The Herbalist: Nicholas Culpeper and the Fight for Medical Freedom

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The proceedings would have been conducted with ceremony and decorum. Harvey was no foppish ‘gallant’ and disliked fancy clothes – ‘the best fashion to leap, to run, to do anything [is] strip [ped] to ye skin,’ he would tell his audience during the section on the epidermis.

(#litres_trial_promo) Nevertheless, he would have felt obliged to wear a purple gown and silk cap, the College livery for such occasions. He also carried a magnificent whalebone probe tipped with silver, which he used to point out parts of the body.

His lectures would begin with a few philosophical observations. Harvey adopted the strictly scholastic view of anatomy, that it was first philosophical (concerned with revealing universal truths about nature and the cosmos), then medical (demonstrating medical theory), and finally mechanical (showing how the body worked). When it came to the philosophy, Harvey’s authority was Aristotle, his intellectual hero. Aristotle taught that knowledge was derived from observation and experimentation. He also taught that the cosmos had an order and unity. Every physical entity, including every organ of the body, had its place and purpose in this greater scheme, which he called nature. ‘The body as a whole and its several parts individually have definite operations for which they are made,’ he wrote in On the Parts of Animals.

(#litres_trial_promo) Time and again in his lectures, Harvey would remind his audience of this. ‘Nature rummages as she can best stow’ in the way she arranges the organs, ‘as in ships’, adding that this arrangement was upset during pregnancy by ‘young girls … lacing’ their girdles too tight, which was why they should be told to ‘cut their laces’. Nature had also created ‘divers offices and divers instruments’ in the digestive tract, so that it could act like a chemical still, with ‘divers Heats [temperatures], vessels, furnaces to draw away the phlegm, raise the spirit, extract oil, ferment and prepare, circulate and perfect’. Considering genitalia, he noted that nature made sex pleasurable, even though it was ‘per se loathsome’. This was so that humans could produce ‘a kind of eternity by generating [offspring] similar to themselves through the ages’. Harvey, whose marriage produced no children, added in a strikingly poetical aside that we are ‘by the string [umbilical cord] tied to eternity’.

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Having covered the philosophical issues, he would move on to the medical ones. His lecture on the thorax would thus begin with some general and orthodox remarks about its function and anatomy, quoting Galen’s observation that the chest provides for the heart, lungs, respiration, and voice. Before it was cut open, he would invite the audience to note the flatness of the human thorax compared to that of the ape and dog, which protrude like a ship’s keel.

Then he threw out a question to his audience: What is the connection between the width of the chest and the ‘heat’ or vital spirit of the animal? ‘Wherefore [do] butterflies in the summer flourish on a drop of blood?’ Because, would come the answer, the heart and lungs act like a furnace, heating the blood that suffuses energy through the body. The potency of that blood is demonstrated by its effect on the cold-blooded butterfly. ‘Especially in the summer the newt is hotter than the fish,’ he added, gnomically.

The shape of the chest also revealed important truths about rank. Roman emperors, Harvey noted, were distinguished by having broad chests, which explained their exceptional ‘heat, animation [and] boldness’. His authority for this claim was the Roman biographer Gaius Suetonius Tranquillus, though the only broad chest mentioned in Suetonius’ On the Lives of the Caesars was that of the ‘well chested’ Tiberius, better known for his hot pursuit of young boys than political or military objectives.

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With the medical remarks concluded, it was the time to open up the body, and reveal the mechanics. Traditionally, physicians did not perform the actual dissection, leaving that job to a surgeon. But Harvey believed in getting his hands dirty. His method was to start with the general and work towards the specific, ‘shew as much in one observation as can be … then subdivide according to sites and connections’. Speed and dexterity were essential, not just to complete the course before the body began to putrefy, but to prevent the audience from losing the thread of the argument. There was no time to ‘dispute [or] confute’. ‘Cut up as much as may be,’ he commanded, ‘so that skill may illustrate narrative.’

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Harvey evidently enjoyed playing on the squeamishness of his audience. As a waft of flatus permeated the room, he would recall for the assembled physicians, many of whom had no practical experience of dissections, how cutting up parts of the body, particularly of abscessed livers, provoked ‘nausea and loathing and stench’. The interior of the chest would prove less noxious than the liver, however. Cutting through the ‘skin, epidermis, membrana carnosa’, penetrating ‘sternum, cartilages, ribs’, piercing ‘breasts, nipples, emunctory [lymphatic] glands’,

(#litres_trial_promo) touching upon respiration, ingestion, hiccoughs, and laughter – prompting a digression on Aristotle’s observation ‘that when men in battle are wounded anywhere near the midriff, they are seen to laugh’ – he would finally come to the pericardium. This was the ‘capsule’ surrounding the heart.

(#litres_trial_promo) He would make some remarks about the structure and use of the pericardium, and respectfully correct errors made by Vesalius relating to the mediastinum (the compartment between the lungs). He discussed the humour or fluid which ‘abounds’ within the percardial sac, a liquid like ‘serum or urine’, which is ‘provided by nature lest the heart become dry; therefore water rather than blood [issued] from Christ’s wounds’, adding that it was ‘wasted away … in persons hanged in the sun’. Then he revealed the organ within.

The heart prompted Harvey into raptures. Other organs were usually described with clinical detachment, but not this one. The ‘empire of the heart’ was ‘the principle part of all … the citadel and home of heat, lar [household god] of the edifice [; the] fountain, conduit, head’ of life: ‘All things are united in the heart.’ Then his notes contain what appears to be an innocuous observation, scribbled next to his initials: ‘Query regarding the origin of the veins. I believe from the heart.’ It was the first sign of the intellectual convulsion to come.

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Fundamental to Galen’s physiology was the belief that the veins originate in the liver. Harvey’s dissection showed that this was not the case, but was ‘an error held now for 2000 years’. He did not say this lightly. ‘I have given attention to it,’ he added, ‘because [it is] so ancient and accepted by such great men.’

(#litres_trial_promo) His notes are ambiguous, but suggest that at some point a live animal was brought into the room, probably stunned with a blow to the head, and strapped to the table for vivisection.

(#litres_trial_promo) Only by such means could Harvey show the audience what he wanted them to see: the beat of a living heart lying in the watery reservoir of pericardial humour. The movements of this glistening organ were complex. He had gazed upon it ‘whole hours at a time’. Initially he had been ‘unable to discern easily by sight or touch’ how it worked, but, by watching the heart as the animal gradually expired, as the muscles began to slacken and the heartbeat slowed, he beheld a revelation, which he now wanted to share with his audience in the most compelling fashion possible. ‘Observe and note,’ he instructed. ‘It seems to me that what is called diastole is rather contraction of the heart and therefore badly defined … or at least diastole [is] distension of the fleshiness of the heart and compression of the ventricles.’

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Galen saw ‘diastole’, the phase of the heart’s beat when it expands, as the active phase, when it mixes pneuma, or vital spirit, from the lungs with blood to vivify it. Systole, the phase when the heart contracts, was when it relaxed. Galen further concluded that, since the pulse of the arteries did not synchronize with the diastole phase, they must pulse of their own accord, in a manner similar to the ‘pulse’ of the intestine passing food through the digestive system.

Harvey turned this idea upside down. He argued that the active phase was systole, when the heart contracted, pushing out the blood that had flowed into the heart’s chambers, or ventricles, during diastole. The pulse was thus not ‘from an innate faculty of the arteries, as according to Galen’, but the pressure wave produced by the heart pumping blood at high pressure into the arteries, which explained why they had walls thicker than those of veins.

(#litres_trial_promo) ‘From the structure of the heart it is clear that the blood is constantly carried through the lungs into the aorta as by two clacks of a water bellows to raise water,’ Harvey concluded. He was referring to the system of valves used to fill a pair of bellows with water, which is then squirted out under pressure.

He used another experiment to show where the blood goes to once it has left the heart. Physicians were familiar with applying ‘bandages’ (tourniquets) to the upper arm for blood-letting. They would know how a tourniquet applied very tightly would cut off both veins (which run just beneath the surface of the skin) and arteries (which are deeper in the arm), while a looser tourniquet would restore the flow of the arteries (indicated by the return of the pulse in the wrist) but not of the veins. Harvey noted that when the tourniquet is applied at its tightest, the hand would turn cold, but when it was loosened sufficiently to restore flow through the arteries it would become flushed and swollen, with the veins standing out. The hand would remain in that state while the tourniquet remained in place, with no sign of the engorgement dispersing, which is what would have been expected if the venal blood was consumed. But when flow was restored to the veins by releasing the tourniquet altogether, the swelling would disappear instantly. Thus, ‘by [application of] a bandage it is clear that there is a transit of blood from the arteries into the veins, whereof the beat of the heart produces a perpetual circular motion of the blood’. In other words, blood did not seep out into the extremities of the body to be turned into living tissue, but circulated around, pumped by the heart. This meant that Galen was wrong, not only about the heart, but about the liver also, and it raised serious questions about the role of blood. If it was not the fuel that fed as well as animated the body, what was it for? On this, Harvey for the time being held to the Galenic belief that it was something to do with delivering ‘natural heat’, the vital spirit that animated the body. The heart’s two chambers were ‘two cisterns of blood and spirit’, as he put it, and the role of the circulation was to ensure the even distribution of these products through the body.

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Charles Darwin wrote to a friend that to publish his theory of evolution by natural selection was ‘like confessing to a murder’.

(#litres_trial_promo) Harvey’s confession was no less dangerous. According to the dating evidence of his lecture notes, he first explained his theory in January 1618. This was eight years after Galileo, who had held the chair of mathematics at Padua at the time Harvey had studied there, had used a telescope to confirm Copernicus’ theory that the earth went round the sun, and just three years after the Catholic Inquisition had formally declared Copernicanism to be heretical. And it was only eighteen years after the philosopher and mystic Giordano Bruno was burned at the stake in Rome for suggesting, among other speculations, that the blood must go round the body as the planets go round the sun.

Harvey faced no such extreme reaction to his theory. In fact, there was barely any reaction at all, merely a respectful hush. This was partly because, though the lectures were in public, no one reported on them, and their content would not be published by Harvey himself for another decade. But, given the College’s commitment to Galen, and its harsh treatment of anyone who failed to follow his principles, some sort of expression of shock might have been expected from his colleagues. There was none. There is not a single mention of the idea in the College Annals for the period, merely lengthy discussions about the chaotic publication of the Pharmacopoeia, the discovery of yet more ‘impure’ medicines during searches of the apothecaries’ shops, and arrangements for the College’s annual feast.

This silence may have been because so few of the Fellows bothered to come to the lectures, or because so few understood them. More likely, it was because Harvey realized from the beginning the political as well as medical implications of his ideas. He did not at this stage spell them out, but they are evident in his discussions about the relative importance of the heart versus the brain.

Despite references to bellows and cisterns, Harvey was emphatic that the heart was no mere mechanical pump. He kept to the principle that it was the body’s most important organ, the ‘source of all heat’, that the ‘vital spirits are manufactured in the heart’, invigorating the blood to keep the body alive.

(#litres_trial_promo) However, when he came to his final lecture, the ‘banquet of the Brain’, he ran into difficulties sustaining this position. The cerebrum, he pronounced, was ‘the highest body in a very well-protected tower; hair, skin &c., as safeguards, so that nature [protects] no part more’. Having reached this conclusion, he paused for thought, as though realizing too late that he had compromised the primacy of the heart. This prompted the assertion that the brain was ‘not to be compared with the heart’. But he could not resist trying, provoking a Herculean struggle to reconcile the importance of one with the ingenuity of the other:

The empire of the heart extends more widely in those [creatures] in which [there is] no brain. Perhaps more worthy than the heart, but the heart is necessarily prior … All animals have one most perfect part; man [has] this, excelling all the rest; and through this the rest are dominated; it is dominated by the stars wherefore the head [is] the most divine, and to swear by the head; sacrosanct; to eat [the brain is] execrable.

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Why did he expend so much effort deliberating on this anatomically trivial rivalry? The reason partly revealed itself in some subsequent remarks about the relative sizes of organs in different animals. The human body, he noted, was like a ‘commonwealth’, with different organs being the different branches of state, each having its function, each having its divinely ordained place. ‘Politicians,’ he added, can acquire ‘many examples from our art’, in other words from anatomy.

(#litres_trial_promo) And with this, he left the matter tantalizingly suspended.

As the body politic began to disintegrate, he would return to this issue. And he would argue that his revelations about the heart, far from overturning the existing order, reinforced it.

ANGELICA (#ulink_1e3bd258-bae6-5142-ae8c-b1a05e540e44)

Angelica archangelica (#ulink_1e3bd258-bae6-5142-ae8c-b1a05e540e44)

In times of Heathenism when men had found out any excellent Herb &c. they dedicated it to their gods, As the Bay-tree to Apollo, the Oak to Jupiter, the Vine to Bacchus, the Poplar to Hercules: These the Papists following as their Patriarchs, they dedicate them to their Saints, as our Ladies Thistle to the Blessed Virgin, St. Johns Wort to St. John, and another Wort to St. Peter, &c.

Our Physitians must imitate like Apes, (though they cannot come off half so cleverly) for they Blasphemously callPansies, or Hartseas, an Herb of the Trinity, because it is of three colours: and a certain Ointment, an Ointment of the Apostles, because it consisteth of twelve Ingredients; Alas poor Fools, I am sorry for their folly, and grieved at their Blasphemy …

[Angelica] resists Poison, by defending and comforting the Heart, Blood, and Spirits, it doth the like against the Plague, and all Epidemical Diseases if the Root be taken in powder to the weight of half a dram at a time with some good Treacle in Cardus Water, and the party thereupon laid to sweat in his Bed. If Treacle be not at hand, take it alone in Cardus or Angelica Water.

The Stalks or Roots candied and eaten fasting are good Preservatives in time of Infection; and at other times to warm and comfort a cold Stomach. The Root also steeped in Vinegar, and a little of that Vinegar taken sometimes fasting, and the Root smelled unto is good for the same purpose …

According to Grieve, in early summer-time, peasants living around the lakelands of Pomerania and East Prussia, where Angelica grew plentifully, marched into the towns carrying the flower-stems chanting songs ‘so antiquated as to be unintelligible even to the singers themselves’, the relic of some pagan festival. According to Christian legend, the plant’s ability to cure the plague was revealed in a dream by an angel. Another explanation of the name of this plant is that it blooms on 8 May (Old Style), the day associated with an apparition of Michael the Archangel at Monte Gargano in Italy.

The candied stems are used as cake decorations.

In the spring 1625, King James, approaching his sixtieth birthday, ‘retired for fresh air and quietness to his manor at Theobald’s’, his country retreat in Hertfordshire, built by Elizabeth’s chief minister William Cecil. In March, he fell ill with a ‘tertian fever’, malaria, and was confined to a sickroom at the house, which later was formally dubbed his ‘Chamber of Sorrows’. As he lay there, he was attended by a busy swarm of courtiers, servants, and medics, bringing documents, linen, and medicines, taking messages, bedpans, and pulses.

Throughout, James’s team of physicians stood by, conferring. They included at least two loyal Scots doctors he had brought with him from Edinburgh when he succeeded to the English throne in 1603, Drs Craig and Ramsay. There was also a sizeable portion of London’s medical élite, including Sir William Paddy, erstwhile President of the College of Physicians, and Dr Henry Atkins, the current President, together with Drs Lister, Chambers, and William Harvey, whose role in the unfolding drama was to be as central as it was obscure.

At this stage, James’s condition gave no cause for alarm, as malarial attacks were common, and in the past the King had managed to fight them off without too much difficulty. As the Venetian ambassador put it in a note to the Doge, ‘His majesty’s tertian fever continues but as the last attack diminished the mischief the physicians consider that he will soon be completely recovered. His impatience and irregularities do him more harm than the sickness.’

(#litres_trial_promo) James was a notoriously difficult patient.

However, on Monday, 21 March his condition took an abrupt turn for the worse. In the afternoon he anticipated a seizure, telling his doctors he felt a ‘heaviness in his heart’. The physicians appear to have been undecided on what to do. At about 4 p.m., the royal surgeon, one Hayes, arrived with a strip of soft leather and a box containing a thick syrup. Watched by Harvey, Hayes soaked the leather with the syrup and lay the impregnated ‘plaster’ upon the King’s abdomen. Soon after, the King suffered a series of fits, as many as eight according to one report.