History of science society distinguished lecture



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HISTORY OF SCIENCE SOCIETY DISTINGUISHED LECTURE
Medicine, 1450–1620, and the History of Science
By Nancy G. Siraisi*
ABSTRACT

History of science and history of medicine are today largely organized as distinct disciplines, though ones widely recognized as interrelated. Attempts to evaluate the extent and nature of their relation have reached varying conclusions, depending in part on the historical period under consideration. This essay examines some characteristics of European medicine from the fifteenth to the early seventeenth centuries and considers their relevance for the history of science. Attention is given to the range of interests and activities of individuals trained in or practicing medicine, to the impact of changes in natural philosophy, to the role of observation, description, and accumulation of information, and to the exchange of knowledge among the medical community.


Notwithstanding some common historiographical trends in the history of medicine and the history of science over the last forty years, the two are today for the most part distinct areas of specialization. Indeed, a recent article on the relation of the two is entitled “Trading Zones or Citadels?”1 But for the years specified in the title of the present essay it would be difficult for historians of science to examine knowledge and practice related to human, animal, or plant life or to alchemy/chymistry without some attention to the intellectual, institutional, or social role of medicine. Yet the “medicine” of the fifteenth to the early seventeenth century was never a single, clearly delimited entity but, rather, a diverse collection of areas of knowledge and of intellectual interests and commitments, pursued in the context of a variety of institutions, occupations, skills, and activities. How, then, should we consider the knowledge and activities of medically trained individuals of this period in relation to the history of science? One possibility is to designate as relevant to history of science only what appear to be instances of technical, theoretical, or methodological innovation—say, anatomy in the age of Andreas Vesalius (see Figure 1) or Girolamo Fracastoro’s ideas about contagion, to choose only two of the best-known examples—and to relegate everything else having to do with medicine to some other category, whether social history, or history of Renaissance humanism, or history of medicine conceived as distinct from history of science. This would probably be a traditional answer, and traditional answers are by no means necessarily wrong. But in this particular instance much historical research has complicated the issue, chiefly by uncovering the ambiguities—in the environment of Renaissance humanism—of the relation between innovation and enthusiasm for the ancient past. Other approaches, well developed over the last two generations, have considered medicine and those involved in practicing or regulating it from the standpoint of social and cultural history, from that of the history of the disease environment and of individual and collective responses to disease, and, most recently, from that of the history of the body. But in the present context, I would like to make a case for also considering as broadly as possible the community of those engaged with natural knowledge—and thus for attention to medicine as an occupation directed toward such knowledge, to the diversity and reach of medical roles and networks, and to the range of activities of medically involved men and some women.

I would further suggest that a noticeable feature of the period in question was the extent of the engagement of those trained in or practicing medicine with a variety of areas of natural knowledge. It comes as no surprise that the recent volume of the Cambridge History of Science devoted to early modern science (“early modern” being defined in that work as from the late fifteenth through the early eighteenth century) includes a chapter on medicine. What is more striking is how often accounts of sixteenth-century medical knowledge, activities, and purposes, and of medically trained individuals, also recur in chapters dedicated to other topics or approaches.2 The understanding and care of the human body in health and disease remained the central task of medicine and the subject of most medical writing and activity, whether highly traditional or in some degree innovative. But in a world in which medicine was one of very few recognized branches of knowledge or professions focused on any aspect of the world of nature, the interests of many medical men extended to a wide range of naturalia.



Many, doubtless most, such men devoted themselves to topics more or less closely connected with medicine or with human health broadly considered. To be sure, in the cultural context of Renaissance humanism some physicians spent their energies on subjects that cannot by any stretch of the imagination be defined as belonging to the history of either science or medicine: for example, I will spare the reader the humanist neo-Latin elegies of the poet Petrus Lotichius Secundus (1528–1560), professor of medicine at the University of Heidelberg.3 It is also true that in some cases qualification in medicine turned out to be the route to a career unconnected to either medical teaching or practice: thus Gabriel Naudé (1600–1653), librarian, bibliographer, editor, and member of a famous circle of French intellectuals and antiquaries, studied medicine at the University of Paris, received a medical degree from Padua, and held an honorary appointment as a royal physician without ever practicing medicine.4 Nor were the scientific interests and writings of practicing physicians always necessarily linked to their professional activities: William Gilbert’s investigations of magnetism in De magnete (1600) (see Figure 2) had minimal connection with his day job as a highly regarded medical practitioner in Elizabethan London. Yet in many other instances, treatises on natural topics by medical men had a closer connection to the author’s profession than might at first appear: thus, the professor of medicine Andrea Bacci’s treatise on the river Tiber (1558)—its propensity for flooding, the history of ancient flood control efforts, and the potability of its water—was strongly connected with his concern for Roman public health.5 In another field, physicians of this period who wrote on astrology addressed a branch of knowledge long considered highly relevant to medicine, but at a time when its validity—and thus its usefulness for medicine—was becoming the subject of criticism and revision: hence both the antiastrological position taken by the humanist physician Giovanni Mainardi in 1500 and the efforts, two generations later, of the physician, mathematician, natural philosopher, and copious medical author Girolamo Cardano to present a reformed astrology.6 (For some other mathematicians medicine provided a way of making a living without being central to their intellectual interests or the subject of any of their published works. Among them were the cosmographer Gemma Frisius and, for part of his career, Georg Joachim Rheticus, who nonetheless became something of an enthusiast for Paracelsian and alchemical medicine.7) Yet others were drawn to areas of knowledge that reflected contemporary cultural norms but also some essential and enduring features of medicine: I have argued elsewhere that the interest of many physicians of this period in history writing of several kinds resonated with the historical and antiquarian interests of Renaissance humanists, but also with the role inherent in medicine itself of narrative, description, and events of individual and collective human experience.8

Thus, for the period from the fifteenth to the early seventeenth century it may be doubtful as to whether one can speak in the singular of “medicine” any more than of “science.” Moreover, notwithstanding an established, and in some respects highly traditional, institutional framework of medical teaching and learning in the universities, the period was one in which many of those involved in medicine—in or outside the university context—proved highly responsive to new information, new questions, and contemporary intellectual trends. Sources of this responsiveness can be located in three major areas: a changing relation of medicine and philosophy; an expanding role for empiricism and observation in medicine; and medical social contexts and communication networks.


Medicine and philosophy

In the first place, the fifteenth and sixteenth centuries were marked by significant developments in philosophy that in turn affected medicine. The author of an article on the relation of history of science and “the sciences of medicine” in the 1995 issue of Osiris devoted to the theme “Constructing Knowledge in the History of Science” characterized “the ways doctors in the past strove to understand and explain illness” as “at least in part efforts to organize knowledge about nature.”9 In the medieval and early modern past, the organization of knowledge about nature was the task of natural philosophy. Moreover, although medicine, unlike philosophy, had the objective of bringing about change in the material world, preliminary training in philosophy was generally considered appropriate preparation for medicine and was assumed in most university curricula.10 Hence, fifteenth- and sixteenth-century developments in philosophy had an immediate impact on medicine, especially given the success of previous endeavors to extend the truth claims of Aristotelian natural philosophy to medicine. From soon after the twelfth- and thirteenth-century reception in the West of Aristotle’s libri naturales and ibn Sina’s (Avicenna’s) encyclopedic overview of medicine, physicians sought to assure themselves and their students or readers that at least some part of medicine, usually medical theory, met the Aristotelian criteria for true knowledge (that is, scientia—meaning “certain knowledge,” not “science”): causal explanation resting on syllogistic reasoning. Insistence that medicine involved scientia as well as ars (ars being understood as encompassing both art and technical skill) reinforced a conceptual division of medicine into theory and practice; helped medicine gain a place as one of the higher faculties in the early universities; and produced a category of academically trained physicians, schooled in natural philosophy as well as in medicine, who set themselves apart from other medical practitioners. The actual content of medical teaching in the medieval schools—that is, teaching regarding the parts, systems, and functioning of the human body and its diseases—was largely derived, directly or indirectly, from some of the Hippocratic books and from Galen. In academic medical education this framework persisted, with modifications, into the seventeenth century, but after 1450 a series of intellectual upheavals called many aspects into question.

As far as the relation of philosophy and medicine was concerned, the harmonization and reconciliation of Aristotle and Galen (tasks that had preoccupied some scholastic physicians of the thirteenth and fourteenth centuries) was no longer the only option. The enthusiasm of Renaissance humanists for every aspect of the written heritage of ancient Greece brought attention not only to hitherto unknown or less studied ancient medical books but also to a range of non-Aristotelian philosophies from Platonism to skepticism. At the same time, humanist scorn for medieval translators (often unjustified) and compendia soon turned to criticism of ancient authorities themselves. One result of the expanded knowledge of ancient sources was that the sixteenth was above all Galen’s century. But another was that intensive study of Galen provided the foundation for critiques of Galen modeled in part on his own works, the first book of Vesalius’s De humani corporis fabrica being only the most famous example.

Moreover, the search of some humanists, notably the fifteenth-century Florentine neo-Platonist physician Marsilio Ficino and his followers, for sources of wisdom older than either of the standard academic authorities, Aristotle and Galen, seemed, however delusively, to hold out the possibility of yet other routes to true knowledge in the imagined ancient Egypt of Hermes Trismegistus or elsewhere.11 Two generations later, Renaissance neo-Platonism (including its religious and magical aspects) shaped the ideas of another influential figure: the Paris professor of medicine and royal physician Jean Fernel (d. 1558). Fernel was the author of a famous treatise, On the Hidden Causes of Things, and of a comprehensive textbook of physiology, pathology, and therapy that remained one of the most widely read general works on medicine until well into the seventeenth century. He positioned himself as a reformer of medicine, although for the most part he espoused a modified Galenism. But Fernel played a significant role in undermining Galenic disease theory through his denial that imbalance in the body’s complexio, or temperament (that is, the mixture of the humoral qualities of hot, wet, cold, and dry), could account for all diseases, especially pestilential epidemics. His alternative explanation, which drew on his ideas about hidden forces in nature to postulate a separate category of “diseases of the total substance,” was one component in the long series of sixteenth-century controversies about the causes, nature, and transmission of disease.12 Yet other physicians—notably Daniel Sennert, professor of medicine at the University of Wittenberg in the early seventeenth century—espoused and developed a corpuscular theory of matter.13

In other medical circles, a reinvigorated Renaissance Aristotelianism flourished; for some midcentury physicians a revived interest in Aristotle’s works on animals seems to have provided part of the context for the composition of new encyclopedic works on natural history (see Figure 3).14 And amid a growing diversity of opinion, arguments leading to conclusions claimed as probable rather than certain became, as Ian Maclean has shown, a common feature of sixteenth-century medical writing, as was repetition of the ancient characterization of medicine as a “conjectural” discipline.15

Between the fifteenth and the early seventeenth century, then, the multiplication of intellectual options in philosophy helped to reshape medicine. One radical departure from learned tradition came in the form of the three principles, ideas about separation, and alchemical therapies of Paracelsus and his followers, but many other options or modifications of basic concepts were also being tried out.16 Yet the impact of philosophical change could be uneven. Many more practitioners seem to have made some use of Paracelsian remedies than espoused Paracelsus’s belief system as a whole. Any effect on actual medical practice of even a radical shift in philosophy might be modified by local conditions, as perhaps the example of the skeptic and medical practitioner Francisco Sanches (1551–1623) suggests. Early in his career Sanches published a treatise entitled That Nothing Is Known (Quod nihil scitur), which from his own time until the present has established his reputation as one of the most committed philosophical skeptics of the sixteenth century. In it he systematically undermined the entire structure of Aristotelian rational, syllogistic argument that for his contemporaries provided the guarantee of “true knowledge” (vera scientia). Only experience and judgment, Sanches declared, provided some kind of knowledge of the world; but experience revealed only the external aspects of things, not their true nature or causes, and was often deceptive. Moreover, only a limited amount of experience could be accumulated in a human lifetime, while the books in which previous generations had recorded their experience were too confused, too numerous, and too frequently untruthful to be relied on to yield real knowledge.17 But when Sanches wrote on practical aspects of medicine, his evaluations did not necessarily imply equally radical skepticism about ancient medical authorities or later medical opinion. In treatises on diseases, remedies, and pharmacology (several of them addressed to apothecaries), he sometimes preferred simply to call attention to the diversity of previous opinions and leave conclusions up to his readers. Moreover, he sometimes defended Galen against recent critics. Sanches often suggested just using whatever remedies were locally customary, advice that could be interpreted as a skeptical position. Yet his denunciations of traditional polypharmacy and emphasis on consistency in medicinal recipes and clear identification of ingredients can equally well be read as implying confidence in the possibility of valid pharmacological knowledge.18

But whatever the effect—or not—on Sanches’s own practice, intellectual and philosophical contexts were of importance in shaping major developments in fifteenth- to early seventeenth-century medicine; they do much to account for the broad connections between medicine and other branches of natural knowledge; and they deserve the careful attention of historians.
empiricism and observation

It is a truism that between the fifteenth and the early seventeenth century medicine became notably more attentive to empirical knowledge. A new level of observation and description is evident in many areas: in the enhanced role of anatomy, of course; but also in the proliferation of descriptive narratives of disease, both individual cases and epidemics; the development of new techniques in surgery for a new age of military technology; the intense interest of medical teachers and practitioners in materia medica; and the hands-on expertise of some of them in alchemical/chymiatric techniques. Notwithstanding earlier antecedents in these areas, much of the change represented a response to new circumstances. But just as it would be a gross caricature to present the medicine of the High Middle Ages as entirely given over to scholastic disputation at the expense of practical involvement with patients and disease, it would also be a mistake to overlook how profoundly change in medicine from the fifteenth to the early seventeenth century is involved with the history of the book.

The dissemination in print of information about medicine and related areas of natural knowledge took place at many different levels both in and outside academic settings. In the university world, although much medical instruction still took the form of lecture/commentary on ancient texts, there was a gradual shift toward the introduction of new textbooks—Fernel’s, which I have already mentioned, being an example—and lectures on specialized topics. Among the topics on which Girolamo Mercuriale (1530–1606) lectured at Padua were, for example, plague, poisons, diseases of children, diseases of women, and diseases of the skin. Each of these lecture courses was taken down by a student auditor and subsequently published with Mercuriale’s authorization.19 Although university lectures on specialized medical topics represented a new trend (and, in this case, probably the freedom of choice accorded an influential professsor), the topics chosen drew on established traditions of medical concern and writing. Thus, Mercuriale’s published Latin lectures on plague both belonged to a long-standing medical genre—the plague treatise—and responded to a current epidemic; and elite medical practice in the cities and princely courts of medieval and Renaissance Italy, a world deeply concerned with family and lineage, provided the social context and motivation, long antedating the sixteenth century, for attention to the medical care of women and children.20

In addition, the large body of sixteenth-century printed medical literature consisting of small, unillustrated practical handbooks (such as brief plague treatises or collections of remedies, many of them in the vernacular) implies a readership among ordinary practitioners and literate laypeople.21 At the same time, learned physicians were engaged in producing massive, copiously illustrated Latin reference works on aspects of the natural world: among others, Vesalius on anatomy, Fuchs and Mattioli on plants, Gesner and Aldrovandi on animals. The accumulation of bookish knowledge from both ancient and recent sources, new empirically acquired information, new investigations, and the capabilities offered by printing for both text and images no doubt all combined to suggest new standards of comprehensiveness to sixteenth-century students of nature.22



In the case of anatomy, dissection of the human cadaver had, as is well known, been an occasional part of medical instruction in some universities since the early fourteenth century. What was new in the sixteenth century—though still only intermittently and only in some places—was the greater frequency and enhanced prestige of dissections, not only in public academic instruction but also in other contexts: autopsies, private lessons for students, and personal investigations by anatomists; also important was the revival of the practice of animal vivisection. The sixteenth-century transformation of anatomy laid the way for subsequent transformations in physiology with some significant and widely discussed findings—notably Realdo Colombo’s account of the pulmonary transit of the blood.23 But it surely also did so, more generally, through enhancement of technical skill and precision and through the publication of a series of major new anatomical books.

And with these developments there emerged a sense of anatomy as a progressive, and competitive, branch of knowledge, such as appears in Girolamo Fabrici’s comments at the turn of the century on the work of his recent predecessors. Fabrici, who is remembered as the teacher of William Harvey at Padua and as the discoverer of the valves in the veins, planned an ambitious—and never completed—comprehensive account of anatomical structure and physiological function throughout the animal kingdom. This undertaking, which was both empirical and broadly influenced by Aristotelian natural philosophy, was well suited to the specific context of the University of Padua, home both to a tradition of anatomical teaching and to a lively and occasionally radical Aristotelianism.24 Fabrici’s was an Aristotelianism modified both by the simultaneous presence of Galenic influence and by the critical stance toward the ancients typical of sixteenth-century anatomical modernism.25 Like other anatomists, and somewhat in the manner of artists of the time, he set himself both to imitate and to surpass the ancients. But the real standard—and in a certain sense rival—against which he measured himself was Vesalian anatomy. The innovative anatomists of the second half of the century measured themselves against, criticized flaws in, and endeavored to surpass Vesalius’s achievement. Characteristic in this respect was the ironic question posed by Gabriele Falloppia (Fabrici’s teacher), who inquired whether, if Hippocrates, Aristotle, Erasistratus, Marinus, Herophilus, and Galen had all at times erred, it was possible that Vesalius alone could always be right.26 Fabrici was thus following a tradition already well established within the milieu of the new anatomy when he both praised the Fabrica and explained the ways in which, in his view, it fell short. According to Fabrici, Vesalius wrote on anatomy “excellently and exactly” and “surpassed even the Ancients in many things,” although his verbose prose sometimes obscured his meaning. But in remarks that simultaneously expressed both appreciation of anatomy as a cumulative science and the element of rivalry with predecessors, Fabrici went on to point out that two generations of anatomists since Vesalius had corrected or added to numerous specific aspects of his work. After acknowledging the contributions of Colombo, Falloppia, Eustachio, and others, he ended rhetorically, “How many things have I even added myself?” He also saw as defects Vesalius’s concentration on descriptive anatomy at the expense of physiology and emphasis on criticism of Galen. But above all he found Vesalius’s illustrations insufficient—in number, size, and lack of natural color (for the last, Fabrici’s own solution was to commission paintings of dissections).27 In turn, students at Padua seem to have found Fabrici’s teaching in his public lectures thoroughly unsatisfying, preferring the more practically oriented, or perhaps pedagogically better organized, private anatomies or the lectures given by the Venetian College of Surgeons.28

Turning from the expansion of anatomy to references to specific cases of disease, occasional anecdotes about individual patients appear in medical or surgical writings of the thirteenth century; and the genre of consilia recording medical advice given to an individual patient emerged in the same period. By the second half of the fifteenth century, some leading physicians were leaving hundreds of consilia to be edited by their pupils or heirs. But consilia—being essentially recommendations for treatment—relatively seldom contain much in the way of history of either the patient or his or her disease; moreover, their therapeutic recommendations, although nominally tailored to the individual, are usually drawn from standard medical authors.29 Nevertheless, the genre focused attention on cases and evidently did inspire some authors of consilia to include narrative about the patient and the course of the disease. In the sixteenth century, narratives about individual patients, descriptions of autopsies, and accounts of epidemics multiplied in medical works of many kinds. The expansion of these genres of medical writing doubtless depended on many factors (among them probably not only the prevalence of epidemic disease but also contemporary controversy over the possibility of “new” diseases unknown to the ancients). But one development that may have helped to foster—and perhaps also reflected—a new attention to narratives of medical experience was the importance attached by humanist physicians to the case histories in the Hippocratic Epidemics (a work not available in its entirety to their medieval predecessors). Printed collections of consilia, of accounts of notable cures, or, later in the sixteenth century, of descriptive narratives termed observationes testify to the new value physicians set on such information. Medical authors and readers appear to have become progressively more attentive to the description of specific cases of injury or illness presented as historical and medical events.30 But some caution is necessary here. Accounts of cases in which the patient recovered often seem designed to display the author’s superior abilities as compared to other, allegedly inferior, practitioners; references to experience (experientia, experimentum) may still refer to assertions found in earlier texts; and accounts of autopsies often display an improbable degree of confidence in the author’s ability to identify the cause of death from internal disease (or poisoning) from appearances in the dissected cadaver.

Indeed, although increased attention to experience and to observation are plainly present in many areas of medical instruction and practice in this period, it is much harder to pin down contemporary concepts of evidence and its interpretation in works relating to disease, diagnosis, and treatment. Yet, as Ian Maclean has pointed out, learned physicians regarded the interpretation of signs as central to their discipline, and many of them devoted much theoretical discussion to the subject. More pragmatically, Girolamo Cardano, who was interested in prognosis/prediction in both astrology and medicine (as well as in probability in games of chance), divided signs interpreted by physicians into three kinds: those that prompted a medical diagnosis—but diagnoses often met with incredulity from laypeople; those that were the basis of prognosis—but prognosis was often dismissed as just a form of divination and was in any case not much help to the patient; and what he called the noblest kind, appearances in the dissected cadaver that retroactively confirmed a previous diagnosis of internal disease. Cardano, characteristically, claimed to be exceptionally successful in obtaining this last kind of confirmation, recounting how appearances in the cadaver of a Bolognese nobleman who had been one of his patients, dissected in the presence of the anatomist Giulio Cesare Aranzio, supported his, Cardano’s, original diagnosis. It is unclear whether Cardano himself was present at the dissection; certainly, the account of it that he included in a subsequent classroom lecture on the Hippocratic work on prognosis contains too many learned Galenic and other citations to have been written on the spot.31

Yet it is possible to find instances in which sixteenth-century medical or surgical practitioners attempted to assemble some body of empirical data as supporting evidence—usually, to be sure, supportive of their own theories. For example, Marsilio Cagnati, professor of medical theory at the University of Rome (La Sapienza), endeavored to disprove the belief that Roman air was unhealthy with a year-by-year summary of health conditions in Rome from 1568 to 1593. In another work Cagnati analyzed a handful of dated case histories of named patients to show how each failed, in one way or another, to correspond to the theory of critical days (that is, the idea—adumbrated in one of the Hippocratic aphorisms, subsequently elaborated and astrologized by Galen, and hotly debated in the sixteenth century—that illnesses reach turning points at fixed numbers of days after onset).32 Again, one can perhaps associate Cagnati’s kind of thinking with a growing emphasis (also found in the dialectic of the period) on probable arguments.

Another approach to empirical evidence in medicine emerges in the endeavors of Santorio Santorio (1561–1636) to develop instruments to measure—and to an extent quantify—physiological change. Santorio spent many years in medical practice in Venice and in his native Istria (then a territory of the Venetian republic, now part of Croatia) before becoming a professor of theoretical medicine at the University of Padua from 1611 to 1624. His writings included a treatise intended to provide rules for a consistent method of medical diagnosis (1603) and the widely disseminated Ars … de statica medicina (1614), in which he expounded the theory that the correct balance of “insensible perspiration” (a supposed excretion through the pores of the skin described in some passages of Galen as well as drawn from ideas attributed to the ancient medical Methodists) was essential to human health.33 In an attempt to show that “insensible perspiration” could be physically measured, Santorio is said to have used a balance to monitor daily fluctuations in the weight of his body and its ingesta and excreta over many years.34 He also sought to measure changes in bodily heat. Fever was a central preoccupation of premodern medical practitioners, as is evident from the discussions and refinements of Galenic fever theory that were a staple of medieval, Renaissance, and sixteenth-century medical writing. Moreover, Galenic ideas about the role of complexio (balance or imbalance of humoral qualities) both in health and disease and in the actions of medicaments already involved the notion of difference of degree.35 But Santorio’s “thermoscope” seems to have been the first application to medicine of an instrument intended to reveal increase or diminution of heat, and Santorio was apparently also the first to add some form of scale to such a device.36
* * *

The last paragraphs have sketched some of the ways of which physicians from the late fifteenth to the turn of the seventeenth century approached the observation, description, and recording of patients and diseases. As important recent studies have shown, the same period saw the emergence from earlier antecedents of two disciplines, each with a strong connection both to medicine as a system of knowledge and to medical therapy: chymistry/chemistry and natural history.37 Notwithstanding the strength of the connection to medicine of both alchemy/chymistry and natural history, the nature of the relation was very different in each case. The attempt to produce transformative, life-prolonging, or simply more powerful remedies by alchemical means was only one aspect of alchemy/chymistry, though it was that chiefly emphasized by Paracelsus and his followers. Paracelsian, or spagyric, practitioners envisaged medicine as a process of separating out impurities from the body and the preparation of remedies as a task that called for the physician to have practical familiarity with chymical procedures. Claude Dariot, a French provincial physician, left an account of his conversion to Paracelsianism, which probably took place in the 1570s. He explained that his interest was first aroused by inquiries about Paracelsian remedies from a noble female patient—an interesting glimpse of patient demand—and then encouraged by an older colleague. Finally, Dariot turned to the study of Paracelsian books and became convinced of the superiority of remedies prepared from mineral ingredients and by distillation (see Figure 4).38 But in chymistry, as Lawrence Principe has observed, Paracelsians constituted only one “subset in the larger sphere.” In medicine, their ideas and remedies remained controversial for several generations, as the repeated clashes at Paris between the Faculty of Medicine and Paracelsian physicians demonstrate.39

By contrast, the interest of physicians in acquiring more and better information about, and access to, medicinal plants, the basis of most Galenic remedies, was central to the sixteenth-century development of natural history, as the establishment of university lectures “on simples” and university botanic gardens, as well as the proliferation of new works on the subject by medical authors, all testify. Over the same period, too, practices of accumulation, exchange, and preservation of natural specimens enabled some physicians to become notable participants in the contemporary culture of collecting. Sixteenth-century botanical observation, description, and illustration eventually amounted to a large and uncoordinated enterprise of data collecting; by the early seventeenth century, naturalists had added many thousands of plants to those named by ancient authors. The proliferation of woodcut images also greatly extended the range of visual information available to readers (though images were not always drawn from personal observation and printers at times reused the same woodcuts in different books).40

In the case of materia medica, as of much else, the initial goal of humanist physicians had been full understanding of ancient authorities—that is, in this context, correct identification of the Mediterranean plants named as medicinal ingredients by Dioscorides, Galen, and others, a task complicated by problems of textual and linguistic transmission, as well as by the geographic distribution of plants. Physicians also suspected pharmacists of making unauthorized substitutions for ingredients, thus making the prescription of medicaments and the correct preparation of compound medicines described by ancient authors (such as the supposedly universal antidote theriac) even more uncertain.41 Confusion in the nomenclature of materia medica was long standing, but improved access to ancient authors, publication of new botanical works based in substantial part on direct observation, and the arrival of hitherto unknown New World plant remedies all both compounded the problem and heightened awareness of it. The prefatory material to the Latin version of the influential commentary on Dioscorides by Pier Andrea Mattioli (1501–1577) casts the study of medicinal plants in terms of medical humanism. Mattioli insisted on the flourishing state of the discipline in Greek and Roman antiquity, its subsequent collapse, and its revival at the hands of Renaissance physicians.42 Despite this sketch of a humanist botanical community, Mattioli himself was an acrimonious controversialist. He engaged in a ten-year dispute with Konrad Gesner when the latter challenged his depiction of a variety of aconite as being based only on Dioscorides’ description, not on actual observation of plants. Mattioli’s response included the multiplication of depictions of plants claimed to be varieties of aconite in later editions of his commentary.43

Mattioli’s preface further explains that he had translated his commentary, originally written in Italian for the sake of pharmacists, into Latin to ensure its wider circulation throughout Europe. In a series of works, Antonio Musa Brasavola of Ferrara (1500–1555) set out to deal with the issue of correct identification of substances and compounds actually available in pharmacies. Brasavola’s choice of the favorite humanist form of the dialogue allowed him both to explain such New World plant arrivals as guaiac wood to his interlocutor, the Senex pharmacopola (cast, as his name implies, as an elderly traditionalist), and to distinguish them from plants known to the ancients. Remedies imported from afar, especially but not only new remedies for supposedly new diseases (as guaiac was claimed to be for the morbus gallicus), aroused controversy as well as enthusiasm. Another view insisted—often appealing in religious terms to the designs of Providence—that the local flora of each region held the cures for local diseases. Paracelsus was only one of many medical practitioners who issued diatribes against reliance on exotic remedies in preference to local herbs. By the early seventeenth century, some botanizing physicians in university towns were beginning to compile, and publish for the benefit of medical students, lists of plants growing in the immediately surrounding countryside.44

Moreover, as a growing body of recent scholarship has emphasized, the need for materia medica (and accompanying concern for the sources, proper identification, and correct preparation of medicinal substances) connected medicine closely to an expanding world of commerce and craft. Medicinal ingredients were a major item of trade flowing into Venice and, later, Amsterdam. A glimpse of the Venetian trade appears in the Heidelberg physician Johann Lange’s reminiscences of a trip to Venice in about 1540, in which he described dining with Venetian physicians and a group of medici herbarii just back from Egypt.45 At another level of commerce, civic authorities and colleges of physicians across Europe made many efforts to regulate both apothecaries and unlicensed sellers of medicines in the marketplace (see Figure 5). Yet the relation of physicians and apothecaries was in reality one of mutual dependence, as those physicians who undertook, either in lectures (as at the universities of Montpellier and Toulouse) or through their writings, to instruct apothecaries clearly grasped.46 Physicians who preferred to make up their own mixtures rather than rely on apothecaries might occasionally run into trouble for derogating their profession (since by so doing they would be selling not just learned advice, but also medicines). In one such case Orazio Augenio, professor of medicine at the University of Turin, forcefully defended a physician threatened with expulsion from the Turin College of Physicians for compounding his own medicines. Augenio insisted on the value and dignity of knowledge of medicinal ingredients and their preparation, clinching his case with a list of famous contemporary physicians who compounded their own drugs.47

Thus, as will have become apparent, fifteenth- to early seventeenth-century medical empiricism took many forms. But I think one could perhaps classify it under a few heads, all of which have some relevance to the history of science. One surely is the acquisition of peritia—hands-on expertise of one sort or another, under which one might include skills or improved techniques in dissection or some surgical procedures acquired by more frequent performance—a necessary prerequisite for physiological as well as anatomical investigations; or the familiarity with mineral substances and some chymical procedures gained by practicing Paracelsian iatrochemists; or, at the end of the period, Santorio’s attempt to develop medical applications for instruments of measurement. Another is the acquisition, and circulation through print and images, of a much wider range of information, based at least to some degree on contemporary experience and observation, about both exotic plants and plants indigenous to Europe. Yet another is a greatly enhanced level of attention to the recording of experience—that is, in the case of medicine, to patient histories and histories of disease. Occasional attempts to test theory, however infrequent and unformulated, are also worthy of note.
Contexts and communication networks

The story of Augenio’s defense of the Turin physician accused by his colleagues serves as an introduction to the many different contexts of medical activity and communication. At the time of that incident, Augenio was a recent hire at the then not very prominent University of Turin, having spent the previous twenty-eight years in local medical practice in small towns; he subsequently became a professor at the very famous University of Padua. And his was far from the only life story to include moves between what are usually regarded as very different spheres of early modern medical life. We are accustomed to think—correctly enough—of the medicine of the fifteenth to the early seventeenth century as involving, in addition to much domestic medicine and home care (often the responsibility of women), a large cast of characters with different occupations and status and attached to or regulated by different institutions: university professors of medicine, medical attendants attached to royal, noble, or clerical courts, town doctors, practitioners connected with hospitals, surgeons learned and unlearned, apothecaries, empiric practitioners, charlatans, and so on.48 Hierarchy there certainly was, and university-educated physicians in its upper reaches did their best to reinforce distinctions of status by the disdain with which they wrote of “empirics.” Nevertheless, there was a large body of common knowledge among these groups, and boundaries were by no means always rigid. For example, Georgius Agricola (1494–1555) studied medicine at the universities of Bologna and Padua and participated in editing the Aldine editions of Galen and Hippocrates in Greek. But when he returned to the mining region of his native Saxony it was to a combined position as town doctor and apothecary. Agricola is remembered as the author of one of the most important sixteenth-century books on metallurgy, but his first work on minerals was a little dialogue in which he set out to recover the meaning of terms for mineral remedies in Galen, Dioscorides, Pliny, and Theophrastus.49

Medical ideas and information circulated throughout Europe via printed books, but also through more personal forms of contact or communication. Agricola was only one of many early modern students who traveled abroad to study at universities famous for medical learning. Some went from university to university without staying long at any one, and from one famous professor to another, in what has been described as a peregrinatio medica. When one such traveler, Christoph Schilling, arrived at Montpellier in 1579 the chancellor of the university, Laurent Joubert, marked the occasion with an oration that was an encomium to a contemporary international community of medical and natural philosophical learning. From Germany, Switzerland, Italy, and France, Joubert listed the names and academic affiliations of more than thirty professors of medicine and natural philosophers, Ulisse Aldrovandi and Bernardino Telesio among them, whom Schilling had visited in his travels.50

And, of course, medical travel was not confined to Europe. Medical travelers beyond Europe—ranging from Jesuit apothecaries to the converso Garcia da Orta, posthumously condemned by the Inquisition—enlarged European knowledge of materia medica and medical practices from both the New World and the Far East. To be sure, not all enthusiasts for exotic materia medica traveled themselves: Nicolas Monardes (1493–1588), whose principal work is in its sixteenth-century English translation enticingly titled Joyfull Newes out of the New-Found World, acquired information and specimens from other voyagers without leaving his medical practice in Seville.51 Physicians who traveled beyond Europe often did so with some form of official support. One notable example of such sponsorship was Philip II’s appointment of Francisco Hernandez (1515–1587) as protomedico (chief physician) of New Spain, with a commission to describe the region’s natural history. Hernandez spent seven years in Mexico, assembling a large store of information of all kinds about plants and animals, but the royal letter of instruction makes it clear that the king or his advisors regarded medicinal substances in colonial territories as an especially valuable resource (see Figure 6).52

Venetian commercial interests in the eastern Mediterranean provided another network of connections offering support, protection, and remuneration to some medical travelers. Not only was Venice, as noted earlier, a major center for the trade in medicinal ingredients; Venetian nobles and other patrons (for example, the French cardinal who supported the voyage of Pierre Belon) sometimes sponsored the travels of medical naturalists to the lands of the eastern Mediterranean; and the Venetian consuls and resident merchant communities in Cairo, Aleppo, and other cities employed Italian doctors. Intellectual and scientific motives for medical travel to the region included the belief that its flora offered the best opportunity for correct identification of medicinal plants named by ancient writers, as well as traditions locating either the origin of, or important early developments in, medicine in Egypt.53 One medical traveler to Egypt in the 1580s was Prospero Alpino (1553–1616), subsequently lecturer on simples at the University of Padua and prefect of its botanic garden. After returning to Italy, Alpino wrote works on Egyptian medicine, the plants of Egypt, and “matters Egyptian” (Rerum Egyptiarum libri). In Egypt Alpino believed he had identified the “true balsam” of the ancients. Perhaps because he viewed Egyptian medicine as somewhat resembling that of the ancient medical Methodists, who were said to have rejected the study of causes as irrelevant to therapy, he also wrote a lengthy work in which he attempted, with only partial success, to delineate a reformed medicine based on Methodist principles.54

Information also circulated among the medical community through correspondence. Most correspondence networks seem to have been regional in scope, though some were more wide ranging.55 More than two thousand letters addressed to the professor of medicine and polymath Theodor Zwinger (1533–1588) survive at Basel. The more than three hundred correspondents of the botanist Carolus Clusius (1526–1609)—a physician by training, though he never practiced medicine—came from all over Europe and included patrons, horticulturalists, and others, as well as numerous physicians and apothecaries.56 Medical letters were vehicles of inquiry, disputation, and controversy as well as information. In the 1570s and 1580s, at a time when both Italy and central Europe were suffering from a series of epidemics described as plague, leading physicians in the German lands exchanged letters with colleagues in the medical faculty at Padua that vigorously debated the concept of contagion. And with the emergence of a genre of published medical letter collections, following the success of Giovanni Mainardi’s collection in the early years of the century, many medical letters reached an audience far wider than the original recipients.57



As travelers from one European center of learning to another or to regions beyond Europe, as correspondents within a regional medical community, as court physicians attached to centers of political power and information gathering, and as collectors of natural specimens, members of the medical profession surely played a significant role in the circulation of new information about the natural world and about medical practices outside Europe, as well as about regional disease environments and medical issues and controversies.
Conclusion

Finally, to rephrase my title, how much of this Renaissance, or first phase of early modern, medicine belongs to history of science? To this question, the highly diversified European medical world of the fifteenth to the early seventeenth century yields answers as multiple as they are ambiguous. Medicine was a craft, with its own skills and techniques, as well as a profession and a branch of learning. Most learned physicians focused their attention either on matters directly related to the understanding and care of the human body, health, and sickness or on branches of natural knowledge broadly connected thereto, as in the case of botany. But, as humanistically trained men of erudition, some of them could and did without incongruity write on subjects ranging from theology (Thomas Erastus) to magic (Heinrich Cornelius Agrippa) and from universal bibliography (Konrad Gesner) to ancient athletics (Girolamo Mercuriale). Moreover, although medicine between the fifteenth and the early seventeenth century proved in some respects intensely responsive to current intellectual trends, new information, and new methods, in others it remained deeply conservative. Thus, as a recent study of patterns of medical logic and argumentation from 1500 to 1630 concludes: “there are … reasons for according to medicine the status of precursor of the new science,” but “the case against seeing medicine as protoscientific is also strong.”58 If we look for classic markers of new science in the medicine of this period we shall find them in only a few places. Colombo’s presentation of pulmonary transit, and his use of animal vivisection in his investigations, marked an important early stage in the overthrow of Galenic physiology. Fernel and others launched philosophically or philologically inspired attacks on Galenic disease theory. Santorio sought to make medical use of instruments of measurement. There is evidence for intermittent efforts to test therapeutic effectiveness (as when Fernel is said to have noted the effects of different purgatives or Ambroise Paré to have applied different remedies to different areas of the same burn), but little for system or control in such endeavors.59 Certainly, the collection and dissemination of information claiming some relation to personal observation—about patients, diseases, medicinal plants, medical practices outside Europe, and much else besides—greatly increased. The circulation of medical books, travelers, and letters across the political and religious boundaries of sixteenth-century Europe produced a community of scholars recently well described as a “medical republic of letters.”60 The world of Harvey, of Descartes, and of the intersections of the mechanical philosophy with the medicine of the late seventeenth century lay directly ahead. But the philosophical developments, and the practices of anatomical investigation, of alchemical medicine, of gathering, recording, and disseminating information, that characterized medicine in the earlier period summarized in this essay surely also deserve some place in relation to the history of early modern science.
* Ph.D. Program in History, Graduate Center, City University of New York, 365 Fifth Avenue, New York, New York 10016; nsiraisi@gc.cuny.edu.

This essay is a revised version of the 2010 History of Science Society Distinguished Lecture, presented at the annual meeting in Montreal. I am grateful to Ann Blair, Domenico Bertoloni Meli, and an anonymous referee for Isis for helpful comments on an earlier draft.



1 Olga Amsterdamska and Anja Hiddinga, “Trading Zones or Citadels? Professionalization and Intellectual Change in History of Medicine,” in Locating Medical History: The Stories and Their Meanings, ed. Frank Huisman and John Harley Warner (Baltimore/London: Johns Hopkins Univ. Press, 2006), pp. 237–261.

2 Lorraine Daston and Katharine Park, eds., Early Modern Science (Cambridge History of Science, 3) (Cambridge: Cambridge Univ. Press, 2006). For the periodization see the editors’ introduction, p. 1; the chapter on medicine is Harold J. Cook, “Medicine,” Ch. 18. A partial list of other chapters in which medicine or medically trained individuals also find a place (taken from the table of contents listed in Cambridge Histories Online) includes Peter Dear, “The Meanings of Experience,” Ch. 4; Steven Shapin, “The Man of Science,” Ch. 6; Anthony Grafton, “Libraries and Lecture Halls,” Ch. 10; Bruce T. Moran, “Courts and Academies,” Ch. 11; Paula Findlen, “Anatomy Theaters, Botanical Gardens, and Natural History Collections,” Ch. 12; Pamela H. Smith, “Laboratories,” Ch. 13; Findlen, “Natural History,” Ch. 19; and William R. Newman, “From Alchemy to ‘Chymistry,’” Ch. 21.

3 On Petrus Lotichius Secundus see Neue Deutsche Biographie, Vol. 15, pp. 238–241.

4 See James V. Rice, Gabriel Naudé, 1600–1653 (Baltimore/London: Johns Hopkins Univ. Press, 1939), pp. 9–46. Naudé was the author of a few brief medical works. His medical quaestiones, originally published as separate items in the 1630s, include Gabriel Naudé, De fato: Ristampa anastatica dall’edizione Joh. Beverovicii, Epistolica quaestio, de vitae termino, fatali, an mobili? Lugduni Batavorum 1639, ed. Anna Lisa Schino (Lecce: Conte, 1995), a contribution to a controversy (actually more philosophical than medical) with the Dutch physician Jan Beverwyck over whether the time of death is predetermined. All were collected as Naudé, Pentas quaestionum iatro-philologicarum, I: An magnum homini a venenis periculum? II: An vita hominum hodie quam olim brevior? III: An matutina studia vespertinis salubriora? IV: An liceat medico fallere aegrotum? V: De fato & fatali vitae termino (Geneva, 1647). Paul Oskar Kristeller, “Between the Italian Renaissance and the French Enlightenment: Gabriel Naudé as Editor,” Renaissance Quarterly, 1979, 32:41–72, provides at pp. 61–68 a list of the numerous works edited or supplied with prefaces or letters to the author by Naudé, but only four of them concern medicine. On Naudé’s medical contacts and interests see also Lorenzo Bianchi, Rinascimento e libertinismo: Studi su Gabriel Naudé (Naples: Bibliopolis, 1996), pp. 70–74; and Schino, “Incontri italiani di Gabriel Naudé,” Rivista di Storia della Filosofia, 1989, 1:1–36, esp. pp. 20–23.

5 William Gilbert, De magnete, magneticisque corporibus, et de magno magnete tellure; Physiologia nova, plurimis et argumentis, et experimentis demonstrata (London, 1600) (Gilbert did include one chapter [1.14] on what he considered to be the medical properties of magnetism); and Andrea Bacci, Del Tevere di M. Andrea Bacci medico e filosofo libri tre (Venice, 1576) (this work was first published in two books: Venice, 1558). On Bacci’s career see Nancy G. Siraisi, “Historiae, Natural History, Roman Antiquity, and Some Roman Physicians,” in Historia: Empiricism and Erudition in Early Modern Europe, ed. Gianna Pomata and Siraisi (Cambridge, Mass.: MIT Press, 2005), pp. 325–354.

6 Daniela Mugnai Carrara, “Mainardi (Manardi), Giovanni,” in Dizionario biografico degli Italiani, Vol. 67 (2007), consulted online at http://www.treccani.it/enciclopedia/giovanni-mainardi_%28Dizionario-Biografico%29/; and Anthony Grafton, Cardano’s Cosmos (Cambridge, Mass.: Harvard Univ. Press, 1999).

7 Rheticus practiced medicine for about twenty years in Cracow after a scandal forced him to leave his professorship of mathematics at the University of Leipzig. For his medical studies and medical and alchemical interests see Karl Heinz Burmeister, Georg Joachim Rhetikus, 1514–74: Eine Bio-Bibliographie, 3 vols. (Wiesbaden: Pressler, 1968), Vol. 1, pp. 152–157; Vol. 3: Briefwechsel, pp. 10–12, 77 (letter 20), 119–127 (letters 29–32, to Johann Crato von Krafftheim), 156–159, 168–169, 190–192 (letters 36, 42, and 51, to Joachim Camerarius the younger), 186–187 (letter 49, to Taddaeus Hayck). In 1558 Rheticus wrote to Camerarius (Vol. 3, p. 156, letter 36): “Nam nostra medicina non est geometria, quae semper suum finem assequatur”; ten years later he claimed, more optimistically, to Ramus (Vol. 3, p. 188, letter 50): “Habeo etiam prae manibus novas de rerum natura philosophandi rationes, ex sola naturae contemplatione, omnibus antiquorum scriptis sepositis. Idem in arte medica factito.” Burmeister points out that Rheticus mainly displayed his enthusiasm for Paracelsus in letters to Camerarius, Crato being an anti-Paracelsian (Vol. 1, p. 153).

8 Nancy G. Siraisi, History, Medicine, and the Traditions of Renaissance Learning (Ann Arbor: Univ. Michigan Press, 2007).

9 John Harley Warner, “The History of Science and the Sciences of Medicine,” Osiris, 1995, N.S., 10:164–193, on p. 188. Ibid., p. 192: “What doctors and patients thought about illness is one part of what people in the past thought about the natural world. There is no particular reason for historians of medicine to preach this point, yet it has important implications for the way historians of science should delineate the intellectual concerns of their field. Medicine, after all, is in some respects singular. People’s conceptions of the normal and pathological in their own bodies are central to popular belief about nature and deployment of natural knowledge.” For an evaluation that attaches much less significance to philosophical or conceptual change in medicine, and emphasizes the need for attention to pragmatic and social aspects, see Harold J. Cook, “The History of Medicine and the Scientific Revolution,” Isis, 2011, 102:102–108 (part of a Focus section entitled “Between and Beyond ‘Histories of Science’ and ‘Histories of Medicine’”).

10 C. B. Schmitt, “Aristotle among the Physicians,” in The Medical Renaissance of the Sixteenth Century, ed. A. Wear, R. K. French, and I. M. Lonie (Cambridge: Cambridge Univ. Press, 1985), pp. 1–15.

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