2024-02-20 15:59:13
Javier Segura del Pozo, health doctor
Although academic medicine was by no means the main health provider (see “Medical Pluralism”), it experienced notable development in this century. According to Mary Lindemann, one of the characteristics of 18th century medicine was easier access to corpses. It was then that governments allowed the bodies of paupers, criminals and lunatics to reach the dissection table, giving impetus to anatomical knowledge begun in the previous century and an interest in pathological anatomy, represented by figures such as the Italian Morgagni (1682 -1771), the Scottish Baillie (1761-1823) and the Frenchman Bichat (1771-1802)[1].
Frontispiece of Morgagni’s book, De Sedibus, with an engraving of John Baptist Morgagni with vestments in the academic style of the 18th century. Fountain: The health diary.
Knowledge of diseased anatomy allowed the development of clinical pathology and of anatomical-clinical method. During the 18th century, the Galenic, iatrochemical and iatromechanical theories of the 17th century were left behind to embrace empiricism, observation and experimentation.[2].
We must also place in the 18th century the renewed interest of medicine in the American medicinal plants. Diana Obregón mentions Hipólito Ruiz, one of the Spanish naturalists in charge of the Royal Expedition to the New Kingdom of Peru and Chile (1777-1780), to describe the discovery of new species as a process of valuing local indigenous knowledge (in which the healers and herbalists had a great role) and its translation into Spanish illustrated botany. A similar process would occur with the subsequent Botanical Expedition of the New Kingdom of Granada by José Celestino Mutis (1783-1810). Although it is also true that this entire process of knowledge transfer was carried out without true recognition of those who had been its original bearers, whose traditions were branded “irrational, wild and superstitious.”[3].
Large folio drawing of Mutis Passiflora adulterina, made by the scientist Jdared Celestine Mutis during the Royal Botanical Expedition to the Kingdom of Granada in the 18th century exhibited by the Royal Botanical Garden of Madrid: Source: The Alert Newspaper.
The birth of the clinic and clinical teaching
The clinical pathology stimulated observation of the patient at the bedside, leading to what was later called the “clinical revolution”, whose genesis is usually located at the end of the 18th century. Since then, Hospital It no longer only serves the function of a “moride for the poor,” but is also an area of clinical learning. The medicalization of hospitals, focusing on their healing functions and separating them from charitable-care functions, although it was a gradual process that began centuries before, accelerated in this century. The military hospitalscreated by absolutist regimes with permanent armies[4]played an important pioneering role in this new clinical conception.
This new “bedside” hospital medicine had precedents in the clinical teaching developed in the hospital of San Francisco de la Padua in 1540, at the hands of Giambatista de Monte. One of his students took these ideas to Leiden, a city that ended up becoming a European reference for clinical training during the 16th and 17th centuries. The figure of Herman Boerhaave (1668-1738). Are crated clinical college o medical practice in different cities (Halle, Gottinga, Berlin, Edinburgh, etc.). At the turn of the century in Padua clinical teaching is offered with supervision of Samuel Tissot (1728-1797) first, and then the same Johann Peter Frank (1745-1821). In France in the 1790s, public hospitals, with about 20,000 patients and the availability of corpses, became an extraordinary pedagogical resource, not only to disseminate knowledge among students, but to create knowledge and systematize it.[5].
In 18th century England, although only two universities (Oxford and Cambridge) granted medical degrees, the English studied in Padua, Leiden or Edinburgh. But in England private schools ended up taking over, like the one in Richard Mead (1676-1754), the most famous doctor of the time, at St. Thomas’ Hospital in London, or the famous Windmill Street School where the scottish midwife William Hunter (1718-1783) teaches anatomy and obstetrics classes[6]. We will mention, as an anecdote, that William Hunter and William Smellie (1697-1763), considered the fathers of obstetrics, especially for their detailed anatomical atlases of the pregnant woman’s body, are suspected of being responsible for a series of crimes of pregnant women, which occurred in London in the mid-18th century, in order to sell their corpses to these doctors[7]. (Ver “Resurrectionists”)
The Anatomist Surprised by the Guard (1773), by William Austin. A caricature of the famous surgeon John Hunter (1728-1793) escaping from two watchmen. John learned from his brother, the midwife William Hunter, at his anatomy school on Windmill Street in London, where the source of corpse supply came under criminal suspicion. Fountain: Resurrectionists in the United Kingdom
[1] LINDEMAN, M. (2002). Medicine and Society in Modern Europe, 1500-1800. . . . Madrid: 21st Century Publishers, p. 92.
[2] Ibidem, pp. 98-99.
[3] OBREGÓN, D. (2000) ed. “Foreword”. In: Scientific cultures and local knowledge: assimilation, hybridization, resistance. Bogotá: National University of Colombia, pp. 12-13.
[4] In the context of the wars between the Habsburgs and the Valois, the first permanent military hospital was created in Spain in 1570.
[5] LINDEMANN, Op, cit., pp. 106-110.
[6] Ibidempp. 110-111.
[7] SHELTON, Don C. (2010). “The Emperor´s new clothes”. Journal Royal Society Medicine103; pp. 40-50.
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