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From Physicians, Midwives, Apothecaries, Surgeons and Barbers to Bathmasters, Peddlers, Corn Doctors, Executioners, Knackers and Quacks for Health and Disease in the Enlightenment

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Vincent Valentine, MD
University of Alabama Birmingham
Birmingham, AL, USA


The last three Links' Issues from the Editor's Corner: 1) examined the scientific revolution which emerged from Natural Philosophy in the Renaissance (July 2017), 2) identified chemistry as a rational science distinguishing it from alchemy in the Enlightenment period (August 2017) and 3) looked at steps in developing and debunking theories through observation, experimentation and reasoning with a focused lens on the discovery of carbon dioxide and oxygen (September 2017). In this issue, we will adjust the lens on ourselves, homo sapiens, to gain a general understanding of health and disease from the 18th century with the bewildering array of medical healers and to understand how to maintain and repair our body when it gets out of balance. An important point of both medical knowledge and practice is that it was not confined by the law, nor did it necessarily follow social rankings to the extent one might expect.

Let's start with a review of health and disease and how it was understood in the18th century, then review the fascinating world of medical healers from 300 years ago. The theme is maintaining equilibrium or balance to recover from illness, the great leveler. Diseases does not discriminate and can affect anyone indiscriminately - from prince to pauper, master to slave and learned to unlearned, thus the best example of how equal we truly are. But before we move on any further, let's digress and take note on how this month's issue differs from the topics in the July, August and September issues of the Links. These topics require abstruse, acroamatic or esoteric knowledge limited to a very small and eclectic group of society. Abstruse by derivation means to push away, and connotes what has been pushed out of the realm of comprehension. Scholars and scientists use abstruse academic jargon to discuss esoteric or acroamatic subjects and ideas. Acroamatic is an abstruse synonym of esoteric. It originally referred to the specific writings of Aristotle addressed to his disciples as opposed to exoteric writings, which were intended for the populace. Don't confuse exoteric with esoteric, the antonym of exoteric. In terms of knowledge about disease and healing in the 18th Century, this knowledge was exoteric extending across the haves and have-nots, noblemen and subordinates and magnates to the nobodies of society.

Enough of this inscrutable and recondite tangent, now back to the task at hand. An important observation to make is we cannot accurately describe healing practices of the 18th century if we impose on them assumptions common to our own day; there is an accepted standard practice dominated by physicians, whose knowledge of health and disease differs drastically from the world of alternative practitioners. The understanding of health and disease was generally the same among physicians and non-clinical healers in the 18th century. This common understanding allowed the infirmed to go back and forth from one type of healer to another until he/she was satisfied, even when it involved crossing social boundaries. Healers were as common as their knowledge with people in both high and low social ranks.

So, what was the exoteric understanding of health and disease in the 18th Century? Health depended mainly on the notion of balance, an ancient theory that endured throughout the Medieval and Renaissance periods into the 18th century. Health required an equilibrium, for example, among the four humors, or fluids, in the body that corresponded to the four ancient elements of earth, wind, fire, and water. The corresponding humors were black bile, yellow bile, blood, and phlegm. If one was healthy, then these four humors were balanced. From ancient and medicinal physiology, the four humors or bodily fluids, were thought to determine a patient's health or disposition by the relative proportions of these humors: blood, choler (yellow bile), melancholy (black bile) and phlegm. Blood, also known as the sanguine humor makes you upbeat, cheerful and confident, Choler, also known as yellow bile makes you passionate or irascible. Melancholy, also known as black bile makes you gloomy or dejected. Phlegm made you either cool and indifferent or dull and sluggish. Disease, then, arose when dysequilibrium occurred in the normal distribution of the humors. What's quite evident and logical, when one is sick the solution is to restore the equilibrium. What's not different from today is the actual first line of defense against disease and illness, prevention. That is, don't get out of balance or off balance.

A modified form of humoralism persisted into the 18th century. The art of living a healthy life, of actively pursuing balance among factors we can control, fell under the concept of dietetics, which was understood in terms of "regimens" as opposed to the narrow view of today referring to food intake. The first step in observing these regimens of a healthy life is looking at the factors we can control. From the perspective of the 18th Century and back to antiquity, the things we can control were called the non-naturals, or things not given by nature. These controllables from three centuries ago are refreshingly no different from the logical regimens of healthy living today:

  1. Fresh air
  2. Food
  3. Movement (exercise)
  4. Sleep
  5. Excretion
  6. Passion

The "naturals" were the things beyond our control - this phrase frequently used today seems to have evolved from here - "we stabilize patients and manage ARDS, septic shock and renal failure." We minimize harm and sometimes wait for the wisdom of the body to heal or let nature take its course, etc. With the evolution of science, we have a deeper understanding of natural law and can observe what's predictable yet at times there's not much we can do to change it. Therefore, perhaps, non-naturals were things you can control, the regimens for good health. For obvious reasons, the first non-naturals is "fresh" air. Not polluted air, not air with foul odors, or with excessive carbon dioxide - obviously air enriched with oxygen, "pure" air - to refer you back to the prior issue. Foul air was not good for health.

Of all the non-naturals, Healers from the 18th Century paid particular attention to food and excretions. In terms of food, what you ate was important for your health. Mobility or exercise can certainly be controlled. It is your choice to do so or not. Couch potatoes or Jabba-the-hut activists or choosing to be physically active is your choice. It seems obvious what might be best for you. As with Nike - refer to thoughts on Nice 2014 Links Issue, "just do it" or the old social adage of industry vs laziness. Laziness is hazardous to your health, which can bring us back to foul air, smoking can be hazardous to your health. Sleep is important, but what is more controllable is the "right" amount of sleep. If you cannot control your excretions then you're going to be ill. Think about the madness of King George III and his worsening condition. The physicians would carefully and incessantly examine his excrements to determine the cause of his affliction. The illness of hampered evacuations prevailed frequently for many millenia as it still does today. The focus of balancing these non-naturals is rooted on the importance of moderation. Too much or perhaps too little of anything can kill you. Don't allow a deficiency or excess of any of these non-naturals. If any of these are neglected and get out of balance, disease will surely set in. To maintain moderation, the most common remedies were blood-letting, purging and cupping. What's crucial to realize here is that healers of all kinds agreed. This was the message reinforced by the increasing, popular literature that appeared in medicine during the 18th century written by physicians. It also marked the general views of all non-physician healers. However, we can distinguish physicians from non-physician healers but not according to the basic content of medical knowledge they possessed. The distinction was much more a social one.

The standards of a practicing physician today are drastically different from physicians and healers of the 18th Century. Today, physicians' practices are governed by a rigid education curriculum and medical boards. In the past, there was no such distinction of physicians from the medical healers. Moreover, there was no way of separating the legitimate from the illegitimate. Simply a grant or license to practice was based on bias. The understanding to be scientific was just starting to emerge simply out of the enlightenment with the systemic study of disciplines such as medicine. The goal was to make all disciplines, including medicine, backed by science. Further, it took time for a consensus to emerge of what was meant by medicine to become a science and what being scientific meant, then the question of a practitioner of science. Before then, these terms were not in existence and only became possible with the professionalization of medicine.

Licensed healers, or officially sanctioned healers, were apothecaries, midwifes and surgeons, all of whom had to complete an apprenticeship before securing approval from a physicus. Physicians had the right to practice internal medicine, but only apothecaries had the right to prepare and sell medicines. Physicians attended universities whereas shepherds and cowherds didn't but were used by common man. There were various healers within the realm of physicians, from general practitioner at the base on up the pyramid to optimal medical faculty then personal physician to royalty. The life of most physicians was not easy and most had to initially treat for free. New graduates who hung out a doctor shingle found things especially tough. A physician might become the district physicus. This position carried administrative duties of overseeing medical practice, but because the physicus answered both to a higher medical board and local political authorities, it was often a no-win situation. The physicus had to make sure all the rules were followed. Best if one could become a court physician or, even better, the personal physician of the duke or king. First class surgeons - did major surgeries, barber surgeons cut hair and performed cupping, heating a cup and applying it to the skin to create negative pressure and mobilize blood flow to promote healing. Unlicensed healers included an array of folks: bath masters, oculists, dentists, peddlers, executioners, knackers, corn doctors, wise women, cowherds, and so on. Authorities were granting permission to just about anyone. What about quacks? Quacks were those who poached on territory where they did not belong, undercutting the livelihood of others. Those with official sanction to practice resented the many healers who practiced without permission. Plenty of healers are saddled with this term. Physicians who dispensed medicine could be accused of quackery. One could be accused of quackery even if one had an official sanction in one area, but poached onto another's territory. People who could pay tended to go to a physician, but most people went to whomever they thought might help, henceforth there remain many who harbor a distrust of physicians.

It wasn't until the turn of the 19th century that the understanding of what it meant to be "scientific" began emerging. The transition to what would become known as "scientific medicine" would take time. It would be another half century before the physician was ever considered a scientist. Then, with the development of the germ theory of disease, the blending of medicine with experimental science became irresistible. It also involved the complicated question of the emergence of a practitioner of science. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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