In his Traité de l'esprit de l'homme (1664), Louis de La Forge, one of Descartes' early followers, wrote:

De La Forge's argument is an interesting one. He begins with two premises. The first is the doctrine of divine sustenance, that God must sustain the existence of every body, indeed, of every thing, mind or body, at every moment of its existence. Second, de La Forge assumes as a result, it would seem, that God causes motion in the material world by re-creating bodies in different places at different times. From this de La Forge draws the conclusion that only God can move a body. When God sustains bodies, He must sustain them in some place or other; He cannot sustain them everywhere, nowhere, or in any way independently of some place or other.

The history of philosophy seems to play a very significant role in the actual practice of philosophy; historical figures come up again and again in the courses we had to take, both as undergraduates and as graduate students, and historical figures continue to come up again and again in the papers we read, the courses we teach, the conferences we attend. Philosophy seems to be a subject that is obsessed with its past, but it is more than just an obsession. Most of us would agree that understanding the history of philosophy is somehow important to doing philosophy, that we are better philosophers for knowing the history of our subject. I think that this is true. As philosophers, we have an obligation to ourselves to reflect on this fact: why is history important to our enterprise, and how is history important to our enterprise?

This is what I would like to do in this short essay, make some observations about the ways in which history of philosophy can and does influence the practice of philosophy. I shall begin by discussing the view of history found in Jonathan Bennett's recent and already enormously influential book, A Study of Spinoza's Ethics. I have chosen to talk about that book in good part because it is, I think, the best representative of a certain genre of writing in the history of philosophy; Bennett nicely articulates a view of the history of philosophy that is widespread among writers on the subject, particularly those writing in English.

SUMMARY

As the Introduction indicated, this is the point in the book where a historiographical switch occurs, with more attention being paid to the history of controversies and to the need to be aware of the themes of the ‘grand narrative’ of history. Nevertheless, the topics of the previous chapters, which were examined in terms of more continuous and ‘placid’ history, are also extremely important for understanding the focus of the next two chapters: the Helmontian enterprise to establish a revolution in therapeutics in England and its failure.

After leading the reader into the 1660s, the height of Helmontian influence, I discuss how the changes in natural philosophy were seen as affecting medicine, it being generally agreed that the former underpinned the latter. In their programme for reforming medicine Helmontians argued that, as the foundations of medicine had been destroyed, so the theories of disease and therapeutics that had been built upon them (especially the cure by contrary quality) should be pulled down and new ones erected on a surer base. The Helmontians also used less intellectual and more emotive and vituperative arguments, for instance, Galenic medicine's therapeutic failure, and its cruelty and lack of Christian charity. In particular, the evacuative procedures of bleeding, purging, etc., which were essential parts of Galenic therapeutics, were attacked as cruel, un-Christian and harmful. They should be replaced, argued the Helmontians, by their own powerful yet safe remedies.

INTRODUCTION AND SUMMARY

The disease regime of England changed between the early modern period and the present day, from one where acute infectious diseases were predominant to one where the chronic illnesses of middle and old age came to the fore. Also, new diseases have appeared whilst others have disappeared, and, in general, it can be difficult to be sure that diseases can be properly identified from past descriptions. Nevertheless, despite these major caveats we can have a hazy, if not precise, certainty that we still share today many of the ills of sixteenth- and seventeenth-century England. And even if the diseases are different, the pains and disabilities of illness and the outcomes of recovery, chronic suffering or death experienced by the sick are recognisable across the centuries, though the environment of illness has moved from home to hospital and though many of the cultural meanings of illness have changed.

This makes the history of diseases relevant and interesting to the present. Historical demographers have assessed the impact of diseases like plague and smallpox upon populations in the past, whilst in recent years medical historians have explored the world of illnesses from the patient's point of view. However, less is known about early modern perceptions of the range of ill conditions, illnesses and diseases, of lay people's ability to diagnose illness, and of the way medical writers constructed images of disease within the body using anatomical signposting.

SUMMARY

Advice on how to live healthily and prolong life aroused great interest amongst the literate public, if the numbers of books devoted to the subject are anything to go by. They were addressed to the middling and upper sections of society, and did not claim, as did works on therapeutics, to be necessary for everyone. Moreover, despite the interest in prevention, it was widely acknowledged that few took up the advice, a paradox that is still present today. Preventive medicine was therefore limited in its ostensible scope; it was, in a sense, the luxury end of medicine. It provided for a choice of diet and lifestyles for those who had the means to make choices that were not so available to the poor; for instance, whether to eat meat and vegetables. But it was also an important part of medical and surgical treatment, for rules on diet, exercise, etc. were relevant for the ill as well as the healthy. It was also one of the primary means whereby the principles and ethos of learned medicine were spread to the literate part of the population, thus helping to create a unified medical culture, with lay writers in turn also taking part in this process. Medical knowledge about health was transferred to readers who were expected then to apply it to themselves.

INTRODUCTION AND SUMMARY

The question to be asked is, ‘Why did the Helmontians fail?’ On the face of it, not to have to keep to the stringent diets of Galenic medicine would seem to have been a relief. Pleasant and mild medicines and the elimination of painful procedures should also have been especially attractive to medical consumers. Who would not have wanted to avoid the use of vesicatories ‘or Raisers of small and great Blisters, by irksome fretting, if not venomous Plaisters, sometimes flaying off as all the skin from the backs, otherwhiles the shoulders, leggs or wrists, the neck, head etc to extream torments, especially when those raw places are rub'd and irritated for diversion of venomous inflammations, hidious Curses and Excrations having been noted the impatient Effects of such cruelties’? Or what patient would welcome the prospect of the ‘tearing and rending’ of vomiting drugs, or the threat to modesty of clysters or enemas ‘by the odd position and Distastful handling of the body’? And yet, the Helmontians' enterprise of a new medicine did fail, and if we believe the comments of Helmontians themselves, this failure was due in large part to patient resistance to their particular brand of medicine.

In this chapter I first consider the Helmontian attack on Galenic regimen which helped to make Galenic medicine distinctive.

Anthropologists used to spend years immersing themselves in the life of small foreign communities in order to bridge the unbridgeable cultural gulf that existed between themselves and the people they studied. What they did with that transfer of cognition lay usually along a spectrum represented at one end by the persona of the naïve observer who tries to retell to the home audience what the alien society is like, and at the other by the theoretician who draws upon the material he or she has collected to reconstruct social structures. Influencing all the points along the spectrum are the present-day concerns and interests of the anthropologist's own society.

Like the ‘naïve’ observer I have tried to recreate the knowledge and practice of that foreign culture: early modern medicine. The subject has been strangely neglected whilst the new discipline of the social history of medicine has been redrawing and enriching our understanding of early modern medicine. Old Whiggish notions of concentrating solely upon what appears to be ‘rational’ and progressive in a modern sense have been abandoned, as has the emphasis on elite professional groups. Instead, demographic studies have uncovered the facts of life and death for the population, the experiences of patients, the poor and women have emerged to the foreground, and the wider cultural and political contexts to medicine have been explored.

INTRODUCTION

This chapter gives the background and context to the rest of the book. It sets out some of the basic findings of historical demographers on mortality and morbidity in early modern England (c. 1550–c.1700). It then sketches in the wide range of medical provision patients could use as described by recent work in the social history of medicine, and discusses how medicine co-existed with the other healing main resource, religion. Finally, the texts that communicated medical knowledge and practice are considered. Most were written in English and this helped to create a literate medical culture that both recognised popular–elite distinctions and accepted that educated lay people and practitioners could share in a common medical culture.

LIFE AND DEATH

Our Clocks of Health seldome go true: those of Death more certaine than beleeved.

Medical writers and practitioners in the early modern period lived in a world where disease and death were ever present, or so it seemed. Death was highlighted in the Christian teaching that emphasised the need to be constantly prepared for death. Illness was ‘the messenger of death’, and the devout declared that ‘every day shall be as my dying day’. However, not all age groups were equally at risk of dying.

Death especially dogged the footsteps of the young. Early modern England had higher infant mortality rates than many Third World countries today, although those in continental Europe and Scotland were worse.

INTRODUCTION AND SUMMARY

Much early modern surgery dealt with cutting out disease by excision or amputation or with mechanical repairs such as setting bones or putting dislocations back in place. It possessed methods such as dressing, bandaging and stitching which helped to heal the effects of accidents, war and surgery. Surgeons were in constant demand. The damage caused by disease, by a variety of accidents at home or at work, as in farms or the fulling and tanning mills, and by falls from horses, the standard mode of transport, all provided a steady stream of clients. Surgeons also treated burns, which were especially frequent amongst young children and the elderly, who often fell into unguarded fires in their homes. Since Hippocratic times, war had been thought to provide excellent training for surgeons, and they did not hesitate to boast of their battlefield experience. Knife wounds and contusions from blunt instruments were repaired by surgeons, as was the new type of wound from gunshot, which resulted from the fact that ‘Man in every age doth devise new instruments of death … we have in our age, Gun-shot, the imitation of God his thunder; but the example is more fierce, and sendeth more souls to the devil, than the pattern.’

The body's outer covering also lay within the province of the surgeon, who applied topical medicines, cauteries of burning iron or corrosives, or the knife to the growths and blemishes that appeared on the skin, such as ulcers, tumours, swellings, spots and discolourations.

SUMMARY

The next two chapters are about plague, the most multifaceted of early modern diseases. Its fatal impact upon the population has aroused the interest of demographers, whilst social, religious and medical historians have examined the complex and often interrelated responses that it elicited. The medical understanding of the cause and spread of plague and of how to prevent and treat it was disseminated to the literate part of the population by numerous plague treatises, and by the advice of the College of Physicians appended to the Plague Orders (first issued in 1578 and unchanged until 1666), together with the Orders themselves and other national and local regulations which justified measures on medical grounds. After discussing the people whom medical writers believed were most liable to contract plague, I will consider a central issue: whether it was thought possible that plague could be treated. This basic question has been generally ignored by historians. As the answer was a qualified yes, the accounts about how the plague entered the body and where it came from were not put forward in the context of fatalistic despair. In chapter 7, the focus will be on the practical advice given on preventing plague and on the instructions on how to treat it.

Both chapters show that traditional medical knowledge from the regimen genre and from well-established theories of disease causation is prominent in the medical understanding of the plague.

INTRODUCTION AND SUMMARY

Plant, animal and mineral remedies were central to therapeutics in the sixteenth and seventeenth centuries. They were ‘the principall part of Physick’: they formed a large part of the published medical literature, and they constituted practically the only type of medical information that lay men and women set down on paper. Their numbers were immense: the whole of the natural world seemed to comprise a vast repository of remedies. Scripture gave credence to the Greek and Arabic use of nature for remedies, for as Ecclesiasticus 38.4 put it, ‘The Lord hath created medicines of the earth, and hee that is wise, will not abhorre them’. Plants, especially, seemed to have been God-given to cure or alleviate humankind's ills. A sign of this was that herbals were both botanical (in the post-medieval sense) and medical works: they described plants and also their healing virtues, almost all of them being written by medical practitioners.

Historians have shown how remedies constituted a battleground between differing medical groups, notably Galenists with largely herbal remedies and Paracelsians who advocated chemical medicines. They have also seen remedies as crucial components in the medical marketplace, for they were what apothecaries, quacks and empirics advertised, sold and made their money from, whilst physicians with business links to apothecaries had a financial interest in their patients buying the remedies of their apothecary.

INTRODUCTION AND SUMMARY

At the close of the seventeenth century much of practical medicine remained unchanged. Disease as putrefaction was still being evacuated from the body, stories of how illness developed in the body were still being narrated, and anatomy still provided the signposting. It appears as if the Helmontian alternative had disappeared without trace. However, this was not altogether the case. Parts of the Helmontian message about disease and its treatment were still in evidence, although one has to be careful about the question of influence: some developments were common both to Helmontian medicine and to other parts of medicine. But, certainly, the Helmontians' view that disease was a ‘thing’, and their belief that it was medicines above all else that were crucial for medicine, remained very much live issues amongst physicians, empirics and quacks. Other individuals and groups were exerting powerful influences upon the future direction that medicine was to take. Empirics, by their mere presence, which threatened to flood the medical market, gave added importance to medicines and acted as a brake against there being any one dominant theory.

Anatomy, a crucial element in the construction of disease narratives and the progressive ornament of learned medicine, was viewed with increasing scepticism as a factor in the improvement of therapeutics. Helmontians and Thomas Sydenham, probably the most influential seventeenth-century medical writer in the eighteenth century, wanted to have nothing to do with anatomy, but ‘modern’ learned physicians believed it had the potential to contribute to future developments in therapeutics.