Monthly Archives: February 2016

Medicine in the 17th Century, Cont’d

Jan_Baptist_van_Helmont_portrait

Johann Baptista van Helmont (1579-1644)

Paracelsus was the primary influence on this Belgian physician-alchemist. Van Helmont was a Paracelsian who used chemical medicines and had a strong interest in alchemy, but revised and elaborated many of Paracelsus’ positions including the nature and number of elements and his explanation of disease. His experimental work included attempts to show that water was an even more basic constituent of matter than Paracelsus’ three philosophical principles of sulfur, mercury and salt. In one famous experiment he planted a willow seed in 100 kilograms of earth, added only water for several years and found that the tree now weighed 75 kilograms while the weight of the earth did not significantly change. Van Helmont denied the explanatory value of Aristotelian final causes but believed something quite similar. The seed contained an archeus, a kind of spirit that could transmute water into willow. He held that there were many different kinds of archei each functioning in this seed-like way. In the body they transmuted food into blood through a process of digestion or fermentation. As external agents archei could enter the body to cause disease by a process of putrefaction. Much of van Helmont’s experimental laboratory work reduced various substances to discover the gases that contained their archei and to produce medicines to counteract their effects.

Van Helmont’s search for the Philosopher’s Stone was an attempt to find the ultimate seed, one that would transmute base metals into gold, but more importantly would function as a panacea by finding a spirit that could cure all ills. His methods, like those of Paracelsus were dependent on mystical visions as well as laboratory experiments. A step toward finding the Philosopher’s Stone was the chemical formation of the alkahest, a kind of counter Philosopher’s stone which was a universal solvent that could ferment or digest material into its basic (lowest) constituents.

Paracelsus, through van Helmont had a growing number of followers in England who were especially interested in iatrochemistry and alchemy, including George Thomson (1617-1677) and the young American George Starkey (1628-1665).

Baldwin_Hamey_van_Dyck

(c) Royal College of Physicians, London; Supplied by The Public Catalogue Foundation

Baldwin Haney (1600-1676)

By the middle of the 17th century, the views of Galen, Paracelsus and Descartes had all become part of the then current understanding of medicine and the human body. However academic physicians continued to be trained as Galenists and they dominated the medical schools, the Royal College of Physicians and were the practitioners to the wealthy. Baldwin Haney (1600-1676) whose wonderful portrait is by Anthony van Dyck is an excellent example of the wealthy physicians who were members of the College.

William_PettyThomas_WillisAnne Greene

William Petty (1623-1687)Thomas Willis (1621-1675) Anne Greene (1628-1665).

In the famous case of Anne Greene, Thomas Willis, William Petty and some medical students who were studying anatomy with them,  revived her after she had been hung for the murder of her illegitimate child (a crime she did not commit). Her body was given to them for dissection, but as they prepared her, they found that she was still breathing. They used humoral techniques to revive her: they poured hot cordial down her (cold) throat, bled her, rubbed her limbs and applied hot plasters.

As we have seen, the three academic medical influences at the time came from Galen, Paracelsus and Descartes. Each was accompanied by a metaphorical picture of health which retains some currency today. The first saw health as a good balance among the humours, the second as appropriate chemical composition, and the third as a smooth running machine. Regardless of their primary orientation many physicians had absorbed and included aspects of each of these three positions, and most employed remedies that were a mixture of all three. The complexity surrounding their ideas about health derived from the intermingling of these different ways of thinking. The theoretical differences among the academic physicians meant little to the vast majority who could not afford expensive doctors.

 

Advertisements

William Harvey and St. Bartholomew’s Hospital

William_Harvey_2

William Harvey (1578-1657) and St. Bartholomew’s Hospital

William Harvey was a careful experimentalist who observed the heart’s activity, proved that blood circulates in the body and that the heart functions as a pump to pulsate blood through the arteries and that the blood returns to the heart through the veins. Harvey had studied and done his early research in Italy and benefited from the more liberal dissection practices and more advanced understanding of anatomy. His discovery was a major revision to the Galenic account that there were two systems of blood: the natural system which was fed by the liver and absorbed by the body and the vital system in which blood flowed from the heart, was cooled by the lungs and distributed heat and life to all parts of the body through the arteries. Harvey was a member of the Royal College of Physicians of London that had been founded in 1518, functioned as a guild in its early days and was an important step in the professionalization of doctors. From a patient’s point of view Harvey’s post as Physician in Charge of St. Bartholomew’s Hospital from 1609 until his death is a critical part of his accomplishment. While at St. Barts he provided free care to the poor, was Royal Physician to the King, maintained a lucrative practice to the rich, and did much of his research. This was early in a long medical tradition of practicing and doing research while caring for the poor while also earning a good living from the well off.

St. Bartholomew’s Hospital

Early hospitals functioned as poorhouses. St. Bartholomew’s which was founded in 1123 was among the oldest hospitals in Europe. During the Reformation it was defunded and then reopened by Henry VIII as the “House of the Poore in West Smithfield in the suburbs of the City of London of Henry VIII’s Foundation” in 1547. And in the tradition of medicine, academic doctors used the hospital as a research and teaching site, although there was no medical school there until the 19th century.

René Descartes and Rational Mechanism

Descartes’ ideas about the nature of matter and of the world are not like Bacon’s. He introduces the notion of the body as a machine: “..so also the human body may be considered as a machine so built and composed of bones, nerves, muscles, veins, blood and skin that even if there were no mind in it, it would not cease to move in all the ways it does at present when it is not moved under the direction of the will.” (Descartes René, Philosophical Essays Meditations Bobbs Merrill 1964 page 138)  However Descartes, like Bacon is deeply interested in health. “The preservation of health has always been the principle end of my studies” (CSMK III 275) Part of the attraction of the idea of the body as mechanism was that it would allow for a rational medicine. If a healthy body is a smoothly running machine, then medical interventions would be much like mechanical ones. He therefore hoped to devise “a system of medicine which is founded on infallible demonstrations.” (CSMK III 17).  Descartes proposes a program of division of effort in research and publication that has become a dominant influence on medicine ever since. In the Discourse on Method he makes an early proposal for a program of work to derive the medical benefits of his approach.

It is true that medicine at present contains little of such great value; but without intending to belittle it, I am sure that everyone, even among those who follow the profession, will admit that everything we know is almost nothing compared with what remains to be discovered, and that we might rid ourselves of an infinity of maladies of body as well as of mind, and perhaps also of the enfeeblement of old age, if we had sufficient understanding of the causes from which these ills arise and of all the remedies which nature has provided. (575) [63] Discourse page 46

 

For Descartes knowledge must carry certainty: he will achieve knowledge by deriving it from first principles which are themselves certain. This method can apply to any area liable to the impact of reason, including medicine.

This approach sets the project of medicine for the next 300 years. It considers the body to be a mechanical device that can be learned about and understood entirely apart from the person who, as it were, inhabits it. Gilbert Ryle describes that person as a ghost in a machine. Such a project can study the body without considering the person at all. They are completely separate, and, according to Descartes, connected only at the pineal gland. This gives medicine a free rein to study the body and its health as distinct from the person who lives in it. This utter separation of body and mind has a powerful effect on the relationship between physicians and patients. If the Cartesian project succeeds then a healthy body is relatively independent of the patient who inhabits it and the physician who is the expert about the body must have the authority to deal with it. It is Descartes who gives our bodies over to scientific medicine, and turns us into patients. We will remain passive subjects well into the 20th century.

Viewing the body as a machine was a very fruitful way of thinking about it. The approach has led to many successes in the history of medicine, from the view of the heart as a pump, to the idea of the digestive tract as part of a food processing plant with plumbing spigots and drains.

Research on the bio-mechanical framework flourished. Later in the 17th century Robert Hooke and Anton van Leeuwenhoek will use the newly developed microscope to learn about the nature of cells. Robert Boyle will use Hooke’s pump to explore respiration and circulation. He will confirm Harvey’s results about the circulation of the blood.  Descartes is a great influence on future investigations of the body. Boyle and his medical colleagues dissected hundreds, if not thousands of live dogs and other animals to try to learn more about the mechanics of the body. The hunt for human cadavers became more intense and medical education included far more anatomical studies. Schools of anatomy under people like John Hunter flourished. Galen, who had dissected only animals, was shown to be mistaken about the many organs which differ in humans and animals. Cadavers were bought, stolen and sold.  Researchers and medical students were always at the scene of public executions to gain access to bodies immediately after death. In the famous case of Anne Greene, medical students revived her after she had been hung for the murder of her illegitimate child.

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.