medicine, development of

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medicine, development of. The wort-cunning of the Anglo-Saxon leeches, allied to nursing skill, became displaced by the introduction of Salernitan doctrine into England as the great medieval schools at Montpellier, Paris, Bologna, and Padua were founded. Ancient and hence medieval medical knowledge had fused around the writings of the Hippocratic corpus and Galen, and was predominantly found in monasteries, where Christian tradition encouraged care for one's neighbour. Such knowledge became institutionalized within the medieval universities of Oxford and Cambridge, which conferred the right to practise. But the bulk of the population had little access to physicians, seeking instead barber-surgeons, apothecaries, empirics such as bonesetters and tooth-drawers, or wise women. In principle subordinate to the medical faculties, these groups in practice had considerable autonomy; separation between the book-learned physicians and the practically-orientated surgeons grew as each developed their own professional structure, while the guilds sought to keep their own practice exclusive. The 16th-cent. attack on the doctrine of the humours (which emphasized symptoms rather than causes of disease) by the turbulent Paracelsus, and his rejection of authority, led to a split with the Galenists; the Paracelsians, or chemical physicians, became particularly prominent in northern Europe and England as they attempted a more rational approach to diagnosis and treatment, favouring metallic rather than herbal remedies. The College of Physicians (established 1518) suffered serious crises in the 17th cent. because of its continued identification with Galenic theory and its links with patronage, heightened by a resurgence of empiricism and knowledge based on experience rather than scholarship. As the natural sciences advanced and old Aristotelian ideas were discarded, observation and experiment gradually replaced theory and guesswork: William Harvey's explanation of the circulation of the blood was confirmed by Malpighi's microscopic identification of the capillary vessels, while Thomas Sydenham encouraged detailed bedside observation.

As the power of the guilds declined, unregulated groups of medical practitioners emerged, whose training and practice were controlled more by the growth of a cash economy, resulting in a highly competitive ‘health-for-sale’ market. The establishment of voluntary hospitals and new medical schools, with increased clinical training at the bedside, broke the monopoly of the medieval universities, while, outside the official schools, private courses in anatomy and midwifery could be purchased. Educated lay people had long had access to medical knowledge, but once microscopic anatomy, pathology, and the stethoscope were developed, and greater rigour demanded, such learning became increasingly exclusive to the professionals. The introduction of inoculation and then vaccination made slow inroads upon the scourge of smallpox, surgery began to acquire some respectability, obstetrics was increasingly in the hands of the man-midwives, specialities began to emerge through new explanations of disease, and public health and hygiene received more attention.

The 19th cent. was characterized by a rise in scientific medicine, convergence between the separate disciplines of physic and surgery, and commencement of regulation throughout the profession. The structure of the body being known, attention turned to its detailed function; the concept of the cell as the centre of all pathological changes finally destroyed the view that an imbalance in the humours underlay disease. General anaesthesia (1840s) increased the scope and practice of surgery, most noticeably after Lister's antiseptic principle had been introduced (1860s), dramatically reducing infections and mortality, especially in hospitals and after childbirth. Verification of the germ theory transformed pathology, though maintenance of health was becoming as important a concern. The overall standard of medical education improved and medical societies burgeoned, but the existence of 21 separate licensing bodies stimulated the 1858 Medical Act, which created a central governing body and established a register of practitioners. Attempts to have a single portal of entry to the profession were thwarted though, and many unqualified practitioners persisted. Radiology, psychiatry, and tropical medicine having been established, the 20th cent. continued to change the face of medicine beyond recognition. Life expectancy increased steadily, particularly after commercial production of antibiotics and vaccines. Developments in immunology have enabled organ transplants and genetic disorders are slowly yielding their secrets, but heart disease and malignancies remain disturbingly prevalent. Improved communication and teamwork have replaced isolated study, with widespread advances in medical technology furthering claims to professional monopoly, if not élitism, at the same time as affecting medical education and generating funding crises. The introduction of the National Health Service in 1948 markedly altered the pattern of provision of health care, but morale within the profession has declined as, increasingly challenged, it struggles to adjust to changing cultural values and expectations.

A. S. Hargreaves

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