The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

Latin editions were now judged incorrect and inelegant. Technical terms had been especially susceptible to adulteration. In 1492 Nicolaus Leoniceno (1428–1524), the doyen of Greek medical scholars at Ferrara, drew attention to this in his De Plinii et aliorum in medicina erroribus [On the Errors of Pliny and of Many Others in Medicine]. Criticizing Pliny’s muddling of plant names, Leoniceno ordered a critical re-examination of medical knowledge through revitalized study of the classics. He urged the recovery and editing of ancient Greek medical texts, and promoted scholarly yet stylish new Latin versions. Scornful of the folios used in medical teaching, he criticized Arabic works such as Avicenna’s Canon for corrupting the Greek treatises they purported to honour. It was he who provided the texts for the first Galenic works to be printed in Greek, and who published Latin versions of Galenic treatises, including the Ars medica.

      Leoniceno delighted in exposing howlers resulting from inept scholarship, showing how mistranslations had clouded the terminology of diseases, plants and anatomy, with dangerous consequences – people would be prescribed the wrong drugs. One of the first treatises on syphilis, his De epidemia quam vulgo morbum gallicum vocant (1497) [On the Epidemic Vulgarly Called the French Disease] predictably denied it was new: he claimed classical texts should be scrutinized and provided a philological survey of Greek terminology for skin diseases.

      In later years, much was done on texts and terms as part of a wider humanist attempt to dispel the medieval murk. Terminological exactitude was, for instance, crucial in a blood-letting controversy initiated by Pierre Brissot (d. 1522), who taught that the Greek texts of Hippocrates and Galen showed blood-letting was meant to be carried out on the same side as the source of illness rather than the opposite side, as in Avicenna’s corrupt versions.

      In 1525 the Aldine Press in Venice, Europe’s leading printing house, published the complete works of Galen in Greek, a landmark in the retrieval of the pure word of the ancients. For workaday practitioners, it had little relevance, for few could read Greek; but they could use the new Latin translations, which after 1525 were mainly based upon the Aldine Greek. Galen’s On the Natural Faculties was published in 1523 in a new translation by Thomas Linacre (c. 1460–1524), physician to Henry VII, and in 1531 Johann Guinther von Andernach (1487–1574) published the newly discovered text of Galen’s On Anatomical Procedures, which sparked a reappraisal of dissection. During the sixteenth century an astonishing 590 editions of Galenic treatises appeared, the main publishing centres being Paris, Lyons, Venice and Basel. There was also a Hippocrates retrieval, the first humanist Latin edition appearing in 1525, and the first Greek edition, from the Aldine Press, a year later. In 1531 Guinther von Andernach, who was also one of Vesalius’s teachers, praised the times as those when ‘medicine has been raised from the dead’, because Hippocrates and Galen – until recently ‘almost utterly corrupt’ – had ‘at last been rescued from perpetual darkness’.

      Greek texts were recovered: how did that affect medicine? It boosted the idea that ancient medicine was the true one and scholars its rightful guardians and interpreters. In Paris, the medical humanist Jacobus Sylvius (1478–1555) approached Hippocrates and Galen with religious awe, declaring ‘they had never written anything in physiology or other parts of medicine that was not entirely true’. His pedantry and Galen worship culminated in an Introduction to Anatomy (1555), vindicating Galen against Vesalius. If what the eye saw at dissections did not correspond with what Galen had reported, the fault lay not with Galen but with the corpse! Puny moderns could not be expected to show so perfect a body structure as that displayed by the ancients.

      Like many contemporary physicians, Sylvius was a bookworm. His Order and Way of Reading Hippocrates and Galen (1539) was one of the earliest attempts to evaluate the authenticity of the Hippocratic Corpus, as well as suggesting the best way for students to approach Galen. His enthusiasm for recovering the true Galen was widely shared. He marks the shift from Arabic to Greek Galenism, notably in his treatises on pharmacology, where he demanded a return to Galenic purity. Galen’s remedies, he argued, were mainly composed of simples; the proliferation of compound medicines (ironically called Galenicals) was an Arab error. Not everyone, however, wanted to throw overboard the medical works of the Arabs and the medievals. Avicenna and Rhazes continued to be taught in most universities, and the tradition of medieval practica – handbooks listing disorders from head to toe with a description of symptoms and treatment – was too useful to be abandoned.

      Scholarly study did not just give medical writings a classical authority and style; humanism spurred innovation as well. With the proliferation of medical discourse created by print culture, questions arose as to how medicine should be structured, taught and practised. Fifteenth-century medical teaching had become centred on the ‘affections’ (the ill happenings) of the body in terms of symptoms and cures, usually in a head-to-heels order; and the tried and tested practica supplied guides to diagnosis and remedies. But that hardly passed the crucial Galenic test: the conviction that therapy had to be rationally connected to aetiology. The practica contained little on disease causation, and failed to satisfy another Galenic requirement: the view that therapy should take into consideration the distinctive characteristics of each patient – constitution, temperament, strength, age and environment. Galen’s Methodus medendi [Method of Healing], extremely influential once it was available in Thomas Linacre’s translation (1519), declared that physicians had to assess not only the cause of the illness but all aspects of the patient.

      Attempts were made to overcome this problem through that characteristic Renaissance solution, the application of method, an idea dear to the French philosopher Peter Ramus (1515–72). Scholars set about reducing Galenic medicine to ‘method’ and therefore certainty. The logical approach, they insisted, would help the physician to choose the correct ‘indications’ and so get the therapies right. The humanist faith in printed texts and academic methodologies encouraged encyclopaedic systematization, which could descend into the vain and verbose pedantry satirized by playwrights; Ben Jonson has one of his characters complain:

      When he discourseth of dissection,

      Or any point of Anatomy: that hee tells you,

      Of Vena cava, and of vena portam,

      The Meseraicks, and the Mesenterium,

      What does hee else but cant? … Who here does understand him?

      Giambatista da Monte (1498–1552), professor of the practice of medicine at Padua, was a pioneer of the new methodology. His ‘universal method’ involved proceeding, by systematic division and elimination, from the general to the particular, from broad disease classifications to specific disorder. His book helped the doctor to run through all possibilities until a full account of the indications for cure was reached.

      The idea of a foolproof method for applying Galenic medicine to the individual (the parallel with computer diagnosis comes to mind) was taken further by Sanctorius Sanctorius (Santorio: 1561–1636), professor at Padua. In his Methodi vitandorum errorum (1603) [Methods for Avoiding Errors], he urged, echoing da Monte, that medicine should not begin with particulars; one had to work from general concepts, which were to be divided and divided again. What was being promoted was a teaching device exalting learning above empiricism.

      Academic medicine was not totally conservative and in thrall to Galen, however; some new ideas were proposed about disease causation and remedies. Debates flared as to whether the traditional humours and temperaments could explain all sorts of illness. New diseases like the pox and the English sweat seemed to call for something beyond the old model of temperamental imbalance. And what of the influences of the heavens, or magic? Astrological powers, like the stars or moon, were ‘occult’, and thus by definition lay outside the Aristotelian-Galenic philosophy which addressed the natural, sensory world; they gained intellectual credit, however, from the neo-Platonic, Hermetic and magical currents popularized through such authors as Marsilio Ficino (1433–99) and Pico de la Mirandola (1463–94). Hidden qualities and sympathies which defied Aristotelian categories might be at work, such as magnetism and the electric discharge of the torpedo fish. These were explained by recourse to ‘occult qualities’ or to the action of what was known as the ‘whole substance’.

      Occult