SCIENCE AND MEDICINE IN THE SEVENTEENTH CENTURY

After a long continued inertia of the dark ages,human reasoning once again woke up from its sleep during the Renaissance and that awakening had positive consequences in the following centuries as well.
During the seventeenth century the different schools like Idealism,Materialism and Substaritialism continued to speculate and interpret their observations in their own methods.

Advancements in physical science provided the materialism with an upper hand over the other schools and as the quantitative such as mass, height e were already separated (once again) from the qualitative such as form, odour colour e.t.c. by Gallileo in the latter part of the seventeenth century, the materialistic interpretations dominated not only the more exact sciences like physics,chemistry e but also the more inexact sciences (inexact because their phenomena can not be completely explained by the laws of physics,chemistry or mathematics) this lead to the ‘ confusion of categories.
Biology began to branch off from philosophy and it too wandered in the notion that matter is the pricipal element of the Universe.It depended too much on physics and chemistry. The qualitative came to be neglected.
The field of medicine owe much to the more exact observations and interpretations of four personalities of the seventeenth century and they are Lord Francis Bacon(1571- 1626),Rene Descates(1596-16 ,Robert Boyle(1626) and Dr .Thomas Sydenham(1.605-89)
 
LORD BACON:
He is considered as the father of objective and realistic tradition ii modern philosophy developed a methodology depending on the inductive logic which gave a positive direction to that age. He indicated the method of achieving real successes in any sphere of human activity and discussed the obstacles which stand in the way of mans realising the truth and nothing but truth.He stressed on the importance of learning in general. Bacon taught men to take reason directly from the pages of nature. He emphasized that “truth is the daughter of time,not of authority” .According to Bacon man using his “art’ could do nothing but bringing things nearer to one another and the rest is performed by Nature,the ways of Nature being quite unknown.Thus art can give only certain powers a particular direction and medicine is the art by which such a particular direction is given to certain powers of natures to enable them to check disease,alleviate pain or prolong life. All therapeutics are only giving certain powers of nature a particular direction. He believed in free experimentations pointed out the necessity of specific medicines for the cure of well ascertained diseases. 

To examine minutely the various forms of diseases, and to adapt to each it’s own particular remedies the general instruction given by Bacon for advancing medicine. He was worried about the lack of exact observations and the apparent absence of laws inter relating the disease processes and drug phenomena.
 
RENE DESCARTES:
He is considered as the father of subjective and idealistic tradition in modern philosophy was a substantialist.He believed that there is a homogenous ‘substance” underlying all forms of matter and another homogenous “substance underlying all forms of mind. Thus he separated reality into two ultimate substances a philosopher and a mathematician,he desired to explain all of the world except God and the Soul,by mechanical and mathematical laws.He insisted that philosophy should begin with the self and travel outwards. He believed that all the world and everybody is a machine,but outside the world is God,and within the body is the spiritual Soul.He ignored the true scientific attitude of mind and, unfortunately, got involved in much unnecessary speculations.
 
ROBERT BOYLE:
He was considerably influenced by Lord Bacon.He asked the physicians to dismiss prejudice and blind authority. He wanted the physicians to concentrate more on the “uncertainities’ of diseases than the ‘certainities” because he visualised diseases as phenomena and he believed that restoration of the sick and relief of sufferings depend on the uncertain aspects of diseases.

He was against mixture prescription. He criticized the blind methods of Galen and also Hippocrates’ imitation of Nature,in their therapeutics.He asked the physicians to find out substances which exercise a directly curative power-a power of neutralising the causes of diseases,without producing any disturbing effects on the body.He considered such medicines as and he wanted the employment of medicines singly and in smaller doses,smaller doses because their must be ternatural1y energetic upon a part preternaturally sensitive.He criticized the futility of the search for the imaginary causes of diseases such as acidity of blood e.t.c.
 
THOMAS SYDENHAM:
He is considered as Engilish Hippocrates. He tried to place the whole living man in front of a physician trying to cure the sick. He went back to the Hippocratic method of recording the sick phenomenon. Like Boyle, he wanted to search for the specifics for disease conditions.

 He put two alternatives before the medical profession - either to follow Hippocrates and imitate the methods of nature, or to attack the maladies directly with specifics. Sydenhamn maintained that as different diseases have relative affinities for particular parts of the body and which cannot be explained different remedies have particular affinities for particular parts,tissues or organs of the. body for some mysterious reasons. He opined that the art of healing would attain full maturity only when specific medicines for all the prevalent diseases are discovered. He could not live up to his ideals due to the ‘shortage’ of such specifics.

With the growth and knowledge in physics and chemistry, there appeared two schools of physicians, the latrophysical group and the latrochemical group. 
The latrophysical group or latromechanical group regarded the body as a machine and sought to explain all its workings,in health as well as in disease,as physical or mechanical in nature.Some of the important persons of this school include Sanctorius(1561—1636),Borelli(1608-79).
The latrochemical group considered life as a series of chemical actions and reactions,assuming the body as a chemical laboratory.Important persons of this group include Van Helmont(1577-1644) and F .Sylvina(1614—72).

Though the advancements in physics and chemistry were having their positive consequences, the therapeutics as a form of art, underwent an unfortunate degradation during the seventeenth century. Though a century was required for the resurrection of the art of therapeutics,the preototypes of many of the Hahnemannjanobservations can be clearly visualised in the works of  the pioneers of this century,especially that of Robert Boyle and Thomas Sydenham. 

    EIGHTEENTH CENTURY MEDICINE

During the eighteenth century, developments were occurring in science also but since the” scientific thought” was rather primitive, plenty of theories and hypothesis came up which also occurred in the field of Medicine as well. Blind respect for traditional authorities remained as ever,thus maintaining the devitalising and toeturesome methods of treatment.Scientificity was lacking the field of Medicine.There were no general principles,no definite law governing therapeutics,no planned method for investigation of action of drugs on the healthy or the sick individuals .The field of Medicine was lacking the Baconian method of enquiry.There was no wholistic approach.Different schools of thought were existing,all of them were imperfect and they narrowed their viewpoints on Universe and Human beings and started quarrelling with each other.
 
The main schools of thought during this era were mechanism, materialism, vitalism and naturalism.
Mechanism is the doctrine that all events and all thought occur according to the laws of mechanics.
Materialism is the doctrine that matter is the only reality.
Vitalism is the doctrine that life is the basic reality and all others are forms or expressions of life.
Naturalism is the doctrine that all realities come under the laws of nature.
 
Samuel Hahnemann is commenting about this situation in his essays, ‘On the substitute for foreign drugs” (1809) and “On the value of speculative system of medicine
Science as well as philosophy under during this period. IMPERFECT OBSERVATIONS lead to one-sided theories and and hypotheses.
The entire thought process of the century took different ways and often contradicting directions thereby creating lots of confusions .The eighteenth century thinkers failed to work on the essential nature of Human being. (But the European mind corrected its thoughts whenever they were proved to be incorrect’).
In Medicine,like any other era,the Dogmatists or rationalists the Empiricists and the Methodists were active in this century also.

Dogmatists: They believe that one can not cure a disease unless it cause is known.They were so particular on” the cause” of a particular disease .For this purpose they theorised too much on pathology and the action of the drugs in the human body. here lies their error.Since the disease process is an evolution and since numerous factors are participating in this disease evolution and since numerous factors are aprticipating in this disease evolution or disease production, it is not correct to consider any one of these factors as the specific disease cause.(Diseases are always multifactorial). 

One should find out the totality of causes.And in this hurry to assemble the exact causes,they seeked even the help of fantacy.Power of observation was adultered with the enthusiasm to find out the specific causative factor.Lots of contradictory theories aroused in this era. With the developments in Anatomy,Physiology and Pathology their attention shifted from the outside world to the inside world and their combination with the materialistic philosophy made them lose the wholistic concept of the human being.The external environmental factors were not given due importance .Thus they made mistakes in their observation,in their diagnosis and in their pharmacology. 

Empiricists: It was originally an school of experiment and experience. Being based on datas or reports it does not allow a reasonable analysis of these datas.They depend a lot on blind experience .they will go on increasing their so called experiences without scientifically analysing them.There was no method of induction, deduction or generalisation in this school.They depend too much on statistical datas.There were no general laws and experiments and observations can never become successful if the general laws operating under these phenomena are not discovered. They experimented as if experiments are ends in themselves .They have done experiments without scientific justifications. 

Methodists or Routinists: They believe that for the cure of diseases only some general symptoms of the disease need be considered and one need not search long to find out the specific causative factor. The error of this method is that they also missed the concept of individualisation.They differ from the empiricists in that they do not give much importance to experiments and they differ from the dogmatists in that they never bothered much about the specific cause of diseases.
They were the classifiers of diseases.But they ignored the existence of a general law of cure. They were good observers but they erred in the therapeutic aspect.they forgot that disease in an entity which does not completely yield to any classification.Later the Methodism got divided itself into the4 physiological school and the pathological school. They believed in a therapeutics in which antidoting the underlying physio— pathological changes should bring back the healthy state. All these three schools developed the scientific aspect of medicine but the art of therapeutics was not recognised properly during this era.(An ideal physician should be a rationalist,an empiricist and a methodist and he/she should be 5omething more than a combination of all these three.)

Life is a quality and each and every individual is a highly complex existence - the working methods of other natural sciences are not completely applicable in the field of Medicine. And a blind and total application of the methods of other science in the field of medicine will produce much confusions and errors and the physicians of 18 century committed this mistake that is,they were always after quantitative analysis than the qualitative analysis (A good method should be a perfect blend Of the quantitative as well as the qualitative method).They made a partial and confused application of reason to Life.

The history of Medicine is a brilliant panorama of human errors but these errors have worked as effective micro constructions of the truth or of a part of the truth.
There are different levels of existence,material,mental and vital.Instead of studying Life from a scientific wholistic viewpoint,the physicians of the eighteenth century went after metaphysical explanation on Life and it’s working and they thus imposed irrelevant concepts on Life on the other,thereby creating lot of confusions.

 They went after unscientific classification of diseases.this tendency quickly paved way for gross materialism in the field of Medicine.While going after the pathological changes,they ignored the individual,the responses of the individual as a whole which is vital in the success of the art of therapeutics. They overlooked the art of observation. Medicine of this century started developing as pathological anatomy,as they absorbed the theory of causality. They left the art of Medicine under the mercy of tradition,speculation,authority,chance and accidental observations. 
 

MEDICINE OF THE l9 CENTURY

The British Scholar Thomas Mc Keown traces the till in mortality in England and Wales in his book “The Role of Medicine”. He ascribes the study downward trend in the rate of death attributable to infectious diseases in the l9 century to three factors.
1. Improvement in water supply, sanitation and food hygiene.
2. Change in the immunity status of the population to more favourable levels.
3. Improvement in agricultural productivity, leading to better nutritional status of the people. He singles out the improvement in nutrition as perhaps contributing the most.
- Medical interventions had little to do with the till of mortality
In the 19 century, the population of Europe was going through the demographic transition, characterized by the fall in mortality , followed by fall in fertility.
During the I9 century the part of hygiene in the cure and prevention was highlighted with deserving significance.
 
Examples
I. Ignaz Semmeiweiss — of Vienna discovered that if the doctor washed  his/her hands with soap before conducting a delivery, it considerably reduced the risk of puerperal infection in the mother.
2. Joseoh Lister of England sprayed carbolic acid liberally in the operating field before surgery to reduce the chances of wound infection after operation (antiseptic surgery).
The outbreak of Cholera in London in 1850’s was traced to polluted water supply from the Thames by John Snow, an outstanding early example of an epidemiological investigation.
All these were based on observation and intuitive analysis.

Studies on the microbial theory of diseases and the vaccination techniques focused attention on the host characteristics to understand the variations in response and the science of immunology was thus born.

Thus by the close of the 19 century ,western medicine had developed along a very distinctive path of its own. The intellectual hallmark of its approach to disease and health was characterized by extreme reductionism i.e. insulating the study of disease from its socio-econoinic, cultural and behavioral interactions , and viewing it in splendid isolation as an aberration from the natural process to be straight by the technical interventions. Though many revolutionary themes came out viewing diseases in their social, economical elements the mainstream approach in western medicine continued to be highly mechanistic and cure oriented.

The microbial theory and the developments in the other branches of biology lead the physicians of the 19 century to the belief that the medicines are cured by two factors.

1. Microorganisms.
2. Deficiency of nutrients. 
During the later part of the 19 century and through the 20 century medicine developed by its interactions with most other physical sciences. While mankind has benefited from the advancement of scientific medicine, its place has perhaps been so fast that there has been an erosion of the human element in medical practice. Society in general has struggled to cope with the ethical and moral dilemmas posed by the commercialization of health care ma large scale.

The epidemiological transition
Though in the 19 century medicine progressed through its general outlook of ‘one disease-one cause’ later it was discovered that many chronic disease were not infective in origin also that though many people harbored potentially dangerous microorganisms they never developed any diseases This lead to studies in the host-agent environment interactions It was observed that any agent needs a susceptible host and a favorable environment to cause fall fledged disease

With the improvement in nutrition and also owing to the different vaccinations there occurred a decline in the incidence of the different infectious diseases With its apparent decline there was a rise in another group of chronic debilitating diseases like Diabetes, Heart diseases etc. this shift in the pattern of sickness was later called the epidemiological transition.

All these observations lead medicine to the multifactorial origin of illnesses and studies were focused on the risk factors of diseases as well.
Any factor which enhances the chance and occurrence of a disease on an individual is termed a risk factor.