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Empirical Physicians vs Experimental Physicians

Alberto Vanzo writes…

As we have already noted on this blog, “empiricism” was mainly used as a medical term in the early modern period. It referred to empirical physicians, a movement that had its origins in ancient Greece. Greek empirical physicians claimed that our knowledge of medical cures derives entirely from experience and derives its justification from experience. It does not derive from any insight into “hidden natures, causes, and actions, not open to observation, but only accessible to reason, e.g., atoms, invisible pores, functions of organs, or essences” (Michael Frede).

These views of ancient empirical physicians were remarkably close to those of the early modern physicians who were associated with the experimental philosophy. They too rejected reasonings from principles and speculations on hidden essences and claimed to derive their cures from experience alone. The early moderns were conscious of this similarity between ancient empirical physicians and modern experimental physicians. They acknowledged that, since empirical physicians relied on “experiments” (that is, experience), their teachings contain “something that is certaine & experimentall” (Hartlib Papers).

In the light of this, it is puzzling that the upholders of the “experimentall” approach to medicine used to criticize medical empiricism and empirical physicians. They generally accepted the then common association of empirical physicians with “Mountebanks, pretended Chymists, Apothecaries, Chirurgeons, Midwives, &c. in which piece of Folly the English surpass all the Nations of Christendom.”

To be sure, there were some cases in which early modern experimental physicians praised ancient medical empiricism, portraying it as a forerunner of experimental medicine. But as far as I know, these were rare exceptions. Why were they exceptions and not the rule? Why did experimental physicians see themselves as opponents, rather than followers, of medical empiricism?

I have found some answers to these questions in the writings of two prominent eighteenth-century physicians. They are the German physician Friedrich Hoffman, a leading systematist of the early eighteenth-century, and the Scottish physician John Gregory, who taught at Edinburgh in the latter half of the century. They both associate medical empiricism with the application of medicines that happened to work in past cases to patients which display similar symptoms. This approach was epitomized in the “empirical books” that were compilations of medical recipes and cures for all sorts of diseases. According to Gregory, this approach raises two problems.

Firstly, it relies on experience in the wrong way. Empirical physicians rely on the recipes that have been shown to work by experience, but true physicians should also rely on experience to improve their remedies and practice.

Secondly and more interestingly, empirical physicians did not pay sufficient attention to experience. They did not carefully inquire into the circumstances of individual patients. Instead, having noted few symptoms, they hastily prescribed a familiar remedy. As Hoffmann pointed out, this “obtuse and most dangerous empiria” was deeply flawed because the “efficacy of a cure” does not reside in the nature of a remedy, but in the way in which the remedy interacts with the specific circumstances of a patient. In Gregory’s words, since “empirics” paid insufficient attention to those circumstances, “notwithstanding their pretensions of relying upon experience alone, have in truth abandoned it”.

Gregory’s preferred alternative to this flawed medical empiricism was what appears to be, broadly speaking, an application of the Newtonian experimental method to medicine. Gregory praised a medical theory that “is produced by practice, is founded on facts alone, and constantly appeals to them for its truth”. He rejected the use of hypotheses, considered as principles devoid of “proof from experience”. He advocated their use, as long as they were “proposed in the modest and diffident manner that becomes mere suppositions or conjectures”, that is, queries. Used in this way, hypotheses “are not only harmless but even necessary in establishing a just theory in medicine”. Gregory portrayed this experimental method as an alternative to medical empiricism. Only one century later, after “empiricism” took on a new meaning, did it come to be regarded as a positive stance even within medicine.

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