Between Flesh and Steel (13 page)

The period was the age of Isaac Newton (1642–1727), himself a devoutly religious man, who wrote his
Principia Mathematica
precisely to demonstrate the empirical reality of a divine order that governed human affairs. The new approach to science was never intended to discredit the conclusions of the old system of reasoning as much as to introduce new methods of demonstrating the validity of those
conclusions through empirical observation. The difficulty was that while the new empiricism could collect data that had yet to await eventual theoretical synthesis, the new knowledge created disturbing observable facts that undermined the assumptions upon which the old scholastic approach was based. It resulted in creating as much of a threat to the old intellectual order as if the assumptions of that order had been directly challenged in the first place.

The seventeenth century witnessed the progressive weakening of the old social, political, and epistemological system as the press of epidemics, wars, and social disruption continued to cripple the social institutions that gave expression to the assumptions of the old knowledge in everyday life. The collectivism that had underpinned the old order was also undermined. The old order had been based upon reciprocity of obligations, but the new knowledge was based on rights.

The erosion of the collective spirit brought with it a decline in those social practices that thrived on collectivism, among them organized nursing, charitable care of the sick, well-managed hospitals, and the general power of the church. In its place, the new experimenters could only offer the promise of eventually complete explanations of human events. With the exception of Newton's work, the seventeenth century produced no new tested theories or agreed-upon set of empirical observations. While the period did generate a number of important discoveries in medicine, few of them were integrated into the medical practice of the day.

Among the more important advances in medical knowledge was William Harvey's demonstration of the circulation of the blood in 1616. Harvey proved mathematically that given the volume and speed of blood in the body, there was no alternative to circulation. Harvey's work destroyed the Galenic dictum that blood passed through “pores” in the heart ventricles; instead, Harvey demonstrated that the heart pumps blood to the body and the veins return blood to the heart. Another major invention, the microscope, belongs to this period. While the instrument's origins are obscure, Athanasius Kircher (1602–1680) was probably the first to use the microscope in investigating the causes of disease. Antonj van Leeuwenhoek (1632-1723) made further advances in medical microscopy, wrote more than 250 papers from data assembled from microscopic investigation, and produced the first scientific description of red blood corpuscles. Marcello Malpighi (1628–1694), the father of histology, was the greatest microscopist of the period and introduced a theory of respiration. Franz de le Boë (1614–1672) established the science of physiological chemistry, and Robert Boyle (1627–1691) conducted experiments on gasses that made a cogent theory of respiration possible.
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The decline of collectivism was evident in these discoveries. Individuals working in private laboratories with little in the way of institutional affiliation or support achieved most of them. The universities and medical schools of the day continued to cling to Galenic and other theories, and their rigorous enforcement of these perspectives prevented them from attracting the best minds to their faculties. Men associated with universities made few of the era's great discoveries. In an age of individualism, individualism propelled investigation and discovery. Yet, the new knowledge cried out for an integrative theory to oppose the standing scholasticism. The search for a new theoretical structure influenced medicine as well.

The search for an integrative medical theory based on empirical observation manifested itself in the development of two major schools of thought that sought to organize the new medical knowledge into a systematic whole. The pull of universal order, assumed for more than a millennium, influenced medicine as much as it did Newton's laws of physics. The two new schools of medical theory were the Iatro-mathematical school and the Iatrochemical school.

The Iatromathematical school sought to apply the new principles of mechanics and mathematics to medical investigation. As represented by René Descartes (1576–1650), Giovanni Borelli (1608–1679), and Santorio Sanctorius (1561–1636), the human body was conceived of as a mechanical machine in which all bodily processes—thinking, respiration, digestion, locomotion, and so forth—were regarded as mechanical processes subject to physical and mechanical laws. The Iatrochemical school, represented by Jean-Baptiste van Helmont (1577–1644), Franciscus Sylvius (1614–1672), and Thomas Willis (1621–1675), saw the body as the product of a series of chemical reactions and processes.
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Both schools ended in sterile failure, as they sought to generalize to operational principles of larger scope without sufficient empirical data upon which the structure of their analysis was built. Both schools were examples of what the new experimentalism was attempting to achieve. Because neither succeeded in enforcing a new theory of medicine upon the discipline, the process of experiment and discovery that characterized the period continued.

A number of important medical advances laid the groundwork for further development in the coming centuries, although few found large-scale application in daily medical practices. The new knowledge of physiological chemistry and of the behavior of liquids and gases was applied to medical experiments. One application was the intravenous injection of drugs, which Christopher Wren (1632–1723) first attempted on dogs. Others experimented with the technique, and Caspar Scotus
carried out the first successful intravenous drug injection on a man in 1664. In England, John Graunt (1620–1674) introduced the science of vital statistics by compiling a statistical study of mortality. Stephen Bradwell (1588–1665) published the first handbook on first aid for common injuries in 1663. Daniel LeClerc (1652–1728) wrote the first comprehensive history of medicine, and the newly introduced medical dictionary became commonplace.
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The seventeenth century also saw the introduction of copperplate engraving to replace the woodcut, revolutionizing the art of anatomical illustration. Johannes Scultetus (1595–1645) wrote
Armamentarium Chirugicum
, the first complete book of surgical instruments with each instrument drawn to scale and complete with illustrations of their application in surgical settings. It was published posthumously in 1655.
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Until this time, armorers, blacksmiths, and razor makers had made surgical instruments to individual specification, with little in the way of standardization. Now highly skilled silversmiths, cutlers, and pewterers made these instruments and produced implements of standard design, balance, and quality.
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The quality of medical instruction, while still generally poor, was improved somewhat by the gradual introduction of clinical instruction in hospitals. A century earlier the Italians had introduced clinical instruction, and in the seventeenth century it was introduced to the universities in Holland, where it became a model for other medical universities. Dissection as a means of teaching anatomy became more common, especially in Italy, France, and Holland, and the anatomical theater became an established common feature of medical education. While corpses and skeletons were difficult to obtain, dissection increased as a means of instruction and discovery. Raymond Vieussens (1641–1716) is said to have conducted five hundred dissections in the course of his career.
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Two other innovations greatly spurred the development and communication of scientific and medical knowledge during this period. The first was the invention of the scientific society. The emphasis on individual efforts of discovery unencumbered by institutional affiliation created the need for a mechanism whereby scholars and scientists could gather, share, and test each other's ideas. The idea for the resulting professional scientific society may have originated during the Renaissance in Italy, where such societies were a well-kept secret lest their members fall afoul of ecclesiastical authority. In 1560, one such secret academic society in Naples was called, appropriately enough, the Secret Academy. In 1603, the Academy of the Lynxes was founded along similar lines in Rome. Thirty-two years later, Cardinal Richelieu
(1585–1642) founded the Académie Française. In 1660, the Oxford Philosophical Society of England opened its first journal book, and two years later Charles II (1630–1685) bestowed its charter as the Royal Society of London. In 1665, Jean-Baptiste Colbert (1619–1683) founded the French Academy of Sciences, and in 1683, the Dublin Philosophical Society came into being. These societies provided invaluable vehicles for transferring scientific knowledge across national borders. The idea survives today in the many societies and professional associations to which scholars, scientists, and other academics routinely belong.

The second stimulus to developing and communicating scientific knowledge was the introduction of periodical literature on a wide scale. First in the form of newspapers, then political tracts, and finally professional journals, these periodicals provided important channels for publishing research results and engendering learned debate. The
French Journal of Medicine
was first published in 1681. The first English medical journal was the
Medicina Curiosa
published in 1684, followed by
Progress in Medicine
in 1695.

The seventeenth century saw the establishment of national medicine in Russia and the United States. In the sixteenth century, Ivan III of Russia (1468–1505) had invited foreign physicians to settle in Moscow, a tradition continued to the end of the Romanov Dynasty in 1917. Both Peter the Great (1672–1725) and Catherine the Great (1729–1796) increased the number of foreign physicians hired. In many ways these foreigners had similar experiences to the Greek physicians in ancient Rome; they were skilled by comparison to Russian folk medicine, but the government and people always regarded them suspiciously for their strange ways. The first native Russian physician was Peter V. Postnikoff, whom Czar Peter sent to study in Padua in 1694.
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With regard to Russian military medicine, the first mention of a physician attached to the army appears in 1615. It seems to have been prior common practice for the state to provide money for barber-surgeons to care for the troops during wartime. In the second half of the century, the first regimental dispensaries appeared. Under Peter the Great, the Ministry of Medical Affairs became a chancellery, and the need to provide medical care to his army stimulated Peter's efforts to attract foreign medical talent. By the end of Peter's reign (1725), Russian military medical care was probably on a par with the rest of Europe, and a royal edict assigned each division of the army a physician, a staff barber, and an apothecary. A surgeon was assigned to each regiment and a field barber to each company. As with the armies of the other nations
of Europe, the Russian armies also used field hospitals behind the lines. There is no mention in contemporary literature, however, of any provision for the long-term care of the wounded or disabled.
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The early settlement of the United States led to the creation of another national medical establishment. Although two doctors, Samuel Fuller and John Winthrop, were among the party on the
Mayflower
in 1620, and the establishment of Harvard College (1636) and the College of William and Mary (1693) gave further impetus to medical training in the early days, Americans traditionally studied abroad at European medical schools. The greatest number of American doctors during the colonial period, however, was trained through apprenticeship programs. Lacking a strong medical establishment made such an innovation possible. Further, the frontier nature of the early American society produced sufficient barriers to education and communication such that on-the-job training and experience were the rule for training physicians. Few of these medical apprentices were encumbered by theoretical knowledge, so similar to the education of the wound surgeons of the Renaissance, observation and experience became the primary emphasis of American medical education. This highly pragmatic emphasis, moreover, distinguishes American medicine to this day. The long-standing conflict between the physician and surgeon that crippled the development of European surgery for more than four centuries never developed in the United States. Meanwhile, in 1663, the first hospital was constructed on Manhattan Island.

Dynastic and religious rivalries caused constant wars that wracked the seventeenth century. The Thirty Years' War and the English civil wars were among the period's major conflicts. The increased number of firearms used by armies and the advent of the mobile field cannon greatly increased mortality rates in these wars, as did epidemic disease. The chief disease killers of the period were bubonic plague, typhoid, typhus, dysentery, and diphtheria. Horrible epidemics were common. In 1665, the Great Plague of London carried off sixty-nine thousand people. In 1679, the plague killed seventy thousand in Vienna. In 1681, more than eighty thousand fell victim to the disease in Prague, and in the Venetian states as many as half a million died.
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Nathaniel Hodges (1629–1688) was the first physician to conduct a postmortem inspection of a plague patient.
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On military campaigns, typhus, typhoid, and dysentery took a heavy toll. Typhus was so common in eastern Europe that it was called the “Hungarian disease,” and so many Germany troops died from it that they called Hungary the “Graveyard
of the German Army.” This area remained a cesspit of infection for centuries, with yet another outbreak of typhus in 1915 decimating the British and Turkish armies there. Smallpox was pandemic in 1614, and a deadly epidemic broke out in England in 1666. Child mortality was high throughout the period, and it is estimated that as many as half of the English children born during the Restoration died from disease.
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The period's only medical high points were that leprosy seems to have died out almost completely, and the treatment of syphilis by mercurial fumigation and inunction had slowed the rate of the disease's spread.