QUESTIONS

My central question here will be: why, with respect to medicine, did Thomas Sydenham see what he saw and do what he did? Answering this will of course entail answering the question what it was that Sydenham did with respect to medicine in the London of the three and a half decades 1656 to 1689.

Thomas Sydenham has posthumously acquired one of the greatest of all names in the history of western medicine. He is celebrated amongst historians of medicine as the inaugurator or reviver of clinical or (to express it in English rather than Greek) bedside medicine – which we treat as a highly positive achievement – and has been awarded the title of the ‘English Hippocrates’. Such was his fame in early nineteenth-century Britain that two successive societies dedicated to the publishing of modern and ancient ‘classic texts’ in medicine were named after him. The works of Sydenham, in Latin and then in English, were amongst the earliest works issued, and I like to think they were planned to be the first. Naturally enough, therefore, Sydenham has attracted his share of medical historians to celebrate his work and achievement. I trust that nevertheless it does not appear too arrogant of me to claim that all this effort has not yet given us a satisfactory account of either the activity or the achievement of Thomas Sydenham. At all events, it is to this most fundamental of issues that I address myself here.

The emergence of Isaac Newton as an intellectual force, as a patron and as a focus for social and political ideas strongly affected both medical theory and the medical profession. The influence of Newton's ideas, particularly his theory of matter on physiological theory, recast iatromechanism. Their effects ranged from chemical notions based on attracting atoms earlier in the eighteenth century, to attempts in the 1730s to resolve the mind–body relationship by means of a Newtonian ether.

The Scottish physician Archibald Pitcairne (1652–1713) and his students and disciples at Edinburgh, Leiden and Oxford envisaged a medical theory on the same level of certainty as Newton's theory of the world, which they referred to as a ‘principia medicinae theoreticae mathematicae’. Indeed, they considered the two systems to be strictly analogous. Their work stemmed from the atomistic theory of matter Newton had outlined in the essay ‘De natura acidorum’ and from queries added to the 1706 Opticks. In 1713, the year of Pitcairne's death, the second edition of Principia appeared, with hints of a change in Newton's thoughts. This change became far more apparent in his 1717–18 revisions of the Opticks, in which Newton's previous reliance upon atomistic explanations of chemical and related phenomena shifted towards a theory relying upon various ‘subtle fluids’ or ‘ethers’. This change, which appeared fundamental to observers although it may not have seemed so to Newton, quickly manifested itself in works on medical theory, often by the same men who had written thoroughly atomistic treatises some twenty years earlier.

INTRODUCTION

What not to ask about science as it lies in the cradle of the ‘scientific revolution’ and in its early childhood, the age of enlightenment, is what ideas it supressed. To concentrate on this question would be to risk simplification in the complexity of the philosophy and natural science that was emerging in the seventeenth century. Ideas construct reality and their successful support by the important men of a period exercises pressure on other methods of perceiving the truth. Although little of what was believed to be scientific in the past would be reconcilable to our own construction of scientific reality, the claim of ‘science’ to ‘truth’ became firmly established by the eighteenth century. That science became equivalent to truth in a world which was primarily religiously oriented was a major shift in the Weltanschauung of an age and much more important than the ‘decline of magic’. In this sense, and indeed more so where science began to define human nature, it is justifiable first to ask who paid the price in political and cultural terms, and secondly to enquire whether science did in fact help to dislocate fundamental perceptions in its seemingly victorious advance.

Science in the seventeenth century has received much attention. Its opposite, ‘superstition’, has, like the ‘decline of magic’, more than equally found its historians. This convenient dichotomy, however, supports a two-class system in which only science is linked with the advancement of learning.

Heterodoxy is as old as Christianity itself but irreligion was perceived as something new in the intellectual life of early modern Europe. Atheism was widely seen as a progeny of the crisis of faith engendered by the changes of the renaissance and the reformation. New discoveries in philosophy, as John Donne said, called ‘all in doubt’, and religious relativism – stemming from an increased awareness of alternative religions in other parts of the world and in the multiplicity of reformed churches – made it easier to deny the absolute truth of any religious claims. Among the remedies which were prescribed for this ‘very plague and pest of humane Polities’ was a new emphasis on socalled ‘natural theology’. It was assumed that even if the atheist remained recalcitrant before Scripture, he could not hold out against ‘right reason’ and the ‘light of nature’. Natural theology was developed, therefore, in order to prove the existence and attributes of God and the immortality of human souls by recourse only to reason and the phenomena of the creation. Proofs of the immortality of the soul were held to be crucially important elements in this natural theology since the fear of post-mortem punishments was regarded as the only guarantee of morality and, therefore, of social and political stability.

The traditional pneumatology of the Roman Catholic Church and, for that matter, the major reformed churches was, of course, dualistic: body and soul were regarded as categorically distinct entities, one being material, the other immaterial.

How did medicine fare in an age of revolution? The aim of the editors in calling for contributions to this volume was to show that medicine in the century approximately from 1630 to 1730 did not exist as an activity unrelated to others, whether intellectual or social. But more than this, the aim was to go beyond putting medicine into a ‘context’ of political, religious and social change, and explore the dynamics that changed the nature of medicine, given the major movements of the time in these other activities and in medicine's substrate, natural philosophy. It was not, after all, until the seventeenth century that the revived classicism of the medical renaissance of the previous century was successfully overturned.

The question of how medicine fared in an age of revolution becomes necessary because it has been given less attention by historians than it deserves. This is partly because the giant figure of Newton has previously focused attention on natural philosophy, so that, for instance, discussions of William Harvey have often been related to the ‘scientific revolution’ rather than to the medicine of the time. Over the last half century too, historiographical trends have tended to express the relationship of medicine, religion and politics in terms of the persuasive puritan-and-science thesis. Both of these approaches too readily identify medicine with ‘science’ and ignore medicine's specific characteristics and development.

As the new philosophy gained in popularity and persuasiveness in England in the later seventeenth century, London physicians became embroiled in a number of disputes. Various aspects of the new philosophy challenged parts of the established outlook held by university-trained physicians. The disputes in which physicians became engaged concerned both intellectual and professional issues, for they involved arguments about both the intellectual foundations and the practice of academic physic. The arguments cannot be characterized simply as quarrels between physicians and their medical rivals, be they apothecaries, chemists, or virtuosi, for the physicians themselves as well as their opponents were divided in their opinions about how they ought to respond to the challenges of the new philosophy. Some physicians vigorously touted the advantages of the new philosophy, while others pointed to the dangers of moving too far from the established ways that made physicians different from other medical practitioners. Because the intellectual issues were so important to the profession of physic, quarrels among physicians and between themselves and others undoubtedly would have arisen in a wide range of circumstances. But in restoration England, a variety of institutional issues complicated the arguments.

INTRODUCTION: THE MAN

The eponymous hero of this chapter is unlikely to be a familiar figure to many historians of medicine of the post-Cartesian era. This is scarcely surprising for from the vantage point of the nineteenth and twentieth centuries, Philippe Hecquet (1661–1737) was just another Paris physician, indistinguishable from the large majority of the three hundred or so medical men who legally or illegally practised their craft in the French capital at the turn of the eighteenth century. Certainly, there were a number of Paris doctors at this time whose shades have been duly honoured in the medical pantheon, such as the botanist J.P. de Tournefort (1656–1708). Hecquet, however, was decidedly not of their stamp. Unlike his more prestigious colleagues, Hecquet's primary concern was with healing the sick. He was totally uninterested in helping push back the frontiers of medical knowledge by personally torturing nature to reveal her secrets. Significantly, he never presented an account of any experimental work to a learned society which he himself had performed; indeed, there is no evidence that he ever did any research.

Nevertheless, in the early eighteenth century the mention of Hecquet's name to a fellow physician, not just in Paris but in virtually any European city, would have elicited an immediate electric response. To some, like the Scot Thomas Bower, professor of mathematics at the university of Aberdeen, Hecquet was the principal physician of the French capital.

Modern concepts of mental illness have usually been depicted as first forming in reaction to witch hunts and demonic possession, so that scientific beliefs triumphed over superstition. Such a view dismisses as irrational belief in the Devil's activity in the world and it overlooks the extent to which medical naturalism was produced out of political struggle in France and England, which combined with a social process of distancing elite from popular culture throughout Western Europe. It was not the triumph of self-evident ideas that led first Anglicans and then dissenters to abandon their belief in supernatural causation and therapy when they had only the first inkling of an alternative explanation.

Historians have turned to anthropology in the search for conceptual tools to help explain belief in the supernatural and its decline. Unfortunately, the static models of society produced by the older schools of anthropological thought, viewing beliefs in terms of their function in maintaining the status quo, were unable to explain change unless imposed from without by a process of modernization or acculturation. More recent work has attempted to apply techniques of linguistics and semiotics and to set magical healing rituals in the context of a culture's other beliefs and practices. When these developments have been fully absorbed, they may provide a more sophisticated understanding of demonology. Nevertheless, given the relative lack of interest shown by English villagers in absolute, transcendent evil, the beliefs of ordinary English men and women may remain inaccessible.

INTRODUCTION

To argue that medicine did not change, or changed slowly, in the second half of the seventeenth century and the beginning of the eighteenth century may appear perverse. After all, as the chapters in this book demonstrate, change was taking place all around medicine and moreover, the institutions and groupings within medicine were changing. But what of medical practice? Here also the different medical sects, the Galenists, Paracelsians, empiricists, chemists, iatrochemists, iatromathematicians had their own particular theories and remedies. Yet there was underlying unity that implied a lack of change both in medical theory and practice. This unity was the consequence of a need by medical practitioners to be understood by patients, to relate to their expectations and hence to attract their trade. Commerce, in other words, could transcend apparent theoretical or institutional differences.

MEDICAL THEORY

It appears obvious that medicine changed radically in this period. The chemical, corpuscular, experimental and mathematical developments in science came to be united in different ways to provide new theoretical bases for medicine. The non-mathematical, non-mechanical, qualitative–humoral system of the ancients seems to have been replaced.

INTRODUCTION

The first major critique of orthodox medical practice in England was composed as early as 1585 by the Paracelsian, Richard Bostocke, yet no attempt to implement a programme of medical reform took place until the 1650s – the years of the so-called ‘puritan revolution’. Not surprisingly, many historians have for some time assumed that the well-documented opposition to medical orthodoxy in the middle decades of the seventeenth century must have been related to some extent to the political and religious upheavals of these years. In particular, it has become widely accepted that the beliefs and values associated with the puritan movement were largely responsible for the promotion of reform, not just in medicine and natural science, but in all aspects of early modern English society. In the words of R.F. Jones, ‘the Puritans were out to reform not only Church and State in their narrow connotations, but almost everything else’.

Since Jones's statement, the ‘puritanism–science hypothesis’ has undergone numerous refinements and, in the process, attracted large numbers of adherents. In particular, the work of Christopher Hill has established beyond reasonable doubt the vogue for new attitudes to science and medicine in revolutionary England, and in 1975 Charles Webster published what is certainly the most thorough and persuasive account to date of the ‘puritanism–science’ connection in The Great Instauration.

The establishing of the Royal Society promised to be an event of great significance for medicine in England. After all, right from the start, a substantial minority of its inner core included those physicians and inquirers into the economy of life who had made the College of Physicians such a lively body during the interregnum – men such as Goddard, Ent, Glisson and Croune – responsible for what Frank has seen as the Harveian research programme. And, more broadly, medical practitioners constituted easily the largest and most active single occupational group – about a fifth – amongst the early fellows. In his History of the Royal Society of London (1667), Thomas Sprat bent over backwards to disarm any hostile critics who might fear that the assimilation of medical men within the Society would prejudice the rights and interests of the College of Physicians; and the fact that some leading College physicians – not least its censor, Thomas Wharton, and its president, Baldwin Hamey, aided by his nephew, the maverick, Henry Stubbe – resented the Society's intrusion and attempted to discredit its pretensions, helps confirm that its foundation was indeed recognized as promising, or rather threatening, a shift in the centre of gravity of medical inquiry and authority.

There can be little doubt that that actually happened, temporarily at least.

INTRODUCTION

The aim of this volume is to relate medicine to the wider historical issues of the seventeenth century, particularly religion and politics. This is not simply to provide a context or background, and this chapter is written on the assumption that these wider issues – questions of men's religious beliefs and of the way in which men were to be governed – had a selective influence on what (and how) they absorbed of new medical doctrines. If this assumption is valid, it must descend from the religious and political through the external institutional arrangements of medicine to the details of medical theory. And of all medical theory, the doctrine of the circulation of the blood is one of the most difficult to see in this kind of relationship with religious and political history. Indeed, Harvey has generally been seen by historians as self-evidently right, and those who did or did not accept the circulation are placed on a scale from the hapless Primrose upwards according to their ability to recognize the truth when they saw it. But what people made of Harvey's doctrine depended partly on how they came across it, and partly on what was already in their minds – whether intellectual or not – which predisposed them to accept or reject it, or parts of it. The result was that most people's idea of what Harvey said was different, sometimes very different, from what Harvey wrote in De Motu Cordis.

So wrote Michael Reynolds in his book Stationary Engine Driving in 1880, yet, just over 100 years later in 1982, the last remaining rotative steam engine in the Lancashire cotton industry ceased driving the looms in Queen Street Mill at Harle Skye near Burnley. It was the end of the era of direct steam power in industry for, by that time, almost all the thousands of reciprocating steam engines that had powered the machines that made England the first industrial nation had been scrapped as obsolete and uneconomic. Yet, 100 years before Reynolds was writing, the rotative steam engine did not exist because it had not been developed out of the earlier forms of pumping engines.

I was fortunate when I went to Manchester in 1965 to study the history of technology and to establish an industrial museum for the city which had been the centre of the Industrial Revolution for I saw a variety of industries still powered by steam. For each, the basic steam engine had been adapted in the way most appropriate for the task it had to do.

‘The power of the steam-engine and its inconceivable importance as an agent of civilization, has always been a favorite theme with philosophers and historians as well as poets. As Religion has always been, and still is, the great moral agent in the civilizing world, and as Science is the great intellectual promoter of civilization, so the Steam-Engine is, in modern times, the most important physical agent in that great work.’ This was the position which R. H. Thurston ascribed to the steam engine in 1878. In its many forms, the steam engine became the major source of power in the nineteenth century, both in manufacturing industry and in transport whether on land or at sea. This book seeks to trace the technical development of the steam engine as applied in industry and centred on the cotton textile industry in the Lancashire region.

I have aimed to set the technical developments against a background of the scientific discoveries which led to a true understanding of the nature of heat and how best steam should be used in these engines. ‘W. S. Jevons wrote in 1865, “The whole question of the steam engine is one of economy” – its development consisted in nothing but the quest for greater efficiency – and indeed, he thought, the material achievement of our civilization could be summed up as “the economy of power”’. The story is traced through more efficient ways of developing power until the original reciprocating engines were replaced by steam turbines both in the textile mills themselves and in electricity generating stations.

The textile industry continued to expand in spite of various slumps up to the beginning of the First World War. Not only were more engines needed for the growing number of mills but the mills increased in size too. In Oldham, the average size of a spinning mill in 1873 was around 50,000 spindles. In 1883–4 75,000 spindles and in 1890 90,000. Gidlow Mill at Wigan must have been one of the biggest in its time for Musgrave built two horizontal engines, each with two cylinders, 40 in bore by 6 ft stroke, which have been described as ‘undoubtedly the largest simple expansion horizontal engines in a mill for many years’. They drove 154 throstle frames with 200 spindles on each, 2 pairs of mules with 600 spindles on each and 13 pairs with 1,076 spindles each, making a total of 61,376 spindles together with the preparation machinery. The increase in mill size may be seen by the Lion Mill, Royton, which was built in 1890 with 109,000 spindles, then the largest single mill. The engine here developed 2,000 h.p. When it was planned in 1898, the Nile Mill at Hollinwood with 104,000 spindles was the largest ring spinning mill in the world. In 1900, the Eclipse Mill, Rochdale, was designed to contain 118,000 spindles.

The increase in size of mills continued during the boom of the opening years of the twentieth century.