Lots of rival camps.  No unity.

Boerhaave:  bedside teaching, Leiden, chem
Hales: iatromechanics, expts.
Stahl: animism
Hoffman: mechanism
de Sauvages: midground
John Hunter: vitalist
La Mettrie: extreme materialist

more anatomy, Sommerring; Wolff,
Naturphilosophie

• pneumatic chemistry and respiration
• Cavendish, Black, Priestley, Lavoisier
• Beddoes Institute

Medicine in Practice

• men of letters, philanthropists, improvers
• E. Darwin, JC Lettsom
• Bedside care
• W. Heberden
• 1761 Auenbruegger and percussion  Inventum novum
• History still more important than 5 senses.

The Study of Disease

Fothergill, Lind, Dobson;
Cheyne; Tissot
Piecemeall advances, with fundamentals remaining contentious.
 contagion  and miasma;   practical concerns >> theoretical

Scottish Enlightenment

Wm Cullen, theory/framework of nervous irritability
Nosology
de Sauvagbes, and Cullen
fevers: typologies.
Cullen: foremost teacher of his age
John Brown, Brunonian medicine

Pathology

Origins of new aproach tht would be transformative:

• Morgagni, 1761, De Sedibus
• localism [organs]
• Baillies 1793.
• Bichat 1799
• localism: organs -->
• tissues.
• the doctrine of tissues.
•   disease: local.

Therapeutics
 

• blood letting, and mercury; not much change.  Good air, travel, spas, waters growing popular.
• Increasingly medication centered
• but few drugs did much good; some dropped, some new good ones added, like castor oil, zinc oxide, paregoric
• Willow bark, 1763 ff
• Digitalis, 1783 ff
• Hahnemann: homeopathy

Insanity

• new science, metaphysics, and neuroanatomy: new ideas.

• moral management
• institutions for treatment.
• disciplined order and resocialization.

Male midwife grad replace female midwifery, save in Germany, Italy, Spain.
Upper class women > and > birth at home with male physician.
By 1730, all have obstet forceps.

Prevention of Smallpox
Wortley Montagu, inoculation; [Mather-Boston trial]; Maitland trial 1721.  Popular.  Dangers.
Jenner, 1798.

Surgery

• some improvements, but still no major internal operations;
• lithotomy : lateral cystotomy: 1 minute!!
• cataract
• anal fistula
• more and more formal education
• screw tourniquet Petit
• 1794 French ed reform
• infirmary as major site of trauma, emergency treatment
• John Hunter: superb expt, anatomy

Medicine and the People

Religion, magic, signatures, home remedies, home health manuals, “Kitchen physick”  Patent medicines, Quacks, entrepreneurs, Joanna Stephens;
more and more regulation:  career of Mesmer and animal magnetism

Medicine, State and Society: the Profession and its Institutions
 

• elite - acad - state powers; lower - apprenticeship.
• schools, licensing,
• country to country variations.
• German speaking very systematic, and hierarchical in Prussia, Habsburg Empire.
• England: free market, little regulation.  RCP a gentleman’s club in 18e.
• Leiden and Edinburgh the star med schools.
• Rise of private anatomy schools [England] and hospitals as teaching institutions of great importance.

More and more public health: Frank’s medical police
Lind and scurvy
1754 World’s first clinical trial.

specialist institutions:

Disease and the Larger Picture

 slavery and spread of disease
 yellow fever
 Industrial revolution
 Malthus

“Enlightenment medicine made few positive advances, but it became the basis of a new materially based science of man, an anthropology in the widest sense, and a far from optimistic one.” 302