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The XVIII century and the Medecine

Straddling two eras, eighteenth-century medicine sought to combat ignorance and superstition and establish the foundations of a body of knowledge based on experimentation.

Aided by biology, chemistry and physics, medicine used the practice of auscultation to take a new approach to patients, analysing their individual circumstances and classifying observed diseases into different categories.

The patient’s hygiene, diet, dwelling, clothing and working conditions were all scrutinised by Enlightenment thinkers, the political authorities, the Church and the newly organised medical profession.

The use of water for preventive or even therapeutic purposes, efforts to combat epidemics, recognition of the hazards of bad air, plus the diffusion of knowledge via the Encyclopédie were to transform man’s relations with society.

Health is better than wealth

God who sent the affliction sends the cure

Healing comes from faith

A saint who does not heal has few pilgrims

Sage saves

Mint washes away all ills

The herb veronica snubs the doctor

Physician, heal thyself

Fever and gout leave the doctor in doubt

The doctor orders a bath when he can find no other path


THE GREAT SECRET

Human self-expression varies according to the society in which people – body and mind – dwell.

The corset – a quintessentially feminine object of symbolic significance – is a powerful, painful and emotion-laden expression of social subjugation, of the primacy of appearance, and of the desire to repress intimacy. The impact of all three on bodies and minds had to be gradually discarded in a process that continued well beyond the eighteenth century.

The abandonment of the corset – which compresses the ribs, forces the shoulders back and brings the shoulder blades together – was recommended by doctors from the 1750s, and became a temporary reality during the French Revolution. This was thanks to vigorous scientific propaganda, but also in response to a new collective fervour inspired by the concepts of liberty and equality.

As old thinking was discarded, a body made of flesh and bones was thus revealed, and the abandonment of the corset mirrors this process.


THE DECLINE OF THE CORSET

Medicine, fashion and commerce

FASHION PREVAILS

The quest for eternal youth, the negative effects of a style of dress which held the body in a tight grip from birth to adulthood with swaddling, garters, laces, corsets and shoe-buckles, and the penchant of the affluent classes for a highly codified form of artificial make-up, led some doctors to speak out vehemently against the arbitrary whims of fashion.

THE GRIP OF COMMERCE

This fantastical and extravagant way of life was partly sustained by the development of a ‘medical’ trade based on self-medication, charlatanism and patent remedies, advertisements for which filled the newspapers.

A SOCIETY OF APPEARANCES

In a society founded on appearance, certain accessories such as hats, spectacles or walking sticks were worn or carried mainly for show, and only sometimes for practical reasons.

Fainting fits, also known as hysterical crises, were another fashionable phenomenon so widespread that scholars wondered whether they were physical afflictions, mere acting or all in the mind.

This [ointment] is a dangerous poison, when its action lies inside the body; and its malignancy can be seen even on the body’s exterior, spoiling the eyesight and the teeth (…) and causing wrinkles earlier than they would naturally appear.

Savary des Brûlons J., eighteenth century.

Scarcely is the infant released from his mother’s womb (…) than he is swathed, and laid on the bed, with his head fixed, his legs extended, and his arms handing down his sides (…)

(…)Well it is for him, if he be not confined so as to prevent him from breathing, and if the precaution has been taken of laying him on his side, to the end that the water that he must discharge by the mouth may run out of itself! Rousseau J.J., eighteenth century.

In the spring of 1793, an epidemic of short-sightedness affected young bachelors of good birth who wished to avoid conscription, and launched the fashion for spectacles. Thanks to medical certificates issued by conniving doctors, their dereliction of duty thus passed for the effect of a physical affliction.

Le Chapelier I., eighteenth century

Hats are more necessary and need to be warmer in winter than in summer; it makes more sense to wear them at night than during the day, and in poor weather than in fine. (…) It is often hazardous to wear other people’s hats.

Macquart J.,eighteenth century.

The vapours for women and hypochondria for men are favourite afflictions today … a woman will arrange her illnesses much as she does her ribbons, assigning one day for migraine, another for dizziness, and invariably resting in bed on these days. Her dressing table is all at once laden with waters of all kinds, and her chamber full of anxious-looking people. It is quite a spectacle.

Caraccioli L.A., eighteenth century.


BETWEEN HUMOUR, ALCHEMY, RELIGION and EXOTICISM

Medicine: a ‘learned’ heritage…

THE THEORY OF HUMOURS

The medical accessories that best symbolise the previous centuries are probably the enema syringe or clyster; the glass flask used for the inspection of urine, or matula; leeches; and the scarificator, used to pierce the skin for blood-letting. Their purpose was to evacuate the excrement and bad blood that were held to be responsible for diseases. At this time, illnesses were treated either by counterbalancing the qualities of the humour held to be responsible for the condition, or by driving it out. Thus a patient afflicted with melancholy – the dry, cold humour – was given wet, hot remedies. This was based on the theory of the four humours: sanguine, phlegmatic, melancholic and choleric.

FROM ALCHEMY TO CHEMISTRY

From the sixteenth century onwards, nearly a thousand years of practical experimentation in the laboratory – using equipment such as retorts, alembics, and crucibles –culminated in alchemists, doctors and apothecaries working together on the notion of the ‘pure body’ and enunciating the principle of a universal remedy. This prepared the way for chemistry.

‘EXOTIC’ MEDICINE

Increasing contacts with other parts of the world and colonisation added further to the medical heritage of the Old World through the scientific input of the Arabs, the introduction of drugs from the New World and the appearance of exotic products through trade. In the West, tea from China was used against the gout, headaches and respiratory problems, while opium became an indispensable remedy for severe pain.

THE PRESENCE OF RELIGION

Religion, which had occupied a central place in people’s lives for centuries, sustained the afflicted in their search for a cure. The huge quantity of ex-votos – offerings in thanks for a recovery – found in churches and the wide range of depictions of the Virgin Mary are evidence for this. The carrying of prayers or vows on the body in little pouches – devotional scapulars – encouraged and protected believers seeking healing.

Next spring, Monsieur will be bled from his arm and purged, and will then take broth to which will be added the legs of half a dozen frogs, followed by goat’s milk diluted with a barley decoction.

Montagne, eighteenth century.

Among all substances, there are three which give each thing its body: sulphur, mercury and salt. If these three things are combined, they form a body. The vision of interior things, which is secret, belongs to doctors.

Paracelsus, sixteenth century.

She steeps it as we do and then fills the cup more than half-full of boiling water. She considered making me vomit. This, she says, cures her of all her ailments.

Mme de Sévigné, seventeenth century.

The doctor said that he would return the next day, and that although he had undertaken to deliver her in three hours if she were possessed, yet he promised nothing if she were mad. The mother said she was sure he would deliver her, and she thanked God for having granted that she should see a saint before dying.

Casanova G., eighteenth century.


THE SCIENCES PROGRESS

The penetration of medicine

THE IMPORTANCE OF INSTRUMENTS

Many seventeenth- and eighteenth-century scholars took an interest in instruments, in laboratory experiments, in the natural sciences, and in chemistry and physics.

Medicine benefited greatly from their discoveries, such as the action of air on living bodies; the use of light in the acquisition of knowledge; the impact of electric currents on animals and humans; phenomena associated with heat; and advances or experiments relating to digestion and reproduction in animals and humans.

THE CLASSIFICATION OF ILLNESS

Gradually, the very concept of illness began to change, as did the way doctors viewed their patients. The work of classifying plants and animals into species had a profound impact on scientists. Applied to medicine, attempts to classify diseases represented an important new stage in the history of the discipline, as it marked a break with the theory of humours.

IMPACT ON SOCIETY

But medicine also found expression in the heart of fashionable society. The famous Leyden jar turned electricity into a hot topic, and the aristocratic salons were the scenes of spectacular demonstrations during which the hope of therapeutic treatments involving static electricity was first conceived. Public dissection sessions in anatomical theatres were introduced, captivating not just students but the general public too.

Military campaigns and expeditionary voyages also offered doctors and surgeons an opportunity to develop new techniques through the experience they gained on the battlefield and in remote lands. The medical sector was beginning to organise its knowledge.

Whenever some novelties in physic appear, curiosity takes them up at first and has its fill of amusement by them, but is soon satisfied. It gives way to interest, and it is expected that the things that have been admired will be useful.

Abbé Nollet, eighteenth century.

Let a person seriously and accurately consider the phenomena which accompany such a fever: the time of its onset, the course it follows, the shivers and feeling of cold, the profuse perspiration with which it ends…Now putting all this carefully together, we find reasons for believing that this disease is a species equally cogent with those that we have for believing a plant to be a species. The plant springs from the earth; the plant blooms; the plant dies: the plant does all this with equal regularity.

Sydenham T., seventeenth century.

What people went to see in the anatomical theatres was consistent with the ordinary events of everyday life. The spectators hovered between disgust, pleasure and the crudest fantasies. Thus the desire that drew the crowds to executions also attracted them to the anatomical show: the desire for cruelty and fear, for experiences on the limits of the bearable and excessive sensations, but also powerful curiosity, the desire to know what the insides of our bodies are made of.

Beier R. (on…), twenty-first century.

The war and electricity are the subject of conversations these days.

Journal de Trévoux, eighteenth century.


MIASMAS AND IRIS POWDER

Medicine and collective hygiene

AIR, WATER AND CONTAGION

During the eighteenth century, a profound shift in attitudes led the authorities to regard miasmas – the foul air from confined spaces and sewage – as one of the main causes of major epidemics. The plague is a good example of a contagion – a disease spread through close personal contact – spreading quickly in particular due to the fleas present on clothes and unwashed skin.

HYGIENE BECOMES ESSENTIAL

In order to protect people’s health, great efforts were therefore made to purify the water: sewerage systems were introduced, public places were cleaned, houses were ventilated, people began to wash themselves and their clothes, prisons and hospitals were cleaned up and cemeteries were relocated outside cities. Hygiene had become essential, and society ensured that it was put into practice.

BACK TO NATURE

It was in this context that the idea emerged of returning to nature, and of the benefits of wholesome waters and a balanced diet. Rooms and boudoirs were scented with floral perfumes. Doctors adjusted diet to the patient’s temperament, sea-bathing was fashionable and ‘taking the cure’ at thermal springs or spas led to a widely practised form of aristocratic tourism in Europe. The town of Spa is one of the finest relics of this period. At the same time, sales of bottled mineral waters grew substantially.

A CRUCIAL DISCOVERY

Despite this, death remained a palpable presence. Towards the end of the century, an English doctor observed that milkmaids who had touched infected cow’s udders did not contract smallpox during periods of epidemics. By introducing pus from cowpox pustules in the human body as a vaccine, doctors were able to protect those at risk of catching the disease by the principle of inoculation. This was the start of vaccination, which was to be one of the greatest advances of the 19th century.

Quite apart from the cemeteries, is it any wonder that the air is tainted? The houses are foul-smelling, and their occupants live in perpetual squalor. Each one has stores of corruption in his house; an infected vapour rises from this multitude of cesspools. Emptying them at night spreads infection through an entire neighbourhood.

Mercier L.S., eighteenth century

At the first rays of morning, I left the nest of vermin. After complaining a little of all the sufferings I had endured, I asked her for a shirt, since the one I had on was hideous with the stains from the lice. She told me that shirts were changed only on Sunday …

Casanova G., eighteenth century.

Whey is purgative, diuretic, thirst-quenching and mildly nourishing. It may be used for serious illnesses and constitutes a treatment in its own right.

Lasonne J.M.F., eighteenth century.

I took the waters this morning, my dearest. How nasty they are…

One goes to the fountain at six o’clock. Everyone is there, one drinks and one pulls a hideous face, because, can you imagine, the water is boiling and has a most disagreeable taste of saltpetre. (…) I must have drunk twelve glasses of it by twelve o’clock. They purged me somewhat, which is what one wishes. I shall take a shower in a few days.

Mme de Sévigné, seventeenth century.

Mineral waters make more cuckolds than they heal sick people

Patin G.,seventeenth century.

Poor Bettina was so covered with this pox that by the sixth day her skin could no longer be seen. Her eyes closed, all her hair had to be cut off, and we despaired of her life when her mouth was found to be full of spots (…)

Casanova G., eighteenth century.

If you want a wife who will never have smallpox scars, marry a milkmaid.

Saying, eighteenth century.


ACTIONS AND REMEDIES

The medical professions

SELF-TREATMENT WITH THE CHURCH

The use of portable medical dictionaries and of village remedies grew. These enabled the sick to act swiftly when no doctor was present. From this viewpoint, the parish priest and nuns played a vital role in spreading knowledge, supporting families and maintaining the faith through popular traditions. The supernatural phenomena associated with miraculous healings also drew large crowds. At the Saint-Médard cemetery in Paris, pilgrims and sick people were seized with supernatural convulsions and spasms on the tomb of a deacon who was regarded as a saint.

BETWEEN CITY AND COUNTRYSIDE

Doctors were few in number, and their work remained difficult in the eighteenth century. They were learned men who could speak Latin and wrote extensively, but they did not explore the bodies of sick people. Based in large cities, they left the paupers and peasants to the hands of the bone-setters and village wise women, or of travelling healers who employed unscientific traditional practices. For these charlatans or ‘tooth-pullers’, annual fairs and festivals were an opportunity to spread their name.

SPECIALITIES

Surgeons were less wealthy and less highly educated. They took care of external ailments, dressing wounds, setting fractures, performing amputations, perforating the skull – trepanning – making incisions in eyes and palpating tumours...They regarded as essential the knowledge derived from experience and from their organisation into a guild – like their precursors, the barber surgeons, who kept shop and fitted wigs …

REMEDIES

There were many different kinds of medicine, and they were presented in many different forms too, depending on whether they were of plant, mineral or animal origin. In addition to its casks, earthenware pots and instruments, the pharmacy was a popular social spot where the apothecary (nuns in the case of hospital pharmacies), his assistants and patients bustled about constantly.

The exorcist took out his pocket ritual and the stole which he put round his neck, then a reliquary, which he placed on the bosom of the sleeping girl, and begged all of us to fall on our knees and to pray, so that God should let him know whether the patient was possessed or only labouring under a natural disease.

Casanova G., eighteenth century

All doctors shall live by the dictates of reason. None shall visit charlatans. Professional secrecy shall be strictly guarded. All prescriptions shall be written in Latin, signed and dated. They shall bear the name of the sick person.

Extract from statutes of 1751

Bone-setters are rough countryfolk who first of all take it into their heads to mend fractures and dislocations in animals. Gradually, they extend their ambitions to people, and if they succeed, they shout everywhere that they have received a gift from God.

‘Medical anarchy, or medicine considered as harmful to society’, eighteenth century

Against all strong fevers: grind garlic with saffron, place it between two cloths, and wrap it around the ring finger on the left hand

‘New collection of the finest secrets of medicine’

The rights of apothecaries are infringed not just by surgeons and druggists, but also by religious, hospitallers and nuns. In all convents in towns and cities alike are to be found pharmacies containing more drugs than would be needed to kill all the monks in a province.

‘Medical anarchy, or medicine considered as harmful to society’, eighteenth century


WHISPERING SWEET NOTHINGS

Love, sex and medicine

IN WRITING

Sexuality in the past was a delicate subject because it belonged to the sphere of intimacy. For couples, marriage could be either a source of genuine love, or a cause of frustration in the case of a marriage of convenience.

Novels from this time tend to be full of stories and engravings of all kinds – by turns endearing, racy or downright pornographic.

PREVENTION

Despite this, the eighteenth century saw the spread of certain practices which were a prerequisite for social progress, in particular relating to efforts to combat venereal diseases using preventive accessories such as the bidet and the contraceptive. Libertines, who were large-scale consumers of condoms, also used them to prevent their partners from becoming pregnant.

THE ORIGINS OF LIFE

The question of the origins of life was also at the centre of medical preoccupations. If diminutive pairs of linen trunks were put on frogs, it did not stop them from mating but it did prevent them from reproducing. What, then, was the secret of impregnation? Who was who, what was the biological difference between men and women, and what place was there for human deviancy and more specifically for hermaphrodites?

GIVING LIFE

At the same time, the desire to improve childbirth conditions developed: the first objective was to save mother and child, and then to stop treating childbirth as a matter for fatalism, to train midwives by organising teaching sessions using cloth models, and to disseminate knowledge and spread the use of suitable instruments via surgeons, in particular forceps.

MEN AND WOMEN: DIFFERENT AT TIMES

Certain illnesses specific to the patient’s sex were also associated with surgical practices at this time. These were lithotomy – an operation involving the extraction of stones from the bladder – and mastectomy – the removal of the breast. The idea arose of a link between certain illnesses and the work people did. Thus breast cancer was believed to be common in nuns, who abstained from sexual relations …

The fact was that she was in a state of advanced undress and so was I. In fact my hand was still where she didn't have anything, and she had put hers where the same thing could not be said of me.

Denis Diderot, eighteenth century.

The technical word is balls… Testicles is the fancy term. These balls contain the reservoir of this abundant seed which I have just spoken of, the ejaculation of which into the woman’s womb produces the human species; but we shall not be greatly concerned with these details, which are more a matter of medicine than of debauchery. All a pretty girl needs to concern herself with is fucking and never fathering.

Marquis de Sade, eighteenth century.

I must enclose myself in a piece of dead skin to prove that I am alive.

Casanova G., eighteenth century

One of these women, being taken by surprise one day by birth pangs, wanted to call to some of her neighbours through the window; she gave birth at the window and dropped the child to the floor; to this accident she added a second, namely to return from the window to her bed, pulling the poor child by the cord across the room without the least discomfort.

Mauquest de la Motte G., eighteenth century

This priest remained fistulous for six months. He is currently in the clear, but he has a connection between his rectum and his bladder so that some of his excrement passes by the route taken by his urine, and some of his urine leaves via his anus.

Hego (anon.), eighteenth century


SOME AILMENTS AND WORDS

I was born almost dying.

Jean-Jacques Rousseau


THE GREAT SECRET

By the end of the eighteenth century, with its weaknesses and contradictions, medicine looked different, thanks to scientific advances and the retreat of religion. The intellectuals of the Enlightenment in their writings developed the critical spirit and trained the intelligence in new ways of thinking. They gradually transformed society. Man cast aside his prejudices and became aware of his body and the impact of his lifestyle on his mode of functioning.

Body and mind were laid bare by science. Riddles, mysteries and supernatural interpretations were all shattered. The body was stripped and guillotined – both literally and figuratively. The acquisition of knowledge now proceeded by reason. As François Quesnay, the French doctor and economist, put it: Reason is to the soul what eyes are to the body: without eyes one could not enjoy light, and without light one could see nothing.

It is perhaps light – the light of the Age of Enlightenment – that is the eighteenth century’s great secret.


The XVIII century and the Medecine

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