In that war for the conquest of knowledge the central battle is that of life against death—a battle which individually is always lost and collectively is regularly won. In fighting disease and pain the physicians and the hospitals had many human enemies: personal uncleanliness, public filth, noisome prisons, quacks with magical potions, “scientific” mystics, hernia setters, stone melters, cataract couchers, tooth drawers, amateur uroscopists. And new diseases ran a race with new cures.
Leprosy had disappeared, and protective devices had reduced syphilis; Fallopio had invented (1564) a linen sheath against such infection. (This soon came to be used as a contraceptive and was sold by barbers and bawds.54) But epidemics of typhus, typhoid fever, malaria, diphtheria, scurvy, influenza, smallpox, and dysentery appeared in several countries of Europe in this period, especially in Germany. Probably exaggerated figures report 4,000 deaths from a plague of boils in Basel in 1563–64; twenty-five per cent of the inhabitants of Freiburg-im-Breisgau carried off by plague in 1564; 9,000 in Rostock and 5,000 in Frankfurt an der Oder in 1565; 4,000 at Hanover and 6,000 at Brunswick in 1566.55 Terrified citizens ascribed some plagues to deliberate poisoning; at Frankenstein, in Silesia, seventeen persons were burned to death on suspicion of “strewing poison.”56 In 1604 the bubonic plague was so severe in Frankfurt am Main that there were not enough people to bury the dead.57 These are palpable exaggerations; but we are told, on good authority, that in a recurrence of the bubonic plague in Italy, 1629–31, Milan lost 86,000 and “no less than 500,000 died in the Venetian Republic…. Between 1630 and 1631 there were 1,000,000 victims of the plague in northern Italy alone.”58The fertility of women barely kept up with the resourcefulness of death. Childbirth was made doubly painful by its frequent futility; two fifths of all children died before completing their second year.59 Families were large, populations were small.
Public sanitation was improving, hospitals were multiplying. Medical education was taking a more rigorous form—though one could still practice medicine without a degree. Bologna, Padua, Basel, Leiden, Montpellier, Paris had famous medical schools drawing students from all Western Europe. We have a peculiar example of patient medical research in the thirty years of experiment by which Sanctorius tried to reduce physiological processes to quantitative measurement. He did much of his work while sitting at a table on a large scale; he recorded the changes in his weight from the intake and the outlet of solids and liquids, and he even weighed his sweat. He found that the human body gives off several pounds daily through normal perspiration, and concluded that this is a vital form of elimination. He invented a clinical thermometer (1612) and a pulsimeter as aids to diagnosis.
Therapy was graduating from toads to leeches. Some reputable physicians prescribed dried toads, sewn in a bag and hung on the breast, as a trap to catch and absorb the poisonous air that surrounded the body in plague areas.60 Bloodletting by leeches or cupping was combined with plentiful drinking of water, on the theory that some of the intaken fluid would form fresh uninfected blood. Two schools of treatment contended for the victim: the iatromechanical, stemming from Descartes’ teaching that all bodily processes are mechanical; and the iatrochemical, originating with Paracelsus, developed by Helmont, and interpreting all physiology as chemical. Hydrotherapy was popular. Curative waters were taken at England’s Bath, the Netherlands’ Spa, France’s Plombières, and a dozen places along the Rhine and in Italy; we have seen Montaigne trying them and shedding stones on the way. New drugs like valerian (c. 1580), antimony (c. 1603), ipecac (1625), and quinine (1632) were introduced to Europe. The London pharmacopoeia of 1618 listed 1,960 drugs. Montaigne tells of special treats which a few doctors kept for patient patients:
the left foot of a tortoise, the urine of a lizard, an elephant’s dung, a mole’s liver, blood drawn from the right wing of a white pigeon, and, for us who have the stone … the pulverized droppings of a rat; and such other tomfooleries that are more suggestive of magic and spells than of a serious science.61
Such delicacies were impressively expensive, and people in the seventeenth century moaned over druggists’ charges more than over doctors’ bills.62
Dentistry was left to barbers and consisted almost entirely of extractions. The “barber-surgeons” now included skilled practitioners like Ambroise Paré, François Rousset, who revived the Caesarean section, and Gasparo Tagliacozzi, specialist in the plastic reconstruction of ears, noses, and lips. He was condemned by moralists for interfering with the handiwork of God; his corpse was exhumed from consecrated ground and was buried in unhallowed soil.63 Wilhelm Fabry, “father of German surgery,” was the first to recommend amputation of a limb above the diseased part; and Giovanni Colle of Padua gave the oldest known description of a blood transfusion (1628).
As in every age, the patients resented the doctor’s fees; the comedians laughed at his long robe, red shoes, and bedside gravity. If we trust the satires of the comic dramatists, his social status was not much above that of the teacher; but when we note the history of Rembrandt’s Anatomy Lesson we perceive a class of men holding a respected position in society and able to pay well for even a share in a great picture. And the most famous philosopher of the age, dreaming like all of us of a better future for mankind, thought of this as depending upon the improvement of human character, and of medical science as the likeliest agent of this basic revolution. “For even the mind,” said Descartes, “depends so much on the temperament and disposition of the bodily organs that if it is possible to find some means by which men might commonly be made wiser and abler … I believe it is in medicine that it ought to be looked for.”64