New Medical Challenges During the Scottish Enlightenment
Amsterdam: Rodopi, 2005.
New Medical Challenges explores a wide range of social and medical practices, exposing the contradictions and ambiguities found in eighteenth-century Scottish health, science and medicine. The overall picture casts further light on the nature of the Enlightenment as a cultural phenomenon. Commercial society created new jobs, wealth and desires, that threatened contemporary values and physical health. Both luxury and poverty took their toll, spawning disease among the affluent and the poor. A number of key issues are examined, including the role of charity, medical debates and competition, vivisection, and diseases of the time – such as ‘pulmonary consumption’, ‘mill reek’ and ‘ague’. Special chapters are devoted to ‘female troubles’, ‘hysteria’ and ‘hypochondriasis’, showing the evolving relationships across gender and class lines between poor patients and their physicians. To place medical ideas and practices into proper context, the essays offer extensive background information and rediscover the lost voices of prominent physicians involved in promoting health and battling illness. Thanks to the richness of seldom-tapped archival sources – book manuscripts, consultation letters, hospital registration and management records, together with student essays, lecture notes and notebooks – the selected episodes expose a world of uncertainty, confusion and paradox. New Medical Challenges tells a wide range of stories that will be of great interest to a broad readership concerned with past health issues.
TABLE OF CONTENTS
Preface
Introduction
PART I MEDICAL INSTITUTIONS
Chapter 1: For God and Country: Duties and Rewards of Charity at the Edinburgh Infirmary.
Within a ‘public sphere’ framework, this essay discusses the meaning and rewards of charity to specifically establish voluntary hospitals during the eighteenth century. The creation and management of the Edinburgh Infirmary serves as a convenient case study to revisit the perceived motives and actions of donors as well as the expectations and duties of the recipients, the “deserving’ poor allowed to enter the institution. Linked to this gift relationship were medicine’s professional interests, especially the acquisition of clinical skills and therapeutic knowledge that created tensions between charitable and scientific objectives. Hospital-based relationships with colleagues and patients prompted new educational guidelines and ethical standards.
Chapter 2: Debates and Experiments: The Royal Medical Society of Edinburgh.
Like other Scottish clubs and societies, this student-run organization was a public forum were medical students could present their own papers and hone rhetorical skills. This essay is a first attempt to present and analyse the broad range of dissertations composed and presented during the last two decades of the eighteenth century. The documents offer a valuable window into contemporary Scottish medical science. Behind a façade of didactic exercises, the Society gradually shifted from an elite debating club into an institution adopting new epistemological foundations for the acquisition of medical knowledge that included the design and execution of human and animal experiments.
Chapter 3: The Royal Medical Society vs. Campbell Donovan: Brunonianism, The Press, and the Medical Establishment.
During the years 1778–90, the activities of Royal Medical Society were severely disrupted because of a growing antagonism between supporters of rival medical theories and practices. Bitter confrontations between Cullenians—supporters of William Cullen--and Brunonians--sympathisers of John Brown, shattered the earlier framework of polite disputations. When accounts of the contentious proceedings were published in a local tabloid, the Society, citing issues of professional privacy, filed a lawsuit involving famous local lawyers. The story provides an extraordinary opportunity to assess the contemporary status of Brunonianism, its efforts to demystify medicine, and the growing power of print media to influence broad sectors of the public.
PART II HEALTH AND DISEASE
Chapter 4: In the Name of Hygieia and Hippocrates: A Quest for the Preservation of Health and Virtue.
Besides random self–help, medicine considered health preservation among its loftiest goals since antiquity. Body, mind and environment appeared inextricably linked. Lifestyle advice, formulated within the Galenic framework of the ‘six non–natural things’, included air, food and drink, sleep and wakefulness, exercise, bodily evacuations, and emotions. Such pursuits were ideally suited to the social realities of the Enlightenment. This inquiry reveals the recommendations made by a prominent Scottish physician, William Cullen, to improve the health of his patients. The information is based on unpublished essays and consultation letters, focusing on his clients’ constitution and temperament, climate and seasons, lodgings, diet and bodily functions, as well as emotional states.
Chapter 5: Ague in Eighteenth–Century Scotland? The Shifting Ecology of a Disease.
Each age and society reveals a unique set of biological and cultural circumstances responsible for the appearance of particular diseases. The study of ‘ague’ in eighteenth–century Britain, including Scotland, suggests that this condition can be generally included under the current concept of malaria. The analysis is based on a variety of sources, including parish reports, institutional records, and the writings of prominent physicians. A careful review of the evidence concludes that ague in Scotland was mostly an import and its eventual disappearance linked to the country’s geography and climate, as well as the agricultural and industrial revolutions that took place on its soil.
Chapter 6: ‘Mill Reek’ in Scotland: Construction and Management of Lead Poisoning.
Since antiquity, the protean and often elusive manifestations of lead poisoning were linked to a variety of agents. This study on lead mining and its health hazards in Scotland seeks to understand the social construction of ‘mill reek’. The condition was linked to the rudimentary extraction and refinement techniques employed in the ‘lead hilies’ of Lanarkshire. As production became more profitable, the deteriorating health of miners came to the attention of physicians, prompting a number of medical studies to determine the causes of their sicknesses as well as design successful therapies to reverse them. In Scotland, new interest in chemistry stimulated a series of clinical and experimental studies concerning the toxic action of lead.
PART III MEDICAL THEORY AND PRACTICE
Chapter 7: Organising Knowledge and Making Clinical Decisions: Phthisis and Student–Selected Case Histories.
Clinical cases have traditionally been among the most important documents for understanding the representation, organization, and transmission of medical information. In hospital practice, they provide a key form of medical discourse shaped by professional and social needs. Based on student casebooks and lecture notes, the essay analyses selected cases admitted to the Edinburgh Infirmary and labelled as ‘phthisis’ or ‘pulmonary consumption’, the most common and deadly ailment of the century. The intent was to employ a clinically complex disease and closely follow the words and actions of notable attending physicians exposing colleagues and students to the ambiguities of medical practice while attempting to save lives.
Chapter 8: Framing Gynaecology in Edinburgh: The Perplexing Nature of Women’s Bodies.
Eighteenth–century gynaecological views and practices have remained virtually unexamined. This paper focuses on ‘female troubles’ and their admission and treatment at the Edinburgh Infirmary based on medical publications, hospital registers, casebooks and student notes. Such activities took place amid serious turf battles between gentlemen physicians and surgeon-midwives wishing to expand the range of their practices. After reviewing fanciful explanations of menstruation and the purported fragility of female bodies since antiquity, the analysis describes the actual medical management of menstrual irregularities and other related conditions. Most of the treatments were rooted in traditional domestic and folk approaches, exposing the contradictions and paradoxes surrounding explanations of women’s pathology.
Chapter 9: Mind–Body Enigma: Hysteria and Hypochondriasis at the Edinburgh Infirmary.
During the eighteenth century, hysteria and hypochondriasis were considered fashionable ‘neuroses’ caused by an affluent, civilised lifestyle. In a most unique way, both disorders entwined biological and mental, environmental, social and cultural aspects, creating representations of considerable medical complexity and uncertainty. The essay examines a paradoxical transfer of these traditional nosological labels to a new environment: the voluntary hospital. As observed at the Edinburgh Infirmary, physicians attempted to contextualise both diseases ‘from below’, branding famished women as hysterics while lethargic men became hypochondriacs. Their institutional progress and management expose the equivocal effects of hospitalisation and contingent nature of medical classifications.
Eighteenth-Century Medical Scotland: A Select Bibliography
Index
REVIEWS
““Upon final assessment, New Medical Challenges is a real gem. It is an outstanding piece of scholarship that will need to be read by anyone seeking to research what Edinburgh’s professors were actually teaching their students—especially since so many of the university’s graduates went on to practice and teach medicine in Britain, Europe, America, Africa and India.””
“Guenter Risse is interested in the social construction of diseases in this period. Diseases given most attention here –malaria. “mill reek” or lead poisoning, consumption, “female complaints,” hysteria and hypochondriasis—are looked at from the perspectives of sex, pathology and medical theory, technology, class and social circumstances, environmental and ecological factors and the contexts in which they were treated…By giving the classical background to may of the topics with which it deals, the study shows the enduring continuities in medical thinking that persisted under new names. That is not news but here it is deftly done.”
“Guenter Risse has done a fine job of integrating a wealth of primary sources from the late eighteenth century Edinburgh medical institutions and individuals into this essay collection. Much of the book focuses on the medical elite, student medical controversies and the evolution of disease identification. While the collected essays or “particular windows into the medical past” have much overlap in term of time, place and key players, they retain the impression of stand-alone topics.”
“New Medical Challenges During the Scottish Enlightenment brings together nine papers that deal primarily, although not exclusively, with medicine in eighteenth-century Edinburgh and that display the analytical preoccupations that have framed his work since the 1970s…The collective portrait he draws of patients and practitioners in the Athens of the North is thus meticulously observed and firmly grounded in archival materials. Furthermore, the analytical tools he employs to create this picture of medicine in eighteenth-century Edinburgh are, on the whole, highly sophisticated and employed with sensitivity and insight.”
“The book is both a ‘medical history from below’ and a medical history attentive to civic and institutional context, to geographic factors, and to the complex connections between medical matters and the social ones such as diet, health, bodily comportment, and (albeit differently for men and women) moderation and modesty. It is an important contribution to the social history of Scottish Enlightenment medicine, for here we can trace the debates within medical institutions, read the notes of anxious bedside physicians, follow disputes in diagnoses, and understand how matters of livelihood and rank, then as now, limited access to health care.”