Bacon, on the Advancement of Medical Learning (1605)

September 15, 2016 by Dr. Geyser

IX. (1) We come therefore now to that knowledge whereunto the ancient oracle directeth us, which is the knowledge of ourselves; which deserveth the more accurate handling, by how much it toucheth us more nearly.  This knowledge, as it is the end and term of natural philosophy in the intention of man, so notwithstanding it is but a portion of natural philosophy in the continent of Nature.  And generally let this be a rule, that all partitions of knowledges be accepted rather for lines and veins than for sections and separations; and that the continuance and entireness of knowledge be preserved.  For the contrary hereof hath made particular sciences to become barren, shallow, and erroneous, while they have not been nourished and maintained from the common fountain.  So we see Cicero, the orator, complained of Socrates and his school, that he was the first that separated philosophy and rhetoric; whereupon rhetoric became an empty and verbal art.  So we may see that the opinion of Copernicus, touching the rotation of the earth, which astronomy itself cannot correct, because it is not repugnant to any of the phenomena, yet natural philosophy may correct.  So we see also that the science of medicine if it be destituted and forsaken by natural philosophy, it is not much better than an empirical practice.  With this reservation, therefore, we proceed to human philosophy or humanity, which hath two parts: the one considereth man segregate or distributively, the other congregate or in society; so as human philosophy is either simple and particular, or conjugate and civil.  Humanity particular consisteth of the same parts whereof man consisteth: that is, of knowledges which respect the body, and of knowledges that respect the mind.  But before we distribute so far, it is good to constitute.  For I do take the consideration in general, and at large, of human nature to be fit to be emancipate and made a knowledge by itself, not so much in regard of those delightful and elegant discourses which have been made of the dignity of man, of his miseries, of his state and life, and the like adjuncts of his common and undivided nature; but chiefly in regard of the knowledge concerning the sympathies and concordances between the mind and body, which being mixed cannot be properly assigned to the sciences of either.

(2) This knowledge hath two branches: for as all leagues and amities consist of mutual intelligence and mutual offices, so this league of mind and body hath these two parts: how the one discloseth the other, and how the one worketh upon the other; discovery and impression.  The former of these hath begotten two arts, both of prediction or prenotion; whereof the one is honoured with the inquiry of Aristotle, and the other of Hippocrates.  And although they have of later time been used to be coupled with superstitions and fantastical arts, yet being purged and restored to their true state, they have both of them a solid ground in Nature, and a profitable use in life.  The first is physiognomy, which discovereth the disposition of the mind by the lineaments of the body.  The second is the exposition of natural dreams, which discovereth the state of the body by the imaginations of the mind.  In the former of these I note a deficience.  For Aristotle hath very ingeniously and diligently handled the factures of the body, but not the gestures of the body, which are no less comprehensible by art, and of greater use and advantage.  For the lineaments of the body do disclose the disposition and inclination of the mind in general; but the motions of the countenance and parts do not only so, but do further disclose the present humour and state of the mind and will.  For as your majesty saith most aptly and elegantly, “As the tongue speaketh to the ear so the gesture speaketh to the eye.”  And, therefore, a number of subtle persons, whose eyes do dwell upon the faces and fashions of men, do well know the advantage of this observation, as being most part of their ability; neither can it be denied, but that it is a great discovery of dissimulations, and a great direction in business.

(3) The latter branch, touching impression, hath not been collected into art, but hath been handled dispersedly; and it hath the same relation orantistrophe that the former hath.  For the consideration is double—either how and how far the humours and affects of the body do alter or work upon the mind, or, again, how and how far the passions or apprehensions of the mind do alter or work upon the body.  The former of these hath been inquired and considered as a part and appendix of medicine, but much more as a part of religion or superstition.  For the physician prescribeth cures of the mind in frenzies and melancholy passions, and pretendeth also to exhibit medicines to exhilarate the mind, to control the courage, to clarify the wits, to corroborate the memory, and the like; but the scruples and superstitions of diet and other regiment of the body in the sect of the Pythagoreans, in the heresy of the Manichees, and in the law of Mahomet, do exceed.  So likewise the ordinances in the ceremonial law, interdicting the eating of the blood and the fat, distinguishing between beasts clean and unclean for meat, are many and strict; nay, the faith itself being clear and serene from all clouds of ceremony, yet retaineth the use of fastlings, abstinences, and other macerations and humiliations of the body, as things real, and not figurative.  The root and life of all which prescripts is (besides the ceremony) the consideration of that dependency which the affections of the mind are submitted unto upon the state and disposition of the body.  And if any man of weak judgment do conceive that this suffering of the mind from the body doth either question the immortality, or derogate from the sovereignty of the soul, he may be taught, in easy instances, that the infant in the mother’s womb is compatible with the mother, and yet separable; and the most absolute monarch is sometimes led by his servants, and yet without subjection.  As for the reciprocal knowledge, which is the operation of the conceits and passions of the mind upon the body, we see all wise physicians, in the prescriptions of their regiments to their patients, do ever consider accidentia animi, as of great force to further or hinder remedies or recoveries: and more specially it is an inquiry of great depth and worth concerning imagination, how and how far it altereth the body proper of the imaginant; for although it hath a manifest power to hurt, it followeth not it hath the same degree of power to help.  No more than a man can conclude, that because there be pestilent airs, able suddenly to kill a man in health, therefore there should be sovereign airs, able suddenly to cure a man in sickness.  But the inquisition of this part is of great use, though it needeth, as Socrates said, “a Delian diver,” being difficult and profound.  But unto all this knowledge de communi vinculo, of the concordances between the mind and the body, that part of inquiry is most necessary which considereth of the seats and domiciles which the several faculties of the mind do take and occupate in the organs of the body; which knowledge hath been attempted, and is controverted, and deserveth to be much better inquired.  For the opinion of Plato, who placed the understanding in the brain, animosity (which he did unfitly call anger, having a greater mixture with pride) in the heart, and concupiscence or sensuality in the liver, deserveth not to be despised, but much less to be allowed.  So, then, we have constituted (as in our own wish and advice) the inquiry touching human nature entire, as a just portion of knowledge to be handled apart.

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X. (1) The knowledge that concerneth man’s body is divided as the good of man’s body is divided, unto which it referreth.  The good of man’s body is of four kinds—health, beauty, strength, and pleasure: so the knowledges are medicine, or art of cure; art of decoration, which is called cosmetic; art of activity, which is called athletic; and art voluptuary, which Tacitus truly calleth eruditus luxus.  This subject of man’s body is, of all other things in nature, most susceptible of remedy; but then that remedy is most susceptible of error; for the same subtlety of the subject doth cause large possibility and easy failing, and therefore the inquiry ought to be the more exact.

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(2) To speak, therefore, of medicine, and to resume that we have said, ascending a little higher: the ancient opinion that man was microcosmus—an abstract or model of the world—hath been fantastically strained by Paracelsus and the alchemists, as if there were to be found in man’s body certain correspondences and parallels, which should have respect to all varieties of things, as stars, planets, minerals, which are extant in the great world.  But thus much is evidently true, that of all substances which nature hath produced, man’s body is the most extremely compounded.  For we see herbs and plants are nourished by earth and water; beasts for the most part by herbs and fruits; man by the flesh of beasts, birds, fishes, herbs, grains, fruits, water, and the manifold alterations, dressings, and preparations of these several bodies before they come to be his food and aliment.  Add hereunto that beasts have a more simple order of life, and less change of affections to work upon their bodies, whereas man in his mansion, sleep, exercise, passions, hath infinite variations: and it cannot be denied but that the body of man of all other things is of the most compounded mass.  The soul, on the other side, is the simplest of substances, as is well expressed:

      “Purumque reliquit
Æthereum sensum atque auraï simplicis ignem.”

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So that it is no marvel though the soul so placed enjoy no rest, if that principle be true, that Motus rerum est rapidus extra locum, placidus in loco.  But to the purpose.  This variable composition of man’s body hath made it as an instrument easy to distemper; and, therefore, the poets did well to conjoin music and medicine in Apollo, because the office of medicine is but to tune this curious harp of man’s body and to reduce it to harmony.  So, then, the subject being so variable hath made the art by consequent more conjectural; and the art being conjectural hath made so much the more place to be left for imposture.  For almost all other arts and sciences are judged by acts or masterpieces, as I may term them, and not by the successes and events.  The lawyer is judged by the virtue of his pleading, and not by the issue of the cause; this master in this ship is judged by the directing his course aright, and not by the fortune of the voyage; but the physician, and perhaps this politique, hath no particular acts demonstrative of his ability, but is judged most by the event, which is ever but as it is taken: for who can tell, if a patient die or recover, or if a state be preserved or ruined, whether it be art or accident?  And therefore many times the impostor is prized, and the man of virtue taxed.  Nay, we see [the] weakness and credulity of men is such, as they will often refer a mountebank or witch before a learned physician.  And therefore the poets were clear-sighted in discerning this extreme folly when they made Æsculapius and Circe, brother and sister, both children of the sun, as in the verses—

“Ipse repertorem medicinæ talis et artis
Fulmine Phœbigenam Stygias detrusit ad undas.”

And again—

“Dives inaccessos ubi Solis filia lucos,” &c.

For in all times, in the opinion of the multitude, witches and old women and impostors, have had a competition with physicians.  And what followeth?  Even this, that physicians say to themselves, as Solomon expresseth it upon a higher occasion, “If it befall to me as befalleth to the fools, why should I labour to be more wise?”  And therefore I cannot much blame physicians that they use commonly to intend some other art or practice, which they fancy more than their profession; for you shall have of them antiquaries, poets, humanists, statesmen, merchants, divines, and in every of these better seen than in their profession; and no doubt upon this ground that they find that mediocrity and excellency in their art maketh no difference in profit or reputation towards their fortune: for the weakness of patients, and sweetness of life, and nature of hope, maketh men depend upon physicians with all their defects.  But, nevertheless, these things which we have spoken of are courses begotten between a little occasion and a great deal of sloth and default; for if we will excite and awake our observation, we shall see in familiar instances what a predominant faculty the subtlety of spirit hath over the variety of matter or form.  Nothing more variable than faces and countenances, yet men can bear in memory the infinite distinctions of them; nay, a painter, with a few shells of colours, and the benefit of his eye, and habit of his imagination, can imitate them all that ever have been, are, or may be, if they were brought before him.  Nothing more variable than voices, yet men can likewise discern them personally: nay, you shall have a buffon orpantomimus will express as many as he pleaseth.  Nothing more variable than the differing sounds of words; yet men have found the way to reduce them to a few simple letters.  So that it is not the insufficiency or incapacity of man’s mind, but it is the remote standing or placing thereof that breedeth these mazes and incomprehensions; for as the sense afar off is full of mistaking, but is exact at hand, so is it of the understanding, the remedy whereof is, not to quicken or strengthen the organ, but to go nearer to the object; and therefore there is no doubt but if the physicians will learn and use the true approaches and avenues of nature, they may assume as much as the poet saith:

“Et quoniam variant morbi, variabimus artes;
Mille mali species, mille salutis erunt.”

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Which that they should do, the nobleness of their art doth deserve: well shadowed by the poets, in that they made Æsculapius to be the son of [the] sun, the one being the fountain of life, the other as the second-stream; but infinitely more honoured by the example of our Saviour, who made the body of man the object of His miracles, as the soul was the object of His doctrine.  For we read not that ever He vouchsafed to do any miracle about honour or money (except that one for giving tribute to Cæsar), but only about the preserving, sustaining, and healing the body of man.

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(3) Medicine is a science which hath been (as we have said) more professed than laboured, and yet more laboured than advanced; the labour having been, in my judgment, rather in circle than in progression.  For I find much iteration, but small addition.  It considereth causes of diseases, with the occasions or impulsions; the diseases themselves, with the accidents; and the cures, with the preservations.  The deficiences which I think good to note, being a few of many, and those such as are of a more open and manifest nature, I will enumerate and not place.

(4) The first is the discontinuance of the ancient and serious diligence of Hippocrates, which used to set down a narrative of the special cases of his patients, and how they proceeded, and how they were judged by recovery or death.  Therefore having an example proper in the father of the art, I shall not need to allege an example foreign, of the wisdom of the lawyers, who are careful to report new cases and decisions, for the direction of future judgments.  This continuance of medicinal history I find deficient; which I understand neither to be so infinite as to extend to every common case, nor so reserved as to admit none but wonders: for many things are new in this manner, which are not new in the kind; and if men will intend to observe, they shall find much worthy to observe.

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(5) In the inquiry which is made by anatomy, I find much deficience: for they inquire of the parts, and their substances, figures, and collocations; but they inquire not of the diversities of the parts, the secrecies of the passages, and the seats or nestling of the humours, nor much of the footsteps and impressions of diseases.  The reason of which omission I suppose to be, because the first inquiry may be satisfied in the view of one or a few anatomies; but the latter, being comparative and casual, must arise from the view of many.  And as to the diversity of parts, there is no doubt but the facture or framing of the inward parts is as full of difference as the outward, and in that is the cause continent of many diseases; which not being observed, they quarrel many times with the humours, which are not in fault; the fault being in the very frame and mechanic of the part, which cannot be removed by medicine alterative, but must be accommodated and palliated by diets and medicines familiar.  And for the passages and pores, it is true which was anciently noted, that the more subtle of them appear not in anatomies, because they are shut and latent in dead bodies, though they be open and manifest in life: which being supposed, though the inhumanity of anatomia vivorum was by Celsus justly reproved; yet in regard of the great use of this observation, the inquiry needed not by him so slightly to have been relinquished altogether, or referred to the casual practices of surgery; but might have been well diverted upon the dissection of beasts alive, which notwithstanding the dissimilitude of their parts may sufficiently satisfy this inquiry.  And for the humours, they are commonly passed over in anatomies as purgaments; whereas it is most necessary to observe, what cavities, nests, and receptacles the humours do find in the parts, with the differing kind of the humour so lodged and received.  And as for the footsteps of diseases, and their devastations of the inward parts, impostumations, exulcerations, discontinuations, putrefactions, consumptions, contractions, extensions, convulsions, dislocations, obstructions, repletions, together with all preternatural substances, as stones, carnosities, excrescences, worms, and the like; they ought to have been exactly observed by multitude of anatomies, and the contribution of men’s several experiences, and carefully set down both historically according to the appearances, and artificially with a reference to the diseases and symptoms which resulted from them, in case where the anatomy is of a defunct patient; whereas now upon opening of bodies they are passed over slightly and in silence.

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(6) In the inquiry of diseases, they do abandon the cures of many, some as in their nature incurable, and others as past the period of cure; so that Sylla and the Triumvirs never proscribed so many men to die, as they do by their ignorant edicts: whereof numbers do escape with less difficulty than they did in the Roman prescriptions.  Therefore I will not doubt to note as a deficience, that they inquire not the perfect cures of many diseases, or extremities of diseases; but pronouncing them incurable do enact a law of neglect, and exempt ignorance from discredit.

What works

(7) Nay further, I esteem it the office of a physician not only to restore health, but to mitigate pain and dolors; and not only when such mitigation may conduce to recovery, but when it may serve to make a fair and easy passage.  For it is no small felicity which Augustus Cæsar was wont to wish to himself, that same Euthanasia; and which was specially noted in the death of Antoninus Pius, whose death was after the fashion, and semblance of a kindly and pleasant sheep.  So it is written of Epicurus, that after his disease was judged desperate, he drowned his stomach and senses with a large draught and ingurgitation of wine; whereupon the epigram was made, Hinc Stygias ebrius hausit aquas; he was not sober enough to taste any bitterness of the Stygian water.  But the physicians contrariwise do make a kind of scruple and religion to stay with the patient after the disease is deplored; whereas in my judgment they ought both to inquire the skill, and to give the attendances, for the facilitating and assuaging of the pains and agonies of death.

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(5) In the consideration of the cures of diseases, I find a deficience in the receipts of propriety, respecting the particular cures of diseases: for the physicians have frustrated the fruit of tradition and experience by their magistralities, in adding and taking out and changing quid pro qua in their receipts, at their pleasures; commanding so over the medicine, as the medicine cannot command over the disease.  For except it be treacle andmithridatum, and of late diascordium, and a few more, they tie themselves to no receipts severely and religiously.  For as to the confections of sale which are in the shops, they are for readiness and not for propriety.  For they are upon general intentions of purging, opening, comforting, altering, and not much appropriate to particular diseases.  And this is the cause why empirics and old women are more happy many times in their cures than learned physicians, because they are more religious in holding their medicines.  Therefore here is the deficience which I find, that physicians have not, partly out of their own practice, partly out of the constant probations reported in books, and partly out of the traditions of empirics, set down and delivered over certain experimental medicines for the cure of particular diseases, besides their own conjectural and magistral descriptions.  For as they were the men of the best composition in the state of Rome, which either being consuls inclined to the people, or being tribunes inclined to the senate; so in the matter we now handle, they be the best physicians, which being learned incline to the traditions of experience, or being empirics incline to the methods of learning.

 

(9) In preparation of medicines I do find strange, specially considering how mineral medicines have been extolled, and that they are safer for the outward than inward parts, that no man hath sought to make an imitation by art of natural baths and medicinable fountains: which nevertheless are confessed to receive their virtues from minerals; and not so only, but discerned and distinguished from what particular mineral they receive tincture, as sulphur, vitriol, steel, or the like; which nature, if it may be reduced to compositions of art, both the variety of them will be increased, and the temper of them will be more commanded.

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(10) But lest I grow to be more particular than is agreeable either to my intention or to proportion, I will conclude this part with the note of one deficience more, which seemeth to me of greatest consequence: which is, that the prescripts in use are too compendious to attain their end; for, to my understanding, it is a vain and flattering opinion to think any medicine can be so sovereign or so happy, as that the receipt or miss of it can work any great effect upon the body of man.  It were a strange speech which spoken, or spoken oft, should reclaim a man from a vice to which he were by nature subject.  It is order, pursuit, sequence, and interchange of application, which is mighty in nature; which although it require more exact knowledge in prescribing, and more precise obedience in observing, yet is recompensed with the magnitude of effects.  And although a man would think, by the daily visitations of the physicians, that there were a pursuance in the cure, yet let a man look into their prescripts and ministrations, and he shall find them but inconstancies and every day’s devices, without any settled providence or project.  Not that every scrupulous or superstitious prescript is effectual, no more than every straight way is the way to heaven; but the truth of the direction must precede severity of observance.

(11) For cosmetic, it hath parts civil, and parts effeminate: for cleanness of body was ever esteemed to proceed from a due reverence to God, to society, and to ourselves.  As for artificial decoration, it is well worthy of the deficiences which it hath; being neither fine enough to deceive, nor handsome to use, nor wholesome to please.

(12) For athletic, I take the subject of it largely, that is to say, for any point of ability whereunto the body of man may be brought, whether it be of activity, or of patience; whereof activity hath two parts, strength and swiftness; and patience likewise hath two parts, hardness against wants and extremities, and endurance of pain or torment; whereof we see the practices in tumblers, in savages, and in those that suffer punishment.  Nay, if there be any other faculty which falls not within any of the former divisions, as in those that dive, that obtain a strange power of containing respiration, and the like, I refer it to this part.  Of these things the practices are known, but the philosophy that concerneth them is not much inquired; the rather, I think, because they are supposed to be obtained, either by an aptness of nature, which cannot be taught, or only by continual custom, which is soon prescribed which though it be not true, yet I forbear to note any deficiences; for the Olympian games are down long since, and the mediocrity of these things is for use; as for the excellency of them it serveth for the most part but for mercenary ostentation.

(13) For arts of pleasure sensual, the chief deficience in them is of laws to repress them.  For as it hath been well observed, that the arts which flourish in times while virtue is in growth, are military; and while virtue is in state, are liberal; and while virtue is in declination, are voluptuary: so I doubt that this age of the world is somewhat upon the descent of the wheel.  With arts voluptuary I couple practices joculary; for the deceiving of the senses is one of the pleasures of the senses.  As for games of recreation, I hold them to belong to civil life and education.  And thus much of that particular human philosophy which concerns the body, which is but the tabernacle of the mind.

 

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