Eighteenth Century

In the occidental world, the Enlightenment created an optimistic outlook concerning the role and bene­fits of medicine. Most contemporary thinkers be­lieved that health was a natural state to be attained and preserved.

Among the requirements of national power per­ceived by European authorities was a healthy and expanding population. Greater emphasis was placed on environmental health, infant and maternal wel­fare, military and naval hygiene, as well as mass treatment of the poorer sectors in newly erected hospitals and dispensaries. Absolutist governments established systems of “medical police.” These orga­nizations were responsible for establishing and im­plementing programs, such as that designed by the German physician Johann P. Frank, to monitor and enforce public and private health regulations from cradle to grave. In Britain, private philanthropy substituted for governmental action in matters of health. Although frequently utopian in its goals, the medical police movement created greater aware­ness of the social and economic factors conducive to disease. In turn, physicians and reformers were suc­cessful in establishing charitable institutions for care of the sick, including mothers and children. Needy ambulatory patients were seen in dispensa­ries and polyclinics. Although often crowded and a source of contagion, such establishments provided shelter, food, and a modest medical regimen de­signed to manage illness.

Efforts to control smallpox focused on a practice popular in the Orient: smallpox variolation.

On the theoretical front, the eighteenth century became the age of medical systems in the Western world. It was clear that a synthesis of the isolated physical and chemical discoveries of the preceding century into a comprehensive system would be neces­sary to provide a rationale for and guidance to clini­cal activities. Spurred by success in the physical sciences, especially Newton’s formulation of the laws of gravity, physicians set out to establish principles governing the phenomena of health and disease. Such efforts were as old as medicine itself. However, new models of anatomy and physiology based on Vesalius’s dissections and Harvey’s experiments, cou­pled with chemical and microscopic findings, de­manded placement into an updated scaffolding.

Most eighteenth-century Systematists tended to be prominent academics. As teachers and famous practitioners, they zealously promoted and defended their creations, fueling bitter controversies within the medical profession. System building conferred status and a mantle of intellectual respectability conducive to patient patronage and separation from quacks. Among those who adhered to mechanical concepts in explaining clinical events were the Dutch professor Herman Boerhaave of Leyden and the German Friedrich Hofimann of Halle. By con­trast, a colleague of Hofimann, Georg Stahl, tried to remedy the apparent inadequacies of iatromecha- nism by postulating the existence of a vital princi­ple, a soul or “anima,” capable of harmoniously di­recting all mechanical activities in the body and thus ensuring organic unity.

Efforts to classify diseases were intensified. Nosology, the systematic division of disease entities, prospered side by side with similar taxonomic efforts directed at plants and animals. Physicians such as Carl von Linne (Linnaeus), Boissier de Sauvages, and Cullen established complex classification sys­tems designed to bring order to the myriad symptom complexes found at the bedside as well as to provide guidelines for treatment. Unfortunately, these sys­tems remained highly subjective and dependent on the clinical experience of the nosologist who pro­duced them. Greater accuracy and uniformity were achieved as bedside experiences were linked to struc­tural changes observed at postmortem dissections, an approach pioneered by the Italian physician Gio­vanni B. Morgagni but not fully implemented until decades later in France.