Chapter 6. The Enlightenment (17th–18th)

New idea: medical education confirmed by a diploma

In 1794, a decree of the National Convention ordered the establishment of three medical schools in Paris, Bordeaux, and Montpellier. However, it is the degree of doctor of medicine in one of these schools that has become necessary for the implementation of medical activities. The cardiologist Jean-Nicolas Corvisard-Desmarets was behind this reform (Fig. 6.1).

Fig. 6.1. Jean-Nicolas Corvisard (1755–1821) — doctor of Napoleon I. One of the founders of internal medicine as a clinical discipline

Recognition of surgery

The Royal Academy of surgery was founded in 1731. Doctors of therapeutic profile and surgeons subsequently began to study in the same medical schools, where they received the title of doctor.

The creation of large hospitals

Louis XIV decided that every major city should have its own hospital. Originally intended to house the poor, hospitals quickly became a place to gain medical experience at the bedside of the sick. Some doctors here specialized in narrower areas of medicine, for example, Philippe Pinel (1745–1826), a psychiatrist, was the first to order that the mentally ill should no longer be put in chains (Fig. 6.2). Pinel showed his talents at the Salpetriere hospice and the women’s prison, which only became a hospital in the early 19th century.

Fig. 6.2. Philippe Pinel (1745–1826) — French physician, founder of psychiatry in France

Was osteoarthritis less common than it is today?

A study of skeletons from the crypt of Christ Church, located in East London and active from 1729 to 1869, showed that men suffered more from osteoarthritis than women [1]. The most common areas affected by osteoarthritis were the shoulder joint, the spine and joints of the hands. In contrast, osteoarthritis of large joints was rare, for example, hip osteoarthritis affected only 1.1% of men and 2.9% of women, gonarthrosis developed in 0.8% of men and 5.2% of women. The incidence of osteoarthritis was more common in the population currently living in the same area of London. In all likelihood, these figures reflect both the difficulties of manual labor at that time (washing clothes may have influenced the development of gonarthrosis in women), and, as in previous epochs, a reduction in life expectancy, reducing the apparent frequency of this disease, which is partly associated with aging.

The first description of nodules of Heberden

The 17th and 18th centuries are full of descriptions of the signs and symptoms of diseases. In his comments on the history and treatment of diseases, William Heberden (1710–1801) described nodules on the distal interphalangeal joints, now one of the signs of osteoarthritis, known as Heberden’s nodes: «What are these small hard nodules about the size of a pea that are often seen on the fingers, especially just below the tip, near the joint? They have nothing to do with gout...». Thus, Heberden was the first to identify «his» famous nodes that affect the distal interphalangeal joints, other rheumatic finger lesions, and gouty tophi (Fig. 6.3).

Fig. 6.3. William Heber­den (1710–1801) — English physician

William Heberden was born in the era that preceded the stethoscope and other medical innovations. The English physician, a follower of T. Sydenham, was a man of brilliant intellect with an outstanding capacity for clinical observation. To most he is known for his description of the osteophytes in osteoarthritis — nodules of Heberden. However, his contribution is much greater — he is considered the father of clinical observations of the 18th century and the founder of rheumatology. Currently, the organization of British rheumatologists is called the society of Heberden. Although the name Heberden is synonymous with» finger nodules», and especially in distinguishing between gout and osteoarthritis, his contribution to medical science is enormous. In 1740, he gave the first of his annual series of public lectures on medicine. He often advised wealthy patients to go to a Spa, preferably a bath, and although his opinion of the healing power of mineral water was not very high, he believed that a change of scenery and a break from work, domestic worries, and abuse were an important factor. «Rheumatism is a common name for many types of pain for which there are not yet correct names, although their causes are different» from «Letter to my son», November 28, 1765 [2].

From the reign of Henry IV to the first British Empire, medicine was still powerless against osteoarthritis.

Description of blood circulation by William Harvey (Fig. 6.4) in 1628, then lymphatic circulation by Jean Pecquet, histological descriptions of the inventor of the microscope, Antoni van Leeuwenhoek, and then Marcello Malpighi and Xavier Bichat. The list of new knowledge gained over these two centuries in the field of human physiology is truly impressive. Remember that Antoni van Leeuwenhoek once again identified the bacteria in 1683 after studying the seminal fluid in 1677.

Fig. 6.4. William Harvey (1578–1657) — English physician, anatomist, founder of physiology and embryology

Descartes was one of the main proponents of Harvey’s theory of blood circulation, which was very rational and in which Descartes undoubtedly recognized the application of his own «method». In this matter, he had to argue with two doctors of the» anti-circulatory system», Jean Riolan (Fig. 6.5) and Guy Patin (Fig. 6.6), who claimed that the arteries contained air, not blood.