Chapter 65
Medicine, health and disease; physicians, surgery, remedies and the care of the body.
713 passages · 305 principal · Covers the 49 volumes of primary texts
Medicine is the art that concerns health and disease, the care of the body, and the relief of its injuries. It sits where nature, technique and morals meet. Physicians make an oath, sell a service, and claim knowledge that patients cannot judge for themselves. The Harvard Classics give the idea unusual range. A whole volume collects Hippocrates, Paré, Harvey, Jenner, Holmes, Lister and Pasteur. Around these founding documents of modern medicine stand the gospel healings, Chaucer’s doctor, Shakespeare’s helpless physicians, Burns’s quack, and Manzoni’s plague. The great questions are whether medicine truly heals or only accompanies nature, how the body’s ills relate to the soul’s, and whether the physician deserves trust. All three persist from the ancient world to the modern, even as the science itself changes almost beyond recognition.
The first question is what health is. Carlyle repeats a physician’s aphorism that the healthy do not know their health. In his view health is an unconscious harmony of the organs, and only discord announces itself1. He calls it the highest temporal good, above nuggets and millions2, and makes health of body and mind a victory, ill-health a defeat3. More argues that health is a positive pleasure rather than a mere absence of pain4. Descartes ranks it the first of blessings5. Pascal adds the sceptic’s note that we misjudge our health, being unconscious of the fever already gathering6.
From antiquity the bodily and the mental are joined. Plato’s Socrates compares the soul’s justice and injustice to the body’s health and disease7, and complains that bodily disease impedes the search for truth8. Pascal likewise holds that diseases spoil judgment and the senses9. Hobbes gives the modern physiological reading: madness arises from disorder of the bodily organs, or from passions that injure them10. Shakespeare marks the limit of the physician’s art. Lady Macbeth’s doctor confesses that her disease is beyond his practice11, that physic cannot cure a guilt-sick mind12, and that the patient must minister to herself13. Webster’s doctor, by contrast, confidently names Ferdinand’s lycanthropia and its melancholy humour14.
The religious writers turn the relation around. Pascal makes bodily sickness a remedy for the soul’s graver disease of insensibility15. Woolman reads his illness as correction and desires no health until its purpose is answered16.
If health is so great a good, how is it kept? A broad tradition answers: by regimen more than by drugs. Herodotus reports that the Egyptians purged monthly, believing all disease came from food17. Cicero would fight the weakness of age with moderate exercise and diet18. Marcus Aurelius cared for his health so as seldom to need physician or medicine19, and Chaucer’s widow keeps off gout by a plain diet20. Bacon’s counsel is prudential: observe what suits one’s own body, use physic sparingly, and be cheerful21. Penn makes labour the body’s physic and prevention the mark of wisdom22,23.
Locke systematizes the hardy view for children. Parents should preserve health without physic and raise children as farmers raise theirs24. He recommends cold washing of the feet25, cold bathing defended against mothers’ fears26, open air27, loose clothing28 and hard beds29. Slight ailments should be left to nature, with a sober physician summoned only when needed30.
Rousseau presses the argument to a polemic. He doubts that medicine lengthens life at all, holds that most diseases are inflicted by civilized living31, and observes that wounded animals heal without surgeons32. Adam Smith, more temperately, faults speculative physicians who thought health required a precise regimen. The body, he says, has its own principle of preservation33. Hume, without hostility, notes that physicians are not surprised when remedies fail, the body being a complicated machine with hidden powers34. Goethe dramatizes the alternative: Mephistopheles offers rejuvenation by rustic labour and simple fare, and Faust refuses it35.
Disease also comes from places, and here the question becomes public. Pliny justifies an aqueduct and the covering of a pestilential sewer on grounds of health36,37. Drake’s chronicler blames a burning ague on the night air38. Darwin weighs miasma, notes that draining pools improved Arica, and warns that a country’s look is no guide to its healthfulness39. The nineteenth century turns such observation into reform. Channing urges that crowded, unventilated dwellings be regulated by commissioners, since housing affects both health and morals40. Faraday shows that air spoiled by breathing is unfit to breathe again41. The Panama Convention commits a government to sewers and preventive ordinances42.
The physician himself is judged by two standards, his ethics and his competence. The Hippocratic Oath binds him to the patient’s benefit, forbids deadly drugs, and enjoins confidence43. The Law calls medicine the noblest of arts, held back by men who are physicians in name only44. Browne, a physician, disclaims any sordid wish for plagues45. Johnson praises Levet’s unshowy relief of the poor46. Chaucer’s Doctor of Physic is learned in astrology and the authorities, but keeps allied apothecaries and loves gold as a cordial47, and the satire grows sharper from there. Sidney charges physicians with lying about remedies48. Pascal says their cassocks and mules dupe the world49. Goethe’s Mephistopheles reduces the craft to bedside manner and a diploma50. Burns’s Death complains that Dr. Hornbook kills more than he does51,52.
Cellini’s memoir supplies the empirical record. In it a surgeon promising miraculous cures for the French disease flees Rome53,54, physicians quarrel over bleeding55, and his own fever yields to water drunk against orders56.
The relation of physician and patient raises its own questions of trust. Epictetus would entrust the body to the expert and take blunt advice without offence57. Pliny describes physicians coaxing patients into wholesome regimens58 and defers to their judgment in fever59. Bacon wants a physician neither too pleasing nor too rigid, and one who knows your body60. Emerson calls reliance on the physician a kind of despair of ourselves61. Mill, on liberty, resists requiring a doctor’s certificate to buy drugs62.
Remedies themselves run from sound to fantastic. Homer’s Egypt abounds in herbs, some healing and some baneful63, and Prometheus claims to have taught mild medicaments64. Harrison argues that native simples, few and well known, are better than foreign compounds whose qualities no one understands65,66. Shakespeare’s doctor restores Lear with rest and simples67. Common practice purged and bled. Pertelote treats Chauntecleer’s choler with laxatives68, and Vespucci finds natives bleeding and fasting by methods unlike Europe’s yet often curing69.
Folk cures are recorded with varying irony. There are Quixote’s balsam, which purges violently70,71, the pigeon’s blood that cures Cellini’s eye72, and the split puppies Darwin met in South America73. Jonson mocks the alchemist’s elixir as a cure for every disease and for the plague74. Goethe’s Faust confesses that his father’s remedies poisoned thousands75. Yet Pascal draws a serious inference from all this credulity: belief in false remedies arises because true ones exist76,77. Raleigh’s search for the antidote to poisoned arrows shows how the same knowledge could be guarded as a priestly secret78.
Over against human art stands miraculous healing. Luke’s woman spent everything on physicians and was healed by touching a garment79. Jesus calls himself a physician to the sick80, and the apostles heal in his name81,82. Malory’s lady has a leprosy that no physician can cure, and it yields only to holy blood83. Shakespeare’s king cures by touch where surgery despairs84. Virgil’s physician Iapis sees that Aeneas’s cure exceeds his art85.
Augustine makes God the inmost Physician86, and Pascal concludes that physicians cannot finally heal, since we die, while Christ makes the body immortal87. Bunyan joins the two orders in Mr. Skill, whose purge is at once physic and the Word88,89.
Surgery has the clearest progress. Paré learned in the field that a gentle digestive salve healed gunshot wounds better than boiling oil, and resolved never again to cauterize cruelly90. He scorned a charlatan’s charms91, judged a prognosis of death correctly against all the physicians92, and cited Hippocrates on the cooperation of surgeon, patient and attendants93. He nonetheless credited the healing to God94.
Care of the sick has also its institutions and its failures. More’s Utopia isolates contagious cases in hospitals the sick prefer to home95, and Franklin helped found one for the poor96. Dana records sailors given no nursing97, and a scurvy that medicines could not touch but raw potatoes cured98,99. Whitman’s dresser and Haskell’s surgeons show the scale of modern war100,101.
Lister marks a new principle. Carbolic dressings prevented suppuration and saved limbs102. Decomposition, he showed, was a self-spreading poison103, and his wards were freed of hospital gangrene and pyaemia104.
Contagion poses the question in its sharpest form. Plutarch blames the Athenian plague on crowding105. Manzoni’s Milan stages the modern drama. Settala reports contagion and is mobbed for it106,107. A barber persuades officials that the disease is not pestilence108, and opposing physicians rename it “pestilential fevers”, a wordplay that obscures contagion by touch109. Darwin collects testimony that ships bring disease to islanders110. Holmes turns the accusation on medicine itself. Puerperal fever, he argues, is carried by physicians and nurses111, as clusters around single practitioners prove112, and he prescribes ablution, changed clothes and abstention113. He also cites Semmelweis’s chloride of lime114.
Pasteur supplies the causes Holmes inferred. Anthrax and septicemia are bacterial115. Furuncles and osteomyelitis share an organism116. Puerperal fever arises from common microbes whose entry must be prevented117,118. He hails germ theory as the foundation of a new surgery following Lister119.
Smallpox shows prevention becoming a moral choice. Voltaire reports inoculation from the Circassians and argues from statistics that France loses lives by resisting it120,121. Franklin regrets not inoculating his son122. Woolman insists on clear knowledge of duty, since life is God’s gift123. Jenner then claims that cow-pox gives lasting protection124. He distinguishes it carefully from spurious forms that give false security125, argues that it is safer than variolation and spreads only by contact126, and gathers colleagues’ confirmations127,128. He ends by foreseeing the extirpation of a scourge129.
Behind all this lies anatomy. Harvey uses phlebotomy and the ligature to prove the course of the blood130 and holds that the circulation illuminates pathology and therapeutics131, including how contagion and poisons spread132. Descartes cites the same surgical practice as evidence133. He also voices the modern hope. Present medicine yields little, but knowledge of causes might free us from maladies and even from the debility of age134, and to that end he would give his remaining life135. Dissection serves the same hope in Drake’s crew136 and in Bacon’s New Atlantis137.
Finally, medicine is a pervasive figure. Plutarch’s Pericles treats the people like a skilful physician138, and Machiavelli likens political ills to hectic fever139. Burke condemns reformers as empirics who scorn regular diet140. Carlyle doses a dyspeptic society with nostrums141 but sees nature exerting a medicative force142. Epictetus makes the philosopher a surgeon of diseased students143, and Marcus accepts nature’s prescriptions as he would Aesculapius’s144. Dryden compares tragedy and epic to quick and slow remedies145.
Some questions these texts settle, at least in their own terms. Holmes, Pasteur and Jenner leave little room for the miasma theorists or the deniers of contagion. Other questions remain open. Can the mind’s sickness be treated by physic, or must the patient minister to himself? Does medicine improve on nature’s healing, or chiefly prevent the harms civilization causes? And if the physician’s art is to deserve the trust the Oath demands, what share of authority belongs to the expert, and what share to the free patient?
Introductory essay written by Claude Opus 5.5 from the outline and the notes on every passage below; quotations are checked against this edition.
See also: Madness 8c
See also: Temperance 2a
See also: Habit 3a · Temperance 2b · Education 3c · Nature 6c
See also: Friendship 4d
See also: Art 3d
See also: Angel 8c · Miracles 4c · Hypocrisy 5a
See also: War and Peace 3b
See also: Charity 4a
See also: Experience 9c · Cause 9b
See also: Life and Death 10a
See also: Life and Death 10a · Opinion 7a
See also: Duty 11b · Cause 9b · Experience 6c · Induction 3a
See also: Cause 9b · Experience 9c · Life and Death 10a
See also: Experience 9c
See also: Experience 9c · Cause 9b · Hypothesis 5d · Science 3b
See also: Experience 9c · Hypothesis 5d · Induction 3a · Cause 9b
See also: Experience 9b · Animal 1d · Cause 9b · Science 3b
See also: Experience, Cause, Life and Death, Madness, Induction, Charity