The Roles of Doctor in the 18th Century - Assignment Example

Question: How did the physicians and the literate lay people in the 18th century explain disease and what did they think were the roles of doctor, the individual, and the state in responding to and preventing it? Answer: Eighteenth century was a time when many changes regarding medical practice were observed. It was a period when new reforms and knowledge was added to the field of medicine. The concept of the term disease itself changed and got a new meaning. The duties of the doctor and the relationship between a doctor and a physician underwent many changes. The state had not been involved previously in the maintenance of health and health related issues but many writings and works led to the initiation of the intervention of the government in these issues. This century could not be considered as an era of great medical development because it did not reach very close to the actual concept and meaning of medical practice. But the advances and progression in this regard was great enough as compared to the previous centuries. The concept of disease was previously considered to be the problems encountered by a patient. It was the presentation of the symptoms and signs by the patient which laid the basis for the explanation of the disease. This practice was very much common till the start of the eighteenth century. This is clearly presented by an example which was put forward by Alexander Morgan who was a surgeon in Bristol. He put forward a case which he encountered with a patient in 1744 when the patient presented him with his problems. This was the period when the doctor was not the person solely governing the pathology with which the patient was suffering and the prescribed medications. It was rather the doctor and the patient who discussed the problems together and reached to a conclusion regarding the treatment to be prescribed to the patient. It is said that during this time it was actually the patient who ruled the right to reach to a conclusion regarding his problem and medicine and practice basically lay in the hands of the sufferer. During this time patients explained the reasons for their diseases. They could actually stand against the treatment given to them by the doctor. The reasons explained for illnesses ranged from sudden changes in temperature to the curse of god. Not only were there vague reasons for diseases but treatments were also of a similar range. By the middle of the eighteenth century certain changes to these concepts were noticed. Hospitals were created by this time. And the other influences on the running of hospitals also changed and it came to be under the responsibility of the doctors to manage them. With the change of time the relation of between the patient and doctor also changed. It started with an equal opportunity to the doctor and the patient in evaluation the disease and by the end of the century it was the doctor who governed the relationship. It was no longer the mutual relationship that it used to be. This fact was true for most of the cases but still for the complete implementation of this it took more years for the authority of the doctor to be fully established. The concept of physical examination of the patient had also emerged and the diagnosis was hence based on this rather than the patients own narrative. It was in the eighteenth century that the switch of medical language from mainly English to Latin took place. The reason behind this was that the physicians believed that Latin could explain the diseases in a broader sense. This accounted to be also one of the reasons for the distance of the doctor and patient bond and assigned the doctor a greater authority. The concept of physical examination of the patient, autopsies for the better understanding of medicine and surgery and testing particularly that of the blood all emerged towards the end of the eighteenth century. Surgery also gained greater roots in this time and during the last few years of this century the doctors were mainly trained in the hospitals. In the eighteenth century though a proper base for the explanation of disease had emerged but the prime focus was upon the symptoms that were produced by the disease rather than on the cause that lead to the disease. This was put forward by Sydenham who argued that people were more concerned about what the disease actually led to and they did not consider the reason which formed the basis for the disease. N.D. Jewson puts forward that medicine in the eighteenth century was still running on the lines of Hippocrates and Galen which were works that dated back to second century A.D. A touch of Newton’s methodologies were applied to it in this century. Disease in the eighteenth century according to N.D. Jewson was never analyzed as being led to by disturbances in organs or cells but rather they were seen to as one form and all the aspects of disease were not properly understood. It is believed that in this time the concept of hospital medicine had arrived but this was mostly for the middle and lower classes. In the eighteenth century disease and practice was very much controlled by the upper class. Class divisions in doctors were also seen. Physicians were the most powerful in this group and they were followed by surgeons and pharmacists. Physicians were those who actually took their degrees from colleges in England and they were mainly related to prescribing medicines. The concept of surgery though employed late in the century was performed by the surgeons as well as the barbers. Physicians used to treat the rich of the society and the doctor patient relationship for the upper class did not change to a similar extent as it applied to the other general public. The upper classes still dominated over the physicians and were the people who played a role in the reaching of a diagnosis as well as the treatment that they actually required. The physicians basically worked to please them. N.D Jewson explains that though progress was made in the process of medicine but still the upper class patients did play a role in the treatments and patterns adopted. Eighteenth century was a time period in which the progression of the state was laid upon an increase in population. The reason behind this was that this measure would lead to an increase in man power required military and labor purposes. The world focused upon methods to increase the health of the individuals. Not only this, there was an urge by the state for a greater number of population which could only be possible by more births and less deaths. All this required new ways of combating disease and understanding the concept of disease. All the countries of the world worked towards this objective. An important step regarding this could be seen in Germany where a concept known as ‘cameralism’ emerged. This concept was related to a kind of monitoring of the state and a sort of police which would look upon things that would be beneficial to state with regard to prosperity. This police was started in the seventeenth century and was initially concerned with administrative matters which included health but by the late eighteenth century the police came to be known as a medical police who would work mainly for the management of health by the state. The concept of state involvement in the health matters was put forward by many philosophers amongst whom was included Christian Thomas who was an important figure in the philosophy of politics in Germany. He argued that for a prosperous state economical issues as well as the maintenance of health of the people by the state was essential. Another philosopher Christian Wolff in 1721 argued that for a long life proper hygiene and sanitary conditions were important and state intervention for creation of these conditions and prevention of disease were important. Joachim Georg Darjes, Johannes Heinrich Gottlob von Justi and Joseph von Sonnenfels are important names of the eighteenth century who explained the role of state in the management of diseases. They all presented with methods for a proper health of the indiciduals and prevention of disease. These included the setting up of hospitals by the state and places where the abandoned could also be looked for. They stressed for the proper sanitation of towns and cities. Justi went as forward as to saying that people who cuffer from diseases which can be transmitted to the progeny should not be allowed to marry. Proper training of practitioners, mid wives and the staff was put forward. Epidemics which erupted should be looked upon seriously ant the root cause of the issue should be found out and eliminated. Hygiene was also put forward as a method for preventing disease. These personalities summed up the actions which were essential and were to be undertaken by the government for proper health of the people. Universities and organizational setup working for the health awareness were all the leaps of this century. Not only philosophers and politicians played their role in the state development for health measures but physicians also played a role in this. Wolfgang Thomas Rau was an important part of this because it was him who actually formulated the name and concept of medical police in 1764. He put forward similar health reforms regarding the prevetnion of diseases but he stressed upon monitoring of the activity of the physicans by the state. Another physician J.F. Zuckert from Berlin also presented ways of preventing widespread diseases. The issue of hygiene was also taken up seriously in this century. It was made clear by philosophers and physicians that health was very much related to hygiene and a clean living environment. They pointed out that disease could be combated and prevented in the first place from becoming an epidemic and a serious issue if hygiene was maintained in the first place. This requires proper sanitary and housing conditions to be worked upon by the individuals themselves as well as the state. The physicians and the other important figures clearly highlighted the roles that the state had to play in the prevention of diseases. They also laid duties and responsibilities upon the doctor to combat health issues by learning properly about their practice. The individuals were also asked to be made aware of issues regarding health and of methods to be employed to prevent disease in the first place. but the main responsibility laid in the hand of the state to regulate and monitor the functioning of the doctors and the paramedical staff and it was also the duty of the state to make its population aware on issues of health and hygiene to overcome disease. This century did prove to be an era for the development of medicine and disease. Roles of the doctor, state and the individual were explained but these developments were not sufficient enough and it was basically the period and time that followed that medicine and surgery actually reached the level where it had to. Autopsies were carried out in this century which did help in the understanding of the working of the human body but much more needed to be done after that. This era cannot be counted as a peak in the development of disease because throughout this time disease and pathology could never be reached to at the grass root level as the anatomy of the body was not studied thoroughly and properly. This can be considered a drawback because anatomy lays much basis for the recognition of disease. The refining of the duties of the doctor took place after that in the years to come. Hospital based medicine took roots in this era and the role of the state also started to be defined in this time. A major breakthrough of inoculation was also introduced in this time which was done by Lady Montague in 1722. The eighteenth century can hence not be looked down upon but it can also not be considered to be a century in which leaps in the recognition of disease were done. References: 1. William Coleman (1974), ‘Health and hygiene in the Encyclopédie: a medical doctrine for the bourgeoisie’, Journal of the History of Medicine and Allied Sciences 29, pp.399–421 2. Ludmilla Jordanova (1979), ‘Earth science and environmental medicine: the synthesis of the late Enlightenment’, in Jordanova, L.J. and Porter. R.S. (eds) Images of the Earth: Essays in the History of the Environmental Sciences, pp.119–46 3. Mary Fissell (1991), ‘The disappearance of the patient’s narrative and the invention of hospital medicine’, in French, R. and Wear, A. (eds), British Medicine in an Age of Reform, pp.92–109 4. N.D. Jewson (1974), ‘Medical knowledge and the patronage system in 18th century England’, Sociology 8, pp.369–85 5. George Rosen (1952), ‘Cameralism and the concept of medical police’, Bulletin of the History of Medicine 27, pp.21–42 6. Charles Rosenberg (1979) ‘The therapeutic revolution: medicine, meaning, and social change in nineteenth-century America’, in Rosenberg, C. and Vogel, M. (eds) The Therapeutic Revolution: Essays in the Social History of American Medicine, pp.3–25 Read More