On the Practice of Medicine: An important work in the history of medical science, published in the 17th century.
Giorgio Baglivi, an Italian physician, published De Praxi Medica in 1699. It was widely translated, and in 1723 an English version was published with the title On the Practice of Medicine.
The Danger of Medical Theories
In De Praxi Medica Baglivi criticised doctors who followed complicated medical theories that claimed to explain all ailments. Many of these theories came originally from Galen, the second century AD Greek doctor. Baglivi thought that people who accepted these theories were blinded to anything that did not fit with their beliefs. Instead of observing and continually learning from real medical cases and patients, they ignored potential lessons because they thought they already had all the answers.
The other major criticism that Baglivi made of the followers of theories was that their writings were not clear. They were experts in writing beautiful prose, but their fancy language made their points much harder to understand, which defeated the point of passing on learning.
The Importance of Observation and Anatomy
Baglivi’s alternative to Galenist theories was observation, observation, observation. He thought that one of the major duties of any doctor was to take down case histories, recording symptoms and outcomes, so that lessons could be learned to improve future treatment.
Autopsy was also an important part of medicine for Baglivi. He said that doctors had to get their hands dirty, literally. There were two key reasons to perform autopsies on people. The first was to establish the cause of death. Combining this knowledge with a good, detailed description of the patient’s symptoms and the course of the illness, meant that next time the doctor would be able to infer the internal causes and symptoms of the disease from the external ones that he could see. That would naturally improve treatment and success rates.
The other reason for dissecting bodies was to discover how they worked. This could be from dissecting human bodies, or animals that share some aspects of our anatomy. Some notable successes for dissection had been the discovery of the circulation of the blood and the structure of the intestines. Baglivi believed that more observation from dissection could advance medicine even further.
Baglivi also believed in the usefulness to medicine of other sciences such as botany, chemistry, diet and exercise. These subjects are all still used in medicine today.
Baglivi’s Colleges of Physicians
Baglivi suggested that colleges of physicians (doctors) should be set up in every city that had a major hospital. These colleges should be split up into one school for reading observations (in the form of medical textbooks) and one school for making more observations, by autopsy and studying actual patients. Each doctor in the college should devote himself to the study of just one disease so that he could collect all possible knowledge of it. In this way, medicine as a whole would advance.
De Praxi Medica ends with Baglivi’s ‘wish list’: He would like to see more knowledge collected about many common diseases; how the progress of disease is affected by age, sex and climate; and how disease affects organs such as the heart, liver, eyes, ears etc. All of these advances could only come from observation, which Baglivi believed to be the cornerstone of medicine.
- De Praxi Medica by Baglivi 1699
- On the Practice of Medicine by Baglivi 1723 (trans. Anonymous)