The Pursuit of Glory, page 10
Successes such as inoculation, vaccination or digitalis were few and far between. Almost all the staples of modern medicine–germ theory, general anaesthesia, radiology, antibiotics, and so on–were discoveries of the nineteenth and twentieth centuries. For most patients in most places, the situation in 1815 was not so very different from that of 1648. In four ways, however, there can be said to have been progress, in the sense that the chances of patients receiving beneficial treatment improved. First, there was a fitful but definite move away from a humoral view of disease to one centred on the material structure of the body and employing a mechanical metaphor to understand its workings. The chief theoretical influence here was Descartes, whose rationalist philosophy divided soul from body, thus allowing the latter to be studied for its own sake and on its own terms. The chief practical influence was the growing practice of conducting post-mortems, which boosted anatomy and pathology at the expense of humoral theory. A landmark was the publication in 1761 by Giovanni Battista Morgagni of Padua of De Sedibus et Causis Morborum per Anatomen Indagatis Libri Quinque (The Seats and Causes of Diseases Investigated by Anatomy in Five Books), which described 640 post-mortems in detail, relating the state of the organs after death to the clinical symptoms displayed during life.
Secondly, in a few places there developed clinical training, which gave aspiring physicians the opportunity to learn their profession at the bedsides of real patients. The most influential figure here was Herman Boerhaave (1668–1738), professor of medicine at the University of Leiden in the Dutch Republic, who applied Cartesian dualism to physiology. He did not invent clinical training, which dates back to sixteenth-century Pavia, but he did popularize it. His clinic came to be a most important institutional influence on the development of eighteenth-century medicine. It was to Leiden that John Monro sent his son Alexander to be trained in anatomy, as part of his plan to give the University of Edinburgh a faculty of medicine, duly established in 1726. It became the most important centre of medical research and training in the British Isles, not least because it was closely linked to the Edinburgh Royal Infirmary, founded three years later. Similar institutions for clinical training were established in Halle, Göttingen, Jena, Erfurt, Strasbourg, Vienna, Pavia, Prague and Pest. Perhaps significantly, it was not the university but the hospital that provided the institutional base for medical progress. At the University of Oxford, the primary duty of the Regius Professor of Medicine was to lecture twice a week during term on the texts of Hippocrates or Galen. Even that modest requirement proved too much for Thomas Hoy, Regius Professor from 1698 to 1718, who preferred to reside in Jamaica and appointed a deputy (who in turn appointed a deputy). Hoy was not untypical: the official history of the University records gloomily: ‘The holders of the office between 1690 and 1800, with minor exceptions, performed their duties with so little commitment that they merit no more than passing mention.’
A third form of progress was provided by voluntary movements of various kinds. There is no reason to suppose that human nature became more charitable in the eighteenth century, but the proliferation of private initiatives to relieve suffering was certainly striking. Whether it was the Medical Institute for the Sick-Poor of Hamburg, set up ‘to return many upright and honest workers to the state’ and ‘to reduce distress of suffering humanity’, the Society for Maternal Charity to serve ‘a class of poor for whom there are neither hospitals nor foundations at Paris, namely the legitimate infants of the poor’, or the self-explanatory National Truss Society for the Relief of the Ruptured Poor of London, the amount of medical attention available greatly increased. This phenomenon appears to have been particularly common in Great Britain, although this may simply reflect greater knowledge. Of special importance for medicine was the ‘voluntary hospital movement’, so-called because the hospitals in question were founded by groups of charitable individuals. The first was the Westminster Infirmary, founded in 1720, followed in London by St George’s, the London and the Middlesex. At least thirty more were founded in the provinces, among them Addenbrooke’s Hospital in Trumpington Street, Cambridge, founded in 1766 following a bequest from a former bursar of St Catharine’s College ‘to hire and fit up, purchase or erect a small, physical hospital in the town of Cambridge for poor people’.
Lastly, there was certainly a marked increase in the number of formally educated and certified practitioners. Three broad categories can be identified: at the summit were the physicians, academically trained, officially licensed and enjoying highest status and highest fees. More disparate were the apothecaries and the barber-surgeons, usually organized in guilds and treated as craftsmen. As the name of the latter group suggests, their primary function was to dress hair. They could turn their hand to simple medical tasks such as extracting teeth, lancing boils or setting bones, but usually were prudent enough to work within their limitations. The development noted above of the mechanistic view of the human body and the accompanying development of anatomy led to a corresponding expansion in the barber-surgeons’ horizons and the dropping of their tonsorial function. In 1745 the London Company of Surgeons broke away from the Barbers, completing their elevation to professional status with a royal charter in 1800 which made them the Royal College of Surgeons. In France, conventional craft-training for surgeons was ended in 1768. Everywhere there was a gradual convergence of training for physicians and surgeons, with a consequent elevation in status for the latter.
Between 1648 and 1815 there were few decisive medical innovations, but there was probably more change than in the previous millennium, especially in the way in which the working of the human body was regarded. It seems appropriate, therefore, to end this section with the optimistic view of the future voiced in 1794 by William Heberden:
I please myself with thinking that the method of teaching the art of healing is becoming every day more conformable to what reason and nature require, that the errors introduced by superstition and false philosophy are gradually retreating, and that medical knowledge, as well as all other dependent upon observation and experience, is continually increasing in the world. The present race of physicians is possessed of several most important rules of practice, utterly unknown to the ablest in former ages, not excepting Hippocrates himself, or even Aesculapius.
WOMEN, SEX AND GENDER
In 1703 Sarah Egerton published a collection of poems entitled Poems on Several Occasions, including ‘The Emulation’, whose opening lines are:
Say, tyrant Custom, why must we obey
The impositions of thy haughty sway?
From the first dawn of life unto the grave,
Poor womankind’s in every state a slave,
The nurse, the mistress, parent and the swain,
For love she must, there’s none escape that pain.
Then comes the last, the fatal slavery:
The husband with insulting tyranny
Can have ill manners justified by law,
For men all join to keep the wife in awe.
Moses, who first our freedom did rebuke,
Was married when he writ the Pentateuch.
They’re wise to keep us slaves, for well they know,
If we were loose, we soon should make them so.
She wrote with the depth of emotion inspired by personal experience. As a penalty for writing a long verse satire The Female Advocate at the precocious age of fourteen (or so she claimed in her autobiography), she was sent away from London by her middle-class parents to live with relations in rural Buckinghamshire and was then forced into a loveless marriage with a lawyer. Released from this servitude by the death of her husband, she then jumped back into the fire by marrying a widower twenty years older than herself in c. 1700. Whatever material advantages the Rev. Thomas Egerton brought her–he was rector of Adstock–they were not sufficient to expunge memories of Henry Pierce, a humble clerk with whom she was in love. The unhappy couple’s early attempt at divorce was frustrated by legal barriers, so they were forced to struggle on in a notoriously stormy marriage. Another female poet, Mary Delariver Manley, witnessed a ‘comical combat’, in which both Egertons resorted to violence, he by pulling her hair, she by throwing food. After the death of her second husband in 1720, Sarah enjoyed just three years of comfortable, and one hopes peaceful, widowhood before expiring herself at the age of fifty-three.
In this brief biography can be found some, but by no means all, of the problems encountered by women in early modern Europe: parental tyranny, the arranged marriage, the loveless marriage, and the inability to divorce. At least poor Sarah had the literary skill to leave a record of her resentment. Nor was she a lone voice. In the very same year that she wrote the lines quoted above, Mary Chudleigh published Poems on Several Occasions, including ‘To the Ladies’, whose first lines are:
Wife and servant are the same,
But only differ in the name:
For when that fatal knot is tied,
Which nothing, nothing can divide,
When she the word Obey has said,
And man by law supreme has made,
Then all that’s kind is laid aside,
And nothing left but state and pride.
In her case, it was Sir George Chudleigh Bart., Devon squire, who was displaying ‘state and pride’, although he did also give her six children, only two of whom survived infancy. Although she never criticized her husband directly, it can be inferred with some confidence that he was less than ideal. Two years earlier, in 1701, Lady Mary had written ‘The Ladies’ Defence’ in answer to a sermon advocating the absolute submission of wives to husbands preached by a nonconformist minister called John Sprint. In the preface she stated that what made the greatest contribution to marital unhappiness was ‘Parents forcing their Children to Marry, contrary to their Inclinations; Men believe they have a right to dispose of their Children as they please; and they think it below them to consult their Satisfaction’. The poem is a discussion between three men, one of them an Anglican clergyman, and a woman. The chief spokesman for the male camp is the aptly named Sir John Brute, who takes the view that ‘Those worst of Plagues, those Furies call’d our Wives’ can, and should, be treated roughly:
Yes, as we please, we may our Wives chastise,
‘Tis the Prerogative of being Wise:
They are but Fools, and must as such be us’d.
In her reply, the female mouthpiece–Melissa–gives as good as she gets, apostrophizing men as arrogant tyrants, complacent hypocrites, sadistic brutes, self-indulgent sots, idle voluptuaries, ‘Empty Fops, or Nauseous Clowns’, just to mention a few of her epithets. Sir John is given strong clerical support from the unnamed parson, who patiently explains to Melissa the great gulf separating men from women:
Your shallow Minds can nothing else contain,
You were not made for Labours of the Brain;
Those are the Manly Toils which we sustain.
We, like the Ancient Giants, stand on high,
And seem to bid Defiance to the Sky,
While you poor worthless Insects crawl below,
And less than Mites t’our exalted Reason show.
Because it was Eve’s fault that mankind was expelled from paradise, he asserts, it is only right that her successors should be enslaved. Melissa replies that any intellectual limitations suffered by women are caused by men:
‘Tis hard we should be by the Men despis’d
Yet kept from knowing what would make us priz’d:
Debarred from Knowledge, banish’d from the Schools,
And with the utmost Industry bred Fools.
Sir John promptly confirms the justice of this complaint by observing that women should not be allowed to read, for ‘Books are the Bane of States, the Plagues of Life, / But both conjoyn’d when studied by a Wife’. The fourth member of the party, Sir William Loveall, the sort of bachelor so very keen to establish his heterosexual credentials by boasting of his conquests, tells Melissa that members of the fair sex should content themselves by being just that–fair–and not trouble their pretty little heads with matters they cannot understand. Faced with Brute’s misogyny, the parson’s theology and Loveall’s condescension, Melissa can only look forward to a more equitable existence in the next world.
Just how representative were Sarah Egerton and Mary Chudleigh can never be established, although there were plenty of other straws in the wind. In Some Reflections upon Marriage (1706) one of Mary Chudleigh’s correspondents, Mary Astell, wrote ‘if all men are born free, how is it that all women are born slaves?’ Rather like the ‘submerged nations’ awaiting discovery by the ethnologist to bring them to the surface, most European women throughout this period were sleeping beauties (to borrow Sir William Loveall’s imagery) whose resentment at millennia of oppression was confined to literary expression. That their general grievances were real is easy to establish. In every European country the legal system discriminated against them. In this respect at least, the spread of Roman Law during the early modern period had a regressive effect, for its attitude to women was underpinned by an assumption of their mental and physical weakness–Justinian’s Code explicitly referred to their ‘fragility, imbecility, irresponsibility and ignorance’. Of course, such empty vessels could not be entrusted with any property they might possess. So whatever a woman brought to a marriage was treated as if it now belonged to her husband; only when he died might she hope to regain control, and even then she might not have first claim on the estate. As for her unmarried daughters, more often than not they found themselves left out in the cold. Even if an estate were not formally ‘entailed’, a legal device to keep the estate intact from one generation to the next, it was usual if not invariable for the male heirs to be privileged. That was what Henry Dashwood’s daughters discovered in Jane Austen’s Sense and Sensibility (1811) when their father died, leaving everything to his son by an earlier marriage and relying on his heir’s good will to ‘do something’ for his half-sisters. He had not reckoned with his daughter-in-law, who in the space of one chapter succeeds in reducing the sum from £1,000 for each of the girls to nothing:
‘He did not know what he was talking of, I dare say; ten to one but he was light-headed at the time. Had he been in his right senses, he could not have thought of such a thing as begging you to give away half your fortune from your own child.’
It might be thought that in this instance Jane Austen did her sex no favours by presenting Fanny Dashwood as the avaricious female bringing out the worst in her well-meaning but weak husband.
The Egertons, Chudleighs and Dashwoods were lucky to be literate, for not the least disadvantage suffered by women was educational. Everywhere in Europe it was men who were more likely to be literate, although there is some fragmentary evidence that rates for women were increasing. In the Electorate of Saxony, for example, the impact of the Reformation with its stress on the need for all believers to be given access to the word of God, meant that by 1580 about half the parishes had licensed German-language schools for boys, but only 10 per cent for girls. By the end of the following century, those figures had increased to 94 and 40 per cent respectively. Elsewhere, the ratio appears to have been less favourable: in France on the eve of the Revolution, for example, about 65 per cent of men but only 35 per cent of women could sign their names. Moreover, where schools for girls existed, there was a growing tendency to concentrate on practical subjects such as sewing and knitting to equip them for their domestic role. In an essay addressed to the two English universities, published in 1655, Margaret Cavendish, Duchess of Newcastle, implored her male superiors not to scorn women’s intellectual endeavours, lest ‘we should grow irrational as idiots, by the dejectednesse of our spirits’. It was that fatal lack of self-esteem
which makes us quit all industry towards profitable knowledge being employed only in looe [sic], and pettie imployments, which takes away not onely our abilities towards arts, but higher capacities in speculations, so as women are become like worms, that only live in the dull world of ignorance, winding ourselves sometimes out by the help of some refreshing rain of good education, which seldom is given us, for we are kept like birds in our houses.
As we shall see in a later chapter, for women the intellectual changes of the eighteenth century were double-edged. On the one hand, the development of the salons offered the opportunity for a few favoured individuals to gain real influence and the emergence of the novel gave them a genre ideally suited to the depiction of their world, but the attitude of the Enlightenment proved to be much more equivocal than might have been expected. A better understanding of the physical world and its laws did not necessarily encourage an egalitarian view of the human beings who inhabited it. By the late eighteenth century, women might no longer be burnt as witches, but they continued to be patronized as weaklings. As Merry Wiesner has pointed out, not only did the ‘scientific revolution’ fail to destroy the traditional belief in the inferiority of women, but by its privileging of such ‘masculine’ characteristics as reason, order, control and mechanical processes, it may have anchored that supposed inferiority even more firmly in European culture. Nor did the development of new ideas of ‘politeness’ by progressive intellectuals such as the third Earl of Shaftesbury or David Hume (both of them bachelors) point towards equality. Apologists for the superiority of modern commercial urban society and its civilized discourse might well call for women to be treated with greater courtesy and generosity, but also assumed continuing deference to the dominant males. It was against this kind of patronizing kindness that Mary Wollstonecraft erupted with such eloquence in her Vindication of the Rights of Women of 1792.
