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Medicine and Public HealthSummary of chapter. The practice of medicine was largely a private matter, the Government only giving charters to regulatory bodies who licensed practitioners. The training of these was often rudimentary but in the course of the century the chartered bodies raised their standards, and medical education improved. The Government also had to provide for public health, like insisting on the quarantine of ships, and providing fever hospitals. It also ensured that a minimum of medical assistance was provided for the destitute. (i) Medical Practice and the Medical
Profession ****************************************************************************************************** (i) Medical Practice and the Medical Profession One
of the most important laws concerning the practice of medicine was to be found
in Canon Law. It was the prohibition on clerics of shedding blood. This was extended to include such minor incisions as were made in
bleeding. Most university students in the Middle Ages enrolled themselves as
clerics while studying to avoid military service, an enrolment with merely
involved wearing the tonsure, i.e. shaving the head at regular intervals.
(Latin tonsura means shearing.) The
effect of this was that medicine, which meant the study of the Latin and Greek
authorities, could be taught and studied at universities, but even in important
matters surgery was left to barbers, at least among Christians. The study of
surgery was therefore conducted by apprenticeship, while medicine was studied
at university and medical degrees in the subject were awarded. A contemporary
rule of thumb in the eighteenth century stated that doctors treated externally
while surgeons treated internally By
its charter granted by Elizabeth I, Shortly after this date some of the medical
faculty considered that there should be some form of regulation of the
practising physicians in The
charter of the College was re-granted and extended by William and Mary at the
end of the century, and from them it took its clumsy name The King's and
Queen's College of Physicians. (A college in this sense is an organised body of
persons with particular rights and duties.) By this charter the College was
empowered to grant a licence to practice medicine anywhere in the The In
the Middle Ages barbers practised hair cutting, surgery, and dentistry, and in
England Edward IV incorporated a Company of Barber-surgeons in 1461 with powers
to licence practitioners. Under Henry VIII the name was changed to the Company
of Barbers and Surgeons, and barbers were restricted to dentistry. Surgery
began to be respectable in the eighteenth century when John Hunter began his
systematic investigations of anatomy. Surgeons thereafter were often men with
university degrees. Earlier bone-setters set broken bones while surgeons were
responsible for the amputation of limbs or the extraction of bullets, besides
bleeding. Surgeons therefore more properly belonged to the army and navy, and
the training given to these was often rudimentary. During the Napoleonic Wars
Wellington was squeamish about dealing with wounded and so neglected them.
Napoleon on the other hand gave every encouragement to his famous surgeon Baron
Larrey and his 'ambulances' for removing the wounded from the field. In
In
1811 a The
Royal College of Surgeons opened a small college for instruction in
A
new charter was given to the College in 1828 allowing it to grant licences in
surgery and midwifery, and the practice of holding examinations was then
introduced. For
most people at the time, in In the early eighteenth century the
apothecaries were still numerous in the guild of barber-surgeons, but like the
surgeons they formed a grouping of their own which was given a charter as a
separate guild in the city of By
1850 medical degrees in medicine and surgery were being awarded by the
universities. The The
founding of hospitals for the sick poor ('A Hospitall or spittle for poore
folkes diseased.') was a popular form of charity. Hospitals were founded for
the treatment of the poor for the rich were treated in their homes. The most
famous of the Midwifery
was a branch of medicine to which Irish doctors devoted much attention. They
trained not only medical students but also those men and women who wished to
practice as midwives. Vaccination against smallpox by means of the cowpox was
introduced into Nursing
became a respectable occupation for young ladies earlier in There
was a considerable body of pragmatic knowledge on the treatment of diseases
like fevers. Doctors, especially army doctors, had great experience in these
matters. The cause of fever might be unknown but its connection with dirt was
noted. It was also known that fever could be contracted from dirty clothes
though the connection with fleas was not spotted. The distinction between
infection and contagion was known namely that a disease could be communicated
from one person to another either by an infection in the air or by physical
contact. Remedies therefore suggested themselves. The air could be kept pure by
proper ventilation. Wards could be washed down with vinegar and their walls whitewashed.
Patients and their bedclothing could be kept clean. Light foods and plenty of
drinks could be provided. Taking
the waters in spas, so popular in the previous century was gradually giving way
to sea-bathing that was considered more efficacious especially when the water
was cold.
It
is safe to assume that the distribution of medical services closely followed
the distribution of schools, namely that they were fairly abundant (by the
standards of the time) in the north and east, but more or less non-existent in
the far west and south, unless perhaps the local clergyman had studied a little
'physick'. We
know little of the distribution of various diseases. From passing references it
would seem that tuberculosis and rheumatism were very prevalent in rural areas.
The agues or malarial fevers noted by Defoe as prevalent in the marshlands of The
ordinary people put their faith in traditional herbs or failing these in
numerous and diverse charms. Carleton notes an herb garden kept by a farmer's
wife. The houseleek was a specific for sore eyes, and tansy for worms in
children. Bogbane was regarded as
efficacious for heart complaints, while 'rosenoble, Solomon's Seal, and
burgloss' treated other afflictions. Some of these herbs may have had curative
properties; for example the foxglove contains digitalis a steroid which can be
used as a heart stimulant. 'Cures' were often entirely irrational like getting
a posthumous child to point seven gooseberry thorns at a stye to cure it.
Superstition could be seen in the application of a piece of paper with the
first chapter of the gospel of It
was always the duty of local and central authorities to take public measures to
ensure the health of the public. In towns and cities the corporations were
bound to provide an adequate supply of clean water, and also to remove dirt and
other nuisances which might lead to the spread of disease. The authorities seem
to have taken their duties seriously. In The
Government was chiefly concerned with the prevention of the spread of fever
especially from abroad. If foreign plagues threatened it established quarantine
stations, and appointed medical inspectors along the coasts. It could also
authorise the setting up of local and national boards of health. Such boards
were empowered to acquire and manage fever hospitals, to clean the streets, to
fumigate houses, and to whitewash the homes of the poor. |
------------------------------------------------------------------------------------------------------------------------------------ Copyright Desmond J. Keenan, B.S.Sc.; Ph.D. ;.London, U.K.
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