The enlightenment and the history of medicine

Elaine DennyCommunity Health and Social Work

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

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

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.

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

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

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

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

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

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

Changes in patterns of ill health

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

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

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

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

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 in1,700 imbeciles2,400 children10,500 healthy old people3,000 able bodied - circa 10%

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

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

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

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

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