Diagnosis and Prognosis
‘He who would correctly know beforehand those that will recover, and those that will die, and in what cases the disease will be protracted for many days, and in what cases for a shorter time, must be able to form a judgment from having made himself acquainted with all the symptoms, and estimating their powers in comparison with one another … with regard to the others, and the urine and sputa, as when the patient coughs up pus and bile together’.
Hippocrates, Prognosticon, part 25.
Galen, Galeni Pergameni De symptomatum differentijs liber unus. Eiusdem De symptomatum causi libri tres T. Linacro interprete (London, 1524), Sig. B1r.
Hippocratic and Galenic diagnosis and prognosis depended on a host of factors but one of the most crucial was a dialogue between physician and patient where the physician listened carefully to the patient and used this information not only to diagnose but also to plot the course of the disease. As Mattern notes, an examination of the pulse was crucial to Galen but he did not limit himself to this, factoring in skin colour, facial expression, and, of course, bodily waste.[1] His interaction with his patients was intense and, as Mattern relates, his case histories suggest that he was very much a ‘hands on physician’, visiting his patients several times a day, and often bathing and feeding them.[2] He was likewise keen to hear about the patient’s emotional state, considering it a major factor in disease.
Hippocratic (and indeed Galenic) medicine focused more on prognosis than diagnosis given that their systems did not, as Pagel argued in 1939, ‘aim at a classification of diseases as special entities’.[3] A focus on prognosis had the added benefit of enhancing the position of the physician, for, as Hippocrates had stated in his Prognostic, part 1:
‘I hold that it is an excellent thing for the physician to practice forecasting. For if he discovers and declares unaided by his patients the present, the past and the future, and fills in the gaps in the account given by the sick, he will be the more believed to understand the cases, so that men will confidently entrust themselves to him for treatment. Furthermore he will carry out the treatment best, if he knows beforehand from the present symptoms what will take place later’.[4]
Gualtherus Bruele, Praxis medicinae theorica et empirica familiarissima Gualteri Bruele: in qua pulcherrima dilucidissimáque ratione morborum internorum cognitio, eorundémque curatio traditur. … (Antwerp, 1585), annotations on end-leaf.
This focus on prognosis and treatment is readily apparent in Worth’s copy of Gualtherus Bruele’s Praxis medicinae theorica et empirica familiarissima Gualteri Bruele: in qua pulcherrima dilucidissimáque ratione morborum internorum cognitio, eorundémque curatio traditur. … (Antwerp, 1585). This work on the practice of medicine proved to be very popular and it was translated into English on a number of occasions during the seventeenth century. The title of one such translation gives us an indication both of its method and scope: Praxis medicinæ, or The physitians practise: wherein are contained all invvard diseases from the head to the foot. Explaining the nature of each disease, with the part affected; and also the signs, causes, and prognosticks, and likewise what temperature of the aire is most requisite for the patients abode, with direction for the diet he ought to observe, together with experimentall cures for every disease. Practised, and approved of; and now published for the good not only of physitians, chirurgions, and apothecaries; but very meet and profitable for all such which are carefull of their health and welfare (London, 1648). As is clear from this title, Bruele, a sixteenth-century German physician, envisaged his potential audience as encompassing not only learned physicians, and other ‘official’ practitioners such as surgeons and apothecaries, but also all those lay practitioners interested in domestic medicine in the home.
In his preface Bruele’s English translator reiterated that the book was not solely written by a physician for a physician. Instead, he drew attention to its potential not only for apothecaries and surgeons, but anyone interested in tried and tested cures:
‘If you be an Apothecary, there you may be provided with all manner of Drugs. If a Surgeon, there also you may be furnished with Powders, Oyntments and Emplaisters, without which a man cannot excel in the Art of Chirurgery. Lastly, there are medicines for inward diseases, of what age, sex, or complexion soever the Patient be. Neither are you brought hither only to take a survey of these Traffiques, but each Medicine doth offer it self unto thee with a ℞ embrace their kind proffers, and be not scrupulous in receiving them; for you may adventure on them with security, because they have been often experienced without danger’.[5]
Like many other early modern works on the practice of medicine, Bruele organised his text from head to foot – an arrangement designed to make his book more easily used by a wide range of readers. Worth’s copy offers us an insight into how one of Bruele’s readers used the book in practice for in the above image we see that the reader has annotated the end leaves with a home-made index, pointing to methods of curing various diseases.
John Pechey, The store-house of physical practice: being a general treatise of the causes and signs of all diseases afflicting human bodies. Together with the … safest way of curing them, by method, medicine and diet. To which is added, for the benefit of young practisers, several choice forms of medicines used by the London physicians (London, 1695), title page.
This emphasis on the practice rather than the theory of diagnosis and prognosis is likewise apparent in another popular work belonging to Worth, this time from the later seventeenth century: the English physician John Pechey’s The store-house of physical practice: being a general treatise of the causes and signs of all diseases afflicting human bodies. Together with the … safest way of curing them, by method, medicine and diet. To which is added, for the benefit of young practisers, several choice forms of medicines used by the London physicians (London, 1695). In his preface Pechey (bap. 1654, d. 1718), advocated for a ‘plain Practice’ of medicine, eschewing ‘the late unaccountable Humour of Romancing on the Nature and Causes of Diseases’.[6] Pechey was anxious that his book, which was ‘chiefly design’d for young Practisers’, should concentrate on practice rather than theory – and be easy to navigate. Indeed he included an index immediately after his preface whereby practitioners of all kinds might more easily find the information they needed. This allowed them to skip to information on a specific disease and quickly find out what symptoms might help diagnose the illness. For example, writing about the London plague of 1665–6, Pechey pointed to some of its characteristic diagnostic signs:
‘Its first approach was always accompanied with shaking and shivering like the Fits of an Ague presently violent Vomitings, a pain about the region of the Heart as if it were pressed, a burning Fever, with the usual concourse of Symptoms perpetually molest the Sick, till Death it self, or a happy eruption of a Bubo or Parotis, discharges the morbisick Matter, and so frees them from that deplorable condition’.[7]
Pechey had strong views on the practice of medicine: he advised his young physicians not to spend too much time on anatomy, chymistry or herbs and to avoid at all costs ‘Hypothesis, the bane of Art’.[8] He argued that it was best to study with ‘practical Physicians’ who made their own medicines rather than those who only prescribed remedies.[9] Above all, he advised his young readers to read as much as possible and to concentrate on the ‘dominant symptom’ before them – lest they lose their patient by concentrating too much on the original disease![10]
Dioscorides, De medicinali materia libri sex I. Ruellio … interprete. Singulis cum stirpium, tum animantium historiis, ad naturae aemulationem expressis imaginibus … ; Accesserunt priori editioni V. Cordi … ; annotationes … in Dioscoridis de medica materia libros. E. Cordi … iudicium de herbis & simplicibus medicinae … ; Herbarum nomenclaturae … aut. C. Gesnero … cum indice … copiosissimo (Frankfurt, 1549), p. 118.
One of the most practical methods of diagnosing and determining the treatment of a disease was by examining a patient’s urine (uroscopy). This image, from Worth’s 1549 edition of De medicinali materia of the first century AD author Dioscorides Pedanius, of Anazarbos, depicts a physician checking the urine of his patient. In his hand the physician holds the matula (glass jar) containing urine to the light to get a better view of both its colour and consistency. Early modern physicians were often depicted with matula in hand as it had been a sign of their profession since the Middle Ages.[11] As we have seen, ancient physicians had used a wide variety of methods in order to attempt a diagnosis of their patient but by the Middle Ages uroscopy had become the dominant method of diagnosis. Perhaps the most important criteria was colour but, as Wittern-Sterzel argues, there were at least four criteria used to inspect urine and chemically minded physicians of the sixteenth and seventeenth centuries explored different methods of evaluation.[12] As the English surgeon Thomas Brugis (b. in or before 1620, d. in or after 1651), stated in his overview of medicine in his popular handbook for young surgeons, Vade mecum: or, A companion for a chirurgion … (London, 1681), urine was to be inspected in the morning and its consistency was regarded as an indication of disease.[13]
Stolberg notes that famous physicians of the early to mid sixteenth century, such as the influential Italian physician Giovanni Battista da Monte (1498–1551), who taught at the University of Padua, increasingly drew attention to the uses of uroscopy in diagnosis.[14] In this Da Monte and his followers were undoubtedly influenced by the importance attached to uroscopy in the later Middle Ages. However, Stolberg points to a decline in interest in uroscopy in the later sixteenth century when physicians became wary of how misdiagnoses might reflect on their professional authority. He argues that uroscopy came under professional attack by physicians who no longer viewed the matula as a status symbol but as something which might actually undermine their position with their patients.[15] However, as he notes, despite some physicians’ desire to relegate uroscopy, it continued to play a major role in diagnosis and prognosis due to ‘patient power’ – patients’ expectations of how physicians and other medical practitioners would diagnose their illnesses.[16] Uroscopy retained its popularity among the general public because, as Stolberg notes, ‘In their eyes, it was the best means by far to arrive at a reliable diagnosis’.[17]
That uroscopy continued to be viewed as an important aid to diagnosis and prognosis during Worth’s lifetime may be seen in Medicina Vindicata: or, Reflections on Bleeding, Vomiting and Purging, in the Beginning of Fevers, Small Pox, Pleurisies, and other Acute Diseases (Dublin, 1727), written by one of his professional colleagues, the early eighteenth-century Dublin physician Henry Cope (1686–1743). Like Worth, Cope was a former President of the King and Queen’s College of Physicians in Ireland (i.e. Royal College of Physicians of Ireland), so his views tell us something about the sanctioned practice of medicine in early eighteenth-century Dublin. Cope likewise pointed to urine as an important indicator which could inform a physician as to what the best treatment should be:
‘so that beside the Abatement or Increase of outrageous Symptoms, there must be many more Signs to satisfy an observing Physician that the Patient is relieved or grows worse, the Chief of which are the Signs of Concoction or Crudity, and these are more especially discovered by the Stools and Urine, upon which Head alone many able Physicians have bestowed a great deal of well employ’d Labour; for every Sediment or Breaking of the Urine doth denote Concoction; on the contrary some of them denote great Crudity.’[18]
Sir John Floyer, The physician’s pulse-watch; or, an essay to explain the old art of feeling the pulse, and to improve it by the help of a pulse-watch … To which is added, an extract out of Andrew Cleyer, concerning the Chinese art of feeling the pulse. (An appendic. I. An essay to make a new sphygmologia … II. An inquiry into the nature … of the respirations … III. A letter concerning the rupture in the lungs) / [Sir John Floyer]. Source: Wellcome Collection.
However, it is clear that it was not enough to inspect urine on its own: hand in hand with uroscopy went an examination of the pulse for an examination of both was considered essential for diagnosis in early modern Europe (indeed the pulse was considered to be one of the chief factors in diagnosis of fevers).[19] As Brugis stated in his Vade mecum for young surgeons, ‘Pulse shews the hearts strength, Urine the nature of the liver, spleen, reins, vessels, &c’. He counselled that both should be viewed together ‘for rarely’s bad urine, with good pulse’.[20] His early eighteenth-century successor, the English physician Sir John Floyer (1649–1734), would certainly have agreed for he produced an important work on the use of the pulse as a diagnostic tool, which Worth owned. Floyer, an Oxford educated physician based in Lichfield, was clearly a favourite author of Worth’s for the latter collected not only his The physician’s pulse-watch (London, 1707–1710), but also Floyer’s previous works such as his two-volume Pharmako-basanos: or, The touch-stone of medicines. Discovering the vertues of vegetables, minerals, & animals, by the tastes and smells (Lichfield and London, 1687), and his notable work on cold bathing: The ancient psychrolousia revived: or, an essay to prove cold bathing both safe and useful. In four letters … (London, 1702), which included a ‘Short Discourse of the wonderful Virtues of the Bath-Waters on decayed Stomachs’, thus indicating his interest in the medicinal properties of the drinking of mineral waters and the use of spas more generally. Floyer was a keen supporter of cold bathing and, given that he himself had asthma, also produced A treatise of the asthma (London, 1717), which was likewise bought by Worth.
As the above title page of his work on the pulse makes clear, Floyer was eager to highlight both his own new discoveries concerning the pulse and his newly developed watch by which its rapidity might be more accurately judged.[21] He was well aware that the pulse as a diagnostic tool had a long history, noting that ‘Hippocrates advised us to observe the Pulse, that thereby we might know both our Health and Diseases, and might also make Prognostications concerning the event of them’.[22] As Townsend notes, though Hippocrates did not write a treatise on the subject he had acknowledged its importance and it was an idea which was subsequently taken up by Praxagoras of Cos (c. 400 BC) and, of course, by Galen.[23] While Floyer was clearly heavily influenced by Galen’s understanding of the pulse he was not limited by it and included a discussion of subsequent commentators, among them Santorio Santorio (1561–1636), whose ‘Pusilogium’ sought to measure the pulse – an aim which endeared him to Floyer.[24] However, as his introduction made clear, Floyer was not content to regurgitate past authorities – he wanted to provide his readers with the most up-to-date information on new experiments:
‘I have for many years try’d Pulses by the Minute in Common Watches, and Pendulum Clocks, when I was among my Patients; after some time I met with the common Sea-Minute Glass; which I used for my Cold Bathing, and by that I made most of my Experiments; but because that was not portable, I caused a Pulse Watch to be made which ran 60 seconds, and I placed it in a Box to be more easily carried, and by I now feel Pulses’.[25]
Floyer’s treatise served not only to make his view on the importance of the pulse in the practice of medicine known as widely as possible – it also heralded the availability of his new ‘pulse watch’, an object which has been described by Gibbs as ‘the first efficient instrument of precision to merit application in clinical practice’.[26] Floyer described in detail the evolution of the mechanism and its use. As Gibbs notes, it had been possible since 1670 to ‘try pulses by the minute in common watches’ but Floyer’s new device sought to popularise a seconds hand.[27] This was crucial because, as Floyer noted, ‘tis almost impossible to know whether a Pulse be more quick and frequent than ordinary, without a measure’.[28]
Floyer was naturally keen to focus on his new pulse watch and the role it could play in the day-to-day practice of medicine but he was also keen to highlight Chinese discoveries and theories of how the pulse could be used as a diagnostic tool. He appended tracts concerning Chinese understanding of the role of the pulse to both volumes of his work on the pulse. Volume one contained ‘An Appendix Containing an Extract of the Chinese Art of feeling the Pulse from Cleyer’ – a reference to Andreas Cleyer (1634–98), a Dutch physician who had popularised Michael Peter Boym’s Latin translation of the Mo Ching of Wang Shu-Ho (265–317), in his own Specimen medicinae Sinicae, sive opuscula medica ad mentum Sinensium (Frankfurt, 1682). Worth was clearly interested for he owned a copy of Cleyer’s work.
As Ghasemzadeh and Maziar Zafari note, the study of the arterial pulse had a long history in China: it was first mentioned in the ‘Internal Medicine Classics, Nei Chiing’, which was considered to be the work of the Yellow Emperor, Huang Ti (698–598 BC).[29] A study of the arterial pulse enabled Chinese physicians to plot the course of a disease between the poles of Yin (disease) and Yang (health) by taking into account factors such as its ‘volume, strength, weakness, regularity’ or types of pulse beats.[30]
Despite his analysis of Chinese methods, Floyer concluded that his own ‘Mechanical’ feeling of the pulse was better than both the Galenic or Chinese method:
‘The Art of Feeling the Pulse, which I have Proposed for distinction sake, I will call Mechanical; ‘tis short, easie, and more certain than the Galenical or Chinese Art, because it requires no more than counting of the Pulse, and observing the time by the Pulse-Watch; this will show the Diseases of the Fluids, that is, of the Blood and Spirits; and the Method to raise or sink the Pulse; and by the same Method the Circulation will be stopt or accelerated; and he who knows and can best regulate the Excesses or Defects in the Pulse, and Circulation (as I conjecture), in the Learned Ages which are to come, will be esteemed the best Physician’.[31]
Floyer’s The Physician’s Pulse Watch provided its readers with a wealth of data from his various experiments to support this view. Indeed, Townsend argues that Floyer’s book was, in fact. ‘the most thorough eighteenth century study of the influence of external factors on the pulse’.[32]
Given his own battles with asthma, Floyer was also interested in the role respiration played in diagnosis.[33] As he noted in the second volume of his The pulse watch, study of the pulse and respiration were intertwined for respiration was ‘a help to the Pulse, in carrying on the Circulation of Blood’.[34] Indeed, he added an essay on ‘An Inquiry into the Nature, Use, Causes and Differences of the Respirations, and the Prognostications which may be made by them in Diseases’ to the second volume of his The Pulse Watch (London, 1710). Floyer argued that the pulse and respiration might not only inform a physician’s diagnosis – they might also be valuable indicators of the likely course of a disease.[35] They thus could be used as both diagnostic and prognostic tools. The idea was not new: as Ghasemzadeh and Maziar Zafari note, the idea of using the pulse as an aid to prognosis dated back to ancient times.[36] However, as Brugis had earlier commented, ‘Prognostics are very difficult’ for the range of things that could impact it was wide – including, in Brugis’ view, ‘the Air, Stars, Devil, Witches, &’.[37]
Prosper Alpini, De prasesagienda vita & morte aegrotantium libri septem. … Cum praefatione Hermanni Boerhaave (Leiden, 1710), title page.
Prognosis (and diagnosis) was focus of Prosper Alpini’s De prasesagienda vita & morte aegrotantium libri septem. … Cum praefatione Hermanni Boerhaave (Leiden, 1710). This work, by the Venetian botanist and physician, Prosper Alpini (1553–1617), had first appeared in both Venice and Frankfurt in 1601, and was subsequently republished a number of times. Worth bought a 1621 Frankfurt edition of Alpini’s works from the auction of the library of the Dutch natural philosopher, Nicolaas Hartsoeker (1656-1725), in 1727.[38] This work, Medicinalium observationum historico-criticarum libri septem (Frankfurt, 1621), was, as the title suggests, a compilation of Alpini’s oeuvre, containing De prasesagienda vita & morte aegrotantium libri septem, but also including other works. It was not the only copy of Alpini’s treatise on prognosis which Worth possessed for he also purchased a 1710 Leiden edition. This latter edition, as the above title page makes clear, included a preface by the celebrated Dutch physician Herman Boerhaave (1668–1738).
Boerhaave was fulsome in his praise of the work:
‘The first Time I read this valuable Production of Prosper Alpinus, I concluded, that there was no where to be found, a Book fitter for promoting Medicinal Knowledge, and consequently none more worthy to be warmly recommended to Students in Medicine’.[39]
It is not hard to see why Boerhaave was so enthusiastic about the pedagogical possibilities of Alpini’s text for the latter wrote in a straightforward style, outlining the importance of his topic by reminding his readers that prognosis lay at the heart of treatment of diseases:
‘The Physician also by his Art, foreseeing the future Symptoms of the Patient, is of Course better qualified for preventing them by proper Remedies. And from these Symptoms comprehending the Nature of the Disease, he understands what Method of Cure is most proper; for if the Prognostics of Diseases are neglected the most important Part of Medicine which is a due Regimen, can never be prescribed under them’.[40]
For Alpini, any prognosis needed to take into account two things: the disease and the role of Nature in any possible treatment:
‘They who are desirous of forming right Prognostics, ought previously to understand from what Things they are to be deduced. Prognostics are therefore to be drawn from two Things, the first of which is the Disease itself, which like an hostile and unfriendly Agent endeavours to destroy the Body, and the second Nature which like a valiant and undaunted General residing in the Body endeavours to defend it against the Stratagems and Attacks of the Enemy’.[41]
Nature (in its many forms) thus played a vital role in Alpini’s De prasesagienda vita & morte aegrotantium libri septem. … Cum praefatione Hermanni Boerhaave (Leiden, 1710), and its role in the practice of medicine runs through Worth’s medical collection. One of the earliest specific explorations of Nature’s role may be found in Worth’s copy of the 1559 Latin edition of Occulta naturae miracula, ac varia rerum documenta, probabili ratione atque artifici conjectura duobus libris explicata, quae studioso avidoque lectori non tam usui sunt futura, quam oblectamento of Levinus Lemnius (1505–68), which, with its many annotations, indicates it was a much thumbed work. It certainly proved to be a popular one for it was translated into Italian, French, German and English, the latter edition appearing almost one hundred years later under the title The Secret Miracles of Nature (London, 1658). As Newton notes, Nature was viewed by writers such as Lemnius as God’s agent in the process of recovery.[42] Emphasis on the role of Nature had received its imprimatur in Hippocrates’ famous axiom ‘Nature is the healer of disease’ a theme which was likewise explored in Galen’s The Natural Faculties.[43] It was a topic which surfaced again and again in discussions on prognosis and, as Newton argues, the idea that the physician acted as ‘nature’s servant’ was not restricted to the works of the ‘New Hippocrates’ Thomas Sydenham (bap. 1624, d. 1689), but was widely accepted by the profession.[44]
It was believed that Nature (and her trusty servant, the learned physician), could heal the patient by bringing humours into balance. By careful examination of ‘concocted’ bodily fluids, physicians sought to track the progress of the disease and the easiest way to check on progress was to examine the patient’s urine and, more generally, the course of evacuation.[45] There were, as Lemnius remarked, many ways by which this might be done for there were many routes by which ill humours left the body:
‘God that made the body of man hath not in vain created so many ways and passages to purge forth the humours. So the head purgeth it self by the Nostrills [and] Ears [;] the Pallate, [by] … [s]neesing and spitting’ The … Lungs by … coughing; the Stomach … by vomit …; The Intestines … by the belly …; The Reins … by the urinary passages …; sweat through the skin that is full of holes’.[46]
A skilled physician sought to work with Nature to bring the patient to and past a crisis whereby s/he might be healed. As Newton notes, the idea was not limited to learned physicians – it was also attempted by lay practitioners in the home – and it cast the most frightening part of the disease, the crisis, as the signpost to returning health.[47] Above all, as Pagel notes, ‘the Hippocratic physician had to be content with supporting the healing power of nature by mild applications, especially laxatives’ and therefore their treatments differed markedly from those advocated by early modern ‘chymical physicians’ such as Philipp Aureolus Theophrastus Bombast von Hohenheim (1493–1541), better known as Paracelsus.[48]
Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.
Sources
Alpini, Prosper, The Presages of Life and Death in Diseases: In Seven Books … , translated by R. James, 2 vols (London, 1746).
Bruele, Gualterus, Praxis medicinæ, or The physitians practise: wherein are contained all invvard diseases from the head to the foot. Explaining the nature of each disease, with the part affected; and also the signs, causes, and prognosticks, and likewise what temperature of the aire is most requisite for the patients abode, with direction for the diet he ought to observe, together with experimentall cures for every disease. Practised, and approved of; and now published for the good not only of physitians, chirurgions, and apothecaries; but very meet and profitable for all such which are carefull of their health and welfare (London, 1648).
Brugis, Thomas, Vade mecum: or, A companion for a chirurgion. Fitted for sea, or land; peace, or war. Shewing the use of his instruments, and virtues of medicines simple and compound most in use, and how to make them up after the best method. With the manner of making reports to a magistrate, or corroner’s inquest. A treatise of bleeding at the nose. With directions for bleeding, purging, vomiting, &c (London, 1681).
Cope, Henry, Medicina Vindicata: or, Reflections on Bleeding, Vomiting and Purging, in the Beginning of Fevers, Small Pox, Pleurisies, and other Acute Diseases (Dublin, 1727).
Estes, J.W., ‘The Medical Properties of Food in the Eighteenth Century’, Journal of the History of Medicine and Allied Science, 51, no. 2 (1996), 127–54.
Floyer, Sir John, The physician’s Pulse-Watch; or, an essay to explain the old art of feeling the pulse, and to improve it by the help of a pulse-watch … To which is added, an extract out of Andrew Cleyer, concerning the Chinese art of feeling the pulse. (An appendic. I. An essay to make a new sphygmologia … II. An inquiry into the nature … of the respirations … III. A letter concerning the rupture in the lungs (London, 1707).
Floyer, Sir John, The pulse watch: vol. II. or, An essay to discover the causes of diseases, and a rational method of curing them by feeling of the pulse. Three essays are added as an appendix. I. An essay to make a new sphygmologia … II. An inquiry into the nature … of the respirations … III. A letter concerning the rupture of the lungs (London, 1710).
Ghasemzadeh, Nima, and A. Maziar Zafari, ‘A Brief Journey into the History of the Arterial Pulse’, Cardiology research and practice, 1 (2011), 1–14.
Gibbs, D.D., ‘The Physician’s Pulse Watch’, Medical History, 15, no. 2 (1971), 187–90.
Mattern, Susan, ‘The art of medicine: Galen and his patients’, The Lancet, 378 (2011), 478–9.
Newton, Hannah, “Nature Concocts & Expels’: The Agents and Processes of Recovery from Disease in Early Modern England’, Social History of Medicine, 28, no. 3 (2015), 465–486.
Pagel, Walter, ‘Prognosis and Diagnosis: A Comparison of Ancient and Modern Medicine’, Journal of the Warburg Institute, 2, no. 4 (1939), 382–98.
Pechey, John, The store-house of physical practice: being a general treatise of the causes and signs of all diseases afflicting human bodies. Together with the … safest way of curing them, by method, medicine and diet. To which is added, for the benefit of young practisers, several choice forms of medicines used by the London physicians (London, 1695).
Stolberg, Michael, ‘The Decline of Uroscopy in Early Modern Learned Medicine (1500–1650)’, Early Science and Medicine, 12 (2007), 313–36.
Townsend, Gary L., ‘Sir John Floyer (1649–1734) and his study of pulse and respiration’, Journal of the History of Medicine and Allied Sciences, 22, no. 3 (1967), 286–316.
Wittern-Sterzel, Renate, ‘Diagnosis: the doctor and the urine glass’, The Lancet, 354 (1999), SIV13.
[1] Mattern, Susan, ‘The art of medicine: Galen and his patients’, The Lancet, 378 (2011), 479.
[2] Ibid.
[3] Pagel, Walter, ‘Prognosis and Diagnosis: A Comparison of Ancient and Modern Medicine’, Journal of the Warburg Institute, 2, no. 4 (1939), 387 and 394.
[4] Ibid., 388.
[5] Bruele, Gualterus, Praxis medicinæ, or The physitians practise: wherein are contained all invvard diseases from the head to the foot. Explaining the nature of each disease, with the part affected; and also the signs, causes, and prognosticks, and likewise what temperature of the aire is most requisite for the patients abode, with direction for the diet he ought to observe, together with experimentall cures for every disease. Practised, and approved of; and now published for the good not only of physitians, chirurgions, and apothecaries; but very meet and profitable for all such which are carefull of their health and welfare (London, 1648), Sig. A2v.
[6] Pechey, John, The store-house of physical practice: being a general treatise of the causes and signs of all diseases afflicting human bodies. Together with the … safest way of curing them, by method, medicine and diet. To which is added, for the benefit of young practisers, several choice forms of medicines used by the London physicians (London, 1695), Sig. A2r.
[7] Ibid., p. 464.
[8] Ibid., Sigs. A2r-v.
[9] Ibid., Sig. A2v.
[10] Ibid.
[11] Wittern-Sterzel, Renate, ‘Diagnosis: the doctor and the urine glass’, The Lancet, 354 (1999), SIV13.
[12] Ibid.
[13] Brugis, Thomas, Vade mecum: or, A companion for a chirurgion. Fitted for sea, or land; peace, or war. Shewing the use of his instruments, and virtues of medicines simple and compound most in use, and how to make them up after the best method. With the manner of making reports to a magistrate, or corroner’s inquest. A treatise of bleeding at the nose. With directions for bleeding, purging, vomiting, &c (London, 1681), Sig. a5v.
[14] Stolberg, Michael, ‘The Decline of Uroscopy in Early Modern Learned Medicine (1500–1650)’, Early Science and Medicine, 12 (2007), 315.
[15] Ibid., 321.
[16] Ibid., 326.
[17] Ibid., 327.
[18] Cope, Henry, Medicina Vindicata: or, Reflections on Bleeding, Vomiting and Purging, in the Beginning of Fevers, Small Pox, Pleurisies, and other Acute Diseases (Dublin, 1727), p. 19.
[19] Estes, J.W., ‘The Medical Properties of Food in the Eighteenth Century’, Journal of the History of Medicine and Allied Science, 51, no. 2 (1996), 130.
[20] Brugis, Vade mecum: or, A companion for a chirurgion, Sig. a5r.
[21] Worth owned both the first volume, which was entitled The Physician’s Pulse-Watch … (London, 1707) and volume two of the work which appeared three years later: The Pulse Watch … (London, 1710). The first volume is among the missing books of the Worth Library. It is tempting to suggest that it might possibly have been borrowed by Bryan Robinson (1680–1754), a fellow Trustee of Dr Steevens’ Hospital around the same time as Worth, who was interested in the relationship between the pulse and respiration and whose thoughts on the subject may be found in his A treatise of the animal economy. It is likely that Robinson had donated a copy of the first edition (Dublin, 1732), of his treatise to Worth for Worth’s 1732 edition bears the inscription ‘For Dr Worth’ on the flyleaf. A copy of the second edition, which was printed at Dublin in 1734 (a year after Worth’s death), may also be found in the Worth Library – no doubt it found its way there via Robinson.
[22] Floyer, Sir John, The Physician’s Pulse-Watch … (London, 1707), p. 2.
[23] Townsend, Gary L., ‘Sir John Floyer (1649–1734) and his study of pulse and respiration’, Journal of the History of Medicine and Allied Sciences, 22, no. 3 (1967), 293–4.
[24] Ibid., 296.
[25] Floyer, The Physician’s Pulse-Watch, Sig. A4r.
[26] Gibbs, D.D., ‘The Physician’s Pulse Watch’, Medical History, 15, no. 2 (1971), 187.
[27] Gibbs mentions an exception to this, in 1665, but makes it clear that it was Floyer who popularised the invention of the horologist Samuel Watson (c. 1635–1710): Gibbs, 187.
[28] Floyer, The Physician’s Pulse-Watch, Sig. A6v.
[29] Ghasemzadeh, Nima, and A. Maziar Zafari, ‘A brief journey into the history of the arterial pulse’, Cardiology research and practice, 1 (2011), 2.
[30] Ibid.
[31] Floyer, The Physician’s Pulse-Watch, p. 425.
[32] Townsend, ‘Sir John Floyer (1649–1734) and his study of pulse and respiration’, 300.
[33] Estes, ‘The Medical Properties of Food in the Eighteenth Century’, 132.
[34] Floyer, Sir John, The pulse watch: vol. II. or, An essay to discover the causes of diseases, and a rational method of curing them by feeling of the pulse. Three essays are added as an appendix. I. An essay to make a new sphygmologia … II. An inquiry into the nature … of the respirations … III. A letter concerning the rupture of the lungs (London, 1710), p. 329.
[35] Floyer, The Physician’s Pulse-Watch, p. 162.
[36] Ghasemzadeh, Nima, and A. Maziar Zafari, ‘A brief journey into the history of the arterial pulse’, 1–3.
[37] Brugis, Vade mecum: or, A companion for a chirurgion, Sig. a7v.
[38] Bibliotheca Hartsoekeriana … & catalogus, variae magnitudine vitra ardentia, specula ustoria, vitra objectiva, &c. Microscopia, & alia id genus complectens (The Hague, 1727), p. 154.
[39] English translation from Alpini, Prosper, The Presages of Life and Death in Diseases: In Seven Books … , translated by R. James, 2 vols (London, 1746), i, Sig. A3r.
[40] Ibid., i, p. 1.
[41] Ibid., i, p. 5.
[42] Newton, Hannah, “Nature Concocts & Expels’: The Agents and Processes of Recovery from Disease in Early Modern England’, Social History of Medicine, 28, no. 3 (2015), 470.
[43] Ibid.
[44] Ibid., 473.
[45] Ibid., 476.
[46] Quoted in ibid., 477.
[47] Ibid., 480, 485.
[48] Pagel, ‘Prognosis and Diagnosis: A Comparison of Ancient and Modern Medicine’, 395.