The Greatest Benefit to Mankind: A Medical History of Humanity

In health care provision in England, the sixteenth century brought a major setback. The dissolution of the monasteries and chantries (rapacious asset-stripping carried out in the name of religious reform by Henry VIII and Edward VI) resulted in the closure of almost all the medieval hospitals, which, even if they had provided little treatment, at least had afforded shelter to the aged, sick and incapacitated. A few institutions survived the Reformation, being re-established on a new, secular basis. St Bartholomew’s and St Thomas’s passed to the City of London after the Dissolution, as did Bethlem for treating lunatics. Despite its burgeoning population, rising to 200,000 by 1600, London long possessed only these three hospitals, not in themselves very large (in 1569 St Thomas’s housed 203 patients); beyond the capital, scarcely any medical institutions survived Henry VIII’s destructive greed.

Shortcomings in institutional medical provision in England and elsewhere may have been counterbalanced, thanks to the development of printing, by the growth of writings popularizing health advice. These sprang largely from the regimen and hygiene traditions incorporated within the Salernitan Regime. Such works, stressing the non-naturals, instructed readers to monitor their constitutions. Andrewe Boorde (c. 1490–1549), an ex-monk turned physician, offered rules in his Compendyous Regyment or a Dyetary of Healthe (1547). He began by prescribing where to situate a house, how to organize a household, what to eat and drink and what to avoid, and what exercise to take, before moving on to more detailed physical methods of preserving and restoring health. The non-naturals were also stressed by Andre du Laurens (1558–1609), physician to Henri IV and professor at Montpellier. In 1597 he published a book translated as Discourse of the Preservation of the Sight; of Melancholic Diseases; of Rheumes and of Old Age, which contended that the causes of ageing were mental as well as physical: ‘Nothing hastens old age more than idleness.’ Early in the seventeenth century, Sir John Harington (1561–1612) brought out a popular English translation of the Regimen sanitatis Salernitanum. Addressed to King James, The Englishman’s Doctor (1608) provided health advice to all:

Salerne Schoole doth by these lines impart

All health to England’s King, and doth advise

From care his head to keepe, from wrath his heart,

Drinke not much wine, sup light, and soon arise,

When meate is gone, long sitting breedeth smart:

And after-noone still waking keepe your eyes.

When mov’d you find your selfe to Natures Needs,

Forbeare them not, for that much danger breeds,

Use three Physicians still; first Doctor Quiet,

Next Doctor Merry-man, and Doctor Dyet.

Temperance was the message of the highly successful Discorsi della vita sobria (1558–65) [Discourses on the Temperate Life] of Luigi Cornaro (c. 1464–1566), which he wrote in his eighties. Cornaro maintained that a temperate life would enable the body’s finite supply of vital spirits to last until life ebbed peacefully away between the ages of five and six score. Practising what he preached, he attributed his longevity to moderation, exercise, keeping his mind occupied and heeding his diet. Old age aroused great interest. In 1635, William Harvey performed a postmortem on Thomas Parr (c. 1483–1635), supposedly the oldest man in England. Brought to London, he was presented to Charles I and exhibited at taverns, but the smoky London atmosphere proved too much and he expired, allegedly at the ripe age of 152.

Printing made other sorts of health literature more widely available. Obstetrics and babycare books began to appear in many languages. The earliest published midwives’ textbook written in the vernacular, Eucharius Rösslin’s (d. 1526) Der Swangern Frawen under Hebammen Rosengarten (1513) [Garden of Roses for Pregnant Women and Midwives] appeared in English as the Byrth of Mankynde (1540) and was still in use in the eighteenth century. Its frontispiece pictures the mother in labour among relatives and midwives, groaning on a birth stool, while the attendant astrologer gazes through the window to cast the baby’s horoscope.

Thanks to printing, stronger links were forged between medicine, learning and culture. Humanism’s preoccupation with recovering the learned medicine of the ancients proved, however, a mixed blessing, and scepticism towards the profession remained deep-seated: ‘Trust not the physician, his antidotes are poison,’ warns Shakespeare’s Timon of Athens. During the following century medicine was to build a new scientific basis.

* (#ulink_17b62cc0-e3cc-576d-8f96-32db67f7d9cd) Unlike syphilis, gonorrhoea is an ancient disease. An Assyrian tablet speaks of thick or cloudy urine, and the Hippocratic writers refer to ‘strangury’, that is, blockage of the urethra. There was no effective cure until sulfonamides became available in the 1930s.

* (#ulink_71dca62b-422c-5a36-b138-6527c990ceff) The ontological view of disease as produced by distinct entities had a few classical antecedents. In Timaeus Plato had compared diseases to creatures, and Varro (116–27 BC) had spoken of animals too small to be seen by the eye, ‘which by mouth and nose through the air enter the body and cause severe diseases’.

* (#ulink_bf74a795-11ac-59ef-807a-d998b00190ee) The heyday of eponyms was the seventeenth century, with Aselli’s pancreas, Graafian follicles, Haversian canals, the circle of Willis, Tulp’s valve, Bartholin’s duct and glands, and many lesser ones.

* (#ulink_75e675d3-61d8-51c9-8473-0362380ac8ea) Montaigne wrote, ‘I am in the grip of one of the worst diseases – painful, dreadful, and incurable. Yet even the pain itself, I find, is not so intolerable as to plunge a man of understanding into frenzy or despair. At least I have one advantage over the stone. It will gradually reconcile me to what I have always been loath to accept – the inevitable end. The more it presses and importunes me, the less I will fear to die.’

Self-possession in the face of sickness, he believed, was crucial. Physicians were of little use: ‘no doctor takes pleasure in the health even of his friends,’ he remarked; this was a long-standing humanist jibe.

CHAPTER IX THE NEW SCIENCE (#ulink_300d18db-26d2-5f43-8aa4-c28de577b13c)

THE DREAM OF RENAISSANCE HUMANISTS was to restore medicine to its Greek purity, but a counter-view gained ground in the seventeenth century as the ‘moderns’ confronted the ‘ancients’: medicine could thrive only if the deadweight of the past were cast off. After centuries of stultifying homage to antiquity, a fresh start was needed. This was a subversive doctrine indeed, but support could be drawn from the Reformation: if Luther could break with Rome, how could it be impious to demand the reformation of medicine? Such revolutionary impulses first found expression in the work of the iconoclastic Paracelsus.

PARACELSUS

Meaning ‘surpassing Celsus’, Paracelsus was the cocksure name adopted in his early thirties by Theophrastus Philippus Aureolus Bombastus von Hohenheim (c. 1493–1542), a medical protestant if ever there was one – though, ironically, he never formally abandoned his native Catholicism. Paracelsus was born in Einsiedeln, Switzerland and educated by his physician father in botany, medicine and natural philosophy. Around the age of twenty he briefly studied medicine in Italy but subsequently led the life of a wandering student. All the while he picked up knowledge from artisans and miners (‘I have not been ashamed to learn from tramps, butchers and barbers’), observed and thought for himself, and acquired a taste for the esoteric. The writings of Trithemius (1462–1516), an occultist who aspired to the wisdom of the mythic Hermes Trismegistus, convinced him of the workings of invisible powers as spiritual intercessors between God and man in an enchanted cosmos.

Paracelsus’s off-beat education marked a drastic break with the orthodox university medical curriculum built on canonical texts; it helps explain how he repudiated Galenism and came up with new disease concepts in a twenty-year career that made him the scourge of the medical Establishment: ‘When I saw that nothing resulted from [doctors’] practice but killing and laming, I determined to abandon such a miserable art and seek truth elsewhere.’ But while there is no denying Paracelsus’s break with the past, the common portrayal of him as the founder of scientific medicine is misleading, for his creed always involved mystical and esoteric doctrines quite alien to today’s science. He thus appears a paradox. For while subscribing to popular beliefs and folk remedies, and lapping up the lore he heard from peasants about the nymphs and gnomes haunting mines and mountains, he also championed new chemical theories, dividing all substances into ‘sulphur’, ‘mercury’ and ‘salt’. Yet these must be understood not as material elements but as hidden powers.

Paracelsus’s fundamental conviction was that nature was sovereign, and the healer’s prime duty was to know and obey her. Nature was illegible to proud professors, but clear to pious adepts. His teachings on remedies thus drew on the popular doctrine of signatures to identify curative powers: the orchid looked like a testicle to show it would heal venereal maladies, the plant eyebright (Euphrasia officinalis) had been made to resemble a blue eye to show it was good for eye diseases. Paracelsus was perhaps influenced by radical Protestantism and its faith in a priesthood of all believers: truth was to be found not in musty folios but in the fields, and in one’s heart. Yet though he displayed a fiercely independent temper, kowtowing to none, unlike Servetus he cannily avoided getting ensnared in Reformation politics.

His fisticuffs mentality comes out clearly in his sublime contempt for academic pomposity: ‘I tell you, one hair on my neck knows more than all you authors, and my shoe-buckles contain more wisdom than both Galen and Avicenna.’ In 1526 he was appointed town physician and professor of medicine in Basel, a post requiring him to lecture to the medical faculty. This he did not in the customary Latin but in German, wearing not academic robes but the alchemist’s leather apron, and his manifesto pronounced that he would not teach Hippocrates and Galen, since experience alone (which included his intuitive flights) would disclose the secrets of disease. Jeering at orthodox physicians, and taking his cue from Luther, he then publicly burned Avicenna’s Canon, the Bible of learned medicine, along with various Galenic texts on St John’s day (24 June 1527). All this was quite unheard of.

Bloody-mindedness aside, Paracelsus’s significance lay in pioneering a natural philosophy based on chemical principles. Salt, sulphur and mercury were for him the primary substances. These did not completely replace the Aristotelian – Galenic system of qualities, elements and humours, but he considered them superior because they were in alchemical terminology ‘male’ – that is active and spiritual – whereas the elements were ‘female’ and passive. His ‘tria prima’ are to be understood not as material substances but as principles: solidity or consistency were represented by salt; inflammability or combustibility by sulphur; and spirituousness or volatility by mercury. Drawing on the occult, he associated diseases with the spirits of particular minerals and metals: ‘When you see erysipelas, say there is vitriol. When you see cancer, say there is colcothar’ (peroxide of iron). But he also boldly deployed metals and minerals – mercury, antimony (stibium), iron, arsenic, lead, copper and sulphur – for therapeutic purposes, together with laudanum (tincture of opium).

Embodying spiritual and vital forces, Paracelsus’s chemical principles explained living processes. These depended upon what he called archei, the internal living properties controlling processes like digestion; and also semina or seeds deriving from God, the great magus (magician) who orchestrated nature. The agents of disease, on the other hand, might be poisonous emanations from the stars or minerals from the earth, especially salts. His belief that there were as ‘many diseases as pears, apples, nuts’, and that each disease had a specific external cause sounds like an anticipation of ontological doctrines, but it must be remembered that he saw the essence of disease as spiritual.

Paracelsus ridiculed hidebound practices. Sickness was to be understood not by conventional urine inspection (uroscopy) but by chemical analysis using distillation and coagulation tests. He also enjoyed mocking innovations championed by others. Dissection, for instance, was worthless ‘dead anatomy’, for it could not reveal how the living body functioned. He died before Vesalius published his Fabrica, but he would probably have deemed it not worth a sausage. True physiology had to discover the nourishment each body part needed, while to fathom pathology stellar influences had to be probed and the presence of abnormal quantities of salt, sulphur and mercury tested. By disparaging humoral balance and stressing the prime role of particular organs in health and disease, he countered Galenist constitutionalism with a new notion of specificity and a pathology of disease as invasion from outside.

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He interpreted familiar diseases in new ways. Take gout, regarded by Hippocratic medicine as a classic humoral imbalance involving defluxion into the foot (‘gutta’ means ‘flowing’). Paracelsus read gout not constitutionally but chemically, seeing it in terms of the wider category of ‘tartaric disease’ (diseases of incrustations). In De morbis tartareis (1531) [On Diseases of Tartar], he proposed that some local external factor, such as water supply, might produce the characteristic chemical deposits in the joints. He boasted patriotically that in Switzerland, ‘the most healthy land, superior to Germany, Italy and France, nay all Western and Eastern Europe, there is no gout, no colic, no rheumatism and no stone’. Gouty nodules, he maintained, consisted of calcined synovia or an excremental salt (tartar) coagulated in a joint. Since the tartar coating wine casks was a product of fermentation, such material could be compared to bodily deposits like gallstones, kidney stones, and the dental incrustations still known as tartar. Bodily tartar was thus derived from food and released through digestion. In some individuals it failed to be excreted, tending instead to be transformed by ‘spirit of salt’ into stony substances like calculi or gouty tophi. This theory of ‘tartarous disease’ was one of the earliest attempts to advance a chemical aetiology for a malady.

Paracelsus sneered at bookworms (‘not even a dog-killer can learn his trade from books’), and his copious writings taught that truth was to be found not in libraries but in the Book of Nature, and issued a health warning: ‘the more learned, the more perverted’. Personal experience was what counted – ‘he who would explore nature must tread her books with his feet.’

However ambivalent such views – Paracelsus was the classic dogmatic anti-dogmatist, the humble chap convinced everyone else was wrong, the inveterate scribbler who told readers to close their books – his commitment to the discovery of truth through observation and experiment was a breath of fresh air. And it became the inspiration of the new medicine emerging in the ‘scientific revolution’ stirring at about the time of his death: 1543 brought not just Vesalius’s De fabrica but also Copernicus’s De revolutionibus orbium coelestium [On the Revolutions of the Heavenly Spheres] with its revolutionary heliocentric astronomy.

MEDICAL CHEMISTRY

Few of Paracelsus’s medical writings were published before his death in 1542, but by the 1550s they were spreading in a blaze of controversy. His followers made an odd bunch. His writings appealed, as would be expected, to radical reformers, such as the Danish Lutheran Peter Severinus, whose Idea medicinae philosophicae (1571) [The Idea of Philosophical Medicine] mocked Galenism, and in true Paracelsan fashion told readers to burn their books (though presumably not the Idea!), sell their houses and go on their travels, studying plants and learning from peasants. But his teachings also found favour in more select circles.

Cold-shouldered by universities, followers sought friends in high places; princely patronage would give Paracelsanism its imprimatur, while royal largesse could equip the laboratories chemical medicine required. In any case, many Renaissance rulers had intellectual aspirations of their own. The elector of the palatinate, Otto Heinrich Duke of Neuburg, was probably the first German noble to favour Paracelsans, and they also found support alongside the astrologers and magicians at the Prague court of the mystically-minded Holy Roman emperor, Rudolf II.