Treatments*
‘Medicines are weapons’…[1]
Galen, Galeni omnia quae extant opera Quorum alia nunc primum sunt inuenta: alia vel denuo fidelius translata, uel innumeris pene locis ad veterum Graecorum exemplarium veritatem castigata; ex secunda Iuntarum editione … (Venice, 1550), title page.
Worth owned a large number of editions of the works of Galen (129–c. 216), the ancient Roman and Greek physician from Pergamum whose works had been the bedrock of medieval medicine. Worth, an avid collector of Aldines, was the proud possessor of the earliest edition of Galen’s works in Greek, produced by the Aldine press at Venice in 1525, and to it he added not only this Giunta Venetian edition of 1550, but also a multi-volume 1538 edition from the Froben press at Basle. This was just the tip of the iceberg of works connected or influenced by galenic thought in his collection for despite numerous challenges, on a host of fronts, in the sixteenth and seventeenth centuries, the Hippocratic-galenic humoural theory was still influential in the practice of medicine in early eighteenth–century Europe.
Given Galen’s philosophy of medicine, with its emphasis on the four humours of blood, phlegm, black bile and yellow bile, and its consequent insistence on the necessity of keeping the humours in balance, galenic medicine not only focused on treatments for disease but also advocated a health regimen to prevent disease in the first place.[2] The foundation of the regimen (which would later be popularised as the ‘Regimen sanitatis Salernitanum’ due to the many commentaries on it produced by the medical school at Salerno during the medieval period), were the six non-naturals: 1) air; 2) sleep and waking; 3) food and drink; 4) rest and exercise; 5) excretion and retention; 6) the passions or emotions; which were regarded as the key to maintaining a healthy lifestyle. Many authors in Worth’s extensive medical collection commented on both Galen’s texts and more specifically the role of the non-naturals in health: in this exhibition Dr Fabrizio Bigotti, Director of the Centre for the Study of Medicine and the Body in the Renaissance, examines one important commentary, that of the Italian physician Santorio Santori (1561–1636).
For the English surgeon Thomas Brugis (b. in or before 1620, d. in or after 1651), ‘Hygiene’ was chiefly composed of the six non-naturals while ‘Therapeia teaches how to cure diseases, by Diet, Pharmacy, or Chyrurgery’.[3] Whether we agree with Brugis’ divisions are not, dietetics certainly played an important role, both in preserving health and treating illness. As Estes argues, whether one adhered to the humoural galenic theory or later solidist ideas of physicians such as Friedrich Hoffmann (1660–1742), a physician based at Halle, or Herman Boerhaave (1668–1738), an even more influential Dutch physician based at Leiden (Worth’s old alma mater), food played a vital role.[4] As the English physician George Cheyne (1671/2–1743), whose works were collected until his death by Worth, memorably stated: ‘It is Diet alone, proper and specific Diet, in Quantity, Quality, and Order, continued in till the Juices are sufficiently thinn’d to make the Functions regular and easy, which is the universal Remedy’.[5]
Angelo Sala, Tractatus duo: de variis tum chymicorum, tum Galenistarum erroribus, in praeparatione medicinali commissis. Opus Italice primum ab auctore conscriptum, jam vero … in Latinam linguam … translatum, labore & conatu M. A. R. (Frankfurt, 1649), engraved title page depicting Hippocrates and Hermes.
Galenic pharmacy revolved around the use of ‘simples’ and ‘compounds’. ‘Simples’ were, as De Vos notes, derived from natural substances such as plants, animals and mineral, while compounds, as the name suggests, were combinations of simples.[6] Such plant, animal and mineral remedies were, as Primrose states, ‘the principall part of Physick’ in the sixteenth and seventeenth centuries.[7] Most people took Ecclesiasticus Chapter 38, verse 4 literally: ‘The Lord hath created medicines out of the earth; and he that is wise will not abhor them’ and many believed that God had provided a cure for each disease. As a result, herbal medicine loomed large in galenic pharmacy, though, as Wear reminds us, Dioscorides Pedanius, of Anazarbos, the first century AD physician, also used minerals in his preparations.
During the sixteenth century there was a direct challenge to the galenic medical world view by a Swiss physician, Philipp Aureolus Theophrastus Bombast von Hohenheim (1493–1541), who is better known under the name Paracelsus. Paracelsus sought a reformation of medicine in much the same way that Martin Luther (1483–1546), advocated a reform of religion. His teaching was radical for it rejected the doctrine of the four humours, the basis of galenic medicine, and advocated instead the Tria Prima of salt, sulphur and mercury. The true physician, for Paracelsus and subsequent ‘chymical physicians’ of the seventeenth century, was one who was adept at manipulating such chemical cures. We see this different approach very graphically depicted in the frame of Angelo Sala’s text above, where instead of the ‘usual suspects’ of Galen and Hippocrates, or Galen and Theophrastus/Dioscorides, we find instead Hippocrates and Hermes – a reference to Hermes Trismegistus, a legendary figure associated with arcane knowledge. As our online exhibition on ‘Alchemy and Chymistry at the Edward Worth Library’ demonstrates, Worth was fascinated by chemical cures and while he eschewed the more occult trappings of Paracelsus, he was eager to collect a large number of pharmacopoeias emanating from the various colleges of physicians in Europe.
Jean de Renou, Peter Uffenbach and Joseph Du Chesne Dispensatorium Galeno chymicum: continens primo Ioannis Renodaei Institutionum pharmoceuticarum [sic] lib. V. De materia medica lib. III et Antidotarium varium et absolutissimum: secundo Iosephi Quercetani Pharmacopoeam dogmaticorum restitutam per Petrum Vffenbachium … (Hanover, 1631), title page vignette.
As this vignette from the title page of Worth’s copy of Jean de Renou’s, Peter Uffenbach’s and Joseph Du Chesne’s, Dispensatorium Galeno chymicum (Hanover, 1631), demonstrates, pharmacy was only one side of the equation. Surgery was, naturally, an important treatment for a host of ailments. Bleeding was just the tip of the surgical iceberg but it was an important one for bleeding remained a dominant therapeutic choice due to the belief of physicians that ‘fevers were due to an excess of hot, agitated blood’ which they thought should be drained to ensure a balance in the humours.[8] Given the importance of balancing the humours, bleeding, vomiting and purging the body – both to ensure health and to treat illness, continued to be popular treatments throughout the early modern period, even after Harvey’s discovery of the circulation of the blood.[9]
Francesco Torti, Therapeutice specialis ad febres quasdam perniciosas, inopinatò, ac repentè lethales, una verò china china, peculiari methodo ministrata, sanabile … (Modena, 1712), title page.
Worth owned a number of works which explored the therapeutic uses of mineral waters, a topic which was increasingly explored throughout the seventeenth century by more chemically-minded physicians. While most of his works on mineral waters were concerned with both the merits of drinking mineral waters and the related pursuit of bathing at predominanly (though not exclusively) English and French spas, he also acquired a number of texts by leading Italian physicians who were keen to explore the possibilites of ordinary drinking water as both an aliment (an aid to the preservation of health) and medicament (a therapeutic response to disease). As Gentilcore has demonstrated, Italian doctors such as Epifanio Ferdinando (1569–1638), and Francesco Torti (1658–1741), addressed the issue in some depth.[10] Worth owned a copy of Ferdinando’s Centum historiae, seu Observationes, et casus medici, omnes fere medicinae partes, cunctosq; corporis humani morbos continentes (Venice, 1621), and the above work, a therapeutic responses to fevers by Torti. As Gentilcore has pointed out, both authors held very different views: Ferdinando viewed medicine from a ‘neo-Hippocratic’ perspective while Torti, writing almost a century later, ascribed to an iatro-mechanical approach.[11]
Ferdinando’s case history approach reminds us of yet another practical pursuit of early modern physicians – the writing up of case histories, using their experience at the bed side (or in epistolary exchanges with patients), to confirm the practical benefit of new methods of therapy. Case books such as Ferdinando’s give us a ‘bed-side’ view into early modern medical therapeutic practice and his case book was certainly not the only one Worth possessed. It was, as Gentilcore notes, based on his professional practice over the period from 1596 to 1613.[12] Ferdinando had made his views on practical medicine known in an earlier work (not collected by Worth), his Theoremata medica (Venice, 1611), where he had divided practical medicine into prevention (such as the non-naturals), and therapeutics, which was further sub–divided into ‘dietetics, pharmaceutics and surgery’.[13] In his Centum historiae, seu Observationes, et casus medici, omnes fere medicinae partes, cunctosq; corporis humani morbos continentes (Venice, 1621), he applauded the use of cistern water but he, like many physicians of his generation, opposed the drinking of ordinary water, arguing instead for the drinking of wine – a stance that no doubt was met with enthusiasm among his patients![14]
Torti, on the other hand, was far more positive about the therapeutic benefits of drinking water, be it mineral or not, and preferred it to wine as a therapeutic aid.[15] As an iatro-mechanist he viewed the role of water as helping to oil the machine of the human body, and he was not the only physician to take this line for Friedrich Hoffmann, whose work Worth evidently admired, also advocated the use of ‘common water’, both as a preventative of disease and a method of during illness.[16] Gentilcore draws attention to the fact that Torti advocated the use of both ordinary water and mineral waters – a trend that was fast growing across Europe.[17]
Torti is perhaps best known for his work on a completely new medicine, Peruvian bark (also called ‘cinchona’), which is explored in Therapeutice specialis ad febres quasdam perniciosas, inopinatò, ac repentè lethales, una verò china china, peculiari methodo ministrata, sanabile … (Modena, 1712). Peruvian bark (as its seventeenth-century name implies), was an import from the ‘New World’ in the 1630s and 1640s. It was promoted by Jesuits (indeed so much so as to lead to it being called ‘Jesuits’ bark).[18] They sought to popularize its use because of its efficacy in treating fevers – and this was unsurprising as it contained quinine. It was particularly useful in treating malaria and, following its introduction into European medical circles, it achieved official recognition in pharmacopoeias such as the London Pharmacopoeia in 1677.[19] The advocacy of the Italian physician Francesco Torti coupled with that of the influential English physician, Thomas Sydenham (bap. 1624, d. 1689), who described Cinchona officinalis as ‘the best Specifick for Agues’, ensured that it became an important ‘weapon’ in the early modern fight against malaria.[20]
Georg Wolfgang Wedel, Opiologia ad mentem Academiae Naturae Curiosorum (Jena, 1674), title page vignette.
Another new drug coming on the European market in the early modern period was opium, and here we see an image of someone extracting the juice in Worth’s copy of the Opiologia (Jena, 1674) of Georg Wolfgang Wedel (1645–1712). Maehle reports that it only became widely available as a remedy in Europe in the seventeenth century.[21] Spary concurs, noting that in France opium was pedalled by itinerant merchants called ‘operators’ throughout the country.[22] Opium was the subject of much experimentation, both by physicians and apothecaries. Spary investigates the networks involved in importing opium into early modern France and the types of experiments being undertaken by medical practitioners (of all varieties), in order to assess its utility as a treatment. In 1698 Moyse Charas (1619–98), a famous French apothecary who is explored in the ‘Apothecaries’ webpage of this exhibition, presented a paper at the Académié des Sciences on his experience of taking opium:
‘I think people will be pleased to see me publish here, in good faith, what I have recently painstakingly observed on my own person, through the whole course of an illness of three months, from which I have recovered thanks to God, which principally consisted of a great reduction in strength and mental exhaustion, and frequent severe episodes of sweating followed by horrible itching, with no pain in any individual part of my body. From the start, I foresaw that this illness which I was experiencing at a very advanced age could only be prolonged … I thought it appropriate to take a grain of Opium Extract, as I did regularly every day at no fixed time … my conviction that this Extract was sustaining my strength, made me punctilious about taking a grain a day. Its most noticeable effect was that of giving me a great inner tranquillity, with no drowsiness’.[23]
Opium was not the only dangerous substance with which Charas experimented – Worth’s owned an English edition of his famous work on viper venom: New experiments on vipers (London, 1677). Many were, however, understandably wary of such dangerous substances and the Jena physician Wedel noted that its use posed problems for a practising physician.[24] Other German physicians concurred, and as Maehle notes, ‘followers of Friedrich Hoffmanns’ iatromechanical system or of Georg Ernst Stahl’s ‘animism’ in Halle were rather critical towards opium therapy’.[25]
Michael Bernhard Valentini, Praxeos medicinae infallibilis pars altera chirurgica (Frankfurt, 1715), frontispiece depicting blood transfusion.
Worth was clearly interested in the applications of new drugs into his medical practice but he was also open to learning about new medical procedures such as inoculation and blood transfusion. This work, by the German physician Michael Bernhard Valentini (1657–1729), on the practice of medicine, demonstrates on its frontispiece the latter procedure. Blood transfusion was, quite literally, cutting-edge: it had been introduced in the later 1660s as an innovative emergency surgical procedure. Worth owned an early text on the subject of ‘Infusional surgery’: Chirurgia infusoria (Kiel, 1667), by another German physician, Johann Daniel Major (1634–93), who explained how the procedure (which in this case involved the infusion of pharmacological liquid) might be undertaken.[26] The earlier 1660s had witnessed a number of experiments, usually on animals, and in 1667 the English physician, Richard Lower (1631–91), attempted it on humans. The technique subsequently became a popular subject in the Philosophical Transactions of the Royal Society and in the Journal des Sçavans. However, it was a controversial one: as Marinozzi et al. report, by 1668 Paris had instituted a ban against the practice.[27]
Elimithar Elluchasem (Al Muhtar Ibn–al–Hasan Ibn–Butlan), Tacuini Sanitatis Elluchasem Elimithar …, De sex rebus non naturalibus, earum naturis, operationibus, & rectificationibus, publico omnium usui, conseruandae sanitatis, recens exarati. Albengnefit De uirtutibus medicinarum, & ciborum. Iac. Alkindus De rerum gradibus (Strasbourg, 1531), p. 103 detail.
Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.
Sources
Benedek, Thomas G., ‘The role of therapeutic bathing in the sixteenth century and its contemporary scientific explanations’, in Albrecht Classen (ed.), Bodily and spiritual hygiene in medieval and early modern literature : explorations of textual presentations of filth and water (Berlin and Boston, 2017), pp 528–67.
Blackmore, Sir Richard, A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation. By Sir Richard Blackmore, Knt. (London, 1723).
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).
Cheyne, George, An Essay on Regimen (London, 1740).
De Vos, Paula S., Compound Remedies. Galenic Pharmacy from the Ancient Mediterranean to New Spain (Pittsburgh, 2023).
Estes, J.W., ‘The Medical Properties of Good in the Eighteenth Century’, Journal of the History of Medicine and Allied Science, 51, no. 2 (1996), 127–54.
Gentilcore, David, ‘In praise of the ordinary: shifting knowledge and practice in the medical use of drinking water in Italy, 1550–1750’, Bulletin of the History of Medicine, 97, no. 4 (2023), 531–59.
Grace, Pierce A., ‘Therapeutic bloodletting in Ireland from the medieval period to modern times’, Proceedings of the Royal Irish Academy: Archaeology, Culture, History, Literature, 121C (2012), 227–48.
Jouanna, Jacques, ‘The legacy of the Hippocratic treatise The Nature of Man: The theory of the four humours’, in Van der Eijk, Philip (ed.), Greek Medicine from Hippocractes to Galen (Leiden, 2012), 335–59.
Lindemann, Mary, Medicine and Society in Early Modern Europe (Cambridge, 1999).
Maehle, Andreas-Holger, ‘Opium: Explorations of an Ambiguous Drug’, in Maehle, Andreas-Holger, Drugs on trial: experimental pharmacology and therapeutic innovation in the eighteenth century (Amsterdam and Atlanta, GA, 1999), pp 127–222.
Marinozzi, Silvia, Daniel Messineo, and Giuseppe Sanese, ‘The origins of the blood transfusion: European literature and Italian debate on new innovations (1667–1668)’, Acta Med. Hist. Adriat., 20, no. 1 (2022), 27–50.
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), 465–86.
Spary, E.C., ‘Opium, experimentation and alterity in France’, The Historical Journal, 65 (2022), 49–67.
Ward, Jenny, ‘Brugis, Thomas (b. in or before 1620, d. in or after 1651), surgeon’, Oxford Dictionary of National Biography (ODNB).
Wear, Andrew, Knowledge and Practice in English Medicine, 1550–1680 (Cambridge, 2000).
Weatherall, Mike, ‘Drug Treatment and the Rise of Pharmacology’, in Porter, Roy (ed.), The Cambridge History of Medicine (Cambridge, 2006), pp 211–37.
Willard, Thomas, ‘Testing the Waters: Early Modern Studies’ in Albrecht Classen (ed.), Bodily and spiritual hygiene in medieval and early modern literature: explorations of textual presentations of filth and water (Berlin and Boston, 2017), pp 568–98.
*Please note that these treatments should not be attempted!
[1] Blackmore, Sir Richard, A treatise upon the small-pox, in two parts. Containing, I. An account of the nature and several kinds of that disease, with the proper methods of cure. II. A dissertation upon the modern practice of inoculation. By Sir Richard Blackmore, Knt. (London, 1723), p. x.
[2] Jouanna, Jacques, ‘The legacy of the Hippocratic treatise The Nature of Man: The theory of the four humours’, in Van der Eijk, Philip (ed.), Greek Medicine from Hippocrates to Galen (Leiden, 2012), makes the point that it took several centuries ‘after Galen, in Greek medicine of late antiquity’ for these ideas to be developed (p. 340).
[3] 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.
[4] Estes, J.W., ‘The Medical Properties of Good in the Eighteenth Century’, Journal of the History of Medicine and Allied Science, 51, no. 2 (1996), 129.
[5] Cheyne, George, An Essay on Regimen (London, 1740), p. 88. This work post-dates Worth’s death.
[6] De Vos, Paula S., Compound Remedies. Galenic Pharmacy from the Ancient Mediterranean to New Spain (Pittsburgh, 2023), pp 3–4.
[7] Primrose, James, Popular Errours. Or the Errours of the People in Physick (London, 1651), p. 196 quoted in Wear, Andrew, Knowledge and Practice in English Medicine, 1550–1680 (Cambridge, 2000), p. 46.
[8] Grace, Pierce A., ‘Therapeutic bloodletting in Ireland from the medieval period to modern times’, Proceedings of the Royal Irish Academy: Archaeology, Culture, History, Literature, 121C (2012), 236.
[9] On this, see ibid., 227–48.
[10] Gentilcore, David, ‘In praise of the ordinary: shifting knowledge and practice in the medical use of drinking water in Italy, 1550–1750’, Bulletin of the History of Medicine, 97, no. 4 (2023), 531–59.
[11] Ibid., 533.
[12] Ibid., 536.
[13] Ibid., 534.
[14] Ibid., 537.
[15] Ibid., 552.
[16] Ibid., 551.
[17] Ibid., 557.
[18] Weatherall, Mike, ‘Drug Treatment and the Rise of Pharmacology’, in Porter, Roy (ed.), The Cambridge History of Medicine (Cambridge, 2006), p. 216; Lindemann, Mary, Medicine and Society in Early Modern Europe (Cambridge, 1999), p. 89.
[19] Weatherall, ‘Drug Treatment and the Rise of Pharmacology’, p. 216.
[20] Wear, Knowledge and Practice in English Medicine, pp 461–2.
[21] Maehle, Andreas-Holger, ‘Opium: Explorations of an Ambiguous Drug’, in Maehle, Andreas-Holger, Drugs on trial: experimental pharmacology and therapeutic innovation in the eighteenth century (Amsterdam and Atlanta, GA, 1999), p. 129. He notes that sixteenth-century doctors such as Felix Platter (1536–1614), had discussed its properties: p. 132.
[22] Spary, E.C., ‘Opium, experimentation and alterity in France’, The Historical Journal, 65 (2022), 57–8.
[23] Translated from French by E.C. Spary in ‘Opium, experimentation and alterity in France’, 52.
[24] Maehle, Andreas-Holger, ‘Opium: Explorations of an Ambiguous Drug’, p. 141.
[25] Ibid., p. 131.
[26] Marinozzi, Silvia, Daniel Messineo, and Giuseppe Sanese, ‘The origins of the blood transfusion: European literature and Italian debate on new innovations (1667–1668)’, Acta Med. Hist. Adriat., 20, no. 1 (2022), 32.
[27] Ibid., 43.