Medical Investigation in Seventeenth Century England Part 2

[23] Harvey, _op. cit._, pp. 462-463.

[24] _Ibid._, p. 457.

[25] F. J. Cole, _Early Theories of s.e.xual Generation_, Oxford, 1930, p.

140.

[26] Thomas Browne, _The Works_, ed. Geoffrey Keynes, Chicago, 1964, I, 261-262.

[27] _Ibid._, II, 265.

[28] _Ibid._, III, 442.

[29] _Ibid._, III, 442-452.

[30] _Ibid._, I, 50.

[31] _Ibid._, I, 14.

[32] Walter Needham, _Disquisitio anatomica de formato foetu_, London, 1667.

[33] John Mayow, "De Respiratione foetus in utero et ovo," in _Tractatus Quinque Medico-Physici_, Oxonii, 1674, p. 311.

[34] _Ibid._, pp. 319-320.

[35] Robert Boyle, _The Works_, London, 1772, I, 548-549.

[36] Browne, _op. cit._, II, 261.

II

_Robert Boyle as an Amateur Physician_

LESTER S. KING

Robert Boyle was not a physician. To be sure, he had engaged in some casual anatomical studies,[37] 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's first major work which dealt extensively with medical problems was the _Usefulness of Experimental Philosophy_. This work, although published in 1663, had been written in two parts, the first much earlier than the second. Fulton[38] indicates it had been drafted around 1650, while Hall[39] ascribes it to the period 1647-1648. This first part has relatively little to do with medicine; the references are few and rather incidental, and have significance only for the light they throw on "natural philosophy" and "natural religion." The second part, however, written apparently not too long before publication, has a great deal to do with medicine and const.i.tutes one of the important medical doc.u.ments of the century.

Deserving of mention is an earlier and minor work of Boyle, indeed, his first published writing, only recently identified. This work, apparently written in 1649, bore the t.i.tle "An Invitation to a free and generous communication of Secrets and Receits in Physick," and appeared anonymously in 1655 as part of a volume ent.i.tled _Chymical, Medicinal and Chirurgical Addresses Made to Samuel Hartlib, Esquire_.[40] For our purposes, it is significant as emphasizing his early interest in medicine.

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. Moliere, 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[41] was translated into English in 1657, and Latin editions continued to be published well into the eighteenth century.[42]

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.

Galenism also faced the rivalry of chemistry. The so-called "antimony war" in the earlier part of the century marked an important a.s.sault on Galenism, and the letters of the arch-conservative Guy Patin (who died in 1672) help us appreciate this period.[43] However, even more important was the work of van Helmont, who developed and extended the doctrines of Paracelsus and represented a major force in seventeenth-century thought. Boyle was well acquainted with the writings of van Helmont, who, although his works fell into disrepute as the mechanical philosophy gradually took over, nevertheless in the middle of the seventeenth century was a highly significant figure. In 1662 there appeared the English translation of his _Oriatrike_,[44]

while Latin editions continued to be published later in the century.

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 (1545-1615), whose books[45]

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 Ga.s.sendi, 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 pract.i.tioner, consultant, and researcher. Repeatedly he speaks of the patients whom he treated, and repeatedly he refers to pract.i.tioners 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.[46] 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 compet.i.tion. In many fields the Establishment took the form of a guild organization--in medicine, the Royal College of Physicians.[47]

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 pract.i.tioners. For one thing, he took great care not to compete with them. As stated,[48] 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 pract.i.tioners who might use them. Boyle seems to have abundantly provided what we today call "curbstone consultations."

In no way bound by guild rules and conventions or by rigid educational standards, Boyle was free to learn from whatever sources appealed to him. Repeatedly he emphasized the importance of learning from experience, both his own and that of others, and by "others" he included not only physicians and learned gentlemen, but even the meanest of society, provided they had experience in treating disease. This experience need not be restricted to treatment of humans but should include animals as well. Thus, in speaking of even the "skilfullest physicians," he indicated that many of them "might, without disparagement to their profession, do it an useful piece of service, if they would be pleased to collect and digest all the approved experiments and practices of the farriers, graziers, butchers, and the like, which the ancients did not despise...; and ... which might serve to ill.u.s.trate the _methodus medendi_."[49] He was quite critical of physicians who were too conservative even to examine the claims of the nonprofessionals, especially those who were relatively low in the social or intellectual scale. This casts an interesting sidelight on the sn.o.bbishness of the medical profession.

Boyle's willingness and ability to ignore the restrictions of an Establishment represent the full flowering of what I might call the Renaissance spirit--the drive to go outside accepted bounds, to explore, to _try_, to avoid commitment, and to investigate for oneself.

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.

We must realize that Boyle was primarily a chemist and not a biologist.

He thought in chemical terms, drawing his examples from physics and chemistry; he did not think in terms of the living creature or the organism, and as a mechanist he pa.s.sed quite lightly over the concept or organismic behavior. His basic anti-Aristotelianism prevented his appreciating the biologically oriented thought of Aristotle. Instead, Boyle talked about the inorganic world, of water, of metals and elements, of physical properties. He ignored that inner drive which Spinoza called the _conatus_; or the _seeds_ of Paracelsus or van Helmont; or the persistence over a time course of any "essence" or "form." Since he dealt with phenomena relatively simple when compared with living phenomena, he could, for this very reason, make progress, up to a point. As a chemist, he could seek fairly specific and precise correlations of various concrete environmental factors, and then a.s.sume that living beings behaved as did the inorganic objects which he investigated. However, he always excepted the soul of man, as outside his investigations.

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.

In 1775, John Hunter wrote a letter to Jenner that has become quite famous. Hunter had just thanked Jenner for an "experiment on the hedgehog." But, continued Hunter, "Why do you ask me a question by way of solving it? I think your solution is just, but why think? Why not try the experiment?"[50] The word "just," of course, in its eighteenth-century sense, means exact or proper, precise or correct. A "just solution" is one that is logically correct. The "think" refers to Hunter's own uncertainty. He is not content with a verbal or logical solution to a problem, he wants empirical demonstration. Why, he is asking, should we be content with merely a logically correct solution when we can have an experiential demonstration. _Try the experiment._ Put the logical inference to the test of experience.

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

Medicine, at least textbook medicine, was rationalistic. Textbooks started with definitions and a.s.sertions regarding the fundamentals of health. This we see particularly in a Galenic writer such as Riverius.

Medicine, he said, "stands upon the basis of its own principles, axioms and demonstrations, repeated by the demonstration of nature."[51] In his text, Riverius first expounded a groundwork concerning the elements, temperaments and humors, spirits and innate heat, the faculties and functions; then the nature of the diseases which resulted from disturbances of these; and finally the signs of disease and the treatment that was appropriate. All were beautifully interdigitated in a logical fas.h.i.+on, and for any recommended therapy a good reason could be found. There was, however, a serious difficulty. If anyone were so bold as to ask, _But how do you know?_ only a rather lame answer would come forth. The exposition rested in large part on authority or else largely on reasoning from accepted premises--a "just" reasoning. And while much keen observation was duly recorded and a considerable ma.s.s of fact underlay the theoretical superstructure, the idea of empirical proof was not current. Riverius chopped logic vigorously and drew conclusions from unsupported a.s.sertions in a way that strikes us as reckless.

For a body of knowledge to be a science, it must indicate a logical connection between first principles, which were "universal," and the particular case. The well-educated physician could always give a logical reason for what he did. The empiric, however, was one who carried out his remedies or procedures without being able to tell _why_. That is, he could not trace out the logical connection between first principles and the particular case.

Galenism suffered especially from logical systematization, and the system of van Helmont, while far less orderly, also had its own basic principles on which all else depended. Boyle, however, practiced medicine on a thoroughly different basis. He did not depend on system or logic. In the words that Hunter used to Jenner over a hundred years later, other physicians would _think_ the answers to their problems.

Boyle, however, preferred to _try the experiment_. He wanted _facts_.

But this att.i.tude, which sounds so modern, so praiseworthy and enlightened, had one serious flaw. What _was_ a fact? And how did you know? This important problem, so significant for the growth of scientific medicine, we can study quite readily in the works of Robert Boyle.

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."[52] 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."[53]

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.