Medical History — The Eighteenth Century

It is often thought that the eighteenth century—with its insistence on a rational and scientific approach to all the historic issues confronting mankind—succeeded in sweeping away forever the tyranny of medieval dogma. Undoubtedly the vistas unfolded in the previous century by the genius of Newton, Descartes, Boyle, and Bacon led men away from a blind belief in authority to a new faith in progress and the inexorable triumph of the human spirit. Nevertheless, the physician, always noted for his conservatism, has seldom been able to keep pace with contemporary scientific advances, especially in other fields, or to put such advances to immediate practical use. The men of medicine could hardly disregard the rapid succession of startling advances in physics and chemistry, but the resultant revival of interest in the systems of the iatrophysicists and iatrochemists did nothing to advance the practice of medicine, and it may have contributed to a period of stasis or decline.

Of special interest to eighteenth-century medical theorists was the celebrated philosopher Gottfried Wilhelm Leibnitz (1646-1716). His basic tenets of logic, natural law, and a vital force governing the body were to find their way into many of the medical systems which came into vogue during the early years of the century. Of these, one of the most influential was that of Georg Ernst Stahl (1660-1734), who rejected the view of Descartes that the body was simply a machine. Instead, Stahl’s theory of vitalism postulated the existence of an “anima” or sensitive soul which regulates the body health in a manner not unlike that of the “physis” of Hippocrates or the “psyche” of Aristotle. Disdainful of anatomy and physiology, Stahl was a strong advocate of bloodletting and other methods aimed at reducing “plethora.” His support of the phlogiston theory of combustion may have delayed the discovery of oxygen by several decades.

A colleague of Stahl’s at the University of Halle (destined to become his bitter rival) was Friedrich Hoffmann (1660-1742). Unlike Stahl, Hoffmann was a warm, inspiring teacher, who attracted to his lectures a host of students. His openly mechanistic system taught that the fibers of which the entire body was composed could dilate or contract in response to a property known as “tonus.” This in turn was controlled by a “nervous ether” emanating from the brain. Health depended on the proper regulating of tonus, and Hoffmann’s relatively simple therapy consisted of administering relaxing sedatives or irritating stimulants—a system reminiscent of the theory of the “pores” which Asclepiades championed in Roman times. In France, Hoffmann’s mechanistic views reached a wide audience through the writings of the medical philosopher Julien de La Mettrie (1709-51) whose L’Homme machine (1748) was greatly admired.

Hoffmann’s system also had great influence on the English-speaking world, having been adopted with some modification by William Cullen (1710-90), professor at Glasgow and Edinburgh, whose First Lines of Physic (1776) was to become the vade mecum of generations of students and practitioners. Cullen’s theory of “nervous energy” as the determinant of the normal state of the body was further simplified, or debased, by a former pupil, the drug- and alcohol-addicted John Brown (1735-88), who considered “excitability” to be the basis of bodily health and who therefore recommended the use of stimulants or sedatives to bring about the desired harmonious balance of “stimuli.” Brown’s classification of all diseases as “sthenic” or “asthenic” had great appeal to the hard-working physician on the American and Canadian frontiers, having received the blessing of no less an authority than the eminent American medical leader Benjamin Rush (1745?-1813).

Still another theory, also highly speculative, had considerable influence in France. Adopting Stahl’s doctrine of a “vital force,” Theophile de Bordeu (1722-76) proposed his own version of vitalism in which he maintained that the three important organs of the body—the stomach, heart, and brain—elaborated a secretion whose proper concentration in the bloodstream helped to maintain health. Bordeu has thus become known as a pioneer in endocrinology. His insistence that every disease ended in a crisis restored interest in this ancient doctrine of Hippocrates. Vitalism continued to exert great influence throughout the century, reaching new heights of popularity through the efforts of a Montpellier professor, Paul Joseph Barthez (1734-1806).

Attempts to classify all diseases were sparked by the success of Carl von Linne or Linnaeus (1707-78), the Swedish botanist-physician, originator of the binomial nomenclature still used to this day in botanical and zoological classifications. Nevertheless the medical classifications of Linnaeus, and later those of Philippe Pinel (1745-1826) and others, proved to be worthless. Only the systematic listings of Boissier des Sauvage were of sufficient validity to entitle him to lasting fame as the founder of medical classification.

EDUCATION AND THE TEACHERS

By the beginning of the eighteenth century the older medical centers of northern Italy had lost their preeminence, and many new schools founded north of the Alps were vying actively for students. It happens not infrequently that a medical school will benefit greatly from the magnetic presence of a single great teacher. We have already noted the success of Hoffmann at Halle, but this was easily surpassed by the throngs which made their way to the University of Leiden to hear the great Hermann Boerhaave (1668-1738). This charismatic individual succeeded in making Leiden the temporary medical center of all Europe. A true humanist in the Renaissance mold, Boerhaave’s interests wandered far beyond medicine to encompass all the arts, including music as well as literature. An eclectic by choice, he was not an outstanding original thinker nor a noted contributor to therapy, but as an observer and instructor he was unsurpassed. Like Sydenham, whom he ardently admired, Boerhaave placed the greatest emphasis on bedside instruction, thus reviving this important aspect of the Hippocratic method. He also insisted that the student follow a patient’s corpse to the autopsy table to fix clearly in mind the correlation between lesions (abnormal changes) and symptoms. Fortunately students at Leiden had the advantage of instruction in dissection from Bernhard Siegfried Albinus (1697-1770), one of the most famous anatomists of the day.

Among the many pupils of Boerhaave who spread the teachings of the master to all parts of Europe was the Dutchman Gerhard van Swieten (1700-72), author of a famous commentary on the Aphorisms (1709) of his teacher. Called by Empress Maria Theresa to Vienna to serve as her personal physician, Van Swieten was also granted a free hand in reorganizing the teaching of medicine at the ancient university after the pattern of Leiden. To assist him in this undertaking Van Swieten called on a fellow-alumnus, Anton de Haen (1704-76). An excellent clinician and hygienist, De Haen did much to popularize the use of the thermometer in medicine and the use of a methodology in solving puzzling cases.

This so-called old Vienna school reached an acme of popularity just after mid-century, drawing flocks of students from all over Europe. Possibly its most illustrious alumnus was Leopold Auenbrugger (1722-1809), whose Inventum Novum (1761) clearly outlined the procedure of percussing the chest (tapping with the fingers) to diagnose abnormalities of the thorax. Although this technique was ridiculed by contemporaries of Auenbrugger, fifty years later his book was rediscovered and translated into French by Jean-Nicolas Corvisart (1755-1821) reintroducing one of the lasting diagnostic tools of the profession. In the construction of the famous Allgemeines Krankenhaus (1784), Vienna set a model for all Europe of a hospital devoted not only to teaching but also to care of the underprivileged.

Earlier in the century, while Boerhaave was still teaching, another of his pupils, Alexander Monro (1697-1767), returned to his native Scotland to add vigor to the ancient University of Edinburgh. A master anatomist, Alexander was succeeded by a son and grandson of the same name, thus providing a dynasty which was to endure for well over a century. Edinburgh rapidly became the principal center of medical instruction for the English-speaking world.

The most notable of all Boerhaave’s disciples, and one of the towering figures of the century, was the Swiss Albrecht von Haller (1708-77), a man of unlimited energy and imagination. He emulated and easily surpassed his own master in humanistic interests. Poet, novelist, writer of thousands of letters, and master bibliographer, Haller has often been described by his admirers as a universal genius. At the University of Gottingen, which he helped to create, he gave courses in a variety of subjects. His botanical garden attracted savants from all over the world, and even in this special field Haller could compete on equal terms with the great Linnaeus.

In the performance of physiological experiments Haller confined himself almost exclusively to the nervous system, refusing to accept the age-old concept of a fluid traversing the nerves as the cause of nerve action. He focused his observations on the nerve fiber itself, demonstrating clearly that while “irritability” was a property of muscle fiber, another factor, “sensibility,” was characteristic of the nerve fiber. He outlined our current theory of the relationship of the brain cortex to the peripheral nerves, and although he still regarded the central area of the brain as the seat of the principle of life, or soul, he decried all mystical systems, and may be regarded as the founder of modern physiological thought.

Other experimenters in physiology whose studies were applicable to medicine were: Rene de Reaumur (1683-1757), inventor of a thermometer and a scale which bear his name and a pioneer in the study of gastric digestion; Lazzaro Spallanzani (1729-99), who helped put to rest the ancient concept of spontaneous generation and who was a pioneer in experimental fertilization; Stephen Hales (1677-1761), who demonstrated the dynamics of blood circulation, stressing the importance of the capillary system and recording blood pressure with a manometer, a forerunner of today’s apparatus.

As the century drew to a close, Luigi Galvani (1737-98) launched the new science of electrophysiology with his observation that nervous action in muscle could be induced by an electrical charge. The erroneous theories and quackeries of “animal electricity” which resulted were disproved by the studies of Alessandro Volta (1745-1827), who not only demonstrated that the galvanic effect did not require the contact of an animal but also pioneered in the development of a battery.

The physiology of respiration received additional impetus in this period, stimulated by exciting advances in knowledge of the composition of air. The isolation of oxygen by Karl Wilhelm Scheele (1742-86) and Joseph Priestley (1733-1804) led to the disappearance of the phlogiston theory which had postulated the presence of a special substance in combustible materials yielded to the air on burning. Antoine-Laurent Lavoisier (1743-94) repeated many of Priestley’s experiments but understood the significance of the results more clearly. Whereas Priestley still steadfastly supported the phlogiston hypothesis, Lavoisier proved its fallaciousness, gave the name “oxygen” to the substance in air responsible for combustion, and even perceived that respiration was necessary to the process we call oxidation in living tissue. Ironically, the pioneer who had advocated adequate housing space so that people could obtain sufficient oxygen was guillotined in the aftermath of the French Revolution by those whose benefit he sought. Eventually his demonstration of the role of oxygen in combustion revolutionized the entire science of chemistry.

The study of anatomy continued an orderly advance during this period, but more interest was directed to the newer subsciences of pathologic anatomy, comparative anatomy, and embryology. One of the greatest names of the century was that of Giovanni Battista Morgagni (1682-1771), whose five decades as professor at Padua were crowned by the publication of one of the acknowledged masterpieces of medical literature. In contrast to the earlier, poorly organized Sepulchretum of Theophile Bonet (1629-89), to which Morgagni paid due respect, his own De Sedibus et Causis Morborum (On the Sites and Causes of Diseases) (1761) contained beautifully arranged descriptions of the five hundred cases which he saw at autopsy, including in each instance a strict correlation of clinical symptoms with postmortem findings. Morgagni’s work disposed of the ancient humoral theory of a single morbid cause for all disease and established the concepts and methods of study which provide to this day the basis of medical investigation and teaching. Among individual entities first clearly identified by Morgagni were hepatic cirrhosis, renal tuberculosis, syphilitic lesions of the brain, and pneumonic solidification of the lung. One of the followers of Morgagni was the brilliant Frenchman Xavier Bichat (1771-1802), who in his short lifetime studied over six hundred cadavers before dying of an infection contracted in the dissecting room. Without the use of a microscope Bichat succeeded in identifying twenty-one different tissues. His insistence that tissue was the prime element in the study of pathology facilitated the transition from Morgagni’s theory of organs as principal components of the body to the doctrine of Rudolf Virchow that the cell was the basic unit.

The first systematic illustrated textbook of pathology, the work of Matthew Baillie (1761-1823), had been anticipated in part by the Irish anatomist Samuel Clossy (1724-88) whose Observations had appeared as early as 1763. What are now the modern concepts of embryology were given considerable impetus by the work of Caspar Friedrich Wolff (1733-94), who dared to oppose the great Haller’s teachings on the development of the embryo. In opposition to the ancient accepted theory of embryonic preformation in miniature, Wolff reintroduced the doctrine of epigenesis, that is, the elaboration of the embryo by division from a single undeveloped form.

The dominating figures in the study of anatomy in England during the latter half of the century were the Hunter brothers. William (1718-83), a pupil of Cullen, founded the famous Great Windmill Street School of Anatomy, the first medical school in London. He also published works of fundamental importance on the human teeth and the pregnant uterus, having succeeded his master William Smellie (1697-1763) as the most fashionable “man-midwife” in the English metropolis. The introduction of the hitherto secret Chamberlen obstetrical forceps into general use (1727) and the delivery of members of the royal family by William Hunter were factors which helped to raise the science of obstetrics from medieval obscurity. Of equal importance in reducing maternal mortality was the establishment of the famous Rotunda in Dublin. This obstetrical hospital under the supervision of Sir Fielding Oulds was to set a standard of cleanliness and efficiency for all the continent to follow. William Hunter epitomized the courtly, humanistic physician of the early Georgian period. Following in the footsteps of Sir Hans Sloane (1660-1753), whose great collections helped form the nucleus of the British Museum, and of Richard Mead (1673-1754), one of the great bibliophiles of all time, Hunter himself became one of the most famous collectors of the period. Fortunately all his books, manuscripts, works of art, and unrivaled Greek and Roman coins can be studied today at the University of Glasgow.

But it was William’s younger brother John (1728-93), brilliant surgeon and experimentalist, who has left a greater impress on the history of medical science. Having become an expert anatomist at his brother’s school, John proceeded to study surgery under the two men who dominated the field in England during most of the century, namely William Cheselden (1688-1752) and Percivall Pott (1714-88). An expert in the practice of lithotomy (removal of bladder stones) when speed in any surgical procedure was of the essence, Cheselden was reputed to have performed this operation in less than one minute. The equally brilliant Pott is the eponym for several medical conditions, including Pott’s fracture of the ankle and Pott’s curvature of the spine. It was this keen observer who first traced the relationship of scrotal cancer in chimney sweeps to their constant exposure to soot.

Following in the footsteps of these famous masters and basing his own work on a firm knowledge of anatomy and physiology, John Hunter was well prepared to raise surgery from a technique to a science. In operative surgery, possibly his single greatest contribution was a new method of closing off an aneurysm (outpouching of an artery), thus preserving the limbs of thousands of soldiers and civilians from unnecessary amputation. A man of the utmost precision in his work, he has been called the founder of experimental surgery and pathology and a pioneer in comparative anatomy. The hundreds of specimens he collected formed the basis of the Hunterian Museum now housed in the College of Surgeons of London. Only once did a Hunter experiment prove fallacious: in an attempt to prove that the two great venereal diseases had a common origin John had himself inoculated with matter from a case of gonorrhea. Unfortunately the donor was suffering from both diseases, and the development of syphilitic signs naturally convinced Hunter of his original hypothesis, which others had also held before him. It was not until a half century had elapsed that Philippe Ricord finally cleared up the confusion. The host of pupils left behind at John Hunter’s death constitute a roster of distinguished names. Of these one may mention the surgeons Astley Cooper (1768-1841) and John Abernethy (1764-1831) and the physicians Edward Jenner (1749-1823) and James Parkinson (1755-1824).

It was during this century that the surgeons of France and England finally managed to cast off the remaining vestiges of medieval restraints, to achieve emancipation and a position of equality with their traditional rivals, the physicians. In France the Royal Society of Surgeons was founded in 1731; in 1743 a royal decree forbade barbers from practicing all except minor procedures in surgery. Two years later in England, the corporation of surgeons was formally separated from the barbers, but it was not until the last year of the century that the Royal College of Surgeons was finally granted a charter.

Among the prominent continental surgeons of this century in France were Jean-Louis Petit (1674-1760), the inventor of the screw tourniquet and of a less lethal procedure for mastoidectomy, and Pierre Desault (1744-95), whose bandage for fractured clavicle is still in use today. In Italy Antonio Scarpa (1752-1832), master anatomist and humanist, devised a successful operation for inguinal hernia, while Giuseppe Flaiani (1741-1808) gave one of the earliest accounts of exophthalmic goiter. The German Lorenz Heister (1683-1758) wrote one of the first systematic illustrated textbooks on surgery (1718) and lived to see this translated into many of the languages of Europe. Indeed an important step toward the final emancipation of the surgeon has sometimes been credited to the fame of this single book—in addition to the successful fistula operation performed by Felix on the grateful Louis XIV.

METHODS OF TREATMENT

In spite of the startling developments in chemistry, there were few therapeutic advances in the eighteenth century. The ancient practices of cupping, bleeding, and purging persisted as the mainstays of the practitioner, while syphilis and other venereal diseases continued to be treated with massive, often fatal, doses of mercury. Theriac, the cure-all of antiquity, was still in use, as was a famous cinchona bark concoction against fevers of all types originated by John Huxham (1692-1768). A disciple of Boerhaave, Huxham deserves to be better remembered as the first physician to differentiate clearly between typhus and typhoid.

Among the more famous English clinicians of the period were William Heberden (1710-1801), who described angina pectoris, night blindness, and the nodules of osteoarthritis on the fingers which still bear his name, and Caleb Hillyer Parry (1755-1822), whose account of exophthalmic goiter is now considered to have precedence over all others. James Currie (1756-1805) sparked a renewal of interest in sea-bathing and hydrotherapy, and the spas of England and the continent became extremely popular with sufferers from gout and other metabolic disorders. Of moderate usefulness were such well-known formulations as Dover’s powders, Hoffmann’s anodyne of opium, Fowler’s solution of arsenic, and Glauber’s salt, all of which retained their place in the pharmacopoeias of the world until quite recent times.

Digitalis

Undoubtedly the most important drug introduced into the armamentarium of the physician during the eighteenth century was digitalis, whose value in the treatment of dropsy (swelling of the limbs) was announced in 1785 by William Withering (1741-99) after many years of study. Having begun his investigations with a secret folk remedy, Withering quickly identified the active ingredient in the herbal brew as foxglove, Digitalis purpurea. This had been used for many years to treat a wide variety of illnesses, but Withering soon discovered that digitalis was not effective in all types of dropsy. At the time, he did not know that dropsy is merely a symptom of different pathological conditions and that only swelling from heart malfunction would respond. Nevertheless Withering did recognize that the drug acted primarily on the heart, was potentially toxic, and had to be administered in gradual doses—essential elements in therapy still observed today.

Treatment of the Insane

In keeping with a more sympathetic approach to problems of the masses inspired by the Enlightenment, the decade of the French Revolution witnessed a dramatic change in the care and treatment of the mentally ill. Foremost in this movement was the Frenchman Phillipe Pinel (1745-1826), who pleaded for a more humane regimen for the inmates of the Bicétre asylum near Paris, where the patients had hitherto been kept chained-up like beasts. An advocate of vitalism, Pinel kept accurate notes of the progress of his mental patients and may well be considered the founder of modern psychiatry.

Of more questionable value to psychiatry were the productions of Franz Joseph Gall (1758-1828), who was diverted from his useful studies on the anatomy of the brain to propound a theory that the strength of certain emotional and intellectual functions associated with localized areas of that organ could be accurately determined by studying the protuberances of the skull. The resulting pseudoscience known as phrenology was to enjoy a wide following for almost a century. Similar in character was the theory developed by the Swiss mystic and physician John Kaspar Lavater (1741-1801), who insisted that from the facial characteristics of an individual one could determine his character and mental capacity.

On the more positive side was the establishment by the English Quaker William Tuke (1732-1822) of the York Retreat for the humane care of the mentally ill. This pioneer institution set a pattern which was soon adopted in many parts of Europe.

Quackery and Cults

In spite of the significant progress in medical science which marked the eighteenth century, this period may also be considered the Golden Age of duplicity and charlatanism. One of the greatest hoaxes was that perpetrated by Joanna Stephens, who convinced even the great Cheselden that she had discovered a sovereign remedy for dissolving urinary stones, with the result that a gullible public paid five thousand pounds for the secret formula of this worthless concoction. Even more ludicrous was the case of Mary Toft, whose claim of having been delivered of rabbits (vouched for by the king’s anatomist and surgeon) had all of London, including royalty, in an uproar. Even so sophisticated a personage as the Duchess of Devonshire was a sponsor of the infamous Temple of Health built and supervised by one of the most adroit of quacks, James Graham. Incorporating recent discoveries, Graham’s erotic Celestial Bed bristled with a gamut of electrical devices guaranteed to spark even the most worn-out of rakes into renewed vitality.

To their credit it should be pointed out that some quacks became quite expert in certain specialties which legitimate practitioners were perfectly happy to relinquish. The Chevalier John Taylor could boast that he had treated the eyes of all the nobility of England, including George II who had appointed him his personal oculist. The setting of fractures was also relegated to highly skilled men and women; even the great Hans Sloane was perfectly willing to entrust the care of his niece suffering from a “broken back” to Crazy Sal, a famous bone-setter.

In that shadowy no-man’s-land which still exists between the charlatan and conventional therapist stood the fascinating figure of Franz Anton Mesmer (1734-1815). A graduate of Vienna, Mesmer soon made his work on animal magnetism the subject of acrimonious debate in every capital of Europe. In Paris his Magnetic Institute attracted hundreds of the idle rich and was castigated as a hotbed of immorality. However, there can be no question that in those darkened rooms Mesmer achieved success in relieving the hysterical symptoms of susceptible young females. Mesmer for a short period had all Paris at his feet; so ardent were his admirers that many followed him to Switzerland after he had been banished from the French capital. That Mesmer’s inadvertent use of hypnotic suggestion led the way to Bernheim and Freud is now well recognized by scholars.

PUBLIC HEALTH

In the eighteenth century only the very wealthy could be assured of the services of a qualified doctor of medicine, and this of course forced the general public into the hands of mountebanks, quacks, and others poorly prepared to offer rational treatment.

Dispensaries were scarce, hospitals had no organized clinics, and even people not actually impoverished had no place to turn for help. As a result, apothecaries gradually began to fill the void by responding to obvious needs of the public, thus destroying the monopoly of the physicians. The situation led to eventual acceptance of the apothecaries as general practitioners within the medical community, but this uneasy alliance raised many questions of medical ethics. The principal statement in this field was made by Thomas Percival (1740-1804), who adopted a somewhat patronizing attitude toward the apothecaries, but in his own conduct and in his book stressed those principles of professional conduct which are still valid today.

In the quest for amelioration of the public health an important part was played by the Quakers. The appalling infant mortality from diphtheria (then unnamed) led the philanthropic physician John Fothergill (1712-80) to study and publish an accurate description of this treacherous killer: Account of the Sore Throat Attended with Ulcers (1748). His disciple John Coakley Lettsom (1744-1815) was also lavish in his contributions to philanthropy and wrote an early paper on the harmful effects of alcohol and drugs among the laboring class. John Howard (1726?-90) so shocked the conscience of the world by his famous account of the dungeons and lazarettos of Europe that there resulted an outcry for more humane treatment of and improved sanitary conditions for the incarcerated.

The military mind also contributed to the betterment of conditions for prisoneres of war. Sir John Pringle (1707-82), a humane and progressive army surgeon, pleaded for decent ventilation for those confined in ship hulks and military prisons, insisting that jail fever and hospital fever were identical. Naval hygiene became the principal concern of James Lind (1716-94), whose insistence on the virtue of lemon juice in preventing scurvy went long unheeded by the Admiralty lords. George Baker (1722-1809) ended the mysterious deaths from “Devonshire colic” when he identified this as lead poisoning caused by drinking apple cider prepared in lead-lined containers.

A modern plan for systematic health coverage was envisaged by Johann Peter Frank (1745-1821). Professor at Pavia and a man of great intellect, Frank conceived a cradle-to-grave supervision of all medical needs not unlike the system now in effect in Great Britain. Although self-medication was frowned upon then as now, the plight of country folk who had practically no access to physicians produced a spate of home medical manuals. Those who did not wish to consult the village dame could turn to Primitive Physick (1747), a product of the pen of John Wesley (1703-91). Avowedly empiric this small book supplied prescriptions for many simple disorders, sold for one shilling, and achieved an enormous success. On a somewhat higher level was the Domestic Medicine of the Scottish physician William Buchan (1729-1805), which went through innumerable editions and was shelved next to the Bible in many a frontier home.

The Discovery of Vaccination

Although somewhat less lethal than in earlier centuries, bubonic plague, typhus, malaria, and diphtheria still returned with distressing regularity to take heavy tolls. But it was smallpox which remained the single most deadly killer of the period. This scourge, always endemic, frequently assumed epidemic proportions in the cramped medieval towns where refuse and even human excrement clogged the narrow streets and inadequate sewers. It is said that one-third of all the inhabitants of London bore pit marks of smallpox. Early in the century Lady Mary Wortley Montagu (1689-1762) brought back to England the Asian technique of variolation which she had observed in Turkey. This consisted of pricking serum from the sore of a person with smallpox into another’s skin to produce a resistance resulting from a mild case of the illness. After two princes of royal blood had been successfully inoculated (1722), the practice became quite popular for a short period but soon lost acceptance as the inherent dangers became increasingly apparent. Inoculation also lost favor in the American colonies and was outlawed by several states until the eve of the Revolution. Debate continued on the value of variolation until Edward Jenner (1749-1823) electrified the world with his famous paper in 1798 on cowpox and the benefits of inoculating humans with the fluid from the sores of vaccinia, a disease of cattle. Vaccination had none of the potential dangers of the earlier inoculation of material from smallpox itself.

Thus the eighteenth century was not merely a period of consolidation or systematization. Overwhelmed as they were by the revolutionary discoveries of the previous century, physicians of the period struggled bravely to absorb and utilize the mass of new science. We can now better assess the considerable contributions of the eighteenth century and observe how closely these can be correlated with the advances which were imminent.

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