Читать книгу The Greatest Benefit to Mankind: A Medical History of Humanity - Roy Porter - Страница 61

Renaissance humanism benefited the doctor more than the patient. The new learning hardly helped physicians to cure diseases. But it gave the medical profession an elevated sense of its proper dignity, and though playwrights loved poking fun at the pedantic pomposities of costly and useless physicians, medicine grew more status-conscious, and more dismissive of its rivals. ‘All that falsely usurp this Title of Physitian’, declared Richard Whitlock, ‘take off their Visards, and underneath appeare Wicked Jewes, Murtherers of Christians, Monks, abdicant of their orders, &c. Unlearned Chymists, conceited Paedagogues, dull Mechanicks, Pragmaticall Barbers, wandring Mountebancks, Cashiered Souldiers … Toothlesse-women, fudling Gossips, and Chare-women, talkative Midwives, &c. In summe … the scum of Mankind.’

This heightened sense of dignity was marked in public recognition. Earlier tendencies towards the public employment of physicians continued. The code of criminal procedure promulgated for the Habsburg empire by Charles V in 1532, known as the Carolina, required judges to consult surgeons in cases of suspected homicide, and midwives in infanticide. A landmark in forensic medicine, the Code was adopted in much of continental Europe. Medical authors were keen to display their expertise in the courtroom. Paré explained how to recognize the signs of virginity in women – important because under ecclesiastical law non-consummation was one of the very few grounds for annulment of marriage – and the indications of death by lightning, smothering, drowning, apoplexy, poison and infanticide; he also showed how to distinguish between wounds given to a body when dead and alive.

Medical institutions continued to develop under royal and municipal patronage. In 1518 Henry VIII chartered the College of Physicians, granting it examining, licensing and policing powers over medical practice in London. (It became ‘Royal’ from the time of Charles II.) Unlike some European counterparts, however, the college did not succeed in extending its jurisdiction to a wider region, nor did it have control over the licensing of surgeons and apothecaries.

In health care provision in England, the sixteenth century brought a major setback. The dissolution of the monasteries and chantries (rapacious asset-stripping carried out in the name of religious reform by Henry VIII and Edward VI) resulted in the closure of almost all the medieval hospitals, which, even if they had provided little treatment, at least had afforded shelter to the aged, sick and incapacitated. A few institutions survived the Reformation, being re-established on a new, secular basis. St Bartholomew’s and St Thomas’s passed to the City of London after the Dissolution, as did Bethlem for treating lunatics. Despite its burgeoning population, rising to 200,000 by 1600, London long possessed only these three hospitals, not in themselves very large (in 1569 St Thomas’s housed 203 patients); beyond the capital, scarcely any medical institutions survived Henry VIII’s destructive greed.

Shortcomings in institutional medical provision in England and elsewhere may have been counterbalanced, thanks to the development of printing, by the growth of writings popularizing health advice. These sprang largely from the regimen and hygiene traditions incorporated within the Salernitan Regime. Such works, stressing the non-naturals, instructed readers to monitor their constitutions. Andrewe Boorde (c. 1490–1549), an ex-monk turned physician, offered rules in his Compendyous Regyment or a Dyetary of Healthe (1547). He began by prescribing where to situate a house, how to organize a household, what to eat and drink and what to avoid, and what exercise to take, before moving on to more detailed physical methods of preserving and restoring health. The non-naturals were also stressed by Andre du Laurens (1558–1609), physician to Henri IV and professor at Montpellier. In 1597 he published a book translated as Discourse of the Preservation of the Sight; of Melancholic Diseases; of Rheumes and of Old Age, which contended that the causes of ageing were mental as well as physical: ‘Nothing hastens old age more than idleness.’ Early in the seventeenth century, Sir John Harington (1561–1612) brought out a popular English translation of the Regimen sanitatis Salernitanum. Addressed to King James, The Englishman’s Doctor (1608) provided health advice to all:

Salerne Schoole doth by these lines impart

All health to England’s King, and doth advise

From care his head to keepe, from wrath his heart,

Drinke not much wine, sup light, and soon arise,

When meate is gone, long sitting breedeth smart:

And after-noone still waking keepe your eyes.

When mov’d you find your selfe to Natures Needs,

Forbeare them not, for that much danger breeds,

Use three Physicians still; first Doctor Quiet,

Next Doctor Merry-man, and Doctor Dyet.

Temperance was the message of the highly successful Discorsi della vita sobria (1558–65) [Discourses on the Temperate Life] of Luigi Cornaro (c. 1464–1566), which he wrote in his eighties. Cornaro maintained that a temperate life would enable the body’s finite supply of vital spirits to last until life ebbed peacefully away between the ages of five and six score. Practising what he preached, he attributed his longevity to moderation, exercise, keeping his mind occupied and heeding his diet. Old age aroused great interest. In 1635, William Harvey performed a postmortem on Thomas Parr (c. 1483–1635), supposedly the oldest man in England. Brought to London, he was presented to Charles I and exhibited at taverns, but the smoky London atmosphere proved too much and he expired, allegedly at the ripe age of 152.

Printing made other sorts of health literature more widely available. Obstetrics and babycare books began to appear in many languages. The earliest published midwives’ textbook written in the vernacular, Eucharius Rösslin’s (d. 1526) Der Swangern Frawen under Hebammen Rosengarten (1513) [Garden of Roses for Pregnant Women and Midwives] appeared in English as the Byrth of Mankynde (1540) and was still in use in the eighteenth century. Its frontispiece pictures the mother in labour among relatives and midwives, groaning on a birth stool, while the attendant astrologer gazes through the window to cast the baby’s horoscope.

Thanks to printing, stronger links were forged between medicine, learning and culture. Humanism’s preoccupation with recovering the learned medicine of the ancients proved, however, a mixed blessing, and scepticism towards the profession remained deep-seated: ‘Trust not the physician, his antidotes are poison,’ warns Shakespeare’s Timon of Athens. During the following century medicine was to build a new scientific basis.

* Unlike syphilis, gonorrhoea is an ancient disease. An Assyrian tablet speaks of thick or cloudy urine, and the Hippocratic writers refer to ‘strangury’, that is, blockage of the urethra. There was no effective cure until sulfonamides became available in the 1930s.

* The ontological view of disease as produced by distinct entities had a few classical antecedents. In Timaeus Plato had compared diseases to creatures, and Varro (116–27 BC) had spoken of animals too small to be seen by the eye, ‘which by mouth and nose through the air enter the body and cause severe diseases’.

* The heyday of eponyms was the seventeenth century, with Aselli’s pancreas, Graafian follicles, Haversian canals, the circle of Willis, Tulp’s valve, Bartholin’s duct and glands, and many lesser ones.

* Montaigne wrote, ‘I am in the grip of one of the worst diseases – painful, dreadful, and incurable. Yet even the pain itself, I find, is not so intolerable as to plunge a man of understanding into frenzy or despair. At least I have one advantage over the stone. It will gradually reconcile me to what I have always been loath to accept – the inevitable end. The more it presses and importunes me, the less I will fear to die.’

Self-possession in the face of sickness, he believed, was crucial. Physicians were of little use: ‘no doctor takes pleasure in the health even of his friends,’ he remarked; this was a long-standing humanist jibe.