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PorterWk01 - 244 THE NEW SCIENCE In Le Me’decin malgre’...

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Unformatted text preview: 244 THE NEW SCIENCE In Le Me’decin malgre’ lui, Moliére presented the following exchange between a patient and a pretender: GERONTE: It was very clearly explained, but there was just one thing which surprised me — that was the posiu'ons of the liver and the heart. It seemed to me that you got them the wrong way about, that the heart should be on the left side, and the'liver on the right. SGANARELLE: Yes, it used to be so but we have changed all that. Everything’s quite different in medicine nowadays. Moliére got it right. There was still much that was laughable about seventeenth-century medicine; but it was changing fast. In The Advancement of Learning, Francis Bacon had proclaimed: Medicine is a science which hath been (as we have said) more professed than laboured, and yet more laboured than advanced; the labour having been, in my judgement, rather in circle than in progression. For I find much iteration, but small addition. By the century’s end, addition was more visible. CHAPTER X ENLIGHTENMENT IN SEARCH OF MEDICAL SCIENCE A MINOR EIGHTEENTH-CENTURY MEDICAL WRITER, Samuel Wood, looked back in his Stricmrer an the Gout (I 77 5) over the previous ‘two thousand years’ and deplored the ‘unenlightened state of the ancient Practitioners’, with whom ‘all was mere conjecture’. ‘There could be no Physiology at all,’ he insisted, ‘before our immortal Harvey’s Dis— covery of the Circulation of the Blood,’ since when, he concluded, ‘it is much more easy to account for life, for health, and for diseases.’ Early-modem times brought Harvey’s and other brilliant break— throughs in anatomy and physiology, but achievements proved more impressive on paper than in bedside practice; the war against death was stalled, and, to make matters worse, epidemics rained down on Europe in the decades around I 700 and mortality rates soared. Warfare, worldwide trading webs, giant cities and the thronging urban poor — the populations of cities like Naples, Paris and London were already topping half a million — all exacerbated health hazards. Better times were on the way, however, according to the new philo- sophy of progress proclaimed by enlightened intellectuals in the Nether- lands, Britain and France: original sin was a myth, and life’s journey was not the preachers’ vale of tears. Reason, proclaimed Enlightenment propagandists, would create a better future; science and technology, as Francis Bacon had taught, would enhance man’s control over nature, and social progress, prosperity and the conquest of disease would follow. In the 17905 the Marquis de Condorcet (1743—94) declared that future medical advances, supported by the civilizing process, would extend longevity, even perhaps to the point of immortality. ‘The improvement of medical practice,’ he declared, 245 246 ENLIGHTENMENT which will become more efficacious with the progress of reason and of the social order, will mean the end of infectious and heredi— tary diseases and illnesses brought on by climate, food, or working conditions. It is reasonable to hope that all other diseases may likewise disappear as their distant causes are discovered. The ogres of error and blind authority had already been challenged by heroes like Vesalius and William Harvey; further progress would‘make medicine yet more scientific. What precisely this scientific medicine should be like was hotly disputed. Iatromathematicians like Giorgio Baglivi (1668— I707) set great store by quantification. His De praxi medita (1699) [On Medical Practice] held that ‘the human body . . . operates by number, weight, and measure’. God, he asserted, ‘seems to have sketched the most ordered series of proportions in the human body by the pen of Mathe— matics alone’. And numbers counted. In 1707, Sir John Floyer (1649— 1734) published The Physician’s Pulse Watch, which acknowledged the Galenists’ skill in interpreting the pulse, but sought to establish objective numerical standards for determining abnormality, recommending checking the pulse against a watch with a special second hand. With the idolization of Isaac Newton (1642— I 727), whose Pfincz'pia had been published in 1687, experimental natural philosophy offered the most persuasive scientific model.'Leading the application of physics to medicine was the Dutch professor, Herman Boerhaave (1668— 1738), who construed health and sickness as expressions of such variables as forces, weights and hydrostatic pressures. Boerhaave was the pre— eminent early Enlightenment physician, holding a succession of chairs at Leiden University from I702. His influence spread through print: his textbook, Institutioner medicae (I708) [The Institutes of Medicine], ran through ten editions and was translated into five languages; protégés like Gerhard van Swieten (1700—72) exported his teachings to Vienna, Edinburgh and Gottingen. Boerhaave promoted mechanistic disease explanation within a cor— puscularian matter theory, seeing health in terms of hydrostatic equilib- rium, a balance of internal fluid pressures. He distinguished between disorders of the ‘solids’ and those of the ‘blood and humours’. Tubercu- losis was an example of weakness of the solid parts, blood clots an example of overly rigid fibres. Give milk and iron for weak fibres; let blood for rigid ones, he counselled. Such views encouraged experimentation. The mathematically ENLIGHTENMENT 247 inclined Anglican clergyman Stephen Hales (1677—1761) thus devised ‘haemodynamic’ experiments to measure blood circulation. Analysing the circulation in his Hammtirks (1733), he measured the force of the blood by inserting into the jugular vein and carotid artery of a living horse a goose’s trachea attached to a glass tube eleven feet long, to see how far up the tube the column of blood was carried. He recorded that the arterial pressure was far greater than the venous. A dauntless animal experimenter, Hales also explored Descartes’s notions of nerve action. His method involved decapitau'ng frogs and stimulating their reflexes by pricking the skin, noting that nervous responses continued. These experiments provoked anti-vivisection protests. The normally thick— skinned Samuel Johnson (1709—84) denounced doctors who ‘extend the arts of torture’. ‘1 know not’, he asserted, ‘that by living dissection any discovery has been made by which a single malady is more easily cured.’ Boerhaave’s hydraulic model of the body incurred criticism, how— ever, and attention shifted from the vascular to the nervous system. Vital qualities like irritability and sensibility were highlighted in the work of Albrecht von Haller (1708—77) in Gotdngen, William Cullen (1710—90) and his colleagues in Edinburgh, and Théophile de Bordeu (1722—76) and other Montpellier vitalists — all of whom developed a more dynamic life-force physiology than Boerhaave’s, in which health was the co-ordination of the separate life of each organ in the body. In other words, eighteenth-century scientific medicine was far from monolithic. Rival camps proliferated, and the traditional Italian and French centres of excellence were challenged by Halle, Leiden, London, Edinburgh, Vienna and Philadelphia, each with its own school. In Halle, Georg Ernst Stahl (1659— I734) denounced the materialism he detected in Boerhaavian mechanical philosophy, advocating instead an ‘animism’ which proposed a God-given, super—added soul (anima) as the prime mover of living beings. Highly influential in German-speaking lands, Stahl attacked reductionism: organisms were more than the sum of their parts, and purposive human actions could not be explained by mechanical chain—reactions alone; activity presupposed the guiding pur- posive power of a soul. This anima was the agent of consciousness and physiological regulation, and disease was the soul’s attempt to expel morbid matter and re-establish bodily order. Stahlian animism made medical sense, but it was also the product of evangelical Lutheran Pietism. Yet even in Halle Stahl did not reign unchallenged, for his colleague 248 ENLIGHTENMENT there, Friedrich Hoffmann (1660—1742), leant towards mechanism. ‘Medicine’, announced his Fundamenta medicime (1695) [Fundamentals of Medicine], ‘is the art of properly utilizing physico—mechanical prin- ciples, in order to conserve the health of man or to restore it if lost.’ Occupying the middle ground was Boissier de Sauvages (1706-67), professor of medicine at Montpellier. He accepted that the body was a machine, mathematically understandable, but disease was the effort by nature or the soul to expel morbific matter, and physiology was the science of that struggle. In their different ways, Boissier de Sauvages’s successors — Théo— phile dc Bordeu, Robert Whytt (I7I4—66) in Edinburgh, and John Hunter (1 728—9 3) in London - also denied the sufficiency of mechanics for explaining the body, postulating some vital force or organization. Very few physicians (the anti—clerical pbilosopbe Julien Offray de La Mettrie (1709—51) was one) went the whole hog and unashamedly reduced man to mechanism. Influenced by the spectacular working auto- mata constructed by craftsmen like Jacques Vaucanson (1709—82), La Mettrie held in his L ’bomme machine (I 748) [Man a Machine] that matter thinks; there was no need for a soul, for the body is ‘a machine that winds its own springs’. There were, in short, numerous ways in which medical authors sought to set their discipline on scientific rails; even so, that medicine failed to match the achievements of experimental physics or chemisz remained scandalous. Towards 1800, Thomas Beddoes (1760—1808), the Bristol practitioner who dreamed of curing lung disorders with respirable gases, rued that medicine was ‘remote . . . from such perfection’. Historians have sometimes explained this apparent paradox of Enlightenment medical science —— great expectations, disappointing results — as the consequence of over-ambitious theorizing. Yet that judgment seems misguided; for one thing, highly practical investigation continued unabated in fields like anatomy. As Italy’s star waned, the lights of science moved north, to France, the Netherlands, England, Scotland and certain German principalities. For long Leiden led the field, thanks to Boerhaave and his pupil, Bernhard Siegfried Albinus (1697—1770) — in a pious gesture, they re-published Vesalius’s works. Albinus’s own writings on the bones, muscles and the gravid uterus were exquisitely illustrated. Many other impressive anatomical atlases appeared, notably William Cheselden’s (1688—17 52) Orteogmpbia (I733) [The Bones Illustrated], Haller’s lame: anatomicae (I743- 56) ENLIGHTENMENT 249 [Anatomical Images], and William Hunter’s (1718—83) Anatomia uteri bumam' gravidi (I 774) [Anatomy of the Human Gravid Uterus], an aston— ishing depiction of the pregnant woman and her foetus in thirty—four copper-plates. Knowledge of gross anatomy was by then well-established, but in- novations were sn'll possible respecting the softer and more concealed fibres: the lacteal, lymphatic and particularly the nervous systems. Build- ing on Willis’s ‘neurologie’, it was studies by Jacob Winslow (1669— 1760) and the Prussian, Samuel Thomas von Sommerring (1755-— 1830) that established the classification of the cranial nerves. A Gottingen contemporary of the great Johann Friedrich Blumenbach (see below), Sommerring produced a major series of anatomical treatises on the sense organs, beginning with the eye (1801). Comparative anatomy received a boost from Pen-us Camper (I 72 z —89), who enrolled at Leiden at the tender age of twelve and went on to win fame for dissections of elephants, rhinoceroses and orang—utans. I-Iis attempt to measure ‘facial angle’ (the line of the brow and nose) was misused in later physical anthropology as an index of racial type. Comparative studies led Caspar Friedrich Wolff (1734—94) to con- clude that ‘all parts of the plant except the stem are modified leaves,’ a metaphysical tenet later endorsed by the poet and polymathJohann Wolf- gang von Goethe (I 749-— 183 2), who interpreted insect jaws as modified limbs, believed the skull was composed of modified vertebrae, and rejected mechanistic views of life in favour of a philosophy of holism. Exponents of Naturpbilosopbie, like Blumenbach’s student, Laurenz Oken (I 779- I 85 I), were soon suggesting that nature embodied a transcendental unity of plan, built upon elemental structural archetypes or anatomical building-blocks; this paved the way for philosophical morphology. It was not only Namrpbilosopbie which insisted there was more to bodies than pipes and pulleys, for experimentation itself revealed the limits of the mechanical model, forcing recognition of the astounding powers of living things — quite transcending clockwork. René Réaumur (1683—17 57) demonstrated the ability of lobster claws to regrow after being severed; Abraham Trembley (1710—84) chopped polyps into pieces and produced new individuals; in 1768 Lazzaro Spallanzani (1 729—99) succeeded in regenerating the tails of salamanders, snails and tadpoles. There was more to life than the mechanical philosophy had dreamt of. But how was it to be explained in an era no longer prepared to 250 ENLIGHTENMENT entertain miracles or Galenic innate virtues? Experimentation prompted new accounts of vitality and the reladons between body and soul, a movement whose towering figure was Albrecht von Haller. Haller learned much from his mentor, Boerhaave —- indeed, one of his first works was an edition of Boerhaave’s Institutes of Medicine (1739—44) — but he went beyond, unifying anatomy and physiology into a single science of ‘living anatomy’ (anatomia animata). An infant prodigy from Bern, Haller studied in Leiden and taught for seventeen years at the newly-founded University of Gottingen, before returning in 1753 to his native Switzerland. Linguist, poet, poly— math and devout Christian, his forte was physiological experimentation. His early Anatomical Image: depicted vascular anatomy, and continuing physiological researches led to a systematic physiology textbook, the Primae lineae physiologiae (1 747) [First Lines of Physiology], which went through several editions and translations and long served as a standard text. There followed his vast synthesis, the Elementa physiologiae empori: bumani (8 vols, I7 57—66) [Elements of the Physiology of the Human Body]. Its organizing assumption was Boerhaave’s principle that man possesses a physical body, analysable in terms of matter and forces, and an immaterial soul. Ironically, it was the pious Haller who conducted experiments which challenged his religiously reassuring dualism. In his De panibu: cor-port's bumani sensibilibw et initabilibu: (I 752) [On the Sensible and Irritable Parts of the Human Body], he made his key contribution to the study of animal economy by showing, rather in line with Glisson’s hypothesis, that irritability (contractility) was a property inherent in all muscular fibres, whereas sensibility was the exclusive attribute of nervous fibres. He thus established the fimdamental division of fibres according to their reactive properties: the irritable and the sensible. The sensibility of nervous fibres lay in their responsiveness to painful stimuli; the irrita- bility of muscle fibres was their property of contracting in reaction to stimuli. Haller therefore had an explanation of why the heart pulsated: it was the most ‘irritable’ organ in the body; composed of layers of muscular fibres, it was stimulated by the influx of blood, responding with systolic contractions. On the basis of animal experiments, Haller graded organs according to their fibres, ascribing to them inherent sensitivities independent of any super-added soul. As to the causes of such living forces, these were beyond knowing, or at least unknown: as with Newton on gravity, it was sufficient to study the effects. ENLIGHTENMENT 251 Haller’s model of fibre sensibility and irritability was open to varied interpretations. Robert Whytt, for instance, was troubled by its implied reductionism, fearing it would lead to materialism and atheism. Indeed, Haller’s findings were appropriated by radical philosophers like Denis Diderot (1713—84), eager for polemical reasons to develop a biological materialism which held that matter possessed vital properties. In On the Vital and Other Involuntary Motions of Animals (1751), Whytt reiterated the role of the soul, understood naturalistically not religiously. Unlike the Cartesian unextended soul, Whytt’s was ener- getic, sentient at a non-conscious level (and so, in a sense, automatic) and spatially extended in the body. The sentience of the soul was funda- mental to his notion of bodily co-ordination by means of sympathy, the irreducible perceptive power of the body. These views brought him into conflict with Haller, who found the notion of non-conscious perception unintelligible. . The problem of vitality also informed Haller’s work on embryological development, conducted in the context of the preformationist/epigenicist debate. Preformationists held that either the egg or the sperm contained a miniature representation (bmunculur) of the adult organism, foetal for- mation being a growth of parts already present at the moment of fertiliz- ation; epigenesists believed that the various organs were not all present but appeared gradually during the formation of the foetus. Early in his career Haller espoused epigenesis, but, in the 17505, once the unsettling implications of the new biological materialism were surfacing, he turned to preformationism. His main antagonist was Caspar Friedrich Wolff, who elaborated a rather Harveian epigenetic doctrine in his influential Tbeoria generationi: (I 7 59) {Theory of Generation]: tissues and organs differentiated and developed, maintained Wolff, rather than being preformed and merely ballooning in size in the fertilized egg. Experimental researches thus forced Haller to confront unpalatable alternatives: Boerhaavian dualistic mechanism (too crude for resolving the puzzles of life), Stahlian animism (concealed theology), or atheistic reductionism. His concepts of irritability and sensibility won support, however, and mainstream successors treated vitality as a property of the organized ensemble of living bodies. Modifying Haller, his Gottingen successor Johann Friedrich Blumenbach (1752—1840) delineated vital properties, including the nisw fbmativus or Bildungrtrieb, an inherent life-force shaping growth and regeneration. Appointed professor in 1776, Blumenbach was to dominate bio-medical thinking in Germany 252 ENLIGHTENMENT for over sixty years. In De generi: humani varietate nativa (I 776) [On the Natural Variety of the Human Race], he accepted Linnaeus’s belief that man (Homo sapiem) could not be exempted from the standard rules of primate taxonomy; nevertheless man should be housed in a separate zoological order (Bimna: two-handed). Committed to monogenesis (the single origin of the human race), be identified five racial varieties: the Caucasian, Mongolian, Ethiopian, Malay and American Indian. Scottish-born but London-based, John Hunter proposed a ‘life— principle’ in the blood to account for the properties which distinguished living organisms from inanimate matter; in France, it was the Mont- pellier pupils of Jean Astruc (1684—1766), who took up the vitality question. While accepting Boissier de Sauvages’s denial that mechanism could explain purposive action, they tended towards a more materialist stance, stressing the inherent vitality of living bodies. Bordeu in particu— lar maintained that each organ was naturally endowed with an inherent responsivity to stimuli: vital function was intrinsic to the fibres. It is no accident that Bordeu pops up as a character in one of Diderot’s philosophical d’esprit, arguing that the new physiology had proved that matter itself was the secret of life. In this speculative context the vogue for electrical experiments proved significant; Haller’s doctrines of sensitivity...
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