Philosophy-RAG-demo/transcriptions/HoP 402 - Life is Not Enough - Medicine in Renaissance France.txt

 Hi, I'm Peter Adamson, and you're listening to the History of Philosophy podcast, brought to you with the support of the philosophy department at King's College London and the LMU in Munich, online at historyoffilosophy.net. Today's episode, Life is Not Enough, Medicine in Renaissance France. There is a scene in the imaginary invalid by the 17th century playwright Moliere that is famous among philosophers. It depicts an examination for entry to study medicine at Paris. The candidate is asked to explain why opium causes sleep, and answers that it is because opium has a normative power, a virtus dormitiva, that is, the power to put people to sleep. This vacuous triviality is, of course, exactly what his foolish scholastic examiners are looking for, and the candidate gets full marks for it. Which is all good fun, but let's face it, it's not as if Moliere had a better answer to give. In fact, you could make a good case that ascribing a normative power to opium is not vacuous after all. Ascribing a power to the opium is a meaningful scientific proposal, which differs from, say, asserting that the more rudimentary material ingredients of opium cause sleep, perhaps by cooling down the body. Instead, the dormitiva power ascribes to the nature of opium a disposition for affecting the world, one that cannot be reduced to other natures, and one that cannot be explained in terms of the perceptible properties of opium. I'm not saying that the dormitiva power is a good explanation, but I am saying that it is meaningful, and that it may have been about as good an explanation as anyone at the time could have offered. As it happens, people back in the 16th century, when mockery of scholastics was a more novel enterprise, devoted serious thought to the effects of opium. A study of doctors at the University of Leiden has shown how physicians there wrestled precisely with the problem that the sensible properties of opium do not seem to match its effects. Apparently, it tastes hot. Kids don't try this at home. Yet, it has this soporific effect which we'd expect to relate to cooling, since the body is cooler during sleep. Some of the Leiden doctors inferred that the powers of drugs cannot be investigated using sensation, or at least, not always. One of them, Gilbert Jaheus, said that we need to draw a distinction between the evident and hidden or occult powers of natural substances. With this, he echoed a real-life doctor of Paris, Jean Fanel, who authored a long treatise whose very title was On the Hidden Causes of Things. It was published in 1548, with the dedication to the king, Henry II. Later on during his reign, Fanel would become royal physician. In the preface, he speaks of his desire to uncover what is divine within the art of medicine, with what follows being the fruits of his labor. It takes the form of a dialogue between three scholars, the two main protagonists being Brutus and Eudoxus. The names are none too subtly chosen, since Brutus is rather brutish in his manners, a fact that may be linked to his favored theories. He believes that the natures, powers, and dispositions of substances can, indeed, be explained in terms of their brute material ingredients. The forms of things emerge from the bottom up, out of mixtures of these ingredients. By contrast, Eudoxus, whose name means correct belief, is a top-down kind of guy. He thinks that medicine needs to be grounded in sound principles of natural philosophy, principles that he defends in the first half of the work. In the second half, the principles are then applied to classify diseases and remedies, with some of these operative at the level of what Fanel calls the whole substance. It's at this level that opium would, hopefully unlike this podcast, put you to sleep. Where do these powerful forms of the whole substance come from, if not from the material elements of the substance? Well, that's where the divine comes in. The forms are received from the heavens, which are the instrument of God. Fanel has his spokesman, Eudoxus, refute all of Brutus's attempts to explain forms in any other way. He does invoke religious considerations. If the form of living things come from bodily mixture, then our souls should expire upon the death of the body, meaning that we cannot look forward to an afterlife. But, for the most part, Eudoxus's arguments draw on philosophical assumptions and plain old common sense. As we know from Aristotle, forms are simple, so it makes no sense to see them as combinations of lower-level qualities like heat and cold. In fact, according to Eudoxus, the constituents of the body don't have forms at all. There is just one overall form whose presence blots out the forms of the bodily parts like a bright light drowning out dimmer ones. The parts are merely potentially present until the total form departs, as on the death of an animal when it turns into a mere heap or aggregation of materials. With this, Fanel signals his allegiance to the form-unitarian position notably defended back in the 13th century by Thomas Aquinas. It was an unpopular view back then, because most scholastics thought it made more sense to acknowledge a multiplicity of forms in an organism, like a human for instance. It's by your human form that you can grow, see, hear, think, and so on, but it's the earthy elements of your body that make you fall downwards, like when you jump off a bench or have just had too much opium. Of course, Fanel has to admit that humans and other natural substances have many powers and perform many activities, but this is not because there are many forms present. Rather, it's because the single form is being received in a complex bodily substrate. During life, the soul is bonded to the body and needs the states of the body to be as they should be in order to perform its full range of functions. If the states are disrupted sufficiently, the soul departs, which is a nice way of saying that the person dies. The material ingredients are also important because they have to be made ready to receive the total form from heaven. In a way, Fanel makes all-natural generation to be like spontaneous generation, the process whereby flies, worms, and the like emerge from rotting matter. For him, the emergence of higher organisms works in more or less the same way, only with better ingredients and better mixtures to prepare the way for better forms. In developing this theory and applying it to drugs and illnesses, Fanel takes a nuanced stance toward the medical tradition and especially Galen. He implies that Galen really wanted to have a view like that of the character Brutus, in which all-natural phenomena would be explained in materialist terms. Thus, drugs would have their effects through manipulations of the four humours and their basic qualities of heat, cold, dryness, and moisture. Health and disease would be explained in the same way, as the result of balance or imbalance in the humoral mixture. Yet, Fanel thinks that Galen grudgingly had to admit the hidden causes that operate at a higher level. While some medical phenomena can be explained in crude material terms, many cannot. As with the case of opium, we could never tell just by examining the basic physical properties of a poison that it is lethal. So poison operates in virtue of its total substance, not by any quality manifest to the senses. Similarly, we can hardly explain plagues and epidemics just by talking about things like hot weather. True, some diseases do spike in summer, but then we might have a sweltering summer where no one gets sick. Fanel also concedes that the individual mixture or temperament of a person's body may have something to do with their health, and admits that medicines can target this bodily mix. But many diseases are evidently spread through air or physical contact, and so are not the result of the body's temperament. They must be coming from what Fanel calls seeds of plague, which induce illness, much as a scorpion bite or poisoned weapon causes death. Not so vacuous after all, then. Especially when you consider that around the same time, the alchemist and doctor Paracelsus was proposing exactly the kind of bottom-up theory that Fanel wanted to refute, one far more unorthodox than voiced by Brutus in Fanel's dialogue. As we saw in episode 388, Paracelsus was a German alchemist and doctor who rejected the standard medical authorities, including Galen, in favor of a theory that reduced all bodies to three principal constituents, sulfur, mercury, and salt. Ironically, he leveled some of the same criticisms at Galenic medicine that we find in Fanel, notably the impossibility of explaining plagues using this classical theory. But Fanel was no Paracelsus, of course. To the contrary, where Fanel urged his readers to continue the powers and dispositions of whole substances, Paracelsus had been an anti-wholist who sought to explain the properties of things in terms of chemical composition. Other contemporaries in France were more ready to accept the novel ideas coming from Germany. Often, they combined Paracelsus with Galen. We see this with Johannes Guenther of Andernach, who got his medical degree in Paris. As Alain Debouss says in his book on Paracelsus in France, for Guenther, it was not a case of using the old medicine or the new, but of using both in concert. Even a more committed follower of Paracelsus, the Calvinist physician Joseph Duchenne, was still willing to use Hippocrates in Galen. His work, The Great Mirror of the World, published in 1587, explored the central Paracelsan theme of the human as a microcosm, that is, a smaller image of the universe. Duchenne even suggested that blood circulates in the body, in a partial anticipation of the ideas of Harvey, on the grounds that fluids also circulate in the meteorological exchange of rain and evaporation. As we would expect, he also deployed Paracelsan principles with reference to concrete examples, such as the question why people sometimes get poisoned after being shot by lead bullets. Surely not because lead is dangerous, says Duchenne, this metal is actually good for us, but because lead contains a lot of mercury, which makes it absorb other pernicious substances. Fresnel is looking better and better, I have to say. If you still aren't convinced, how about another Paracelsan named Alexandre de la Tourette? He encouraged people to drink liquid gold because it is the purest and most balanced fusion of the three fundamental substances. Unfortunately, or perhaps fortunately, he doesn't suggest a way of making gold liquid while still cool enough to drink. Or take the debate between Loyes Delaunay and Jacques Revan about antimony. Delaunay had endorsed the use of this metal as a purgative following Paracelsus. This alarmed Revan, who rightly warned that antimony might be poisonous. Revan also made an astute observation about, well, observation. The Paracelsans had not collected enough empirical evidence to say whether or not antimony was safe to consume. In fact, this was a weakness in both the Paracelsans approach and in that of Fernes. He explicitly asked whether we should perform tests to confirm the efficacy of various drugs on various types of people. But then he distanced himself from this empiricist method on the grounds that there would just be too many variables to consider, too many ways that patients differ from one another. Something else Fernel had in common with the Paracelsans is that they were all challenging the orthodoxy that reigned at university medical faculties, especially in Paris. As we saw, Fernel became a royal physician, and at the end of the 16th century, the same post was given to a Paracelsan, a Protestant named Jean Roubide. All the while, the medical faculty fought against the creeping influence of the new theories. Notably, another royal doctor named de Bailly was prevented from practicing in Paris and then ejected from the city in 1579, thanks to the influence of the faculty. This may evoke an image of the Paris University doctors as hidebound conservatives, unwilling to budge from the Galenic tradition as it had come down to them through the medieval period. But the truth is more like what we see with the Sorbonne, where theologians were willing to accept limited reform and exploit the resources of humanism to some extent, so long as it didn't rock the boat of their authority too violently. A good illustration here would be Jacques Dubois, who lectured as a member of the Paris medical faculty from 1536 to 1555. He was one of the many Renaissance thinkers who believed that the best way to make progress was to look backward, all the way to antiquity. In a work on compound drugs, he said that anything valuable in it was to be credited to Galen. Unlike some classicizing doctors of this period, he was willing to accept the authority of doctors from the Islamic world, especially Ahrazi and Evasenin. But he was scornful of more recent physicians who based themselves primarily on these sources. Dubois preferred Greek authors, as when he produced a catalog of diseases that drew on Galen and Hippocrates, rather than the so-called Arabs. Ahrazi and Evasenin did write in Arabic, but they were Persian, not Arab. More genuinely innovative was Dubois's admirable project of writing on diseases of the poor, a welcome correction of the tendency of Galenic physicians since Galen himself to attend upon the rich and powerful who could pay for the bespoke treatment they offered. Yet even here, Dubois showed his Galenic sympathies, tracing the perilous health condition of the destitute to their humoral balances, rather than, oh, I don't know, economic oppression? Even more extreme in his classicism was Guillaume de Bayeux, who lived into the second decade of the 17th century. His work on epidemic diseases was so closely based on Hippocrates that he sprinkled the latter's original vocabulary into the text. One scholar says that it's as if he was getting as near as he dared to actually writing in Hippocrates' Greek. Speaking of derivative writings about medicine, let's finish up by looking at a somewhat earlier author named Sinfarion Champier, who was distinguished by his undeviating unoriginality. This according to Brian Copenhaver, author of the most important book on Champier and a guest on this series back in episode 367. Nonetheless, Champier does give us something interestingly new in French medicine because his main inspiration was neither Galen nor Paracelsus, but Italian Platonism. This interest is one he acquired as a young man, when he studied at Paris and fell under the influence of Lefebvre de Taple, whose own thought was so powerfully marked by his time in Italy. Actually, Champier's very first work was an introduction to Aristotle that was based on the writings of Lefebvre. He went on to study at Montpellier, where he got his doctorate in medicine in 1504. Champier then set himself up as personal physician to the poor and indigent of France. Just kidding, of course he actually went into the service of a nobleman, in this case the Duke of Lorraine. Champier is actually most famous for something other than his medical writings. He composed The Ship of Virtuous Ladies, yet another contribution to the debate over the moral qualities of the female sex. But since we've talked about that topic quite a bit, I thought it would be more interesting to cover Champier as a medical author. Like the Parisian masters, he brought a humanist agenda to this discipline, ignoring medieval sources. He was willing to use translations of Arabic medicine, but had rather mixed feelings about it, decrying doctors who had never read Galen and Avicenna, while also complaining that Avicenna was unduly under the sway of Islam, which he considered criminal and most filthy, and referring to Ivarides as an impious apostate. What differentiated him masters then was not his approach to the medical tradition, but his extensive use of Platonism, and especially Marsilio Ficino. You might recall that Ficino wrote a work called Dei triplici vita, Three Books on Life, on using medicine and magic to prolong longevity. Not to be outdone, Champier wrote Dei quadriplici vita, in which he investigates life at four levels, daily health, longevity, heavenly life, and super celestial salvation. His motivation for integrating medicine into this more cosmic perspective is clear from the motto he gives in his introduction, non sat est vivere, meaning, it is not enough just to live. His attitude reminds me of something a philosopher colleague of mine once said in the context of an academic dispute between the medical faculty and the School of Humanities. Doctors only keep us alive, she argued, whereas in the humanities, we study what makes life worth living. Champier would have wholeheartedly agreed. He argued that medicine must be joined to philosophy and even theology, just as the body is joined to the soul, and connects the good state of the body to ethical virtue. Much of his advice was drawn directly from Ficino, to the extent that critics charged him of plagiarism, but his response was that he was openly stealing from the best. He had always acknowledged Ficino as his teacher and model. So in this episode, we've seen various ways to approach medicine and integrate it with philosophy. What they all had in common was a return to ancient sources, especially Galen, but also Hippocrates. This is the Renaissance, after all. In other respects, they diverged widely. Where Fresnel advanced a holistic theory of substance and understood medicine accordingly, the Paracelsans applied the analytic tools of chemistry. They drew parallels between the physical system of the body and that of the cosmos, whereas Champier saw the physical side of humans as their least important aspect, and connected medicine to the metaphysical speculations of Florentine Platonism. If you asked me who was most on the right track, I'd probably say the followers of Paracelsus. Their idea that we might use chemical analysis to understand how drugs work has stood the test of time, in a way that dormative powers and other such postulates have not. Which is not to say that I'd like to be treated for an illness by a 16th century Paracelsan any more than I'd want to be treated by a Galenist. In the wise words of Montaigne, they say that some newcomer called Paracelsus is changing or reversing the entire order of the old rules, maintaining that up to the present, medicine has merely served to kill people. You will be able to prove that easily enough, I believe, but it would not be very wise for me, I think, to test his new empiricism at the cost of my life. With that, we're ready to take a break over the summer, since as usual there will be no new episodes in August. Enjoy the heat, and let's hope it's one of those summers that is not marked by the spread of any infectious diseases. When we come back, we'll be changing and reversing some more old rules as we meet the man who ripped up the Aristotelian playbook for teaching and learning. He was a royal professor at Paris who introduced new methods for philosophy that spread across Europe like wildfire. So join me in September when it will be back to school to meet the greatest teacher of 16th century France, Peter Ramos, here on The History of Philosophy Without Any Counts. you