Medical Investigation in Seventeenth Century England Part 3

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 (not to say incredible) 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."[54] Here, of course, we see further a feature of critical ac.u.men. 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 a.s.sertion cannot carry conviction. "Sufficient experience" must play its part, and just what const.i.tutes "sufficient" we are not quite sure.

In judging the effectiveness of a remedy or the credibility of a statement, one of the most important weapons was _a.n.a.logy_. Direct observation of a phenomenon was good. Next best was direct observation of some _a.n.a.logous_ phenomenon whereby one body acted upon another to alter its properties or induce significant changes. Boyle drew his a.n.a.logies largely from chemistry, but he had no hesitation in applying them to medicine.

Claims that medicines swallowed by mouth could dissolve stones in the bladder seemed a priori unlikely. Yet there was considerable authority that this took place; many persons had reported that this was a _fact_.

Boyle kept an open mind. He might be highly skeptical in regard to the claims for any particular medication, but he did not deny the principle involved. The possibility that some fluid, when swallowed, could have a particular specific action on stones in the bladder, without affecting the rest of the body, he considered quite plausible through the a.n.a.logy that quicksilver has an affinity with gold but has no effect upon iron.

Furthermore, a substance than can corrode a solid body may nevertheless be unable to "fret" a different body which is considerably softer and thinner, if the "texture" does not admit the small particles.[55]

Reasoning by a.n.a.logy served to explain the logical plausibility. In other words, he was very open-minded. He refused to dismiss all such claims, and provided a.n.a.logy as a reason for keeping his mind open; yet he refused to accept particular claims of medicine that dissolved stones, because the evidence was not convincing. We could scarcely ask for more.

An important seventeenth-century medical doc.u.ment was the report of Sir Kenelm Digby, regarding the so-called "weapon salve." The essay describing this famous powder was written in 1657, and I have discussed it at some length elsewhere.[56] Here again Boyle keeps an open mind, saying, "and if there be any truth in what hath been affirmed to me by several eye-witnesses, as well physicians as others, concerning the _weapon-salve_, and _powder of sympathy_, we may well conclude, that nature may perform divers cures, for which the help of chirurgery is wont to be implored, with much less pain to the patient, than the chirurgeon is wont to put him to."[57]

One great advantage of chemistry, thought Boyle, lay in the help it provided in investigating the _materia medica_. Chemistry, he thought, could help to purify many of the inorganic medicines and make them safer, without impairing their medicinal properties. Furthermore, chemistry could help investigate various medications customarily employed in medicine, where "there hath not yet been sufficient proof given of their having any medical virtues at all."[58] Boyle believed that by proper chemical a.n.a.lysis he could isolate active components, or, contrariwise, by failing to extract any valuable component, he could eliminate that medicine from use. While a major interest, perhaps, was a desire to provide inexpensive medicines, he was well aware that much of what went into prescriptions probably had no value. Furthermore, he felt that his chemical a.n.a.lysis could indicate whether value and merit were present or not.

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 compa.s.s.

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."[59] 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.[60]

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.[61]

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 quant.i.ty 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" [migraine] 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.

Van Helmont makes it very clear that this is not magic or sorcery; there is no diabolic influence, no necromancy. He drew attention to the overwhelming effects which might result from a cause which was so minute that it could not be perceived by the senses. We cannot here go into the theoretical background which underlay van Helmont's conceptions, but we must mention at least briefly his idea of a basic mechanism. Van Helmont considered the action to be that of a ferment, where an extremely minute quant.i.ty can produce a tremendous effect. He gives the a.n.a.logy of the tooth of a mad dog, which, although any saliva has been carefully wiped off, can nevertheless sometimes induce madness. The effect of the stone seems to be comparable. Its power becomes manifest even in enormous dilution and can multiply, for it can import its remedial virtue to a vast quant.i.ty of oil. Moreover, the stone had a sort of universal power against all diseases. Such a virtue could not be vegetable in its nature, but was, he thought, connected with metals. He pointed to the well-accepted medicinal virtues which inhered in gems. Metals also had great medicinal potency. Antimony, lead, iron, mercury, were well known, and of special importance was copper, the _Venus_ of the early chemists.

The medicinal virtue which inhered in Butler's stone and in other powerful fermental remedies, van Helmont designated as "drif," which he said means, in the vernacular, virgin sand or earth. This virtue requires a metallic body in which to inhere. The general concept is not unfamiliar, of a virtue or power or ferment which was attached to a material object, and it is this type of explanation which was so preponderant in, for example, Porta's _Natural Magick_. Van Helmont speaks of the "first being," which translates the Latin _Ens_, of Venus or copper. Vitriol is the basic substance, and for purification of the virtue we require a "sequestration of its Venus from the dregs of the vitriol."[62]

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 appet.i.te. It worked, he declared, through the sweat and, to some extent, the urine.[63] 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 princ.i.p.ally in affections of the brain...."[64]

While Boyle was a far more skillful chemist than van Helmont, he did not have any greater diagnostic ac.u.men. And clearly, from the standpoint of scientific method, he lacked any sharp criterion of cure. Various patients were ill with various diseases; he gave them one or another preparation; the patients recovered. Controls there were none. Boyle, with great enthusiasm, believed that through natural philosophy we would eventually discover "the true causes and seats of diseases" and also find out effective remedies which would quickly free the patient from the disease.[65] But faith and enthusiasm did not compensate for the _post hoc propter hoc_ att.i.tude.

According to Galenic concepts, if diseases are due to alterations of humors either in their quality or in their proportions, then the suitable remedy will restore the appropriate quality or proportion. In Galenic doctrine, the disturbance of the humors should be perceptible, and a sound Galenic remedy should work by perceptibly changing the nature and proportion of the humors back to normal. However, side by side with the Galenic medical doctrines, there were the other prevalent doctrines, among which I can mention the idea of "specifics." I can emphasize three features: the specific remedy was active against a particular disease, in a quite specific fashion, in the same way that an antidote acted against a specific poison; second, the effectiveness was a matter of direct experience, based on empirical observation; and third, the mode of action remained relatively obscure, but nevertheless the medicines did not seem to behave as did the so-called "Galenicals."

Thus, whether they acted by "sympathy," or by a special hidden virtue, or by a peculiar microcosmic energy, we cannot say. But the _fact_ remains that many people a.s.serted the specific effectiveness[66] of this or that remedy against a specific disease--e.g., that snakeweed was an effective cure for the bite of a serpent.

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 pa.s.sage 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 [dough] into leaven."[67]

Boyle strongly supported the well-known quotation of Celsus, that the important thing is not what causes the disease but what removes it. In strong terms he criticized "many learned physicians" who rejected specifics on the ground "that they cannot clearly conceive the distinct manner of the specificks working; and think it utterly improbable, that such a medicine, which must pa.s.s through digestions in the body, and be whirled about with the ma.s.s of blood to all the parts, should, neglecting the rest, shew it self friendly to the brain (for instance) or the kidneys, and fall upon this or that juice or humour rather than any other."[68] Boyle then went into considerable detail to show how this can take place through the action of ferments, combined with a theoretical exposition of atomistic philosophy, which we do not have time to go into at present. He gave in great detail an exposition of how these specifics _may_ operate, but did not in any way produce cogent evidence that they do in fact operate in such fashion.

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 "circ.u.mscribe, 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."[69] 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,"[70] but what const.i.tutes 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[71] has considered in detail the religious att.i.tudes 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 (when the _historia facti_ shall be fully and indisputably made out, and the theories thereby suggested clearly established) highly conduce to the improvement of the therapeutical part of physick...."[72] 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 quant.i.ty 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 "att.i.tude." He marked the transition between the old and the new, and pointed up the difficulties which transition always involves.

_Notes_

[37] Thomas Birch, _The Life of the Honourable Robert Boyle_, in Robert Boyle, _The Works of the Honourable Robert Boyle_, ed. Thomas Birch, London; 1772, I, liv, reprinted Hildesheim, 1965, I, Introduction, viii-ix; Marie Boas Hall, _Robert Boyle on Natural Philosophy: An Essay with Selections from His Writings_, Bloomington, Indiana, 1965, p. 16.

[38] John F. Fulton, _A Bibliography of the Honourable Robert Boyle_, 2nd ed., Oxford, 1961, p. 37.

[39] Hall, _op. cit._, p. 47.

[40] Margaret E. Rowbottom, "The Earliest Published Writing of Robert Boyle," _Annals of Science_, VI (1950), 376-389; R. E. W. Maddison, "The Earliest Published Writing of Robert Boyle," _Annals of Science_, XVII (1961), 165-173.

[41] Lazarus Riverius, _The Universal Body of Physick, in five books,...

Exactly translated into English by William Carr_, London, 1657.

[42] Lazari Riverii, _Opera Medica Universa_, Geneva, 1727.

[43] J.-H. Reveille-Parise, ed., _Lettres de Gui Patin_, Paris, 1846.

[44] Jean Baptiste van Helmont, _Oriatrike or Physick Refined ...

faithfully rendered into English by J. C._, London, 1662, and _Ortus Medicinae_, Editio Quarta, Lugduni, 1667.

[45] Giovanni Battista della Porta, _Natural Magick_, London, 1658, reprinted New York, 1957, and _Magiae Naturalis Libri Viginti_, Rothomagi, 1650.

[46] Richard F. Jones, _Ancients and Moderns: A Study of the Rise of the Scientific Movement in Seventeenth-Century England_, 2nd ed., St. Louis, 1961; Richard S. Westfall, _Science and Religion in Seventeenth-Century England_, New Haven, 1958; Marjorie Hope Nicolson, _Pepys' Diary and the New Science_, Charlottesville: The University Press of Virginia, 1965; Walter E. Houghton, "The English Virtuoso in the Seventeenth Century,"

_Journal of the History of Ideas_, III (1942), 51-73, 190-219; and Dorothy Stimson, _Scientists and Amateurs: A History of the Royal Society_, New York, 1948. See also, for an entertaining primary source, Thomas Shadwell, _The Virtuoso_, ed., Marjorie Hope Nicolson and David Stuart Rodes, London, 1966.

[47] Sir George Clark, _A History of the Royal College of Physicians of London_, Oxford, Volume I, 1964, Volume II, 1966.

[48] Boyle, "Memoirs for the Natural History of Human Blood," _Works_, IV, 637.

[49] Boyle, "On the Usefulness of Natural Philosophy," _Works_, II, 169.