by Will Durant
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 Philadelp
hia. 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.
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.
V. SURGERY
Next to the development of inoculation into vaccination, the most substantial advance in eighteenth-century medicine was in surgery. The old tie with the barber’s art survived till 1745 in England, but in France it was ended by Louis XIV. (The barber’s red-and-white-striped pole, symbolizing a bloody bandage, still recalls his surgical past.)
In 1724 Louis XV sanctioned the creation of five chairs of surgery in the Collège de St.-Côme at Paris. The Faculty of Medicine at the University of Paris protested against exalting surgery to such dignity; the physicians, decked out in their red scholastic robes and preceded by a beadle and an usher, marched to St.-Cóme, where a lecture on surgery was in process; finding the door locked, they tried to break it open, and shouted imprecations against surgeons as upstart barbers; but the crowd that had assembled turned upon the physicians and drove them away. In 1731 Georges Maréchal and François de La Peyronie secured a royal charter to found the Académie de Chirurgie (Academy of Surgery); and in 1743 the King issued an ordinance freeing the surgeons of France from union with the barbers’ guild, and requiring a college degree as prerequisite to surgical practice. Henceforth a surgeon could look a physician in the face.
A similar development took place in England. In 1745 the surgeons were formally separated from the barbers, and it was made a penal offense to practice surgery in or near London without examination and licensing by a committee of master surgeons; the Royal College of Surgeons, however, was not officially chartered till 1800. In Germany, before Frederick the Great, surgery was mainly in the hands of barbers, executioners, and strolling unlicensed practitioners who set bones, couched cataracts, bound up hernias, and cut out stones. In the army—which was Prussia’s pride—the surgeon was called Feldscherer, field cutter, because his functions included serving as barber to the officers. But a Collegium Medico-Chirurgicum was opened in Berlin in 1724.
Most of the great surgeons of the eighteenth century were French. Jean Louis Petit invented the screw tourniquet, and made improvements in amputations and herniotomy. Dide
rot, in The Dream of d’Alembert, made the famous physician Théophile de Bordeu describe an operation on the brain by La Peyronie. Jean André Venel of Geneva founded surgical orthopedics (1780). In England William Cheselden developed the lateral operation for stone (1727) to a point hardly improved upon since,40 and boasted of having performed one lithotomy in fifty-four seconds. English surgery became a science when John Hunter established it on the basis of sound anatomy and physiology. He experimented on animals to find substitutes for operations often fatal in man. In 1786, having discovered, in the case of a buck, that collateral blood vessels can continue the circulation when passage through a main trunk is arrested, he saved the life of a man suffering an aneurysm of the leg by tying the artery above the swelling and relying upon the surrounding parts of the body to absorb the contents of the tumor. This operation has saved countless limbs and lives.
John Hunter’s name stands high also in the development of dentistry. In seventeenth-century England this art was mostly left to tooth pullers, who cried out their arrival and displayed strings of teeth as their coat of arms. In 1728 Pierre Fauchard proclaimed dentistry a branch of surgery, in his treatise Le Chirugien dentiste. But Hunter was the first to apply scientific methods to the study of teeth. He introduced their classification as cuspids, bicuspids, molars, and incisors; he devised appliances for correcting malocclusion; and he was the first to recommend complete removal of the pulp before filling a tooth. He summed up his views in his Natural History of the Human Teeth (1771).
