Clinical and Preventive Medicine

12 May

and  perfumes  it provided  an  antidote  to  the  aroma  of the  sickroom. Perhaps  all too  many physicians resembled Molie`re’s caricature  of the physician, whose prescription  for any illness was always ‘‘clyster, bleed, purge,’’  or  ‘‘purge,  bleed,  clyster.’’  (Clyster  is  an  archaic  term  for enema.)  In  Molie`re’s  play  Love’s the Best Doctor,  we learn  that  ‘‘we should  never say, such a one is dead  of a fever,’’ because,  to  tell the truth,  the patient  died of ‘‘four doctors  and two apothecaries.’’

Nevertheless, physicians were mastering the art of using new drugs, such as quinine and ipecac, while the introduction of New World foods, especially potatoes  and  corn,  had  a remarkable effect on  health  and population growth.  The potato  became the staple food  of the poor  in northern Europe,   the  British  Isles,  and  Ireland.   A  one-acre  plot  of potatoes  could feed a family of six all year. Over-dependence  on a single crop has always been one of the risks of agricultural societies, as demon- strated  by the Irish potato  famine of 1845. (In 2001, scientists were able to use PCR  amplification of samples taken  from historic  specimens to identify the specific strain of the plant pathogen, Phytophthora  infestans, that was responsible for the devastating  potato  blight.) Corn, which was usually called maize, or Turkish wheat, provided much needed calories, but  also  made  pellagra  (a  nutritional disease  caused  by  insufficient niacin and protein  in the diet) an endemic disease in many areas. Some New World plants,  such as tobacco,  were simultaneously credited with medicinal virtues and condemned  as poisons.

Although  mortality  rates  for this period  are generally crude  esti- mates,  interest  in the accurate  measurement  of births  and  deaths  was growing.  John  Graunt (1620–1674), author of  Observations  upon the Bills of Mortality  (1662), the  first  book  on  vital  statistics,  attempted to derive general trends  from  the local Bills of Mortality (weekly lists of burials)  and  the records  of marriages  and  baptisms  kept  by parish clerks.  Graunt called  attention to  the  fact  that  the  urban  death  rate was greater  than  that  of rural  areas.  Infant  mortality,  a good index of general  health  and  sanitation,  was  very  high:  probably   40  percent of  all infants  died  before  reaching  their  second  birthday.  Renowned astronomer Edmond   Halley  (1656–1742), who  was  interested  in  the theory  of annuities  and  mortality  rates,  noted  that  those who reached maturity  should not complain about the shortness of their lives, because half  of  all  those  born  were  dead  within  17 years.  Nevertheless,  the physical  sciences had  been  transformed and  it  seemed  reasonable  to expect a similar revolution  in medicine. To this end, physicians devoted to scientific research developed elaborate  theories, which had little to do with the practical  details of patient  care. Thomas  Sydenham,  who has been honored  as the English champion  of clinical, or bedside medicine, provides  an  instructive  example  of  a  physician  who  recognized  the growing tension  between medicine as science and medicine as the care of the sick.

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