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CLINICAL SCIENCE IN THE AGE OF REASON CHRISTOPHER C. BOOTH* Eighteenth-century medicine is traditionally associated with the lancet and the purge. There was no greater enthusiast than Dr. Benjamin Rush of Philadelphia for these hallowed methods of treatment. He thought that there was only one disease process and that was "irregular convulsive or wrong action of the system affected." Treatment was therefore to reduce convulsive and wrong action by depletion, and this entailed a murderous regimen of bleeding and purgation [I]. Joseph Priestley, visiting Philadelphia at the end of 1800, had the misfortune to encounter Benjamin Rush who diagnosed his malady as a "bilious fever" with pleurisy; seven profuse bleedings did much to prolong his recovery [2]. The influence of Rush probably hastened Washington's end the year before, though it had been the president himself who had insisted, against his wife's better judgement, that he be bled [3]. Since Rush had learned his medicine in Europe, it is not surprising that patients fared little better on the other side of the Atlantic where the old mad king suffered countless indignities at the hands of his physicians. England in the eighteenth century, as portrayed by Hogarth, Fielding, and Smollett, was unwashed and unsavoury, and much of its medicine was little better. It was the England of Tom Jones, the Rake's Progress, or Marriage à la Mode. The upper classes—powdered, rouged, and bewigged—flirted at masked balls, played cards until daylight, recited scandal to each other, and then retired to take the waters of the Spa where Beau Nash presided over the gaming table and the doctors, obFitzpatrick Lecture delivered at the Royal College of Physicians of London, December 5, 1979. The author particularly thanks Dr. W. F. Bynum of the Wellcome Unit for the History of Medicine at University College, London, for his kindness in providing reading lists for the preparation of this lecture and for his generosity in lending a copy of his invaluable paper, then unpublished, "Enlightenment Medicine and Physiology." Mr. H. Davenport, Assistant Librarian at the College Library, has given much patient help, both with books and illustrations, and Miss Terry Parker has searched the College Archives. The Librarian and Archivist at the Library of the Royal Society have also been most helpful; and a special thanks to Dr. George W. Corner for his advice. ?Clinical Research Centre, Watford Road, Harrow, Middlesex HAI 3UJ, England.© 1981 by The University of Chicago. All rights reserved 003 1 -5982/82/250 1 -0244$01 .00 Perspectives in Biology and Medicine · Autumn 1981 | 93 sequious and guinea collecting, hovered discreetly. Old theories, derived from the humoral concepts of ancient times, permeated clinical practice. Evil humors had to be removed from both blood and bowel. The inadequacies of medicine provided endless opportunities for the quack whose patent remedies were officially encouraged by the new patent laws and widely advertised in the newly developing newspaper trade. It is perhaps for these reasons that many medical historians have dismissed the eighteenth century as a fallow period "sandwiched between two centuries of intellectual excitement" or as the darkness before the dawn. Others have followed Richard Shryock in concluding that modern medicine had its origins in the medical renaissance that followed the revolutionary reforms in France in the 1790s [1, p. 129]. D'Arcy Power was one of the few who saw things differently, believing that SamuelJohnson had witnessed the replacement of the old medical order by the new [4]. It is doubtful whether in his final illness Johnson himself, reaching surreptitiously beneath the blankets with a scalpel in a vain attempt to relieve his swollen and dropsical legs, could have thought that medicine in 1 784 had much more to offer than when he was born in the early years of the century [5]. Lewis Thomas has written perhaps the most severe indictment of the era preceding the nineteenth century. "The history of medicine," he wrote, "has never been a particularly attractive subject in medical education and one reason for this is that it is so unrelievably deplorable. . . . bleeding, purging, cupping and the administration of infusions of every known plant, solutions of every known metal, every conceivable diet including total fasting...


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