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THE EARLIEST PUBLICATION IN EUROPE OF A SYSTEMATIC TREATISE ON HYGIENE, PUBLIC HEALTH AND MEDICO-LEGAL SCIENCE

In the early part of the eighteenth century municipal and private-house sanitation existed in comparatively few cities of Europe, and then only in the wealthier quarters. Such a thing as sanitary police was practically unknown, and public health was considered only when the inhabitants were threatened with a serious epidemic like that of cholera, the plague, or leprosy. This indifference to public sanitation persisted down to the end of the nineteenth century. On arriving in Paris in the spring of 1857, at a time when the city was overcrowded with travelers, my friend and I were glad to secure a room on the fourth story of a modest hotel situated in the central part of the city, quite near the Palais Royal. We found no good reason to complain of the room itself; it was clean and adequately well ventilated. But the toilet facilities were such as one might expect to find in a hotel of the fourteenth or fifteenth century. On the roof of our building a lean-to had been constructed alongside a broad brick chimney, and this shack, which was distant at least forty feet from the doorway that led by a short stair-case to the fourth story of the hotel, could be reached only over a narrow plank walk that was wholly unprotected by a railing. Then again, on a bicycling trip which I made in 1896, through the central part of France, my friend and I experienced more than one surprise of a similar nature. For example, in several of the smaller towns we found that the ancient practice of throwing the slops out of the second-story windows into the middle of the narrow street, still persisted. But, in a matter of this kind, nothing is to be gained by entering into many details; “enough is as good as a feast.” I merely wish to emphasize the fact that even France, where civilization was so far advanced in many respects, was fearfully slow in adopting the first principles of house and municipal sanitation. It was only toward the end of the nineteenth century that London, the birthplace of the finest types of house and municipal sanitation, began to give serious attention to this subject. During the early part of the eighteenth century, however, even this great metropolis was very backward in manifesting any marked desire to improve the sanitary condition of its dwellings; for, was it not the Earl of Chesterfield who, at this very period of time (about 1750) made the statement, in a letter to his natural son, that “the lanes or narrow passage-ways in Holland are cleaner than the houses are in London?”

It was in Germany, many of my readers will doubtless be surprised to learn, that the first really serious attempt was made to present to the world a scientific treatise on this subject, a work which was published in several consecutive volumes and which even to-day is consulted as a most trustworthy and remarkably complete authority on municipal and private-house sanitation. The work referred to was written by J. P. Frank.

Johann Peter Frank, more commonly spoken of as Peter Frank, was born in 1745 at Rothalben, a village located in territory which at that time belonged to the Grand Duchy of Baden. He received a good preliminary training at the High School of Pont-à-Mousson, and then afterward took courses at the Universities of Heidelberg and Strassburg. His medical degree was bestowed upon him in 1766 by the first of these institutions, the subject of his thesis being “Medical Police.” Two years later he commenced the practice of his profession at the city of Baden-Baden, and in 1769 was appointed Court Physician at Rastatt.

During these early years of his career he did not lose interest in the subject which he had chosen for his thesis, but continued to work upon it until, in 1768, he was ready to submit to a bookseller the manuscript of Vol. I. The latter, after receiving from a so-called medical expert an unfavorable report on the quality of the text, expressed his unwillingness to publish the work. Frank’s discouragement over this result was so great that he proceeded without delay to throw the manuscript into the fire. Then, after further reflection, he decided to begin work afresh on the same theme, and thus it came about that he devoted the following eleven years to the preparation of a new text for Vol. I. In 1779 this first volume was published. In 1780, 1783, 1788 and 1813 four more volumes were issued. Volume VI and two supplementary volumes were issued between the years 1817 and 1819.

“Notwithstanding its defects,” says Puschmann, “this work is one of the most important, one of the greatest and most creditable pieces of medical literature of which the Germans may rightfully boast. Blumenbach called it a classic, the first treatise of its kind and indeed possessing a unique character.”

Of the other works published by Peter Frank, works which deal with pathology and the practice of medicine, the most important is that entitled “De Curandis Hominum Morbis Epitome” (“An abridged treatise on the diseases to which man is liable”). As he progressed with the writing of this treatise Frank undoubtedly discovered that he could not, with any degree of satisfaction, accomplish his original design of compressing what he had to say into an “epitome”; and so, from this time forward, he carried on the work, without paying any further attention to his original plan of an abridgment, until the book had reached its sixth volume; and even then it was not completed.^[8] Despite its incompleteness this work passed through several editions, for it was highly appreciated for its practical character and for the clearness of its descriptions of disease.

In 1785 Frank accepted an invitation to take charge of the clinical instruction at the University of Pavia, in the place of Tissot who had resigned. Through Frank’s advice and persistent efforts the medical department of the Pavia University was enriched by the addition of a chair of physiology and comparative anatomy, an anatomical theatre capable of seating 400 auditors, and a collection of pathologico-anatomical preparations to which all the hospitals of that part of Lombardy were obliged to contribute suitable specimens. The establishment of a surgical clinic was another of the improvements in the teaching facilities of the University that should be credited to Peter Frank. The length of the medical course was at his suggestion extended to five years. Among his associates in the Faculty at this period were the following distinguished men: Scarpa, in the chair of surgery, Scopoli, in that of pharmacology, and Volta in physics.

In November, 1795, Frank returned to Vienna and was almost immediately appointed Director of the Allgemeine Krankenhaus and Professor of the Medical Clinic with a salary of 5,000 florins and the privilege of occupying rent-free a house that was located in the immediate neighborhood of the hospital. At the same time the title of Aulic Councillor (Hofrath) was conferred upon him. One of the first improvements which he effected in the clinic was to have the small wards for male and female patients materially enlarged so that when twenty-five or thirty patients were present, as was often the case, the air might not become noticeably contaminated and thus rendered unfit for all who were present to breathe.

In his teaching Frank never forgot, on all possible occasions, to impress upon the students the importance of thinking independently on the subjects that were brought before them, as in this way they would learn to distinguish the false from the true. Whenever he discovered that he had made a mistake in one of his statements he did not hesitate to confess the fact. His son, Joseph, is responsible for the statement that his father never seemed to him happier than when he had an opportunity of making to his auditors some such speech as the following: “Gentlemen! Strike out this or that line in one of the volumes of my work! When I wrote it I believed that it was correct; but now I am convinced that the very opposite is the truth!” When Brunonianism was first transplanted from Great Britain to the Continent and was received enthusiastically by many physicians, Frank was not disposed immediately to accept its teachings, and yet at the same time he did not believe that it was quite fair to ignore the thing altogether. Not a few men inferred from this hesitating attitude on his part that he rather favored Brown’s system. As a matter of fact he was an eclectic in his views and was always ready to appropriate whatever seemed to him good in any system or school of doctrines. As Director of the Allgemeine Krankenhaus he adopted the plan of having the leading physicians and surgeons of the Clinic first report publicly once a week what were the important diseases that had come under observation during that period; and then he would call upon the auditors to discuss the subject freely.

Peter Frank died at his home in Vienna on April 24, 1821.