The Greatest Benefit to Mankind. Roy Porter

qualities were suspect in the eyes of many learned physicians, for they were the stock in trade of quacks, magicians and heretics. Nevertheless, thanks in part to the Platonic revival with its edifying vision of grand cosmic spiritual powers – and the undeniable fact that Plato preceded Aristotle and so was more ‘pristine’ and pure – they took hold.

      Consider the career of Jean Fernel (1497–1558), one of the ornaments of the Paris medical faculty, who vowed there were some things ‘beyond the power of the elements’ (i.e., beyond Galen). Fernel devoted himself to philosophy, mathematics and classical writers such as Cicero, and wrote two major works of theoretical medicine. One was published in 1542 as De naturali parte medicinae [On the Natural Part of Medicine], reappearing in 1554 as the first book, Physiologia, of a general treatise, Medicina, which also included sections on pathology and therapeutics (Fernel introduced the terms ‘physiology’ and ‘pathology’). The other was a speculative dialogue, De abditis rerum causis (1548) [On the Hidden Causes of Things], in which two friends, Brutus and Philiatros, question the physician Eudoxus on the ‘hidden causes’ of certain diseases. In particular they ask: Is there not something in disease which is divine? The discussion ranges widely over the philosophical basis of medicine.

      Fernel was a reformer of Galenic medicine who interwove other philosophical and Christian strands. His physiology had recourse to the four elements; to the qualities; to the action of innate heat, found only in living things; and to a subtle substance, mediating soul and matter, which he called spiritus (spirit), present only where there was life; his emphasis upon the workings of spirit owed much to Platonists. Fernel’s Medicina synthesized classical, medieval and Renaissance medical thought. By integrating Galenic medicine into wider Renaissance visions, his work achieved phenomenal popularity: ninety-seven complete editions or translations appeared between 1554 and 1680.

      The problems posed by ‘new diseases’ forced Galenic theory to adapt. Debate raged about the nature and cause of syphilis. In his Tractado contra el mal serpentina (1539) [Treatise on the Serpentine Malady], the Spanish physician Ruy Diaz de Isla (1462–1542) judged that the great pox had been brought back from the New World, claiming he had treated Columbus’s pilot in 1493. In 1530 the Veronese physician and humanist Girolamo Fracastoro (Hieronymus Fracastorus: 14781553) published his Syphilis sive morbus gallicus [Syphilis or the French Disease], describing in verse the disgusting symptoms and treatment of the disease to which he gave the modern name. The poem tells the story of a shepherd named Syphilis who, for insulting Apollo, was punished by a ‘pestilence unknown’, which brought out ‘foul sores’ upon his body that could be washed away only with quicksilver. Fracastoro offered a clear if poetical diagnostic portrait. While the disease ‘arose in the generative organs’, it would then ‘eat away the groin’ or race through the whole body. Severe pain arose in the bones; eruptions appeared, and ‘unsightly scabs break forth, and foully defile the face and breast’.

In his more theoretical De contagione et contagiosis morbis curatione (1546) [On Contagion and the Cure of Contagious Disease], Fracastoro developed the ideas of the Greek atomist Epicurus and the Roman philosopher-poet, Lucretius, to explain contagious diseases in general by the presence of ‘seeds’, which could infect by contact at a distance, or by ‘fomites’, substances such as textiles which harboured and transmitted ‘disease seeds’. It is not likely that he thought of the seminaria (imperceptibly small particles) as micro-organisms – rather he imagined something more like a leaven or spores. A contagious disease like syphilis was, however, specific, retaining its character in person-to-person transmission.^*

      Whatever the cause, syphilis had to be treated – but how? Quacks offered nostrums, but the basic therapy, as recommended by Fracastoro, was the classically impeccable bleeding, together with the application to the sores of unguentum Saracenicum, a mercurial ointment long used for skin eruptions like scabies and leprosy (‘a night with Venus, a lifetime with mercury’, people quipped). Controversy raged as to how mercury cured – or rather seemed to bring improvement – but most agreed that by means of the copious salivation and sweating it raised, aided by fires and much ‘rubbing and tubbing’ in special heated barrels, the poison would be expelled. Humoralists argued that the pox produced an excess of phlegm; hence, mercury, which provoked evacuant drooling, seemed the right intervention. Therapeutic hyperthermia (induced fever) long remained popular.

      Mercury treatment involved the isolation, tubbing and sweating of the patient for up to one month, though in that process the ‘cure’ might become almost indistinguishable from the disease, as mercury produced drastic side-effects, including gum ulcerations, tooth loss and bone deterioration. Given the lethality of syphilis, these side-effects could be viewed in a favourable light: had not Hippocrates taught that desperate diseases needed desperate cures? For those wary of mercury and seeking gentler specifics, sarsaparilla was recommended, as was guaiacum bark (see below). But nothing was truly effective against a frightening new disease associated with sex and partly responsible for the bleak, puritanical and often misogynistic mood pervading contemporary sermons and plays. ‘How long will a man lie i’ the earth ere he rot?’, asks Hamlet: ‘Faith,’ replies the grave-digger, ‘if he be not rotten before he die, as we have many pocky corpses now-a-days.’ The syphilis threat led authorities to close bath-houses and brothels and to victimize prostitutes; Henry VIII shut down the London ‘stews’. Many believed that it was God’s will that a disease due to vice should wreak great havoc – a view which has surfaced again today with AIDS.

      ANATOMY

      The theory and practice of Galenic medicine were under debate, but in essentials Galenism remained intact, queried by some, defied by quacks and mavericks, but challenged head-on only occasionally, notably by the Swiss iconoclast, Paracelsus (see Chapter 9). Substantial change did, however, occur in anatomy. For long but an antechamber in the palace of medicine, anatomy’s rise owed much to Renaissance artists who grew fascinated with body form and developed the representational, naturalistic techniques so conspicuous in the magnificent illustrations of sixteenth-century anatomy texts.

      In his De statua (c. 1435) [On the Statue], the humanist Leon Battista Alberti (1404–1472) argued that knowledge of the bodily parts was vital for the artist, providing him with insight into human proportion which echoed the harmonies of nature and art. Lorenzo Ghiberti (d. 1455) claimed that the artist had to be proficient in the ‘liberal arts’, including perspective, drawing-theory and anatomy. Knowledge of the skeleton conferred insight into proportion in both microcosm and macrocosm. Art theory and practice emphasized the value of anatomical knowledge and hence of dissecting experience. Underlying this was a naturalistic impulse, though one with its eye on the ideal beauty glimpsed in Graeco-Roman statues. Like the literary humanists, Renaissance artists believed the ancients had observed nature best.

      Painters were soon pursuing anatomy as a matter of course. Leonardo da Vinci’s teacher Andrea Verrocchio (1435—88), Andrea Mantegna (d. 1506) and Luca Signorelli (c. 1444–1524) all showed some knowledge of muscular and perhaps of deeper anatomy: Verrocchio had his pupils study flayed bodies. It was, however, da Vinci (1452–1519), Albrecht Durer (1471–1528) and Michelangelo (1475–1564) who most clearly applied the knowledge gained from anatomy.

      A brilliant anatomical illustrator, Leonardo was also a perceptive investigator of the mechanics of the human body. Ironically, given the humanist creed, he had no medical education, stumbled over Latin and knew no Greek. His anatomical notebooks show him comparing anatomy with architecture, and using it to probe the mysteries of the microcosm. Although it was never fully realized, from 1489 he planned an anatomical atlas of the stages of man from womb to tomb. His earliest investigations in the late 1480s centred upon a series of skull drawings, which outclassed all previous descriptions. He prized ‘experience’, but retained a traditional view of brain functions, attributing mental activity to three ventricles governing respectively sensation, intellect, and memory. The nervous system was rendered as a series of passages through which sensations and signals ebbed and flowed.

      ‘Passing