Read Ebook: Medical Investigation in Seventeenth Century England Papers Read at a Clark Library Seminar October 14 1967 by Bodemer Charles W King Lester S Lester Snow

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verything else they agree; they are both alike primordially vegetables, potentially they are animals.

Let thy Studies be free as thy Thoughts and Contemplations, but fly not only upon the wings of Imagination; Joyn Sense unto Reason, and Experiment unto Speculation, and so give life unto Embryon Truths, and Verities yet in their Chaos.

Browne greatly admired Harvey's work on generation, considering it "that excellent discourse ... So strongly erected upon the two great pillars of truth, experience and solid reason." Browne carried out a variety of studies upon animals of all kinds, in them joining Sense unto Reason, and "Experiment unto Speculation." Thus in his studies of generation, he made observations and also performed certain simple chemical experiments. Noting that "Naturall bodyes doe variously discover themselves by congelation," Browne studied experimentally the chemical properties of those substances providing the raw material of development. He observed the effects of such agents as heat and cold, oil, vinegar, and saltpeter upon eggs of various animals, recording such facts as the following:

To affirm that Sir Thomas Browne was the founder of chemical embryology or, indeed, to contend that he made a great impress upon the progress of embryology is to humour our fancy. As Browne himself reminds us, "a good cause needs not to be patron'd by a passion." His work and interpretations of generation are most important for our purposes as an indication of the rising mood of the times and an emerging awareness of the physiochemical analysis of biological systems. Although this mood and awareness coexist in Browne's writings with a continued reverence for some traditional attitudes, they mark a point of departure toward a variety of embryological thought prominent in England during the second half of the seventeenth century.

Needham's book contains many splendid observations, including an accurate description of the placenta and its vessels, the relationship of the various fetal membranes to the embryonic fluids, and rather complete directions for dissection of various mammals. These need not detain us, since the important aspect of Needham's work relevant to our purpose is his continuation of the chemical analysis of the developing embryo and its demonstration that, although Harvey might have despised the "chymists" and been contemptuous of the "mechanical, corpuscular philosophy," this system and approach was not to be denied.

It is very probable that the spermatic portions of the uterus and its carunculae are naturally suited for separating aerial particles from arterial blood.

These observations premised, we maintain that the blood of the embryo, conveyed by the umbilical arteries to the placenta or uterine carunculae transports to the foetus not only nutritious juice, but also a portion of the nitro-aerial particles: so that the blood of the infant seems to be impregnated with nitro-aerial particles by its circulation through the umbilical vessels in the same manner as in the pulmonary vessels. Therefore, I think that the placenta should no longer be called a uterine liver, but rather a uterine lung.

The studies of such individuals as John Standard reporting the weight of various parts of the hen's egg, e.g., the shell, the yolk, the white, reveal the wing of embryological investigation that was increasingly obsessed with quantification and the physicochemical analysis of the embryo and its vital functions. In this they were following the injunction of Boyle, who used the developing embryo as a vehicle in an attack upon the idea that mixed bodies are compounded of three principles, the obscurities of which operated to discourage quantification:

How will this hypothesis teach us, how a chick is formed in the egg, or how the seminal principles of mint, pompions, and other vegetables ... can fashion water into various plants, each of them endowed with its peculiar and determinate shape, and with divers specifick and discriminating qualities? How does this hypothesis shew us, how much salt, how much sulphur, and how much mercury must be taken to make a chick or a pompion? And if we know that, what principle it is, that manages these ingredients, and contrives, for instance, such liquors, as the white and yolk of an egg into such a variety of textures, as is requisite to fashion the bones, veins, arteries, nerves, tendons, feathers, blood, and other parts of a chick? and not only to fashion each limb, but to connect them all together, after that manner, that is most congruous to the perfection of the animal, which is to consist of them?

LESTER S. KING

Robert Boyle was not a physician. To be sure, he had engaged in some casual anatomical studies, but he had not formally studied medicine and did not have a medical degree. Nevertheless, he engaged in what we would call medical practice as well as medical research and exerted a strong influence on the course of medicine during the latter seventeenth century, an influence prolonged well into the eighteenth. He lived during the period of exciting yet painful transition when medical theory and practice were undergoing a complete transformation towards what we may call the "early modern" form. The transition, naturally gradual, extended over three centuries, but I wish to examine only a very small fragment of this period, namely, the third quarter of the seventeenth century.

Boyle seems to have acquired most of his medical knowledge between, say, 1649 and 1662. It is worth recalling some of the trends and conflicts that formed the medical environment during this period. Among the major trends, first place, perhaps, must be given to Galenic doctrine, which had come under progressively severe attack. Moli?re, who lived from 1622 to 1673, showed in his comedies the popular reaction to a system which, although dominant, was clearly crumbling. The cracks in the edifice even the layman could readily see. Nevertheless, Galenism had its strong supporters. Riverius, who lived from 1589 to 1655, was a staunch Galenist. An edition of his basic and clinical works was translated into English in 1657, and Latin editions continued to be published well into the eighteenth century.

Galenism, of course, had to withstand the great new discoveries in anatomy and physiology made by Vesalius, Aselli, Sanctonius, Harvey, and others, not to mention the host of great investigators who were more strictly contemporaries of Boyle.

In this connection I might also mention the subject of "natural magic," which had considerable significance for medicine. The best-known name is, perhaps, Giovanni Battista della Porta , whose books continued to be published, in Latin and English, during this period when Boyle was achieving maturity.

Profound developments, of course, arose from the new mechanics and physics and their metaphysical background, for which I need only mention the names of Descartes, who died in 1650, and Gassendi, who died in 1655. And then there was also the new methodological approach, that critical empiricism whose most vocal exponent was Francis Bacon, which led directly to the founding of the Royal Society in 1660 and its subsequent incorporation. These phases of seventeenth-century thought and activity I do not intend to take up.

In this turbulent riptide of intellectual currents, Robert Boyle, without formal medical education, performed many medical functions, as a sometime practitioner, consultant, and researcher. Repeatedly he speaks of the patients whom he treated, and repeatedly he refers to practitioners who consulted him, or to whom he gave advice. In addition, through his interest in chemistry, he became an important experimental as well as clinical pharmacologist, and his researches in physiology indicate great stature in this field. If we were to draw a present-day comparison, we might point to investigators who had both the M.D. and the Ph.D. degrees, who had both clinical and laboratory training, and who practiced medicine partly in the clinical wards, partly in the experimental laboratories. Boyle, of course, did not have either degree, but he did have a status as the leading virtuoso of his day.

The virtuoso has been the subject of a most extensive literature. He aroused considerable contemporary hostility and satire and his overall significance for medical science is probably slight, with a few striking exceptions. Robert Boyle is one of the great exceptions.

First of all, the virtuoso was an amateur. In the literal sense the amateur loves the activities in which he engages, and in the figurative sense he remains independent of any Establishment. Not trained in any rigorous, prescribed discipline, he was not committed to any set doctrine. Furthermore, he was not restricted by the regulations which all Establishments employed to preserve their status, block opposition, and prevent competition. In many fields the Establishment took the form of a guild organization--in medicine, the Royal College of Physicians.

Boyle was a wealthy and highly talented man who could pursue his own bent without needing to make concessions merely to earn a living. He remained quite independent of the cares which oppressed those less well endowed in worldly goods or native talent. Sometimes, of course, necessity can impose a discipline and rigor which ultimately may serve as a disguised benefit, but in the seventeenth century, when Boyle was active, the lack of systematic training and rigorous background seemed actually an advantage. Clinical chemistry and the broad areas which we can call experimental medicine had no tradition. Work in clinical chemistry, clinical pharmacology, and experimental physiology was essentially innovation. And since innovations are often made by those who are outside the Establishment and not bound by tradition, we need feel no surprise that the experimental approach could make great progress under the aegis of amateurs. Necessarily the work was rather unsystematic and undisciplined, but system and discipline could arise only when the new approach had already achieved some measure of success. Through the casual approach of amateurs this necessary foundation could be built.

Boyle, as a clinician, remained on excellent terms with medical practitioners. For one thing, he took great care not to compete with them. As stated, he "was careful to decline the occasions of entrenching upon their profession." Physicians would consult him freely. As a chemist and experimental pharmacologist, he prepared various remedies. Some of these he tried out on patients himself, others he gave to practitioners who might use them. Boyle seems to have abundantly provided what we today call "curbstone consultations."

What internal and external factors permit a successful breakaway from tradition? Rebels there have always been, yet successful rebels are relatively infrequent. The late seventeenth century was a period of successful rebellion, and the virtuosi were one of the factors which contributed to the success. Robert Boyle played a significant part in introducing new methods into science and new science into medicine.

But while Boyle was a skillful chemist, judged by the standards of his time, we cannot call him a skillful medical investigator. This represents, however, the fault of the era in which he lived rather than any fault peculiar to him. Boyle's medical studies fall into at least two categories. These were the purely physiological experiments, such as those on respiration or on blood, and the more clinical experiments, concerned with pharmaceuticals, clinical pharmacology, and clinical medicine. The purely physiological experiments have great merit and were profoundly influential in shaping modern physiology. The clinical experiments throw great light on the development of critical judgment in medical history, and the relations of judgment and faith.

This empirical attitude, not at all infrequent in the latter eighteenth-century medicine, was quite unusual in the seventeenth-century medicine. This was precisely the attitude that Robert Boyle exhibited in his clinical contacts.

The problem, in a sense, resolves around the notion of credulity. What shall we believe? Boyle makes some distinctions between what he has seen with his own eyes and what other people report to have seen. Thus, he mentions "a very experienced and sober gentleman, who is much talked of" who cured cancer of the female breast "by the outward application of an indolent powder, some of which he also gave me." But, he adds cautiously, he has not yet "had the opportunity to make trial of it." Clearly, since he cannot make the trial himself, Boyle withholds judgment, even though the material came from a "very experienced" gentleman. Or again, he talks about "sober travelers" who made certain claims regarding the treatment of poisons. But, he says, "having not yet made any trial of this my self, I dare not build upon it."

There are numerous such instances, scattered throughout his works, where he reports an alleged cure but specifically indicates his own mental reservations. Clearly, he is quite cautious in accepting the statements of others, even though they were "sober" or "experienced" or even "judicious." On the other hand, he is extremely uncritical when he himself uses the term "cure" and when he attributes cures to particular medicines.

His skepticism he indicates in references, for example, to Paracelsus and van Helmont. Their specific remedy against "the stone," he says, and their claims that they can reduce stones to "insipid water, is so strange that their followers must pardon me, if I be not forward to believe such unlikely things, til sufficient experience hath convinced me of their truth." Here, of course, we see further a feature of critical acumen. A claim is made, but if this claim runs counter to Boyle's own accepted body of knowledge, or to logical doctrines derived from other directions, mere assertion cannot carry conviction. "Sufficient experience" must play its part, and just what constitutes "sufficient" we are not quite sure.

The same skepticism applies to remedies that, far from being expensive, were common and yet rather disgusting. The use of feces and urine as medication was widespread. The medical virtues of human urine represent, he believed, a topic far too great to be considered in a brief compass. But he declared that he knew an "ancient gentlewoman" suffering from various "chronical distempers" who every morning drank her own urine, "by the use of which she strangely recovered." Boyle was quite skeptical of the reports of others, which he had not had opportunity to try himself. But in therapeutic trials that he himself had witnessed, he seemed utterly convinced that the medication in question was responsible for the cure and was quite content to accept the evidence of a single case.

He discussed the "efficacy" of millepedes, which he found to be "very diuretical and aperitive." And he indicated, on the evidence of a single patient whom he knew, that the millepedes had great medicinal value in suffusions of the eyes.

Many remedies of this type, the so-called old wives' remedies, were those of empirics. As mentioned previously, Boyle felt deeply concerned because physicians tended to ignore the alleged remedies of those who had not had formal training in medicine. He believed that great specific virtue probably lurked in many of these remedies, and he maintained that the chemists should investigate them without the prejudice that the medical professions exhibited. As part of this view, he felt that "simples" should be more carefully studied, because medicinal virtues inhered in single substances and that complicated combinations were unnecessary.

We find innumerable examples scattered through Boyle's writings regarding the relations between chemistry and medication, numerous descriptions of cures, and skepticism regarding other alleged cures. As an important example, I would indicate Boyle's discussion of one of van Helmont's alleged cures.

Van Helmont described the remarkable cures brought about by a man identified only by the name of Butler. Apart from van Helmont's discussion, we can find no trace of him in medical annals, and van Helmont's own account is extremely skimpy. There are no dates given, and the only temporal clue is that Butler apparently knew King James--King James I, naturally. Butler was an Irishman who suddenly came into world view while in jail. A fellow prisoner was a Franciscan monk who had a severe erysipelas of the arm. Butler took pity on him, and to cure him took a very special stone which he had and dipped it briefly in a spoonful of "almond milk." This he gave to the jailer, bidding him convey a small quantity of it into the food of the monk. Almost immediately thereafter, the monk, not aware of the medicine, noted an extremely rapid improvement.

Van Helmont related other cures. For example, a laundress who had a "megrim" for sixteen years was cured by partaking of some olive oil, into a spoonful of which Butler dipped the stone. Other cures for which van Helmont vouched included a man who was exceedingly fat; he touched the stone every morning with the tip of his tongue and very speedily lost weight. Van Helmont's own wife was cured of a marked edema of the leg. Similarly, a servant maid who had had severe attacks of erysipelas which were "badly cured," and the leg leaden colored and swollen, was cured almost immediately. An abbess, whose arm had been swollen for eighteen years, partly paralyzed, was also cured. Van Helmont, however, indicates that he himself, when he thought he was being poisoned by an enemy, did not secure any benefit from the use of the stone. Later, however, it turned out that, because of the nature of the illness, he should have touched the stone with his tongue, to take its virtue internally, rather than merely anointing the skin with oil into which the stone had been dipped.

This was the background from which Boyle set about to secure a potent remedy. Van Helmont had discussed his experiments whereby he tried to create a medicine which would have the virtues of Butler's stone. Boyle attempted to improve on van Helmont's technique. Copper--Venus--was the basic metal, and Boyle started with vitriol or copper sulfate. He gave fairly explicit directions for the preparation, including calcination, boiling, drying, adding sal armoniack, subliming twice. The resulting chemical represented a purified medicine which he prescribed in variable dosage, from two or three grains, up to twenty or thirty at the maximum. He declared it to be a "potent specifick for the rickets," since he, and others to whom he had given it for use, had "cured" a hundred or more children of that disease. The medicine he also prescribed in fevers and headache, and he thought it "hath done wonders" in obstinate suppressions of the menses. It also improved the appetite. It worked, he declared, through the sweat and, to some extent, the urine. It is noteworthy that Boyle did not claim to have cured the same illnesses than van Helmont reports as having been cured by Butler's stone.

As another example, he gave directions for preparing essence of hartshorn--prepared, literally, from the horn itself. The preparation, strongly alkaline, he prescribed in small doses of eight to ten drops. The medicine "resists malignity, putrefaction, and acid humours," for it destroys the acidity. He used it "in fevers, coughs, pleurisies, obstructions of the spleen, liver, or womb, and principally in affections of the brain...."

Learned physicians, unfortunately, refused in large part to accept the validity of these alleged cures. Their hesitancy rested not on statistical evidence or on niceties of scientific method, but on the grounds that the alleged mode of operation was quite unintelligible and not at all in accord with accepted doctrine.

Boyle, as a chemist, insisted on keeping an open mind in regard to so-called specifics. He objected strongly to the argument that simply because we cannot account for their mode of action, we should conclude that they were not effective. In a passage of great importance, he declared, "Why should we hastily conclude against the efficacy of specificks, taken into the body, upon the bare account of their not operating by any obvious quality, if they be recommended unto us upon their own experience by sober and faithful persons?" Thus, his chain of reasoning is, first of all, these remedies work, as attested by direct experience; we are not able to explain why or how they work; we must not, however, fly in the face of experience and deny their effectiveness simply because of our inability to explain the workings. He gives the example of a "leaven," which in minute amounts is able to "turn the greatest lump of dow into leaven."

As a physician, Boyle insisted on facts over theory. He was constantly pleading for physicians to enlarge their experience, to try new medicines, even though these were not based on traditional doctrine. Where observed fact conflicts with theory, the fact cannot be ignored. Credulity of physicians, he indicated, may do the world "more mischief" than any other profession, but nevertheless he condemned those who would try to "circumscribe, or confine the operations of nature, and not so much as allow themselves or others to try, whether it be possible for nature, excited and managed by art, to perform divers things, which they never yet saw done, or work by divers ways, differing from any, which by the common principles, that are taught in the schools, they are able to give a satisfactory account of." Surely, this is not a model of elegant English style, but the message is clear. Boyle was emphasizing the message taught earlier in the century by Francis Bacon, that we must judge the theory by the fact, and not the facts by the theory. It is the same philosophy that Hamlet expounded, that there are more things in heaven and earth than are dreamed of in our philosophy.

We see, thus, that Boyle had taken a mighty step toward modern scientific medicine, but he covered only a small part of the total distance. He insisted that we should accept facts, but he did not realize the difficulties attendant on defining a fact and making it credible. He indicated that when strange results are alleged, "these need good proof to make a wary man believe so strange a thing," but what constitutes proof was a problem which he was not able to wrestle with and, indeed, a problem which he did not clearly perceive.

I would emphasize that Boyle was in essence a man of great faith. He had great faith in religion, and was a deeply religious man. He was a great supporter of so-called "natural religion" and tried to reconcile the doctrines of natural philosophy with those of traditional religion. Westfall has considered in detail the religious attitudes of late seventeenth-century writers, Robert Boyle in particular. The "proofs" alleged by the proponents of natural religion have, of course, little cogency. As Westfall points out, they examined nature in order to find what they already believed.

Nevertheless, religious faith was only one part of the total faith which Boyle exhibited. He had as much faith in the capabilities, the future progress, and the promise of science as he did in traditional religion. Throughout all his works we see great evidence of his religious piety. But his faith in science, particularly as it affected medicine, we see with utmost clarity in the essay "The Usefulness of Natural Philosophy." He had great vision of the benefits that science would eventually bring to the healing arts. Unlike many of his contemporaries, particularly persons such as Glanvill or Spratt, he realized that many anatomical discoveries, for example, were of little practical value, but he felt that such discoveries would, "in process of time highly conduce to the improvement of the therapeutical part of physick...." And with extraordinary perceptiveness he indicated the different ways in which he expected progress to be made through the proper application of mechanical philosophy. He was clear-sighted enough to realize that the discoveries made hitherto were not of great practical value but that the future was indeed bright, and he provided a remarkable blueprint of progress to come.

The measure of progress is, perhaps, the quantity of faith which moves mankind. The study of Robert Boyle emphasizes some divisions among mankind. Some are content to look backward, to be satisfied with the achievements of the past, to rely on accepted systematization, doctrine, and explanation. Others, while dissatisfied with the past, have no guide to lead them anywhere. Still others, however, have a strong faith in the new course which they are pursuing, a faith which can guide them over great difficulties. Boyle was such a man of faith--a word which is really synonymous with "attitude." He marked the transition between the old and the new, and pointed up the difficulties which transition always involves.

Boyle, "Usefulness," pp. 74-75. See also pp. 115-116.

Boyle, "Usefulness," p. 115.

Boyle, "Usefulness," pp. 135-136.

Boyle, "Reconcileableness of Specific Medicines," pp. 80-81.

Boyle, "Usefulness," p. 183.

Boyle, "Usefulness," pp. 163-164.

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