Health in England During the Scientific Revolution

The level of mortality of 17th century England was far higher than it is today. English life expectancy at birth the first half of the century was 36.4 years. If one succeeded in living until 30 one could expect to live another 30 years. In London the situation was worse. The high rate of mortality was comprised of infant deaths: (Between 149 and 160 of every thousand infants died in the first year of life), a high level of maternal mortality, and death as a result of epidemics of plague and the ague (various fevers like malaria). Apart from immigration, the population of London was actually declining during this period.

Added to the mortality figures, the state of health of the living was also poor. Those who survived the various epidemics and fevers suffered from uncomfortable chronic conditions for much of their lives. Morbidity affected all classes especially in cities. A person from the working class was old by the age of 40. The biographies of most of the luminaries of the period point out their individual ill health, but few recognize how widespread ill health was among the general population. The diaries and memoirs of the time give many indications of the fact that the vast majority of those who lived beyond 40 suffered from debilitating chronic conditions. We will review only a few of the major figures, most of whom lived with chronic diseases into old age.

  • Francis Bacon, like many of his contemporaries, was in somewhat delicate health because he had survived serious fevers and other more minor complaints at frequent intervals, and famously died at age 65 of a chill trying to find out how long a chicken could be preserved by stuffing it with snow.
  • René Descartes escaped early morning classes as a child because of his poor health and later expressed a strong interest in the health consequences of his work. He died on February 11, 1660 at the age of 54 from a serious respiratory infection he contracted in the draughty castle of Queen Christina of Denmark.
  • Thomas Hobbes’ poor health until he was forty was followed by an increasing palsy that made his hands tremble so that he was forced, like Bacon before him, to dictate his writings. He lived to the ripe old age of 81.
  • John Locke (died age 71), himself a physician, was asthmatic and was given detailed regimens by Thomas Sydenham, who sent him to the country for long periods of recuperation.
  • Robert Hooke’s biographers describe his poor health as an infant and child and his stooped walk as a result of a malformed spine. His diaries record his constant struggle with a number of chronic and uncomfortable conditions including “giddiness, indigestion, flatulence, blockages in his nose and ears, occasional loss of the sense of taste and smell, headaches, heart palpitations, sore and watery eyes, noises in the head, fevers, chills and insomnia.”(Bio page 145) When well, he always attributed his recovery to God’s intervention. (Jardine page 89-90). Hooke died at 68.
  • Among Thomas Sydenham’s works was his clinical account of gout, based largely on his own experience.( Died at 65)

It is hardly surprising that many active participants in the scientific revolution had a strong interest in health issues and participated actively in research associated with it. The widespread incidence of ill health and chronic disease was tied to the hope that the new science would unlock some of nature’s secrets about the maintenance and recovery of health. There were some very powerful patients in the seventeenth century.

Francis Bacon

Sir Francis Bacon

Francis Bacon proposed methods of investigation which concentrated on observation and inductive reasoning rather than arguments by analogy. Historians have argued that his legal background led him to clarify the distinction between “fact” and “law” and hence to recognize the importance of empirical evidence as distinct from metaphysical speculation. These ideas were among the seeds of the Scientific Revolution of the 17th century. Though he did little experimentation himself, Bacon clearly valued it, and argued for the systematic collection of experimental results and other scientifically relevant information.

Bacon believed that science should be “luciferous” and shed light on the secrets of nature, but also “fructiferous” and enable man to gather the fruits of this study by regaining dominion over nature that had been lost after the expulsion of Adam and Eve from the Garden of Eden. He allowed for a very wide array of investigative procedures and extended the notion of scientific authority to include all those who could gather and disseminate valid observations. This included connecting scientific study to the state rather than the church. As a result “natural philosophers” no longer had to be clerics but could include aristocrats and craftsmen, like goldsmiths who had particular skills, physicians with collections of remedies and others. In The New Atlantis he described Solomons’s House, that part of a utopian society which gathered information about “the sciences, arts, manufactures, and inventions of all the world,” engaged in experimentation and elaborated the fullest extent of human knowledge.

His contribution to the new science has been widely recognized for centuries, but the extent of the influence on him of such earlier thinkers as Paracelsus has only become clear over the last hundred years. For example, he shared with Paracelsus a belief not only in observation and experiment, but also in astrology and in the less modern notion of “natural magic,” which is largely a positive force meant to “marry Heaven and Earth” (Pagel page 38) by the application of divine forces in human affairs. These are secrets of nature that will allow humans to regain their dominion over nature after their expulsion from Eden. Some of these pieces of knowledge can be obtained only with the help of divine agency and the use of natural magic. The leaders of Solomon’s House must decide “which of these shall be published and which not, and take all an oath of secrecy for the concealing of those which we think fit to keep secret…” (reference in the New Atlantis Works Volume 1 page 215

Bacon followed Paracelsus in his abiding belief in the possible transmutation of gold and in the use of gold for the purposes of prevention of disease and prolongation of life. His writing includes recipes for making gold and for medical potions containing gold. “Gold is given in three Formes; Either in that, which they call Aurum potabile; Or in Wine wherein Gold hath beene quenched; Or in Gold, in the Substance; such as are Leafe Gold, and the Filings of Gold.” (Bacon, Francis, 1561-1626.: Historie naturall and experimentall, of life and death. Or of the prolongation of life. Written in Latine by the Right Honorable Francis Lo. Verulam, Vis-count St. Alban. (page 166-167)).

There is no doubt about Bacon’s influence on the founders of the Royal Society in 1660. He is depicted as the figure on the right in the frontispiece of the contemporary history of the Royal Society

220px-Frontispiece_to_'The_History_of_the_Royal-Society_of_London'

He even had a direct connection to Thomas Hobbes, who was never admitted to the Society. Aubrey in his Brief Lives tells of their meetings:

(c) National Galleries of Scotland; Supplied by The Public Catalogue Foundation

(c) National Galleries of Scotland; Supplied by The Public Catalogue Foundation

The Lord Chancellor Bacon loved to converse with him. Hobbes assisted his lordship in translating several of his essays into Latin… His lordship was a very contemplative person, and was wont to contemplate in his delicious walks at Gorhambury….His lordship would often say that he better liked Mr. Hobbes’s taking his thoughts on paper, than any of the others, because he understood what he wrote, which the others not understanding, my lord would many times have a hard task to make sense of what they wrote.  (Aubrey, Lives  Hobbes)

Bacon’s influence went beyond England to all of Europe and the ideas that led towards a new science are now felt to have affected René Descartes’ (1596-1650) thinking about a new science. It certainly helped Descartes to spurn the previous approaches and to see the need for a new way of thinking, and especially to aim for its practical consequences. “It is possible to reach knowledge that will be of much utility in this life; and that instead of the speculative philosophy now taught in the schools we can find a practical one….and so make ourselves masters and possessors of nature.” Discourse Part six page 45 (574) [61-62]

Bacon’s views have become more controversial in the last fifty years. Earlier interpretations assert that science would help us regain dominion over nature and gain control over natural phenomena. We would then be able to use nature for human ends. Our ideas about the relationship between man and nature have changed considerably in the last century. Many contemporary thinkers now believe that science must help us learn to live in harmony with nature rather than try to master and exploit it. Bacon’s pursuit of the exploitative and interventional role of science is now slowly being revised.

 

John Dee: The Royal Astrologer

John Dee

Paracelsus’ writings were widely available and almost certainly were owned by avid book collectors like John Dee, who was one of the major advisers and the personal astrologer to Queen Elizabeth I, as well as the first English astronomer to accept the ideas of Copernicus. He played no little role in introducing ideas about the various aspects of the new natural philosophy into British aristocratic circles and making natural philosophy fashionable among young gentlemen. It was at this time that aristocrats who had been collectors of art and antiquities developed an interest in the collection of natural curiosities. It has been argued that when Dee organized a kind of scientific academy made up of friends and other gentlemen to discuss natural science he began a tendency that culminated in the formation of the Royal Society in 1660. He was also the Royal Astrologer and associated himself with Edward Kelley a devotee of the more arcane aspects of magic, which resulted in accusations of illicit conjuring and led to Dee’s eventual downfall. Magic was widely desired and also widely feared. The consequence of his secret forays into magic certainly assured that Francis Bacon would take great care in distinguishing natural magic from dangerous conjuring. As we shall see the streams of magic and science persisted together through the Scientific Revolution from the time publication of Copernicus’s account of planetary rotation. We will look closely at the persistence of these views through the 17th century

Renaissance Anatomy

Leonardo Da Vinci Skull da vinci Baby davinci

Leonardo da Vinci (1452-1519)

Leonardo da Vinci was supposed to publish a book of anatomical drawings with the anatomist Marcantonio della Torre, but della Torre died of the Black plague in 1511. Leonardo continued this work secretly because dissection was against the church’s teaching at the time. He dissected more than 30 bodies and amassed more than 750 anatomical drawings. However it is not clear if the drawings were ever published in book form. The ones that remain display Leonardo’s conviction that however illegal, dissection was necessary to gain a full understanding of the human body.

Vesalius von Gebweiler Skeleton

Andreas Vesalius (1514-1564) Jakob Karrer von Gebweiler,

Andreas Vesalius discovered that all of Galen’s anatomical studies were done on animals and not humans. As a result much of Galen’s understanding of the human body was skewed. Although his own dissections were not the first or even the most complete, the publication of Vesalius’ book De Humani corporis fabrica, (On the fabric of the human body,) which contained numerous anatomical illustrations, was very widely distributed in many different editions (some pirated). It set a new modern standard for anatomical depictions of the body, which were drawn by professional artists, not Vesalius himself. This was yet another step to amend the Galenic understanding of the human body.

In a rare instance for this period we still have the name of one of his human specimens. Jakob Karrer von Gebweiler was a notorious felon from Basel. After he was beheaded, Vesalius prepared and donated his skeleton to the University of Basel where it is displayed to this day.

 

 

Paracelsus

ParacelsusParacelsus (1493-1541)

The Renaissance not only brought a new way of reading the Roman and Greek, classics, it also reintroduced hermetic writings about magic and a renewed interest in the Philosopher’s Stone. Paracelsus’ ideas about medicine and chemistry had vast influence in the Renaissance. He was violently opposed to the entire medical tradition of the mediaeval period. His full name is worth saying out loud: it is Theophrastus Bombastus von Hohenheim.  Paracelsus famously lost his job as municipal physician for burning Galenic books in the town square. He derided the academic doctors of his day for blindly following useless outmoded humoral practices based on Aristotle, Galen and Avicenna. For a long time Paracelsus’ influence on later thinking was neglected. However, it became clear in the 20th century that he exerted a major influence on the scientific practices of the 17th century. He was the father of iatrochemistry seeking medical solutions through chemical cures. Paracelsus considered the body to be something like a chemical retort in which food, liquids and air are processed into blood, muscle and various excreta. For him, a healthy person is someone in whom the necessary chemicals are present and the appropriate chemical reactions take place. Diseases are the result of either chemical imbalances or the introduction of poisons into the system. Once one had identified a particular disease, it would become possible to test and apply chemical treatments.

Paracelsus traveled across Europe introducing new chemical remedies. He is famously credited with introducing the use of mercury to reduce the side effects of syphilis – a remedy that was in use until the mid-20th century introduction of antibiotics.

The Black Plague

Plague Doctor during Black Plague

Most discussions of the Renaissance stress the reintroduction of ideas from Greece and Rome and the spread of a new humanism by the introduction of the printing press. But the Renaissance was also deeply affected by the enormous health catastrophe of the Black Plague which killed off almost half the population of Europe over a seven year period from 1346 to 1353 – recent estimates have raised the number of deaths to over 60 million. This was by far the largest number of deaths caused by a single epidemic in European history. The population was not replenished until  after 1700.The plague had a major effect on the feudal system of the time by increasing the value of labour and improving the lives of the fewer agricultural workers who survived. They had been tied to their masters as serfs and could suddenly improve their lives and their standard of living because of the increased demand for their now scarce services and the lessened authority of the church.

There were no effective public health measures except to try to isolate those suffering from the plague. The picture of the traditional plague doctor wearing a beak filled with lavender to keep out the foul smelling pestilence. There were also attempts to isolate the victims of the plague so as not to spread it. Neither dealt with the infected rats who carried the true means of contagion.

There were of course other less devastating plagues cited in ancient literature including the bible. But in this context it might be useful to compare this rate of mortality to the devastation which we have more recently learned about in the Americas in the 15th century soon after the European plague. The population decline in America is now estimated at about 60% of the native population. Between 40 and 60 million vulnerable people who had no immunity to the diseases died of pox, measles and other communicable diseases if they survived the battles with invading armies.

Geoffrey Chaucer 1343-1400

chaucer3

Chaucer`s account of a doctor in the Canterbury Tales captures some of the perception by patients of a successful mediaeval  doctor. It contains a quick peek at the kind of practice that educated doctors of the day had: his astrological knowledge to get an appreciation of the individual patient, his diagnostic capacity to understand how to rebalance the humours of a particular person, his link to the herbalist/apothecary for medications, his familiarity with the important medical texts of the day including both older and contemporary authors. There is a hint about the Philosopher’s Stone by mentioning the place of a gold cordial among his cures. Finally it describes his care for himself in his moderate diet and his dress and finally his appreciation of the finer things, especially the gold that comes from his high fees.

With us there was a doctor of physic

In all this world there was none like him

To speak of medicine and surgery;

For he was instructed in astrology.

He cared for and saved a patient many times

By scientific magic and studying their horoscopes.

Well could he calculate the planetary position

To improve the state his patient is in.

He knew the cause of every sickness,

Whether it was heat or cold, or moist or dry,

And where engendered, and of what humour;

He was a very good practitioner.

The cause being known, the root of the malady,

At once he gave to the sick man his remedy.

Prepared he was, with his apothecaries,

To send him drugs and all electuaries;

By mutual aid much gold they’d always won-

Their friendship was a thing not new begun.

Well he knew the old Asculapius,

And Deiscorides, and also Rufus,

Old Hippocrates, Hali, and Galen,

Serapion, Rhazes, and Avicena,

Averroes, Gilbertus, and Constantine,

Bernard and Gatisden, and John Damascene.

In diet he was measured as could be,

No one could blame him of superfluity,

But greatly nourishing and digestible.

His study was but little on the Bible.

Blue and scarlet his clothes were therewithal,

Lined with taffeta and with silk;

And yet he was right chary of expense;

He kept the gold he gained from pestilence.

Since gold in physic is a fine cordial,

Therefore he loved his gold exceeding well.

 

1000 AD Maimonides

Maimonides

Beginning in the ancient world, learned and adept physicians had an international role. In an earlier part of this book we spoke of an ancient Egyptian doctor who received enormous payment for his treatment of a foreign ruler. It has not been unusual for foreign dignitaries to pay high fees to exceptional doctors. At times, however, there was a conflict between medical advice and religious requirements. We all know about the ethical issues that arise when religious beliefs conflict with medical directives. Prescribing blood transfusion for Jehovah’s Witnesses is only the latest of these kinds of conflicts. And the tension can be great between such competing demands. Now the law is on the side of medicine – this was not always so.

In the Jewish tradition, life preservation takes precedence over religious requirements and so there are many stories, some of them no doubt apocryphal, of mischievous Christian doctors who prescribed pork products to Jewish patients as if nothing else would cure them. There was no question of not listening to the doctor’s advice; the question was how you got the pork to the patient without contaminating the whole house. For some patients this might have been a delight, but for others it was unpleasant medicine. Still, for others their religion gave them good reason for non-compliance.

It turns out that not only Christian doctors made these kinds of recommendations – medieval Jewish doctors did too. Here is a complete letter from Maimonides to his presumably depressed royal patient. It is a good early discussion of the relation between medical advice and religious and other personal beliefs.

Maimonides’ Medical Letter

His servant is well aware that our Master, with his broad intelligence and profound understanding, will be able to conduct himself in the proper manner, in accordance with the previous treatise and these chapters. All the more so, when there stands before him [a physician] from whom he may request professional guidance or seek out practical instruction.

God, may He be exalted, is a witness, and His testimony suffices (Koran 4:79–81), that his humble servant’s great desire is to serve our Master with his own person and conversation, and not with paper and pen.

However, his poor constitution and the weakness of his natural faculties—already in his youth, and how much more so in his old age—constitute a barrier between him and many pleasures. I do not mean pleasures, rather good deeds, the most important and elevated of which is to serve our Master in actual practice. God be thanked for all the circumstances that befall us, the general and the particular, in the totality of existence and its particulars, in each and every individual, in accordance with His will, which accords with what is dictated by His wisdom, the depths of which no man can fathom. And God be thanked for every circumstance, whatever direction events may take.

Our Master should not criticize his humble servant for having mentioned in this treatise the use of wine and songs, both of which are abhorred by the religion. For this servant did not command acting in this manner; he merely stated that which is dictated by his profession. Indeed, the religious legislators know, as do the physicians, that wine has benefits for man.

A physician is bound, inasmuch as he is a physician, to present with a beneficial regimen, whether it is forbidden or permitted; the patient is endowed with the freedom to choose whether to follow or not. If [the physician] fails to mention everything that may be helpful, be it forbidden or permitted, he is guilty of acting dishonestly, for he did not offer trustworthy advice.

It is well known that religious law commands what is beneficial and prohibits what is harmful with respect to the world-to-come. The physician, on the other hand, instructs what will benefit the body and warns about what will harm it in this world.

The difference between religious commandments and medical counsel is that religion commands and coerces a person to do what will benefit him in the future, and prohibits what will harm him in the future, and punishes for it. The physician, on the other hand, counsels [a person] about what will benefit him, and warns him about what will cause him harm. He does not use coercion, nor does he punish; he merely presents the information to the patient in the manner of advice. And it is [the patient’s] choice [whether to follow that advice].

The reason for this is obvious. The harm and benefit from a medical perspective are immediate and clearly evident. Thus, there is no need for coercion or punishment. As for religious commandments, however, the harm and benefit that they bring are not evident in this world.

The fool might, therefore, imagine to himself that everything that is said to be harmful is not harmful, and everything that is said to be beneficial is not beneficial, because these things are not clearly evident to him. For this reason religious law compels one to practice good and punishes for doing evil, for the good and evil will only become apparent in the world-to-come. All this is benevolence toward us, a favor to us in light of our foolishness, mercy upon us owing to the weakness of our understanding. This is the measure of what the servant saw fit to set before his Master and Ruler, may God grant him long years. I remain readily available to serve our Master.

Thanksgiving and praise to God. (Quoted in Gesundheit et al. 425-426)

Here we have this tension being considered in the medieval period by a very articulate medical practitioner who will let the patient decide whether to accept the suggested regimen which is very much against the directives of his religion. It is hard to tell how much Maimonides is in league with his patient, but it is clear that this letter is for public consumption.

 

Hildegard of Bingen 1098-1180

Hildegard-of-Bingen-51243669a

A good example of the role of women as herbalists was Hildegard of Bingen. Her medical writings included much about her experience as a healer, as well as the herbal remedies she acquired. She placed humoural medicine in the context of a particular Christian world view. The first part of her major medical work, Causae et Curiae sees medicine in the context of the creation of the cosmos with humanity as its summit. She believes that there is a constant interplay between the individual as a microcosm and the macrocosm of the universe; she emphasizes the vital connection between the health of the natural world and the health of the human person. She sees medicine as a type of gardening, and considered plants in the garden as direct counterparts to the humors and elements within the human body, whose imbalance led to illness and disease.

The Great Chain of Being

 

250px-Great_Chain_of_Being_2 - Copy

The Great Chain of Being which began to be described in late antiquity was greatly developed during the mediaeval period. It is a strict religious and hierarchical structure of all matter and life that was believed to have originated from god. God is the highest being and the order descends down into angels, demons, stars, moons, kings, princes, nobles, commoners, wild animals, domesticated animals, trees and other plants, precious stones, precious metals and then base minerals. It is through god’s grace that we can come to understand which herbs and minerals can effect cures for certain diseases.

The Great Chain of Being contributed to the secret magical tradition in medicine which emerged from the earlier oral tradition of magical cures. Written work in the hermetic tradition developed the links between medicine, astrology, and alchemy. The search for the Philosopher’s Stone which was said to be capable of turning base metals into gold required the use of the alkahest which was the universal solvent that could take the metals that were lowest (most base) on the Great Chain of Being and transmute them into gold. The alkahest was also the cure-all which could bring health to the ill and extend life indefinitely. Hermetic texts from the early Christian period are augmented throughout the Middle Ages and the practices associated with it are yet another continuing strand of history of medicine.

The appeal of a magical cure for illness extends much further back than the Middle Ages. People who are very sick want any cure they can find and when all else fails they will spend a great deal of money and effort on magical cures. The hermetic tradition is only one of many responses to this need for cures for the incurable. Magical cures continue to emerge regularly. Sometimes such miraculous cures are even promised by scientific organizations. A sign over a major hospital in Toronto asks people to contribute to their research so that they can conquer cancer, knowing full well that as more and more people become older there will be an ever increasing number of cancer deaths.

Mediaeval religious institutions became closely tied to healing and planted herb gardens with an ever widening range of medicinal plants. It was not uncommon for a church medicinal garden to contain plants that had been imported from distant countries and needed special tending to survive in a more difficult climate. To some extent this created an opportunity for those women in the clergy who could read and write to became expert in herbal medicine.