Further instances of the Fingerpost

Sunday, July 29th, 2012 | Peter Anstey | No Comments

Terry Doyle writes …

In 1999, a seminal paper appeared in the medical literature entitled ‘Tamoxifen Prevention of Breast Cancer: an Instance of the Fingerpost’ (Scott M. Lippman and Powel H. Brown. J. Natl. Cancer Inst. (1999) 91 (21): 1809–19). After analyzing the results of a large trial, the authors discussed the value of the oestrogen antagonist drug Tamoxifen in reducing the growth of breast cancers, calling it ‘an instance of the fingerpost for resolving the intense debate on the future direction of chemoprevention research’.

The first use of the term ‘an instance of the fingerpost’ was by Francis Bacon in his Novum Organum (II, Aphorism 36) referring to a scientific test ‘borrowing the term from the fingerposts which are set up where roads part, to indicate the several directions’. It is one of the Prerogative Instances, which he cites in describing his inductive method, where an investigator must make a correct choice of direction between ideas the initial evidence for which is ‘so balanced as to be uncertain’.

These and other Baconian ideas are explored in An Instance of the Fingerpost by Oxford art historian Iain Pears, where mid-1660s Oxford is used as a microcosm for the intellectual, religious and political turmoil of the period just after the Restoration of Charles II. The aporias of the novel centre on the mysterious death of Robert Grove, a Fellow of New College. Explanations of his death are given by four witnesses. The first is a Venetian Catholic intent on claiming precedence over Richard Lower as the first blood transfusionist. The second is the son of a supposed traitor to the Royalist cause intent on vindicating his father. The third is John Wallis (1616–1703), mathematician and cryptographer to both Cromwell and Charles II. The fourth is Anthony Wood the Oxford antiquarian (1632–1695). The Dramatis Personae include famous virtuosi from the period; John Aubrey, Robert Boyle, John Locke, Richard Lower, the German chymist Peter Stahl and Christopher Wren.

The intellectual backbone of the novel is Francis Bacon’s discussion of inductive reasoning in Novum Organum (1620), where he points out the fallacies that may beset logical thinking. Each of the four sections of Pears’ novel is preceded by an epigraph from Bacon’s work. The first are three of his four ‘Idols of the Mind’ –– ‘The Idols of the Market’ (referring to a misuse of language); ‘The Idols of the Cavern’ (meaning personal obsessions); ‘The Idols of the Theatre’ (the danger of false reasoning). The fourth section is entitled ‘An Instance of the Fingerpost’ and the epigraph is an abridged version of the original.

When in a Search of any Nature the Understanding stands suspended, then Instances of the Fingerpost shew the true and inviolable Way in which the Question is to be decided. These Instances afford great Light, so that the Course of the Investigations will sometimes be terminated by them. Sometimes, indeed, these Instances are found amongst that Evidence already set down. Aphorism 36.

Among other interesting matters considered in the novel is the theory of fevers; ‘Could a loss of blood mean that there is insufficient to vent the excess heat from the heart?’ (p. 58) and Sylvius’ theory of the life spirit. ‘You have fallen under the influence of Monsieur Descartes’, says Richard Lower . . . ‘you have constructed a theory, and that leads you to recommend a practice. You have no evidence that it would work . . .  The alternative, proposed by my Lord Bacon, is to amass evidence, and then to frame an explanation which takes into account all that is known’. (Iain Pears, An Instance of the Fingerpost. New York: Riverhead Books, 1998, p. 59–60)

The authors of the Tamoxifen paper acknowledge in their title that they rely for their conclusions on Bacon’s notion of eliminative induction. This was the means by which they established that the growth of oestrogen receptor positive breast cancers is halted by the drug Tamoxifen. So Sir Francis’ work turns out to be pretty useful. Little wonder that the late great Bacon scholar Graham Rees regarded the passage in which Bacon discusses instances of the fingerpost as ‘a startlingly original expression of a central aspect of the theory of experiment’.
 

Early Modern Thought Colloquium Schedule

Wednesday, July 25th, 2012 | MICHAEL COP | No Comments

We have finalized the schedule for our Early Modern Thought Research Theme’s colloquium on 27-28 August held at Otago University.  The full abstracts are available on our conference page. Everyone is welcome; for registration details please contact Michael Cop (michael.cop@otago.ac.nz):

Monday 27 August Otago Museum Kakapo Room

9:15 Registration

9: 30 Peter Anstey, University of Otago: Introduction and remarks: Practical and Speculative Knowledge

10:00 Peter Harrison, University of Queensland: “Contemplation and Creation: Some Theological Motivations for the Pursuit of an Experimental Natural Philosophy“

11:00  Morning tea

11: 30 Sorana Corneanu, University of Bucharest: “The Parts of Prudence and the Virtues of Experimental Knowledge”

12:30 – 2:00 Lunch

2:00 Peter Marshall, Warwick University: “How to Recognize a Heretic in Sixteenth-Century England”

3:00 Afternoon tea

3:30 – 4:30 Terry Doyle, University of Otago: “Pharmaceutice Rationalis: Patterns of Medical Treatment in the Seventeenth Century”

 

Tuesday 28 August Otago Museum Hutton Theatre

9:30 Evelyn Tribble, University of Otago & John Sutton, Macquarie University: Introduction and Remarks: The Historical Study of Skill

10:00 Paul Menzer, Mary Baldwin College: “Sophistication”

11:00 Morning Tea

11:30 Michael Neill, University of Auckland: “‘A book where one may read strange matters’: Envisaging Character on the Shakespearean Stage.”

12:00 Tom Bishop, University of Auckland, “Work and Play”

Lunch 12:30 – 2:00

2:00-4:30 Roundtable: Theatrical Skills, then and now
Brief remarks from Paul Menzer, John Sutton, Ros Knutson, David Carnegie, Evelyn Tribble, and Lisa Warrington; followed by open discussion

John Locke and Anne Docwra

Sunday, July 8th, 2012 | Peter Anstey | 1 Comment

In 1695 the philosopher John Locke, who was residing at Oates, the family home of Francis and Damaris Masham, recorded a treatment for cancer and king’s evil in one of his medical notebooks (Bodleian Library MS Locke d. 9, pp. 306–7). The receipt was for a combination of black lead and red lead boiled and mixed with oil of roses or linseed oil. This was then to be applied as a plaister to ‘cancerous knots’, particularly those in the breast of a woman.

The source of this medical receipt is recorded in Locke’s notebook as ‘Mrs Docwra’. Could this be the Quaker Anne Docwra (c.1624–1710) who published a number of works on Quakerism and who was renowned for her views on the role of women in the church, enthusiasm and toleration?  Until now there has been no known connection between Locke and Docwra. Her name does not appear in any of Locke’s extant writings or correspondence and his name is absent from her writings. However, the circumstantial evidence that we have, together with the contents of Locke’s receipt for cancer, suggest that it is highly likely that the Quaker Anne Docwra is Locke’s source.

Docwra moved to Cambridge after her husband’s death in 1672. Interestingly, Locke’s source records that:

My kinswoman who first used this plaister made it mostly of Linseed oyle. Mrs Fox of Cambridg had a cancerous knot on her breast crookd about the bignesse of my litle finger as hard as a bone. She used this plaister made with Salet oyle for about 14 years before she died. She felt noe pain after she used it, neither did she perceive it grow biger. She told me a short time before her death that she did not find that to be any cause of her death. She died of a consumption & when her flesh was wastd the knot appeard much biger than it did when her breast was plump. (Bodleian MS Locke d. 9, p. 307)

The term ‘kinswoman’ suggests a female relative and ‘Fox’ was a name strongly associated with Quakerism in late seventeenth-century England. The fact that this kinswoman resided in Cambridge provides a link between Mrs Docwra and Cambridge, though one cannot conclude definitively that this Docwra was herself from Cambridge. At the least, however, Mrs Docwra, claims to be an eyewitness just before Mrs Fox’s death, testimony that establishes that this Mrs Docwra was in Cambridge at the time.

Another clue lies in the comment that:

Sometimes upon Knots that are not very hard I lay a litle peice of leaf gold as big as a new threepence or more according to the bignesse of the Knot … (ibid.)

This indicates that Mrs Docwra was a woman of some means as was Anne Docwra after the death of her husband James Docwra.

Locke recorded scores of medical receipts from friends and acquaintances, many of them women. For example, in 1691 he recorded a receipt from Damaris Masham’s mother Mrs Cudworth (ibid., p. 62). And in the same year as the Docwra receipt, 1695, Locke recorded a treatment for ulcers of the mouth recommended by Damaris Masham and Lady Barnard (ibid., p. 58). Normally when Locke derived a medical receipt directly from someone he would add their name after the notebook entry and this is the case with the Docwra receipt. If a receipt derived from a third party he would note its provenance in the entry itself or, occasionally, in the marginal head for the entry. In the case of the receipt for cancer then, it would appear that this derived directly from Mrs Docwra. She, in turn, informed Locke that ‘This plaister was made by a consultation of Surgions at London for a relation of mine who had a Cancerous knot on her breast as hard as a bone’ (ibid., p. 307).

Both Locke and Damaris Masham had theological and philosophical interests in common with Anne Docwra. Moreover, Masham, the daughter of the Cambridge Platonist Ralph Cudworth, had lived in Cambridge from her birth until 1685, overlapping with Docwra in Cambridge by some thirteen years. Did they meet in Cambridge? Did Anne Docwra’s interests also extend to medicinal receipts? Who was Mrs Docwra’s relative in London? We can only await further research!

Rembrandt’s hand – in praise of God or Man?

Monday, June 25th, 2012 | MICHAEL COP | No Comments

Terence Doyle writes…

‘The Anatomy Lesson of Dr Nicholaas Tulp’ is an enigmatic painting. Firstly, Tulp was not the praelector’s real name and secondly, whatever else this is, it is not a usual anatomy lesson. Many interpretations of it have been given but none, as far as I know, have suggested the one which I am about to offer.

At the age of 26, Rembrandt was commissioned by the Amsterdam Guild of Surgeons to paint the picture in 1632. It shows Dr Tulp lifting the flexor digitorum superficialis muscle of the cadaver forearm and at the same time flexing the fingers of his left hand to demonstrate the effect of contracting this muscle. The flexor digitorum profundus muscle can be seen deep to Tulp’s forceps and importantly the insertion arrangement of the two tendons at the fingers is shown in superb detail. Inspection shows how the superficialis tendon inserts on the middle phalanx after splitting and passing on either side of the profundus tendon, which carries on to insert into the distal phalanx. But why is the painting paradoxical?

Nicholaas Tulp was born in 1593 Claes Pieter or Nicholaus Petrus, son of Pieter Dirks, a prosperous Amsterdam merchant. As part of a successful medical career, Tulp became Praelector in anatomy in 1628 to the Surgeons Guild in Amsterdam. He seems to have adopted the name Tulp (tulip in Dutch) early on for reasons that are not clear. The individuals in the painting, including the cadaver, are all known. The spectators are Amsterdam surgeons – none medically qualified – who are named on the list held by the one to Tulp’s right. The surgeon standing upright at the back originally wore a hat, the outline of which can just be made out, and the figure to the far left of the group was added later by a hand inferior to that of Rembrandt (note the different skin tones). The inner three are looking at Tulp’s hand but the outer four are not.

Members of the Surgeon’s Guild, in England as well as in Holland, were required to attend anatomy demonstrations as part of their continuing education. However, this is not a usual anatomy demonstration for several reasons. Dissection always followed a set pattern of the abdomen being examined first since its organs putrefied rapidly, then the chest and brain for the same reason, and finally the limbs. In the painting, only the forearm has been dissected – with the fingers shown in great detail and the flexor muscles in just enough detail to show their function. The dissected hand is noticeably larger, and the left arm longer, than the right. Finally, the only spectators are surgeons (and only half of them are watching the ‘lesson’), whereas there would commonly be other prominent persons who came to witness the spectacle for a fee. We might therefore suppose that this painting is largely to do with surgeons and the hand.

The idea of Man as microcosm was common in the Early Modern Period and thus the study of anatomy was a study of the works of the Almighty – cogitio sui and cogitio Dei. Moreover, the hand was emblematic of such miraculous works. This was a view of Aristotle who considers the hand the physical counterpart of the human psyche, being an instrument for using other instruments. Galen, in book XVII of On the use of the parts, says of the tendons: ‘their insertions in the bones and their relations with each other are amazing and indescribable.’

The anatomist John Banester says of the hand: ‘no member more declareth the unspeakable power of almighty God in the creating of man.’ (John Banester. The historie of man, sucked from the sappe of the most approued anathomistes, London, 1578, p. 61).

Helkiah Crooke, in his ‘μικροκοσμογραφία [mikrokosmographia]: a description of the body of man . . . collected and translated out of all the best authors of anatomy especially out of Gasper Bauhinus and Andreas Laurentius’, London, 1615, considers that the hand ‘may justly be compared to the soule . . . By the helpe of the hand laws are written, temples built for the seruice of the Maker’ (p. 729). The hand is ‘the most Noble and prefect organ of the body;’ and Laurentius, whom he refers to as ‘one of the outstanding Doctors and teachers of divine wisdom’ noted the wonderful artistry ‘with which nature perforated the tendons of flexor superficialis in order to provide the passage for the profundus tendons’ (p. 730). This encomium on the hand comes from the chapter de praestantia manus in Laurentius’s Historia anatomica humani corporis, Frankfurt, 1599, pp. 61-3.

I think the painting is an allegory on the word ‘surgeon’. In this period, the word was often written (even in Dutch) something like ‘cheirurgeon’ which derives from the Greek χείρ (hand) ἔργον (work). Since the painting is so clearly about surgeons and hand function (as Tulp is demonstrating), the connection seems to me compelling. Perhaps it also suggests that those individuals are metaphorically closer to God by association – they did pay for the painting after all. An interesting area for future research might be the use of the hand as emblem of the Divine in Early Modern period.

What killed Charles II?

Sunday, June 17th, 2012 | Peter Anstey | No Comments

Terence Doyle writes…

Charles II, at the age of 54, laid down his earthly crown for an immortal one at noon on Friday February 6th 1685. His last illness is surely the best documented case history in the seventeenth century. There were multiple eyewitness accounts. The official version was penned by the Chief Royal Physician Sir Charles Scarburgh and later transcribed in The Last Days of Charles II by Raymond Crawfurd, (Clarendon Press, Oxford, 1909). It makes disturbing reading.

Charles was an apparently healthy man, reputed to have had thirteen mistresses and fifteen illegitimate children. On Monday morning, February 2nd 1685, while at his ablutions, he suffered a seizure with convulsions and temporary slurring of speech. Two physicians were on hand and one, Edmund King, withdrew 16 ounces of blood (450ml) from the king’s right arm, apparently with immediate relief. Six more physicians soon arrived and removed another 8 ounces with cupping glasses applied to deep scarifications in the shoulders. He was then given both an emetic and a purgative to empty his stomach and bowels. This was followed by two enemas and further purgatives. Then, according to the official account, Praeterea ut nullum lapidem immotum reliquerent (to leave no stone unturned) blistering agents were applied all over his head, after his hair had been shaved.

It was then decided to relieve the pressure of the humours on the brain by inducing sneezing, with a powder of white hellebore roots and later Sal Ammoniac applied to the nostrils. So as to keep his bowels active at night, more laxatives were given two hourly. At the same time, to counteract the scalding of his urine, from the Cantharides in the blistering drugs, a soothing emulsion of barley with liquorice was given. Et ne quid intentum relinqueretur (so as to leave nothing untried), plasters containing Spurge and Burgundy Pitch were applied to the soles of his feet.

On Tuesday he was bled ten ounces from the jugular veins. On Wednesday he was given further laxatives but that night he became so ill that his doctors prescribed Spirit of Human Skull (40 drops). This was commonly used in convulsive disorders and thought to act through the power of suggestion, since the skull had to be from someone who had died violently. On Thursday the King’s ministers were asking just what was wrong with him – a piece of intelligence the doctors themselves would have been happy to have. It was then suggested that he was suffering from intermittent fever and so was given syrup of Chinchona (Jesuit’s) bark three hourly, according to a prescription signed by 14 doctors.

On the morning of Friday 6th he was bled again and given an extract of a very large number of herbs, powdered oyster shells and Goa stone. This latter was a concretion (bezoar) formed in the stomach of an East Indian goat and was believed to have mystical ability to counteract poisons and strengthen the vital powers.  By mid-morning he was severely short of breath compelling him to sit upright. By ten he was comatose, and at noon he died.

On Saturday 7th an autopsy was performed, presumably because the illness was unexplained. The results of the autopsy are well documented.

 In Cerebri Cortice Venae et Arteriae supra modum repletae. (The veins and arteries on the brain surface were abnormally full).

Cerebri tum ventriculi omnes serosa quadam materia inundati, tum ipsa substantia consimili humore haud leviter imbuta. (The cerebral ventricles were filled with a kind of bloody material and the brain substance contained a similar humour).

The lungs were Sanguine referta (congested with blood). The heart and abdominal organs were unremarkable.

Crawfurd confidently sums this up with: ‘From these accounts one may assert with considerable confidence that his death was due to chronic granular kidney (a form of Bright’s disease) with uraemic convulsions, ‘He was a large eater and mainly of albuminous food. Alcohol he had taken freely, at times to gross excess: he had been the slave of sexual passion’ (p. 16).

This is manifestly incorrect. At autopsy the kidneys were normal and so Bright’s disease (chronic glomerulonephritis) is most unlikely. Overindulgence in eating, alcohol and sex, although lamentable, rarely results in death. The clinical history sounds like cerebral bleeding, probably subarachnoid. This is due to leakage from an arterial aneurysm, minor at first but irritating to the coverings of the brain. Charles remained conscious and there was no limb weakness. The first subarachnoid haemorrhage has an increased likelihood of a second more catastrophic bleed after a few days, this time into the brain substance. This pattern fits Charles’ clinical course. Just before he died he became severely short of breath. This is likely to have been caused by neurogenic pulmonary oedema, sometimes associated with intracerebral events. Finally, the autopsy findings state that the cerebral ventricles were filled with bloody fluid and a similar kind of material in the brain substance. This is just what would be expected in subarachnoid and secondary intracerebral bleeding.

Who performed the autopsy is not recorded. However, since Richard Lower had much the most experience of intracranial examination after working with Thomas Willis, he must have been involved.

Despite theoretical advances in medical science at this time, practical treatment as shown in the King’s management was still rooted in humoural theory. Towards the end of his illness Charles made his famous remark about being an unconscionable time a-dying, which sounds more like a prayer for deliverance than an apology.

 

Richard Lower’s De Catarrhis and Charles II’s last sneeze.

Monday, May 28th, 2012 | Peter Anstey | No Comments

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.

Richard Lower

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?

Thomas Sydenham’s Tractacus de Podagra

Sunday, May 13th, 2012 | Peter Anstey | No Comments

Terry Doyle writes …

If Thomas Sydenham (1624–1689) were transported to a modern lecture hall to hear a chemical pathologist explaining how gout is caused by the bodies of some individuals being unable to metabolise and excrete uric acid, which is then deposited in the peripheral joints, he would probably mutter to himself, ‘that is just as I thought’. Reading his Tractacus de Podagra of 1683 in Latin is interesting on at least two counts. The first is for the excellent clinical description of gout and the second is the frequent use of Greek text. As Peter Anstey most helpfully pointed out to me, Sydenham wrote only in English and had all his work translated into Latin, and his Tractatus was probably translated by Gilbert Havers or John Mapletoft.

Coming to De podagra as a neophyte in this area, a working doctor is immediately impressed that here one is reading the product of practical experience – obviously Sydenham is very familiar with the various presentations of gout, of which he was, famously, a sufferer himself. He describes the systemic and prodromal symptoms leading up to a full-blown attack of the disease, noting that although it most commonly affects middle aged men, it rarely affects women and then after menopause. He notes that some cases seem to have a hereditary basis and these individuals may be more slender and younger than the stereotypical obese over-imbiber of port wine. Some observations, seemingly inconsequential to the casual reader, are typical of the notes of a working doctor – such as his reference to the desquamation of the skin over a gouty tophus and the fact that although the initial attack affects one joint, later attacks are polyarticular and febrile. The work is sprinkled with such insightful observations.

Sydenham has been frequently referred to as the ‘English Hippocrates’ (see Peter Anstey, ‘The Creation of the English Hippocrates’, Medical History, 2011, 55: 457-78). One justification for this might be that he discusses the disease in terms of the Hippocratic doctrine of humours. If one were to substitute the words ‘uric acid’ for ‘excess of humour’ in De podagra (Sydenham freely admits he has no idea of the nature of this humour) one would have a fair description of the pathophysiology of gout. He says that the body of the sufferer is unable to ‘cook’, ‘separate’ and ‘evacuate’ whatever humour it is, and the products are deposited in the peripheral joints – which is essentially what happens. Secondly, Sydenham follows Hippocrates’ belief in the value of careful observation of symptoms. One of Hippocrates’ aphorisms is that if one listens to patients long enough, they will tell you the diagnosis. Thirdly, both believe that if the doctor can do no good, at least no harm should be done. Thus Sydenham suggests avoiding bleeding and purging, since in his experience they are not only useless but harmful. On the contrary, he found that drinking liberally of non-spirituous fluids (to flush out the renal stones) and partaking of mild sudorifics such as Sarsaparilla are at least helpful to the sufferers.

The other feature of interest in the Latin text of 1683 is the frequent use of Greek words in original script – at total of 37 words or phrases in 130 pages. On the first page he describes gout as ‘naturam δυσνοητον’ meaning ‘difficult to understand’. Most of the words are fairly straightforward like απεψια, αταξια, μιασματα, ανωμαλια. At one point he coyly says that flatus may be evacuated ‘sive ανω sive κατω’ (either upwards or downwards). Some words seem like new coinages, such as γαλατοποσια (a milk drinker) and ποδαγιωντων (of gout sufferers) but they appear in Liddell and Scott. The word ‘podagra’ is derived from the Greek for ‘foot trap’, and is of ancient usage in English. The OED notes that John of Trevisa used it in his De proprietaribus rerum of 1398.

Greek words and text interspersed with Latin in medical books was not new. The first textbook on anatomy published in England, David Edwards’ Introduction to Anatomy of 1532 (facsimile edition edited and translated by C.D. O’Malley and K.F. Russell, Stanford UP, 1961), uses them freely. Edwards was Reader in Greek at Corpus Christi College Oxford in 1521 in addition to studying medicine. Sydenham would have studied Greek as part of his undergraduate course in medicine and his friend John Locke taught Greek for a time. What was the reason for the insertion of Greek words in to Sydenham’s Latin text? None appear to clarify the argument. They seem rather in the nature of literary flourishes, particularly when he refers to Lucian’s play Τραγοποδαγρα (The Gout Tragedy). He may be merely using the professional argot of his medical contemporaries, who mostly had a similar educational background. Modern doctors seem to use baffling acronyms for a similar end.

Three questions remain to be answered. (1) To what extent did Sydenham work in the reference frame of the Hippocratic doctrine of humours? (2) To what extent did 17th century doctors’ knowledge of Greek contribute to medical nomenclature? (3) What was Sydenham’s relationship with Thomas Short to whom Tractacus de Podagra was dedicated? Short took over Richard Lower’s lucrative practice when the Lower fell from Court favour because of his Whig politics. I look forward to hearing from readers who might be able to help with these questions.

Hard words from Thomas Willis

Monday, April 30th, 2012 | Peter Anstey | No Comments

Terry Doyle writes …

In Book I of his Novum organum, Francis Bacon discussed four Idols, or false images of the mind, which he viewed as impediments to scientific reasoning. Of these he considered Idols of the Marketplace, by which he meant the confusion between scientific and common usage of words, to be the most troublesome (see Aphorisms LIX, LX, XLIII).

An attempt to overcome this Idol can be seen in an appendix to the 1681 English language edition of Thomas Willis’s The Anatomy of the Brain and Nerves (as well as in two other 1681 editions of Willis’s work printed for T. Dring et al., Five Treatises and Dr Willis’s Practice of Physick). They were all translated from the Latin by ‘S P Esq’, who styles himself ‘student of physick’. This is Samuel Pordage (1633–1691) a literary figure with a poetical bent who was lampooned in Dryden’s Absalom and Architophel as ‘Lame Mephibosheth’.

The appendix is entitled ‘A table . . . for the benefit of meer English Readers . . . of words derived from the Latin and Greek , usual among Scholars, yet not frequently known of the vulgar’.

The content is interesting on several counts. Firstly, it shows medical words familiar and unfamiliar to an educated mid-seventeenth-century non specialist.  Secondly, it demonstrates the difficulty inherent in translating medical concepts from the Latin and Greek into an English language which was still rapidly adding new technical words to its stock. Thirdly it shows many words of a semi-technical nature, which the seventeenth-century reader would probably recognize but which have lapsed into desuetude.

It is questionable whether Willis actually read the appendix (at least he did not proof read it carefully) for there are several obvious errors; such as ‘sternothyroeidal muscle – reaches from the sternon to the Os Pubis’ [the muscle is actually in the neck]. Some are mysterious; as ‘tabes dorsalis’ [modern day syphilitic myelopathy] is described as ‘mourning of the Chine.’ We can recognize the beginnings of the modern word ‘alkali’ in ‘Sal-alcali – salt of ashes made of the herb Kali, but used also for the salt of other herbs burnt to ashes and so extracted’. This was the standard way of making alkalis at the time.

It is a shame that some of the words have disappeared like; ‘Lethiferous – deadly’; ‘Torrified- parched’; ‘Farciments – stuffings’; ‘Fungitive – prickling’; or ‘Aculeation – made sharp’. Others words are perhaps better forgotten like; ‘Demersed – drowned’; ‘Depauperated – made poor or wasted’; ‘Depuration – a cleansing or making pure’.

Some definitions were clearly difficult for Pordage – like; ‘Mediastinum – the thin membrane that divides the middle belly or the Breast, from the Throat to the Midriff, into two bosoms or hollows’ and ‘Conarium – A Kernel sticking to the outside of the Brain in the form of a Pine-apple’ [probably referring to the pineal gland]. Others are quite straight forward; ‘anus’- fundament or Arse-hole [with a capital A]. ‘Archeus – the chief operator’ is there, indicating the influence of van Helmont, while ‘Trachea – the Weasand or Wind pipe, the sharp artery’ encompasses the then current Old English name Weasand, while ‘the sharp artery’ echoes the Greek αερ τηρεω (air, I carry) and τραχυς (rough).

My ongoing project is to identify more precisely which words in Willis’s Latin text gave difficulty in translation and the provenance of the archaic English words in OED. If you can help I would be keen to hear from you.