IV. SPECIALISTS

The medical art was becoming so complex with increasing medical science that it budded specialties. Gynecology was not yet a separate devotion, but obstetrics was now a distinct skill, and passed more and more into male hands. Feminine modesty still preferred trained midwives where these were available, but several royal mothers in childbirth set the example of accepting the ministrations of men. William Smellie led the way in England with his studies in the mechanism of labor and the use of the forceps-studies brought together, after thirty years of experience, in his classic Midwifery (1752).

Ophthalmology made a significant advance with operations for cataract by William Cheselden (1728) and Jacques Daviel; the latter originated (1752) the modern treatment of cataract by extraction of the lens. In 1760 the first bifocal spectacles were made, for Benjamin Franklin and apparently at his suggestion. We shall find Diderot studying the psychology of blind persons, and suggesting that they might be taught to read by touch; perhaps in collusion with him Rousseau (it is said) proposed embossed printing for the blind.38

Otology progressed through the use of the catheter for cleansing the Eustachian tube (1724), through the first successful operation for mastoid (1736), and through the discovery of an elastic fluid in the labyrinth of the ear (1742). Giacomo Rodríguez Pereira of Spain, having fallen in love with a deaf-and-dumb girl, devoted himself to developing a sign language using only one hand; the Abbé Charles Michel de l’Épée improved silent chatter with an ambidextrous alphabet, and dedicated his life to the education—even to the maintenance—of his pupils.

The treatment of the insane became more humane with the decline of the old theological view—held by Bossuet and Wesley—that insanity was a diabolical possession allowed by God as a punishment for guilt inherited or acquired. In the Narrenthurm (Fools’ Tower) at Vienna the inmates were on view to paying sightseers like animals in a menagerie. The Bethlehem (“Bedlam”) Hospital for Lunatics was one of the showplaces of London, where, for a fee, the public might gaze upon madcaps tied by chain and iron collar to the wall. In the HÔtel-Dieu at Paris the insane were treated with cruelty or negligence by underpaid and overworked attendants. Still worse were private asylums, which could be persuaded to accept for incarceration sane persons delivered to them by hostile relatives.39 Various drugs or devices were used to cure or quiet the victims— opium, camphor, belladonna, bleedings, enemas, or a mustard plaster on the head. Some specialists thought that a sudden douche of cold water could mitigate melancholia; others recommended marriage as a cure for insanity. The first modern move toward a saner treatment of insanity was made by the Quakers of Pennsylvania, who established asylums where the condition was treated as a disease. In 1774 Grand Duke Leopold I of Tuscany founded in Florence the Ospedale Bonifazio, where, under the direction of Vincenzo Chiarugi, a scientific approach to the problem was inaugurated. In 1788 the French government appointed a commission to reform the care of the insane. The chairman, Philippe Pinel, had begun as a divinity student, had changed to philosophy, and had imbibed the humanitarian ethics of Voltaire, Diderot, and Rousseau. In 1791 he published his Traitémédico-philosophique sur l’aliénation mentale, a milestone in modern medicine. In 1792 he was made medical director of the Bicêtre, one of the largest asylums in France; two years later he was advanced to the still larger Salpêtriére. After many appeals to the Revolutionary government he received permission to strike off the chains from his patients, to release them from their cells, and to give them fresh air, sunlight, exercise, and progressive mental tasks. This was one of many triumphs of secular humanitarianism in the most agnostic of centuries.

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