This had already been done by a Dorset farmer, Benjamin Jesty, in 1774–89, without attracting the attention of the medical world. In May, 1796, Jenner performed vaccination by inoculating James Phipps with cowpox pus. In July he inoculated the same boy with smallpox virus. The boy did not develop smallpox. Jenner concluded that cowpox vaccine gave immunity to smallpox. In 1798 he published his epochal Inquiry into the Cause and Effects of the Variolae Vaccinae (variola was the medical name for smallpox), reporting his twenty-three cases, all successful. Subsequent experiments were so convincing that in 1802 and 1807 Parliament granted Jenner thirty thousand pounds to extend his work and improve his procedure. Smallpox, which for centuries had been one of the major scourges of human life, thereafter rapidly diminished its incidence, until today its occurrence in Europe and America is almost always due to the infection of unvaccinated persons by the importation of the virus from countries where inoculation is not practiced.