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The enlightenment and the history of medicine

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Title: The enlightenment and the history of medicine


1
The enlightenment and the history of medicine
  • Elaine Denny
  • Community Health and Social Work

2
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

3
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

4
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.

5
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

6
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

7
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

8
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

9
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

10
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

11
Changes in patterns of ill health
  • Mainly caused by the conditions in the emerging
    cities
  • Overcrowding
  • Poor sanitation
  • Poverty
  • Poor working conditions

12
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

13
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

14
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

15
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

16
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17
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

18
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

19
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

20
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21
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

22
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
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