first published writing, only recently identified. This work, apparently
written in 1649, bore the title "An Invitation to a free and generous
communication of Secrets and Receits in Physick," and appeared
anonymously in 1655 as part of a volume entitled _Chymical, Medicinal
and Chirurgical Addresses Made to Samuel Hartlib, Esquire_.[40] For our
purposes, it is significant as emphasizing his early interest in
medicine.
Boyle seems to have acquired most of his medical knowledge between, say,
1649 and 1662. It is worth recalling some of the trends and conflicts
that formed the medical environment during this period. Among the major
trends, first place, perhaps, must be given to Galenic doctrine, which
had come under progressively severe attack. Molière, who lived from 1622
to 1673, showed in his comedies the popular reaction to a system which,
although dominant, was clearly crumbling. The cracks in the edifice even
the layman could readily see. Nevertheless, Galenism had its strong
supporters. Riverius, who lived from 1589 to 1655, was a staunch
Galenist. An edition of his basic and clinical works[41] was translated
into English in 1657, and Latin editions continued to be published well
into the eighteenth century.[42]
Galenism, of course, had to withstand the great new discoveries in
anatomy and physiology made by Vesalius, Aselli, Sanctonius, Harvey, and
others, not to mention the host of great investigators who were more
strictly contemporaries of Boyle.
Galenism also faced the rivalry of chemistry. The so-called "antimony
war" in the earlier part of the century marked an important assault on
Galenism, and the letters of the arch-conservative Guy Patin (who died
in 1672) help us appreciate this period.[43] However, even more
important was the work of van Helmont, who developed and extended the
doctrines of Paracelsus and represented a major force in
seventeenth-century thought. Boyle was well acquainted with the
writings of van Helmont, who, although his works fell into disrepute as
the mechanical philosophy gradually took over, nevertheless in the
middle of the seventeenth century was a highly significant figure. In
1662 there appeared the English translation of his _Oriatrike_,[44]
while Latin editions continued to be published later in the century.
In this connection I might also mention the subject of "natural magic,"
which had considerable significance for medicine. The best-known name
is, perhaps, Giovanni Battista della Porta (1545-1615), whose books[45]
continued to be published, in Latin and English, during this period when
Boyle was achieving maturity.
Profound developments, of course, arose from the new mechanics and
physics and their metaphysical background, for which I need only mention
the names of Descartes, who died in 1650, and Gassendi, who died in
1655. And then there was also the new methodological approach, that
critical empiricism whose most vocal exponent was Francis Bacon, which
led directly to the founding of the Royal Society in 1660 and its
subsequent incorporation. These phases of seventeenth-century thought
and activity I do not intend to take up.
In this turbulent riptide of intellectual currents, Robert Boyle,
without formal medical education, performed many medical functions, as a
sometime practitioner, consultant, and researcher. Repeatedly he speaks
of the patients whom he treated, and repeatedly he refers to
practitioners who consulted him, or to whom he gave advice. In addition,
through his interest in chemistry, he became an important experimental
as well as clinical pharmacologist, and his researches in physiology
indicate great stature in this field. If we were to draw a present-day
comparison, we might point to investigators who had both the M.D. and
the Ph.D. degrees, who had both clinical and laboratory training, and
who practiced medicine partly in the clinical wards, partly in the
experimental laboratories. Boyle, of course, did not have either degree,
but he did have a status as the leading virtuoso of his day.
The virtuoso has been the subject of a most extensive literature.[46] He
aroused considerable contemporary hostility and satire and his overall
significance for medical science is probably slight, with a few striking
exceptions. Robert Boyle is one of the great exceptions.
First of all, the virtuoso was an amateur. In the literal sense the
amateur loves the activities in which he engages, and in the figurative
sense he remains independent of any Establishment. Not trained in any
rigorous, prescribed discipline, he was not committed to any set
doctrine. Furthermore, he was not restricted by the regulations which
all Establishments employed to preserve their status, block opposition,
and prevent competition. In many fields the Establishment took the form
of a guild organization--in medicine, the Royal College of
Physicians.[47]
Boyle was a wealthy and highly talented man who could pursue his own
bent without needing to make concessions merely to earn a living. He
remained quite independent of the cares which oppressed those less well
endowed in worldly goods or native talent. Sometimes, of course,
necessity can impose a discipline and rigor which ultimately may serve
as a disguised benefit, but in the seventeenth century, when Boyle was
active, the lack of systematic training and rigorous background seemed
actually an advantage. Clinical chemistry and the broad areas which we
can call experimental medicine had no tradition. Work in clinical
chemistry, clinical pharmacology, and experimental physiology was
essentially innovation. And since innovations are often made by those
who are outside the Establishment and not bound by tradition, we need
feel no surprise that the experimental approach could make great
progress under the aegis of amateurs. Necessarily the work was rather
unsystematic and undisciplined, but system and discipline could arise
only when the new approach had already achieved some measure of success.
Through the casual approach of amateurs this necessary foundation could
be built.
Boyle, as a clinician, remained on excellent terms with medical
practitioners. For one thing, he took great care not to compete with
them. As stated,[48] he "was careful to decline the occasions of
entrenching upon their profession." Physicians would consult him freely.
As a chemist and experimental pharmacologist, he prepared various
remedies. Some of these he tried out on patients himself, others he gave
to practitioners who might use them. Boyle seems to have abundantly
provided what we today call "curbstone consultations."
In no way bound by guild rules and conventions or by rigid educational
standards, Boyle was free to learn from whatever sources appealed to
him. Repeatedly he emphasized the importance of learning from
experience, both his own and that of others, and by "others" he included
not only physicians and learned gentlemen, but even the meanest of
society, provided they had experience in treating disease. This
experience need not be restricted to treatment of humans but should
include animals as well. Thus, in speaking of even the "skilfullest
physicians," he indicated that many of them "might, without
disparagement to their profession, do it an useful piece of service, if
they would be pleased to collect and digest all the approved experiments
and practices of the farriers, graziers, butchers, and the like, which
the ancients did not despise...; and ... which might serve to
illustrate the _methodus medendi_."[49] He was quite critical of
physicians who were too conservative even to examine the claims of the
nonprofessionals, especially those who were relatively low in the social
or intellectual scale. This casts an interesting sidelight on the
snobbishness of the medical profession.
Boyle's willingness and ability to ignore the restrictions of an
Establishment represent the full flowering of what I might call the
Renaissance spirit--the drive to go outside accepted bounds, to
explore, to _try_, to avoid commitment, and to investigate for oneself.
What internal and external factors permit a successful breakaway from
tradition? Rebels there have always been, yet successful rebels are
relatively infrequent. The late seventeenth century was a period of
successful rebellion, and the virtuosi were one of the factors which
contributed to the success. Robert Boyle played a significant part in
introducing new methods into science and new science into medicine.
We must realize that Boyle was primarily a chemist and not a biologist.
He thought in chemical terms, drawing his examples from physics and
chemistry; he did not think in terms of the living creature or the
organism, and as a mechanist he passed quite lightly over the concept or
organismic behavior. His basic anti-Aristotelianism prevented his
appreciating the biologically oriented thought of Aristotle. Instead,
Boyle talked about the inorganic world, of water, of metals and
elements, of physical properties. He ignored that inner drive which
Spinoza called the _conatus_; or the _seeds_ of Paracelsus or van
Helmont; or the persistence over a time course of any "essence" or
"form." Since he dealt with phenomena relatively simple when compared
with living phenomena, he could, for this very reason, make progress, up
to a point. As a chemist, he could seek fairly specific and precise
correlations of various concrete environmental factors, and then assume
that living beings behaved as did the inorganic objects which he
investigated. However, he always excepted the soul of man, as outside
his investigations.
But while Boyle was a skillful chemist, judged by the standards of his
time, we cannot call him a skillful medical investigator. This
represents, however, the fault of the era in which he lived rather than
any fault peculiar to him. Boyle's medical studies fall into at least
two categories. These were the purely physiological experiments, such as
those on respiration or on blood, and the more clinical experiments,
concerned with pharmaceuticals, clinical pharmacology, and clinical
medicine. The purely physiological experiments have great merit and were
profoundly influential in shaping modern physiology. The clinical
experiments throw great light on the development of critical judgment in
medical history, and the relations of judgment and faith.
In 1775, John Hunter wrote a letter to Jenner that has become quite
famous. Hunter had just thanked Jenner for an "experiment on the
hedgehog." But, continued Hunter, "Why do you ask me a question by way
of solving it? I think your solution is just, but why think? Why not try
the experiment?"[50] The word "just," of course, in its
eighteenth-century sense, means exact or proper, precise or correct. A
"just solution" is one that is logically correct. The "think" refers to
Hunter's own uncertainty. He is not content with a verbal or logical
solution to a problem, he wants empirical demonstration. Why, he is
asking, should we be content with merely a logically correct solution
when we can have an experiential demonstration. _Try the experiment._
Put the logical inference to the test of experience.
This empirical attitude, not at all infrequent in the latter
eighteenth-century medicine, was quite unusual in the seventeenth-century
medicine. This was precisely the attitude that Robert Boyle exhibited in
his clinical contacts.
Medicine, at least textbook medicine, was rationalistic. Textbooks
started with definitions and assertions regarding the fundamentals of
health. This we see particularly in a Galenic writer such as Riverius.
Medicine, he said, "stands upon the basis of its own principles, axioms
and demonstrations, repeated by the demonstration of nature."[51] In his
text, Riverius first expounded a groundwork concerning the elements,
temperaments and humors, spirits and innate heat, the faculties and
functions; then the nature of the diseases which resulted from
disturbances of these; and finally the signs of disease and the
treatment that was appropriate. All were beautifully interdigitated in a
logical fashion, and for any recommended therapy a good reason could be
found. There was, however, a serious difficulty. If anyone were so bold
as to ask, _But how do you know?_ only a rather lame answer would come
forth. The exposition rested in large part on authority or else largely
on reasoning from accepted premises--a "just" reasoning. And while much
keen observation was duly recorded and a considerable mass of fact
underlay the theoretical superstructure, the idea of empirical proof was
not current. Riverius chopped logic vigorously and drew conclusions from
unsupported assertions in a way that strikes us as reckless.
For a body of knowledge to be a science, it must indicate a logical
connection between first principles, which were "universal," and the
particular case. The well-educated physician could always give a logical
reason for what he did. The empiric, however, was one who carried out
his remedies or procedures without being able to tell _why_. That is, he
could not trace out the logical connection between first principles and
the particular case.
Galenism suffered especially from logical systematization, and the
system of van Helmont, while far less orderly, also had its own basic
principles on which all else depended. Boyle, however, practiced
medicine on a thoroughly different basis. He did not depend on system or
logic. In the words that Hunter used to Jenner over a hundred years
later, other physicians would _think_ the answers to their problems.
Boyle, however, preferred to _try the experiment_. He wanted _facts_.
But this attitude, which sounds so modern, so praiseworthy and
enlightened, had one serious flaw. What _was_ a fact? And how did you
know? This important problem, so significant for the growth of
scientific medicine, we can study quite readily in the works of Robert
Boyle.
The problem, in a sense, resolves around the notion of credulity. What
shall we believe? Boyle makes some distinctions between what he has seen
with his own eyes and what other people report to have seen. Thus, he
mentions "a very experienced and sober gentleman, who is much talked of"
who cured cancer of the female breast "by the outward application of an
indolent powder, some of which he also gave me." But, he adds
cautiously, he has not yet "had the opportunity to make trial of
it."[52] Clearly, since he cannot make the trial himself, Boyle
withholds judgment, even though the material came from a "very
experienced" gentleman. Or again, he talks about "sober travelers" who
made certain claims regarding the treatment of poisons. But, he says,
"having not yet made any trial of this my self, I dare not build upon
it."[53]
There are numerous such instances, scattered throughout his works, where
he reports an alleged cure but specifically indicates his own mental
reservations. Clearly, he is quite cautious in accepting the statements
of others, even though they were "sober" or "experienced" or even
"judicious." On the other hand, he is extremely uncritical when he
himself uses the term "cure" and when he attributes cures to particular
medicines.
His skepticism he indicates in references, for example, to Paracelsus
and van Helmont. Their specific remedy against "the stone," he says, and
their claims that they can reduce stones to "insipid water, is so
strange (not to say incredible) that their followers must pardon me, if
I be not forward to believe such unlikely things, til sufficient
experience hath convinced me of their truth."[54] Here, of course, we
see further a feature of critical acumen. A claim is made, but if this
claim runs counter to Boyle's own accepted body of knowledge, or to
logical doctrines derived from other directions, mere assertion cannot
carry conviction. "Sufficient experience" must play its part, and just
what constitutes "sufficient" we are not quite sure.
In judging the effectiveness of a remedy or the credibility of a
statement, one of the most important weapons was _analogy_. Direct
observation of a phenomenon was good. Next best was direct observation
of some _analogous_ phenomenon whereby one body acted upon another to
alter its properties or induce significant changes. Boyle drew his
analogies largely from chemistry, but he had no hesitation in applying
them to medicine.
Claims that medicines swallowed by mouth could dissolve stones in the
bladder seemed a priori unlikely. Yet there was considerable authority
that this took place; many persons had reported that this was a _fact_.
Boyle kept an open mind. He might be highly skeptical in regard to the
claims for any particular medication, but he did not deny the principle
involved. The possibility that some fluid, when swallowed, could have a
particular specific action on stones in the bladder, without affecting
the rest of the body, he considered quite plausible through the analogy
that quicksilver has an affinity with gold but has no effect upon iron.
Furthermore, a substance than can corrode a solid body may nevertheless
be unable to "fret" a different body which is considerably softer and
thinner, if the "texture" does not admit the small particles.[55]
Reasoning by analogy served to explain the logical plausibility. In
other words, he was very open-minded. He refused to dismiss all such
claims, and provided analogy as a reason for keeping his mind open; yet
he refused to accept particular claims of medicine that dissolved
stones, because the evidence was not convincing. We could scarcely ask
for more.
An important seventeenth-century medical document was the report of Sir
Kenelm Digby, regarding the so-called "weapon salve." The essay
describing this famous powder was written in 1657, and I have discussed
it at some length elsewhere.[56] Here again Boyle keeps an open mind,
saying, "and if there be any truth in what hath been affirmed to me by
several eye-witnesses, as well physicians as others, concerning the
_weapon-salve_, and _powder of sympathy_, we may well conclude, that
nature may perform divers cures, for which the help of chirurgery is
wont to be implored, with much less pain to the patient, than the
chirurgeon is wont to put him to."[57]
One great advantage of chemistry, thought Boyle, lay in the help it
provided in investigating the _materia medica_. Chemistry, he thought,
could help to purify many of the inorganic medicines and make them
safer, without impairing their medicinal properties. Furthermore,
chemistry could help investigate various medications customarily
employed in medicine, where "there hath not yet been sufficient proof
given of their having any medical virtues at all."[58] Boyle believed
that by proper chemical analysis he could isolate active components, or,
contrariwise, by failing to extract any valuable component, he could
eliminate that medicine from use. While a major interest, perhaps, was a
desire to provide inexpensive medicines, he was well aware that much of
what went into prescriptions probably had no value. Furthermore, he felt
that his chemical analysis could indicate whether value and merit were
present or not.
The same skepticism applies to remedies that, far from being expensive,
were common and yet rather disgusting. The use of feces and urine as
medication was widespread. The medical virtues of human urine represent,
he believed, a topic far too great to be considered in a brief compass.
But he declared that he knew an "ancient gentlewoman" suffering from
various "chronical distempers" who every morning drank her own urine,
"by the use of which she strangely recovered."[59] Boyle was quite
skeptical of the reports of others, which he had not had opportunity to
try himself. But in therapeutic trials that he himself had witnessed, he
seemed utterly convinced that the medication in question was responsible
for the cure and was quite content to accept the evidence of a single
case.
He discussed the "efficacy" of millepedes, which he found to be "very
diuretical and aperitive." And he indicated, on the evidence of a single
patient whom he knew, that the millepedes had great medicinal value in
suffusions of the eyes.[60]
Many remedies of this type, the so-called old wives' remedies, were
those of empirics. As mentioned previously, Boyle felt deeply concerned
because physicians tended to ignore the alleged remedies of those who
had not had formal training in medicine. He believed that great specific
virtue probably lurked in many of these remedies, and he maintained that
the chemists should investigate them without the prejudice that the
medical professions exhibited. As part of this view, he felt that
"simples" should be more carefully studied, because medicinal virtues
inhered in single substances and that complicated combinations were
unnecessary.
We find innumerable examples scattered through Boyle's writings
regarding the relations between chemistry and medication, numerous
descriptions of cures, and skepticism regarding other alleged cures. As
an important example, I would indicate Boyle's discussion of one of van
Helmont's alleged cures.[61]
Van Helmont described the remarkable cures brought about by a man
identified only by the name of Butler. Apart from van Helmont's
discussion, we can find no trace of him in medical annals, and van
Helmont's own account is extremely skimpy. There are no dates given, and
the only temporal clue is that Butler apparently knew King James--King
James I, naturally. Butler was an Irishman who suddenly came into world
view while in jail. A fellow prisoner was a Franciscan monk who had a
severe erysipelas of the arm. Butler took pity on him, and to cure him
took a very special stone which he had and dipped it briefly in a
spoonful of "almond milk." This he gave to the jailer, bidding him
convey a small quantity of it into the food of the monk. Almost
immediately thereafter, the monk, not aware of the medicine, noted an
extremely rapid improvement.
Van Helmont related other cures. For example, a laundress who had a
"megrim" [migraine] for sixteen years was cured by partaking of some
olive oil, into a spoonful of which Butler dipped the stone. Other cures
for which van Helmont vouched included a man who was exceedingly fat; he
touched the stone every morning with the tip of his tongue and very
speedily lost weight. Van Helmont's own wife was cured of a marked
edema of the leg. Similarly, a servant maid who had had severe attacks
of erysipelas which were "badly cured," and the leg leaden colored and
swollen, was cured almost immediately. An abbess, whose arm had been
swollen for eighteen years, partly paralyzed, was also cured. Van
Helmont, however, indicates that he himself, when he thought he was
being poisoned by an enemy, did not secure any benefit from the use of
the stone. Later, however, it turned out that, because of the nature of
the illness, he should have touched the stone with his tongue, to take
its virtue internally, rather than merely anointing the skin with oil
into which the stone had been dipped.