THE MEDICAL HUMANISTS

12 May

The Scientific Revolution is generally thought of as the great transfor- mation  of the physical sciences that  occurred  during  the sixteenth and seventeenth   centuries,   and   is  primarily   associated   with   Nicolaus Copernicus  (1472–1543), Johannes  Kepler (1571–1630), Galileo Galilei (1564–1642), and Isaac Newton  (1642–1727). Some scholars have tried to  explore  the  problem  of why the  Scientific Revolution occurred  in Europe in the seventeenth century, rather than in China or Islamic areas, which reached a sophisticated level in science and technology  centuries earlier.  Other  scholars  have  dealt  with  the  questions  by arguing  that there was no such thing as a European Scientific Revolution. After all, during  the alleged Scientific Revolution, interest in astrology,  alchemy, magic, religion, and theory persisted. Yet other scholars see the Scientific Revolution are a valid metaphor for the transition from a pre-modern  to a modern  worldview,  in which science is at  the  very core of life and thought.   Writers  who  lived  through   the  era  traditionally called  the Renaissance  often expressed an awed awareness of changing ideas, such as the Copernican Theory.  John  Donne  (1572–1631), English poet and clergyman,  thought that  the sun-centered  image of the cosmos  might well be  true,  but  he  lamented  that  the  new  philosophy  ‘‘calls all  in doubt.’’ Truly, the world had lost its traditional ‘‘coherence.’’ Men no longer knew where to find the sun, the earth, and the planets. Yet poets and the human  mind can eventually adjust even to the displacement  of earth   and  sun.  Alexander   Pope  (1688–1744), in  his  Essay  on  Man (1734), saw the new vision as exciting rather than frightening, and hoped new ideas about  the universe might tell us ‘‘why Heaven has made us as we are.’’

Thus,  just as the Renaissance  transformed the arts,  the Scientific Revolution ultimately  transformed ideas about  the nature  of the uni- verse and  the  nature  of man.  During  the  period  from  about  1450 to 1700,  medieval  scholasticism   was  replaced   by  a  new  approach to understanding the natural world.  Applying  this new mode  of thought to  anatomy,   physiology,   and   medical  education   would   have  been impossible   without   the   work   of  the   humanist   scholars.   Like  the scholastics  of the Middle  Ages, the humanists  were devoted  to words and books  and the difficult task of integrating  experience and practice with classical learning. While the intellectual ferment and scholarly enthusiasms   of   this   period   were  unique,   religion   still  permeated Renaissance   life  and  the  way  in  which  scholars,   artists,   explorers, and  natural philosophers saw the  world,  even the  New  World.  Even  if humanism  was indicative  of a new state  of mind,  half of the books printed  during  this era dealt  with religious  subject  matter.

A good case can be made that humanism  and humanists  at univer-sities throughout Western  Europe  played  a  key role  in transforming the scholastic medieval curriculum. University faculties fought about funding,  arrogant celebrity  scholars,  full-time  and  adjunct  positions, pensions,   and  dress  codes,  and  complained   about   town  and  gown tensions,  while students  attempted to censure professors  for what they considered  inadequate teaching.  In other  words,  much  about  the aca- demic environment has remained  the same. Despite  the persistence  of many aspects of the medieval intellectual  tradition, humanist  scholars, especially those at Italian  universities, fomented  a real intellectual revo- lution.  But, for many reasons, the Italian  universities were in decline in the seventeenth  century  as universities  in other  regions  offered  strong competition  for students  and faculty.

While the humanist  scholars  were generally more concerned  with art  and  literature  than  science, their  new perspective  served the needs of the medical sciences as well. As staunch  supporters of the newly puri- fied Galenic  texts,  humanist  scholars  rejected  corrupt  medieval  trans- lations.   Nevertheless,   their  excessive  respect  for  ancient   authorities made  them skeptical  of attempts  to create  a new medical science that would  be  independent   of  the  ancient  Greeks.  The  work  of  Thomas Linacre (1460?–1524) and John Caius (1510–1573), outstanding English medical  humanists, exemplifies the nature  of scholarship  and  medical education  during  this period.

Thomas   Linacre  studied  Greek  in  Florence   and  Rome  before receiving  the  degree  of  Doctor   of  Medicine  from  the  University  of Padua  in  1496.  In  addition   to  his  scholarly  work,  he  maintained a lucrative private medical practice, taught  Greek, and served as personal physician  to  King  Henry  VII.  Linacre  edited  and  translated  Galen’s writings on hygiene, therapeutics, disease symptoms,  the pulse, and so forth.  He was also highly regarded  as a grammarian. His last book,  a study  of Latin  syntax,  was published  posthumously. As founder  and guiding light of the College of Physicians,  Linacre  helped to mold the character  of the English medical profession.  He and other  elite English physicians  gained  the  power  to  determine  who  could  legally practice medicine in the Greater  London  area. The Royal College of Physicians had  the  power  to  fine and  imprison  unlicensed  medical  practitioners. Graduates  of  Cambridge   and   Oxford,   which  Linacre   himself  had attended,  were exempted from these harsh  penalties.  Under  the leader- ship of Linacre’s devoted disciple John Caius, the College of Physicians grew in power  and  prestige,  taking  control  of medical licensing away from  religious  authorities, and  using strict  regulations  to enhance  the status  of  approved   physicians.  Nevertheless,  Caius  was  troubled   by what he saw as a decline in English medical humanism.

In  terms  of  the  development  of  institutions of  higher  learning, England   lagged  behind  the  universities  and  professional   schools  of the continent.  Thus,  like other  English  scholars,  Caius  had  to pursue his  studies  abroad. After  abandoning his  theological  studies,  Caius became  a medical  student  at  the  University  of Padua,  where  he met Andreas  Vesalius (1514 –1564), the rising star of Renaissance  anatomy. Both men were involved in editing and publishing new Latin versions of Galenic  texts,  but  their  reactions   to  discrepancies  between  Galenic anatomy  and  the human  cadaver  were quite  different.  While Vesalius insisted  on  returning  to  the  ‘‘true book  of  the  human  body,’’ Caius was confident  that  once all the writings of Galen were critically edited, medical knowledge would be virtually  complete.

In  1546,  Caius  was  appointed anatomical demonstrator  to  the

United  Company  of Barbers  and  Surgeons.  Since 1540, the Company of Barbers and Surgeons had been allotted  the bodies of four convicted felons per year for anatomical demonstrations. After considerable  lob- bying  by Caius  and  other  elite physicians,  the  College  of  Physicians received  a  similar  bequest  in  1565. Whereas  other  presidents  of  the College of Physicians  had  generally  ignored  unqualified  practitioners, especially outside  London, Caius  wanted  to  control  medical licensing for all of England.  Although  his goal of raising standards for medical education  and practice was laudable, efforts to limit the number of prac- titioners  by dictating their credentials had adverse effects, especially for women and the poor. Obviously, the needs of the common people could not  be met by the  small numbers  of physicians  who  belonged  to  the medical aristocracy,  which was not  necessarily a meritocracy.  Because women were not admitted  to the universities, female practitioners were easy targets  for licensing reforms. In addition  to his campaigns  against unlicensed  practitioners, quackery,  witchcraft,  and  superstition, Caius challenged those who dared  to criticize Galen.

Respect for the ancients did not blunt Caius’ ability to observe and describe new phenomena, as shown in his account of an illness known as the English sweating sickness. His remarkable Boke or Counseill against the Disease Called the Sweate (1522) was the first original description  of disease to  be written  in England  in English.  In  all probability, Caius would  be  distressed  to  know  that  his  vernacular   description   of  the ‘‘sweats’’ is now regarded  as his most important medical work. At leas five severe outbreaks of Sudor  Britanica,  or sudor anglicus, apparently occurred  between  1480 and  1580.  The  disease  was  characterized   by copious  sweat, fever, nausea,  headache,  cramps,  pain  in the back  and extremities,  delirium,  hallucinations, and  a  profound stupor.  Within about  24 hours  the  disease  reached  a  critical  stage,  when  either  the disease  or  the  patient  came  to  an  abrupt end.  Even  among  strong, healthy  men,  the  mortality   rate  was  extremely  high.  Many  victims lapsed into coma and died within 24 to 48 hours. Moreover,  the disease seemed  to  seek out  Englishmen  even if potential  Scottish,  Irish,  and Welsh victims were available.

According  to Caius, a stricken town was fortunate if only half of all  souls  were claimed  by  the  disease.  After  carefully  evaluating  the clinical pattern and  natural history  of the  disease, he concluded  that the sweating sickness was a new disease. Some historians  believe that the disease was brought  to London  in 1485 when Henry  VII’s merce- naries returned  from France  and Flanders.  The disease might have been a virulent form of influenza, ergotism (a reaction to fungal toxins), food poisoning,  or  a  totally  unknown   and  extinct  disease,  but  the  exact nature  of these epidemics and the reason for their peculiar geographical distribution are still obscure.

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