Terry Doyle writes…
To the modern mind, one of the more surprising therapeutic manoeuvres inflicted on the Charles II as he lay dying of a cerebral disorder (more of that in another blog) in February 1685 was to make him sneeze. This was done by applying powder of white hellebore roots to his nostrils. He was also given Spirit of Sal Ammoniac tam ad invigorandum Cerebrum quam ad Sternutationem excitandum (both as a cerebral stimulant and to provoke sneezing). The ancient belief was that the animal spirits are produced and stored in the fluid of the cerebral ventricles. This was secreted through the pituitary, then dripped into the palate and also through the cribriform plate of the ethmoid bone into the nasal cavity. According to the medical theory of the time, sneezing would help to purge the brain of humours affecting it. What is interesting is whether or not one of the Royal Physicians, Richard Lower agreed to this.
Lower is best known for performing the first successful blood transfusion and for his Tractacus de Corde wherein he accurately described the structure of heart muscle. Later editions of this work contained a short additional chapter entitled Dissertatio de origine catarrhi.
A reviewer noted that Lower demonstrated ‘the erroneousness of the Vulgar opinion . . . of those that apprehend great danger to the Brain from the excrementitious matter fathered therein, if it should not be purged out from thence by the Eyes, Nostrils, Ears and the Palat.’ (Philosophical Transactions 6 (1671) 2211-2). A facsimile reproduction of De Catarrhis was produced and edited by R. Hunter and I. Macalpine London, Dawsons, 1963.
Lower had extensive experience in brain research from his days in Oxford where he was the valued assistant to Thomas Willis in his production of Cerebri Anatome.
In the preface to the 1664 edition Willis wrote: ‘I made use of the Labours of the most Learned Physician and highly skilled Anatomist, Doctor Richard Lower, for my help and Companion . . . the edge of whose Knife and Wit I willingly acknowledge . . . as also his indefatigable Industry, and unwearied Labour.’ In the twelfth chapter of that work, Willis concluded that it was not possible for the cerebral fluid to be secreted into the palate. Among other things Lower investigated the ability of the arterial circle at the base of the brain, eponymously styled the Circle of Willis, to maintain the blood supply to the brain after three of the four feeding vessels had been tied off – as he described in his correspondence with Boyle (1744) The Works, London, Millar, vol. 5.
In De Catarrhis Lower demonstrated by injection of milk and ink that cerebral fluid could not pass from the brain, through the cribriform plate of the ethmoid bone into the nasal cavity and that nasal catarrh had nothing to do with the brain. He suggests that ‘almost everyone is agreed’ that the substance of catarrh consists of the serum of the blood and that it originates . . . by blocked perspiration through the pores of the body.’ Lower correctly suggests that the function of the moisture of nasal mucosa is to lubricate the inspired air. However, he mistakenly thought that the cerebral fluid passed directly from the pituitary into the bloodstream. He arrived at this conclusion by injecting milk into the internal jugular veins in the neck and noting that it bubbled out in two vessels on either side of the pituitary stalk. These are the cavernous sinuses which are next to but not in communication with the pituitary.
Yet despite Lower’s demonstration that catarrh had nothing to do with the brain, doctors continued to treat diseases of the head with errhines and sternutatories to encourage the flow of ‘pituita’ to clear the brain. Similarly, phlebotomy was a standard treatment long after humoural theory had been abandoned. Furthermore, liver disorders were treated with bleeding from the right arm and splenic disorders from the left arm. Charles II was bled from his jugular veins since his disorder was cerebral.
In all there were fifteen Royal Physicians, including Lower, attending Charles in his last illness. We know who they are as they signed the prescriptions given to the king as recorded in The Last Days of Charles II by Raymond Crawfurd, (Clarendon Press, Oxford, 1909), pp 56-68. They were all prominent London physicians and likely represented the best medical opinion of the day. Four are of particular interest.
The Chief Royal physician was Sir Charles Scarburgh, a founding member of the Royal Society, an accomplished mathematician and bibliophile. He had been a protégé of William Harvey, assisting him with De generatione animalium and attending him in his last illness.
Sir Thomas Millington 1625-1703, graduate of Westminster School (like, Lower, Wren, Hooke and Locke), friend of Hobbes and executor of Richard Lower’s will. Tractacus de Corde was dedicated to him by ‘Your most affectionate friend Richard Lower.’
Walter Charleton played a major part in introducing the ideas of Epicurus and Pierre Gassendi into England in his Physiologia Epicuro-Gassendo-Charletonia: or a fabrick of science natural, Upon the Hypothesis of Atoms (1654)
Sir Edmund King, like Lower, was a pupil of Thomas Willis in Oxford. In November 1667, he assisted Lower in performing the first human blood transfusion (on Arthur Coga who had agreed to this for a guinea). He later claimed to have dissected more than a hundred brains: Philosophical Transactions of the Royal Society 185 (Nov. – Dec., 1686), 231.
When each prescription was made out for the King, it was signed by 10 or 12 of the physicians. Most were for purgatives or bleeding. This raises the interesting research question – To what extent was humoural theory practised by physicians who decried it in their written work. Was this because they deferred to the patient’s expectations?