Part 19

Internal Medicine lagged behind Surgery at this period. The anatomical reforms of Vesalius were unaccompanied by any commensurate advance in physiological knowledge, and without a scientific Physiology there can be no science of Internal Medicine. The practice of the physicians thus remained in effect that of the Middle Ages. The ruling idea was still that of the ‘four humors’ corresponding to the four ‘temperaments’ (Fig. 13, p. 34, and compare Fig. 34, p. 97).

There are, however, three respects in which we see an improvement of the physician’s art during the sixteenth and first half of the seventeenth century.

Firstly, there was some improvement in the medical texts that were habitually read. More reliable translations were now available. Notably the great Hippocratic works became more widely disseminated. They formed a substitute for the old texts translated or mistranslated from the Arabic.

Secondly, the extension of geographical knowledge and the formation of settlements and colonies brought new drugs upon the market. These were often a mixed blessing, for some of the drugs were useless and others dangerous. Nevertheless, to this process Medicine owes several important contributions, among them Ipecacuanha, Cinchona (p. 326), and, by no means least, Tobacco (Fig. 35). Apart from the amenities introduced by Tobacco, it was for long of great value as a narcotic drug. Moreover, there was a corresponding advance in Botany. The movement was cursed with the ‘practical’ spirit, and only those plants thought to have an application as drugs were exactly figured and described. Nevertheless, the beautifully illustrated herbals of the sixteenth and seventeenth centuries exercised, by the care and accuracy of their execution, an exemplary influence on the development of Biological Science in general and of Medical Science in particular.

Thirdly, there was some advance in the knowledge of the natural history of infectious disease. A rational theory of the nature of infection was placed before the public as early as 1546 by the Veronese physician, Girolamo Fracastoro (1483-1553). He regarded infection as due to the passage of minute bodies from the infector to the infected. These hypothetical minute bodies had the power of self-multiplication. The conception bore a superficial resemblance to the modern germ theory of disease. An important contribution to the conception of epidemics was also made by the French physician Guillaume de Baillou (1538-1616), who reintroduced the old Hippocratic idea of ‘Epidemic Constitution’, i.e. that particular seasons and particular years are of their nature subject to particular diseases. The idea was extended and developed by the English physician Thomas Sydenham (1624-89), and it still has its value.

FIG. 34. FIGURE ILLUSTRATING THE ‘FOUR TEMPERAMENTS’, from the Guild Book of the Barber-Surgeons of York, now in the British Museum. The figure was prepared about 1500. Above, to the left, is the Melancholy man, and to the right the Sanguine. Below to the left is the Choleric man, and to the right the Phlegmatic. On the scroll work is written in English ‘Ther ar the iiij umors, thath ar oderwysse calde the iiij complecconis thath ar resceuid un to the iiij elementis, Hafyng the kynd of humors’, which may be rendered ‘There are the 4 humors, that are otherwise called the 4 complexions, that are received unto the 4 elements, having the nature of humors’. For the theory compare Fig. 13, p. 34.

In connection with their epidemiological work these three men, Fracastoro, de Baillou, and Sydenham, made significant additions to the knowledge of particular infectious conditions. Thus, during the sixteenth and seventeenth centuries there arose an exact body of teaching concerning acute infectious diseases which was the necessary prelude to the introduction of more effective preventive measures at a later date. To one infectious disease we may refer more particularly.

During the Middle Ages there had smouldered in various districts an obscure disease, sometimes more or less dimly distinguished under various specific names, but most frequently confused with Leprosy. Towards the end of the fifteenth century this disease, which was still imperfectly distinguished in men’s minds from Leprosy, broke out in epidemic and virulent form all over Europe. It caused great destruction of life and developed everywhere as a problem of national importance. Various titles were given it, such as ‘pox,’ ‘the French disease’, ‘the Spanish disorder’. Only tardily was it recognized that the disease was usually of venereal origin. Not till 1530, on the suggestion of Fracastoro, did it receive its modern cognomen Syphilis. From the time of its recognition, Syphilis has been pursued by a portentous mass of literature, the mere sifting and verification of which is a formidable task. Alarm, misunderstanding, religious feeling, false modesty, wilful misrepresentation, and change in type of the disease itself have all contributed their quota of obscurantism and fable to a naturally difficult subject (Figs. 35 and 36). Fracastoro did something to bring order out of the confusion. To him also we owe the first good scientific descriptions of several other destructive diseases, among which Typhus fever, now known to be conveyed by lice (p. 258), takes a prominent place.

FIG. 35. THE EARLIEST PICTURE showing the use of Tobacco. From a work on Brazil, printed in Paris in 1558. In the center of a native hut stands an Indian suffering from Syphilis. Behind him, on the left, a man smokes a huge cigar over him as a curative measure. Right and left his arms are held by two figures who seek to suck the poison out of him. Another offers him a curative plant. Behind him is a ‘hammock’--the word is of American-Indian origin and means ‘tobacco-bed’. Above his head are a monkey, a parrot, and a bale of tobacco.

De Baillou (1538-1616) first described Whooping Cough, and was the first to use the word Rheumatism in the modern sense. He was moreover the first, since Hippocrates, to distinguish between Rheumatism and Gout. De Baillou’s works deeply influenced Sydenham, who held very similar epidemiological views, and uses a somewhat similar vocabulary (p. 100).

We have seen how the knowledge of Anatomy forwarded Surgery, while, with the lag in Physiology, Internal Medicine remained in a backward state. It is well to recall however that a knowledge of Anatomy and Physiology will not, of themselves, make a man a scientific physician. The object which presents itself to a physician is neither a living anatomy nor a physiological model. It is a sick and suffering patient. The physician’s first task is to examine exactly the phenomena of sickness and suffering, and in doing this the first demand on his knowledge will be the history and fate of others who have endured like sickness and suffering. When he has ranged these instances in his mind he may turn, for explanation and relief, to the resources suggested by other sciences, Anatomy and Physiology among them. But all the Anatomy and Physiology in the world will not aid the practitioner who is unacquainted with the natural history of disease. This is the truth that was firmly seized by Thomas Sydenham.

The Natural History of Disease was a subject which Sydenham pursued with lifelong devotion. Before his time the phenomena of disease had been classified, subdivided, discussed, and treated with all the subtlety and skill of scholastic thought. Men had now and again shaken themselves free from the shackles of the medieval system, and had here and there corrected the views of Galen or amplified the limited achievements of their predecessors. Yet none before Sydenham had set himself to consider all the actual cases of disease that lay before him as a subject of scientific description and analysis. That was the great achievement of the ‘English Hippocrates’. We should not find it easy to point to any important discovery to associate with his name. But he did more than discover. He initiated a new mode of approach. He was the founder of modern Clinical Medicine.

In 1666 Thomas Sydenham published his classic work, The Method of Treating Fevers, dedicated to his friend Robert Boyle, ‘the Father of Chemistry’ (pp. 124-6). The book opens with the almost Hippocratic phrase ‘A disease, in my opinion, how prejudicial soever its cause may be to the body, is no more than a vigorous effort of Nature to throw off the morbific matter, and thus recover the patient’. We have here the healing power of Nature of Hippocrates (p. 21), which had been obscured and overlaid in the twenty centuries which lay between the two great physicians. The works of Sydenham may reasonably be regarded as the first great commentary on the Hippocratic theme. Sydenham set well on its way the conception of infectious conditions as specific entities, a conception which has since been illuminated by the germ theory of disease (p. 224 ff.).

From a work printed in Germany in 1496. The Virgin sits enthroned on clouds, crowning a crusader, who kneels at her right hand. The Holy Child on her knee sends forth the plague of Syphilis as a scourge on mankind. Two women, spotted with the rash of the disease, kneel in supplication before her on her left. In the foreground of the picture lies a corpse dead of the disease, the speckled ravages of which may be seen upon it.

§ 4. The First Physical Synthesis.

Manifestations of the Human Spirit are not accustomed to confine themselves exactly within the convenient limits of the centuries. Nevertheless, it happens that in the History of Science the year 1600 does, in fact, correspond to something of the character of a real change in the current attitude to Nature. That year really ushers in the era of physical experiment. The last of the great transitional thinkers who mark the waning of Renaissance philosophy was Giordano Bruno, the martyr of science.

Giordano Bruno (1548-1600), who was no practical scientist, had eagerly incorporated into his often fantastic philosophy the ill-worked-out conclusions of Copernicus (p. 88). Nominally adopting the Copernican theory, he modified it fundamentally. Copernicus, having placed the Sun at the center of the World, and made the Earth and other planets circle round it, had still left the stars at a fixed and definite distance, as had the ancient astronomers. The limitation of the sphere of the fixed stars was obnoxious to Giordano, and he removed the boundaries of the Universe to an infinite distance, in accordance with the principles of his philosophy. The change may seem unimportant save for astronomy, but, in fact, it came to influence every department of scientific thought, for the endlessness of Nature is implicit in the modern scientific attitude.

Giordano was burned at the stake at Rome, after seven years’ imprisonment, in 1600. In the same year the experimental era was ushered in with the work of William Gilbert (1544-1603), On the Magnet, in which he not only demonstrates experimentally the properties of magnets but also shows that the Earth itself is a magnet. In the same year, too, Tycho Brahe (1546-1601) handed over the torch to Johannes Kepler. Tycho was the last of the older astronomers who worked on the Aristotelian view of circular and uniform movements of heavenly bodies. Kepler was the real founder of the modern astronomical system. The period from 1600 onward lies with new men, Galileo (1564-1642) and Kepler (1571-1630) among astronomers and physicists, Harvey (1578-1657) among biologists, Descartes (1596-1650) among philosophers.

The seventeenth century opened with an extraordinary wealth of scientific discovery. As we glance at the mass of fundamental work produced during that period, we perceive the major departments of Science, as we know them to-day, becoming clearly differentiated. The acceptance of Observation and Experiment as the only method of eliciting the Laws of Nature reaches an ever-widening circle. Even to enumerate the names of the seventeenth-century pioneers would be a formidable task. The sciences penetrated to the Universities and influenced the curricula. The number of scientific men became so large and so influential that separate organizations were formed by them in the interests of their studies. It is the age of the foundation of the ‘Academies’, of which the English Royal Society is a type.

From the multitude of workers on these subjects we can but select a few names. In the first half of the century Galileo and Kepler are the main exponents of natural law. Descartes takes his place here as the first since antiquity who sought to explain the phenomenal universe on a unitary basis. In the second half of the period comes the mighty figure of Newton, whose researches ushered in that phase in our story in which we live to-day.

The early training of Galileo Galilei had been scholastic and Aristotelian. By 1590, however, he had begun to doubt, and was making experiments on the rate of acceleration of falling bodies. His conclusions were demonstrated in 1591 from the leaning tower of Pisa. By that famous experiment he showed, in the most public manner, the error of the Aristotelian view that the rate of fall was a function not of the weight of the object but of the period of fall. Revolutionary also was Galileo’s work of 1604. In that year a new star appeared in the constellation Serpentarius. He demonstrated that this star was situated beyond the planets and among the remote heavenly bodies. Now this remote region was regarded in the Aristotelian scheme as absolutely changeless. Although new stars had been previously noticed, they had been considered to belong to the lower and less perfect regions nearer to earth. To the same lower region, according to the then current theory, belonged such temporary and rapidly changing bodies as meteors and comets. But Galileo had attacked the incorruptible and unchangeable heavens.

In 1609 Galileo made accessible two instruments that were to have a deep influence on the subsequent development of Science, the Telescope and Microscope. It is with the former instrument that his name is most frequently associated. His first discoveries made by means of the Telescope were issued in 1610. That year was crowded with important observations especially on the inner planets and notably on Venus. It had been rightly claimed in criticizing the Copernican hypothesis that, if the planets resemble the Earth in revolving round the Sun, only such parts of them should be luminous as are exposed to the Sun’s rays. In other words, they should exhibit phases like the Moon. Such phases in Venus were now actually observed by Galileo. In the following year he described sunspots and traced them round the Sun’s disk.

We need not follow the further astronomical observations of Galileo, nor need we discuss the contest with the older school on which he embarked. It is sufficient to remind ourselves that the appearance of a new star, the behavior of the rings of Saturn, the observations of the phases of Venus and of the Sun’s spots, struck a blow at the Aristotelian astronomy comparable to that delivered against the Aristotelian physics by the falling weights from the leaning tower of Pisa. Aristotelian astronomy demanded heavens eternally changeless. Here were changes and new appearances in the heavens, clearly visible to all who would see.

During these years too, Galileo was laying firm the foundations of the science of Mechanics. Out of his mechanical researches came a new way of looking at the objects of Nature which has profoundly influenced the entire subsequent course of science. That way is best expressed in Galileo’s own words, which place him among the philosophers whose thought influences all those who deal with scientific themes.

‘As soon as I form a conception of a material or corporeal substance, I simultaneously feel the necessity of conceiving that it has boundaries and is of some shape or other; that relatively to others it is great or small; that it is in this or that place, in this or that time; that it is in motion or at rest; that it touches, or does not touch, another body; that it is unique, rare, or common; nor can I, by any act of imagination, disjoin it from these qualities. But I do not find myself absolutely compelled to apprehend it as necessarily accompanied by such conditions as that it must be white or red, bitter or sweet, sonorous or silent, smelling sweetly or disagreeably; and if the senses had not pointed out these qualities language and imagination alone could never have arrived at them. Therefore I think that these tastes, smells, colors, &c., with regard to the object in which they appear to reside, are nothing more than mere names. They exist only in the sensitive body, for when the living creature is removed all these qualities are carried off and annihilated, although we have imposed particular names upon them, and would fain persuade ourselves that they truly and in fact exist. I do not believe that there exists anything in external bodies for exciting tastes, smells and sounds, &c., except size, shape, quantity, and motion. If ears, tongues, and noses were removed, I am of opinion that shape, quantity, and motion would remain, but there would be an end of smells, tastes, and sounds, which abstractedly from the living creature I take to be mere words.’

This passage is a veritable Charter of Science. From Galileo’s day to ours, men of science have occupied

themselves in measuring size, shape, quantity, and motion, the ‘primary qualities’, and expressing their knowledge in that measured form. They have relegated colors, smells, tastes, sounds, and other sense-impressions to the position of ‘secondary qualities’, and have tried to express them, when they express them at all, in terms of the primary qualities. We need not enter on the philosophical discussion as to how far the primary qualities are in truth more real than the secondary, but it is a fact that, since the time of Galileo, Science has come to be regarded more and more widely as an exact process. Science is Measurement. It is a conception that has affected the medical no less than the other sciences, and it is a conception that Medicine, for good or ill, owes to Galileo.

FIG. 37. SANCTORIUS IN HIS BALANCE. Sanctorius was able to eat and even to sleep in his balance, counterpoised by a weight working on the principle of the steelyard. He was thus able to test his weight under various conditions, and notably to estimate the amount of the ‘insensible’ perspiration. His were the first experiments on ‘Metabolism’ (see p. 108).