The enlightenment and the history of medicine

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The enlightenment and the history of medicine

• Elaine Denny
• Community Health and Social Work

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The Enlightenment

• Refers to the period spanning most of the
  eighteenth century
• Promoted new philosophical systems for
  understanding the natural and human worlds
• Move towards secular explanations
• Reason replaced myth and superstition
• Have the courage to use your own mind Kant
• Humanity was governed by free will

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How do we characterise enlightenment

• The gaining of knowledge by the use of reason,
  critical questioning (Descartes)
• The belief that all knowledge comes from
  experience (John Lock)
• The new knowledge should be disseminated and
  debated
• Logic deductive and inductive argument
• Induction is concerned with making
  generalisations about the world based on
  observation
• Deduction starts with a theory and applies it to
  the empirical situation

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Why did this change occur?

• By the middle of the 17th century in Britain
  events such as the Civil War, and the Reformation
  had made some question the inevitability of
  traditional teaching.
• Experimentation and discovery was contradicting
  previously held beliefs e.g. to do with the
  universe, chemistry etc.

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Conditions for the industrial revolution

• England was a nation of production of goods for
  sale
• England had become a monetary rather than a
  bartering nation for those goods
• The development of the market meant communities
  did not have to produce all goods, but could
  purchase them in shops
• Self sufficient peasants had largely died out
• As the division of labour developed more
  specialised, skilled and inventive production
  occurred

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Cotton

• Pre-industrialisation spinning of cloth was a
  cottage industry where clothes were made for the
  household.
• A surplus population in the countryside which had
  to move into the new towns and cities for worked
  provided labour for factories where cotton could
  be produced cheaply.
• Those who were left in the country could not
  compete with the new factories, as the
  productivity was lower, and therefore cost was
  much higher.
• As the handloomers in the factories were replaced
  by machines, they too were forced out of work

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Industrialisation and urbanisation

• Population increase between 1750 and 1830 -
  6m-18m
• Move from rural areas to the new and expanding
  cities
• Migration mainly young people 15-30 years
• From 1850 there was an increase of births over
  deaths
• Cities were designed to segregate rich from poor
• Industrialisation took place in a haphazard way
• Overall the 19th century saw a growth in living
  standards, but there were peaks and troughs

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Results of industrialisation

• Population growth
• Urbanisation
• Segregation between rich and poor
• Rising prosperity but not for all
• Emergence of the middle classes
• Changes to the role of women

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Population changes

• Between 1750 and 1850 the population of England
  rose from 6-18million
• By the 1901 census it was 32,527,843
• The proportion of the population living in urban
  areas rose from 33.8 in 1801 to 78 in 1901
• The population of Birmingham grew fro 60,000 in
  1800 to 260,000 in 1851

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Rural areas

• The most obvious feature was depopulation,
  especially after 1850
• Agricultural work was declining, and wages were
  low
• People left to work in industries, and in
  domestic service
• Land ownership meant that one family could
  control whole villages and the behaviour of
  tenants
• Conditions were often as insanitary as in towns,
  but without the density of population

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Changes in patterns of ill health

• Mainly caused by the conditions in the emerging
  cities
• Overcrowding
• Poor sanitation
• Poverty
• Poor working conditions

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Changes to ideas on health and medicine

• The enlightenment changed ideas about examination
  of the body, and led to doctors and scientists
  questioning traditional ideas e.g. sin and
  sickness
• Health and illness were not god given and could
  be controlled
• Doctors collaborated and exchanged ideas
• The growth of science and industrialisation led
  to the developments and discoveries of 19th
  century
• The development of social investigation enabled
  statistics to be collected and studied
• Urbanisation led to the growth of hospitals and
  many poor patients to experiment on

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Results

• Dissection and post-mortem
• Collection of social statistics (births,
  marriages and deaths) and epidemiological data
• The institutionalisation of ill health
• The development of alloys for surgical
  instruments, and discovery of gases for
  anaesthetics led to rapid growth in surgery
• Therapeutic optimism

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Provision of health and welfare

• Poor Law - publicly funded
• Public health measures - a mixture of private and
  public funding
• Philanthropic - voluntary hospitals, visiting
  societies
• Private - fee for service
• Provident - self help

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Poor Law health

• Outdoor relief was believed to create dependency
• In an era of enlightenment help should only be
  given to the deserving poor
• 1834 Poor Law Amendment Act created the class
  pauper by the doctrine of less eligibility
• From 1848 workhouse infirmaries built
• In 1869 inmates were on average
• 6,000 ordinary sick - including lying in
• 1,700 imbeciles
• 2,400 children
• 10,500 healthy old people
• 3,000 able bodied - circa 10

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Philanthropic provision

• Charity - the giving of material aid in times of
  misery
• philanthropy - centred around advice in the hope
  of averting expense by encouraging behaviour
  change
• - encouraged self help
• - reflected enlightenment theory

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Philanthropy

• Felt to be superior to state provision as aid
  could be channelled where the donor wanted it
• Could discriminate between the deserving and the
  non deserving poor
• Could set conditions for giving aid
• Could monitor the use to which aid was put
• Demonstrated the superiority of the giver over
  the receiver
• Many philanthropists were committed to helping
  the poor

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Examples of philanthropic societies

• Voluntary hospitals - subscribers had tickets for
  admissions
• Ranyard mission - an evangelical bible society
  and nursing mission
• Charity Organisation Society (COS) - forerunner
  of social work, used casework with deserving
  clients

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Provident societies

• Especially important for those just above the
  poor, who were not helped by charities
• Organised by trade unions, friendly societies,
  and epitomised the doctrine of self help
• People would pay small weekly sums to receive
  help from a doctor or dispensary when needed
• Provident societies were also available for
  savings and pensions

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Summary

• The enlightenment period changed the way men
  viewed the world
• This led to more rational development of
  knowledge and the idea that humanity had free
  will
• The ensuing scientific and technological
  developments meant greater industrialisation of
  production and urbanisation of the population
• Medicine became more scientific and health care
  more institutional