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The medical philosophy of Francis Bacon (1561–1626)
Medical Hypotheses, 4: 208-220, 1978
THE MEDICAL PHILOSOPHY OF FRANCIS BACON (1561-1626) Jeffrey Boss.
Department of Physiology, The Medical School, University of Bristol, Bristol, BS8 lTD, U.K. ABSTRACT
Francis Bacon's view of man is dualistic but, although he takes note of mental faculties, he makes the relation between mind and body, rather than the substance of mind, the basis for enquiry into mental processes and, more particularly, for the (He uses 'mind' and 'soul' medically relevant study of mind. The healing of the body requires study as equivalent terms.) of the body, and the ineffectiveness of physicians is due to their failure in this respect rather than to the body's complexity. To learn about the body requires clinical observation and recording, together with the comparison of bodies, experiments on living animals and attention to The aims of medicine should include not pathological changes. only the restoration of health but also the relief of suffering, and they are not to be limited by putting aside a disease as To learn from treatment it must be fixed in its incurable. Bacon has no ordering with controlled and limited variation. separation of medicine from natural science; his philosophy of medicine is his general philosophy of the advancement of knowledge, but limited to a particular field of application. If medicine is separated from natural philosophy it is changed wholly or greatly into empiricism. Key words:
Francis Bacon - philosophy, medical - medicine science - pathology - anatomy, comparative ethics, medical.
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INTRODUCTION Bacon's medical imuortance Francis Bacon's influence on the development of medicine is threefold. First, his philosophy was an important element in general thinking about the function of medicine in society in the seventeenth century (1). Secondly, Bacon's teaching provided an acknowledged philosophy for natural philosophers such as the founders of the Royal Society (2), who in their turn influenced the history of medical knowledge; Bacon was in fact praised by Huyghens, adapted extensively by Hooke, and regarded by Boyle as by a disciple (3). Bacon's third and most direct influence on medicine was through Thomas Sydenham (1624-1689), the 'English Hippocrates', a professed Baconian (4,5), whose philosophy penetrates clinical science even to-day. Bacon's importance for medicine is not only historical, however. He has three lessons to which we may still listen with profit, even if we do not agree. The first lesson is that, in the practice and advancement of medicine, clinical practice and natural science may not be separated without a great and detrimental change in medicine itself. (Sydenham, it may be argued, did not wholly adhere to this principle.) This point will be taken up again, below. The second, related lesson is that the interpretation of nature requires an attitude to truth and utility such as to preclude any distinction between 'pure' and 'applied' science. The purpose of a particular experiment is to be light rather than fruit (6), but the overall aim of enquiry, for heuristic as well as altruistic reasons, is that human life be endowed with new discoveries and resources (7). Those who make fruitbearing experiments, and those who do not have as the goal of enquiry this endowing of human life, are described by Bacon in very similar terms (8). Thirdly, Bacon offers, by implication, a lesson in practice. If medicine and natural science are not separated, and if there is no distinction between 'pure' and 'applied' science, the scientist and the clinician may perhaps be expected best to achieve their ends by meeting in one and the same person. Sources Francis Bacon's theoretical treatment of the increase of knowledge is in the Novum Organum, while the New Atlantis is concerned with certain social aspects of scientific research. Between these two topics lies the practice and scope of discovery, and this is the field of Bacon's De Augmentis, which incorporates his Advancement of Learning. It may not be surprising therefore that most of what Bacon has to say on medicine is found in the Advancement of Learning, and it is this 209
work which has proved the richest source in the study now presented, as the citations will indicate. (All Bacon's philosophical
works
were
examined.)
Partus Masculinus, were published between the first appearance of the Advancement of Learning (1605) and the time of its re-publication as part of De Augmentis (1623), and there are no contradictions between cited works with respect to any matter raised in this It is, therefore justifiable and convenient to bring essay. together evidence from different works without regard to temporal sequence. The works
to be cited,
other
than Tempo&s
DEFINING MEDICINE The division
study
of learning
The wholeness of man.
of learning
is especially
important
in the
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 content 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 ... 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 phainomenu,yet natural philosophy may So we see also that the science of medicine if it correct. be destituted and forsaken by natural philosophy, it is not much better than an empirical practice (9). Bacon elsewhere makes his general point about empirics, who At the other extreme are spiders, collect and use, like ants. but the bee gathers and, by who spin webs out of themselves; In practice changes what it gathers (10). its own capability, the empiric physician is limited. We see it is accounted an error to commit a natural body to empiric physicians, which commonly have a few pleasing receipts whereupon they are confident and adventurous, but know neither the cause of diseases, nor the complexions of patients, nor peril of accidents, nor the true method of cures (11).
Therefore medicine is not to be separated from natural philosophy. Nevertheless, the nature of man makes possible some division of knowledge by subject-matter, and the first passage quoted (9) continues:
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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 or particular, Humanity particular consisteth of or conjugate and civil. the same parts whereof man consisteth; that is, of knowledges which respect the body, and of knowledges that respect the mind. The terms The soul,
in Bacon's usage (12). 'mind' and 'soul' are synonymous contrary to Aristotle, is a substance (13); indeed,
Aristotle 'made us slaves of words' (14), for 'how could anything solid be expected of a man who created a universe out of categories?' (15). Dualism and the mind Thus Bacon is a dualist. Nevertheless the study of the soul as substance, even when a matter for natural philosophy, is 'bounded by religion' (12), and the faculties of the mind receive consideration in a non-medical context (16). Attention, however, is to be directed not to the mind in isolation but to its correlations with the body. 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 of 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 (9).
Bacon refers to a soul able to gather itself up from being diffused in the organs of the body (17) but he is noting the beliefs of others and it is not clear whether he is in agreement on this point, and whether therefore we may infer his teaching that the soul and body are distributed in the same space. The correlations which Bacon certainly would have us seek are functional, even when they are correlations of mental functions with parts of the body (below). In general, correlations showing the unity of mind and body are of two kinds: 'discovery', enquired into by Aristotle, whereby the lineaments of the body show the disposition of the mind, and 'impressions', enquired into by Hippocrates, whereby imaginations of the mind show the state of the body ('natural dreams') (18). Correspondingly, these principles have two groups of applications (19). Physicians give bodily medicines for mental states, although Bacon is of the opinion that most bodily treatment directed to the mind is through religious dietary laws and fastings, such as those practised 'in the sect of the Pythagoreans, in the heresy of the Manichees, and in the law of Mahornet'. (The omission of Jews may be taken with the
211
somewhat unconvincing picture of them in the New AtZantis (20) as evidence that for Bacon Jews were a matter of theory rather than experience.) Conversely, wise physicians consider the power of the mind to help or hinder treatment of the body. Bacon advocates, as the most necessary study of the correlations between mind and body, that of the bodily seats of mental faculties. Such correlations were a major theme of physiology for a century and a half after Bacon (21,22,23), remained important in neurology in the nineteenth century (24), and are of practical importance in our own day (25). The body and medicine The body has four kinds of good: health, beauty, strength and pleasure (26). Thus there are four kinds of relevant knowledge, and it is noteworthy that Bacon's word 'knowledge' comprehends arts, without distinction of knowing and doing; later he expressed this unity in relation to his inductive mode These kinds of knowledge, in corresponding of enquiry (27). sequence, are medicine or the art of cure, cosmetic or the art of decoration, athletic or the art of activity, and what Tacitus calls eruditus Zuxus, or the art voluptuary. (Note that 'cure' is near in meaning to our word 'care', not to 'cure' in its Thus medicine is concerned with the body, but modern sense.) the body and mind are not functionally separate. The body, being complex, is compared with an instrument to be kept tuned. It cannot be denied but that the body of man of all other things is of the most compounded mass ... 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 reduce it to harmony (28).
This last remark could suggest that, since an instrument tends to drift spontaneously out of tune, health is maintained or restored by active intervention rather than by merely creating the best conditions for the uis medicatrix naturae, but it can be misleading to read too much into a metaphor. The complexity of the body makes medicine difficult. last quoted passage continues: So then the subject being so variable, hath made the art by consequence 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 But the physician ... hath no particular acts events . . . 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, ... whether it be art or accident? And therefore many times is the imposter prized and the man of virtue taxed (28). 212
The
But the condition of medicine cannot be blamed on the sutble We recognize a face or a voice, variety of the body's states. despite its indefinite range of variations, and reduce the whole range of words to a few 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 the remedy whereof is, not to is it of the understanding: 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, vavyiabimusartes; MilZe maZi species, miZZe salutis ermnt (28).
Just as elsewhere (29) Bacon tells What is at fault is method. us that experiment is more effective than instruments in overcoming the fallibility of the senses, so here the remedy is 'not to quicken or strengthen the organ, but to go nearer to the object'. The fault, dear Brutus, is not in our material (or our instruments) but in ourselves and our methods. Towards a definition What has been noted thus far may now be summarised: it will be convenient to take the main points in reverse order, and so interpret Bacon's view of medicine in a broadening setting. (i) The art of medicine can become dependable in its effects only when combined with the study of the body. (ii) The mind is to be studied in its correlations with the body, and localisation of mental functions is the most necessary kind of such study. (iii) With a union of theory and practice concerning a united body and mind, what remains is further to break through the partitions between the sciences, and extend and multiply medicine's relationships. THE ADVANCEMENT OF MEDICINE General Medicine considers causes of diseases, diseases themselves and their cures (i.e. treatments) (29). It advances but little, and the remedies for this failure form the basis for the rest of this section of the essay. The defects are of method, of aim and of tactics. Method There is need for diligent recording and observation, as practised by Hippocrates (30). Thus the study of the body, already referred to, includes clinical study. Mere observation
213
and recording is not, however, sufficient and, if Hippocrates is commended for these, he is attacked for his general maxims, which are based on no experience; his eyes seem to gaze on experience , being really sunk in stupor (14). Celsus pruned the luxuriance of error but could not nip it in the bud. As for Paracelsus and Severinus, their call for experience is commendable, but what next? That kind of truth which is deduced from scientific analogy is very different from a mere coincidence between experiments and some baseless hypothesis (14).
In fact observation and recording can lead to a further stage of understanding only if carried out rightly. Here Bacon gives three examples of current deficiencies in anatomy (and thus he tells that the study of the body includes more than clinical First, anatomy is not carried out with study) (31). Secondly, it investigation of the differences between bodies. is not carried out on living bodies and, although Celsus rightly objected to human vivisection, beasts might be used to satisfy enquiry despite 'the dissimilitude of their parts'. Thirdly, pathological anatomy is too frequently passed over. And as for the footsteps of diseases, and their devastations of the inward parts, impostumations, exulcerations, . . discontlnuatlons, 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 contributions 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 (31).
Thus we come to right reasons by search and comparisons, unlike Galen, attacked by Bacon for spinning idle theories of causation This requires that we see the unity of human and other (14). nature, again unlike Galen, for he prevented the improvement of medicine by diminishing human power, in that he said that the heat of fire and of the sun were different (14). Aims Galen also shortened the patient's hopes and the physician's On the work by declaring certain diseases to be incurable (14). consequences of this Bacon remarks
214
The medical practitioner ... seeks to transform the present limitations of his art into a permanent reproach against nature and whatever his art cannot achieve he artfully declares to be impossible in nature. And of course his art escapes condemnation in a court where it is itself the judge (32). means that physicians are responsible for death and suffering because they are unnecessarily ignorant.
This
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 (33).
Therefore the aims of medicine must be not only the application of existing knowledge to the relief of disease, but also the extension of that knowledge, and this not only for reasons of principle (for it is in accord with Bacon's general philosophy) but also because of the personal responsibility of the physician towards the patient. The aims of medicine must also include, beside the restoration of health, the relief of pain and suffering, and not only when it contributes to recovery but even at the approach to death (34). This breadth of purpose is humane, but it also makes for the advancement of knowledge for, like not putting a disease aside as incurable, it increases the scope and opportunity of enquiry. Tactics Bacon draws attention to three defects in the tactics for (i) Physicians do not try to learn more advancing medicine. about treatments that are known to have a use; for example, they do not attempt to imitate curative natural waters by artificial compounding (35). (Bacon, like Paracelsus, rejects the Galenical doctrine that only nature can produce a compound of (ii) Nothing can be learnt by experience medical value (14).) of the effects of treatment if the treatment is not controlled. Yet physicians neither keep to traditional remedies nor change them according to good learning, but they alter treatments at pleasure, so that empirics and old women may do better than learned physicians, 'because they are more religious in holding their medicines' (36). (iii) It is of little use to attend only to the composition of the medicament prescribed, for there is also 'order, pursuit, sequence, and interchange of application, which is mighty in nature' (37). GENERAL DISCUSSION It is not the purpose of this essay to seek influences on Bacon's medical ideas, nor to trace their own influences, if any, on later medicine. The essay has two aims: to set out
215
what Bacon, in his philosophical works, had to say about medicine, and to show the relation of his medical philosophy to his teaching as a whole. The first of these has, I hope, been in some measure fulfilled by the essay thus far. To the second I will now turn. Features of Bacon's method of enquiry will be taken severally and sought in what he writes about medicine. Bacon holds it to be a fault of syllogistic reasoning that it proceeds from the general to the particular rather than conversely (38). From this 'mother of errors and calamity of all science' (39) comes a divorce from particulars which has 'thrown the human family into confusion' (15). Medicine in particular, like the advancement of knowledge in general, must proceed from carefully and accurately recorded instances (30). Since, however, the senses are fallible (39), experiments must be used mediately between sense and the matter to be judged (29). As has been noted, through the anatomising of living beasts experimentation is introduced into medicine; however, it is perhaps more important to note that Bacon lays great stress on the collation of findings, whether of experimental origin or not, rather than on experiment alone, as his examination of heat shows (40); this has a medical parallel in his commendation of Hippocrates (30), already noted. According to Bacon's method it is necessary to derive from the primary data what we would now call an hypothesis, to be tested in action (41). This leads to further hypothesising, and an alternation of 'effects and experiments' with 'causes and axioms' (42) by a road which rises and falls 'uphill to axioms and downhill to effects' (43). That medicine should not rest merely on collected data is made plain in the condemnation, already quoted, of 'empirical practice' (9). But to proceed in this way, that is, by what Bacon terms 'induction', is not to jump to a 'baseless hypothesis', which is not then tested, as the Paracelsians do (14). In Baconian induction the aims are integral with the method, and the sciences progress poorly without their true goal. Again, anothergreat and powerfulcause appearswhy the scienceshould advanceso meagrely. It is in fact this; that true progresscannotbe made in a race when one's goal is not rightlyplaced and fixed. The true goal of the scienceshoweveris none other than that human life shouldbe endowedwith new discoveriesand resources(44). On this ground, at least, medicine need have no quarrel with Baconian science. It may however be argued that, even if in Bacon's philosophy medicine is a natural science, this is only because it alternates between two activities, investigation for its On the advancement and daily practice for the care of the sick. contrary, these two activities, according to Bacon, do not 216
It is true that natural necessarily alternate, but are one. philosophy is held to be separable from medicine, although not without an important effect on the essential nature of the latter, as already noted, and that medicine is to be advanced by the anatomy, physiology and pathology of animals or dead But the two activities can be seen bodies, as the case may be. to be one in Bacon's strictures on uncontrolled variations in Without such control, and observation of treatment (36,37). subsequent events, nothing can be learnt of the effects of a treatment. Further, there is not the slightest suggestion that Bacon, in commending careful observation and recording in medicine, would have his own principle flouted, namely, that this is only the beginning of a rolling road with alternating 'axioms' and 'effects' (45). Nevertheless, if there are these formal resemblances between medicine and the advancement of knowledge generally, is there not a distinction between a 'science' and an 'art', in practice at least, and is not medicine the latter? On this, let Bacon himself give the word or, rather, two words. For in one place he calls medicine 'the art of cure' (i.e. of treatment) (26) and in another declares that medicine is a science which hath been (as we have said) more profesed than laboured, and yet more laboured than advanced; the labour having been, in my judgement, rather in circle than in progression. For I find much iteration, but small addition (46).
Medicine is both art and science. And science itself is an art; for Bacon, discoveries are like creations (47) and discovery, like a craft, has transmissible techniques (48). To-day one hears of 'clinical medicine', 'medical sciences' and (as a hybrid?) 'clinical science'. Bacon did not use these categories. It may or may not be that the present use of them tends to advance medicine; that is another matter. CONCLUSIONS Francis Bacon's medical philosophy is integral with his total philosophy. Nevertheless, Bacon's writings contain direct references to medicine. Mind and body are to be studied in their interactions, and medicine must be founded on the observation of the body in health and disease, with theoretical constructs arrived at by an alternation of hypothesising and testing. The aim of medicine is to increase powers to relieve suffering, even if life cannot be prolonged, this relief of suffering and the advancement of knowledge being two aspects of a single activity. In practice, Bacon notes in particular the importance of controlling treatment and noting its effects, and of seeking greater understanding of treatments already known to have some merit.
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ACKNOWLEDGMENT I am grateful to Dr. Charles Webster for comments leading to improvements in this essay. REFERENCES 1.
Webster C. The Great Instauration: science, medicine reform 1626-1660. London (Duckworth), 1975.
2.
Purver M. The Royal Society: (Routledge), 1967.
3.
Fowler T. ed in Introduction to Bacon F, Novum 2nd edn, Oxford 1889; pp 101 ff.
4.
Sydenham T. Opera omnia, ed WA Greenhill, London (Sydenham Society), 1844; p. 10. (: The works of Thomas Sydenham M.D., transl. RG Latham, London (Sydenham Society), 1848; vol I, p 12.) Dewhurst K. Dr. Thomas Sydenham (1624-1689): his life and original writings, London (Wellcome Historical Medical Library), 1966; p 62 et passim.
5.
concept
and creation.
and
London
Organum.
6.
Bacon F. The advancement of learning and New Atlantis, London (Oxford U.P.), repr 1969; p 278 (New AtZ.). Novum Organum (edn. as ref. 3, and throughout) 1:99 and 1:121. (The two numbers in a ref. to Nov. Org. indicate the book and aphorism respectively.)
7.
Bacon F. The masculine birth of time (Temporis partus maseuZinus) 2, in Farrington B, The philosophy of Francis Bacon: an essay on its development from 1603 to 1609 with new translations of fundamental texts, Liverpool U.P., 1954. Advancement of Learning (edn. as ref 6, and
throughout) 1:5:11. (The three numbers in a ref. to L. are of the book, chapter and section respectively.) Nov. Org., p 175 (Distrib. op.), p 188 (Praefat.), 1:3 and 4, 1~81. Thoughts and eoneZusions (Cogita et visa, edn. as for Temp. part. masc. and throughout) 5.
Adv.
8.
Nov. Org. 1:70 with 1:81.
9.
Adv.
L. 2:9:1.
10.
Nov. Org. 1:95.
11.
Adv.
L. 1~2~3.
12.
Adv.
L. 2:ll:l.
13.
Nov.
Org.
14.
Temp.
1:63.
part. masc. 2. (The relation of Bacon's teaching to that of Paracelsus, Severinus and other non-Galenists is outside the scope of this essay, which is not concerned with the origins of Bacon's medical ideas.)
218
15.
cog. et visa 12.
16.
Adv. L. 2:12:1.
17.
Adv. L. 2:11:2.
18.
Adv. L. 2:9:2.
19.
Adv. L. 2:9:3.
20.
New AtZ. (n. 6), p 283-284.
21.
Keele KD. Anatomies of pain, Oxford (Blackwell) 1957.
22.
French RK. Robert Whytt, the sou2, and medicine, London (Wellcome Historical Medical Library), 1969.
23.
French RK. Sauvages, Whytt and the motion of the heart: aspects of eighteenth century animism, Clio Medica 7, 35-54, 1972.
24.
Young RM. Mind, brain and adaptation in the nineteenth century: cerebral localisation and its bioligical context from Gall to Ferrier, Oxford (Clarendon) 1970.
25.
E.g. Williams M. Brain damage and the mind, Harmondsworth (Penguin), repr. 1973.
26.
Adv. L. 2:lO:l.
27.
Cf e.g. Nov. Org. 1:73, 1:103 and 1:117.
28.
Adv. L. 2:10:2. At the end of the third quotation from this passage: 'For since disorders vary, we shall vary our arts; for a thousand kinds of disease there are a thousand remedies.' (Ovid, Remediorum Amoris 525; the original has animi not morbi: 'for since natures vary'.)
29.
Nov. Org., p 174 (Distrib. Op.).
30.
Adv. L. 2:10:4.
31.
Adv. L. 2:10:5.
32.
cog. et visa 2.
33.
Adv. L. 2:10:6 ('Law of neglect': i.e. permitting negligence, cf O.E.D. S.V. 'neglect'.)
34.
Adv. L. 2:10:7.
35.
Adv. L. 2:10:9.
36.
Adv. L. 2:10:8.
37.
Adv. L. 2:lO:lO.
38.
Nov. Org. 1:19. Adv. L.
39.
Nov. Org. 1:69.
40.
Nov. Org. 2:ll-20.
41.
Nov. Org. 1:106.
42.
Nov. Org. l:ll7.
2:13:4.
219
43. 44. 45.
NOV. Org. 1:103. Nov. Org. 1:81. Bacon himself suggests an 'axiom', and trials of its 'effects*, in his Historia vitae et mortis (in vol. 2 of Bacon's Works, ed. J Spedding e-t: aZ., London, Longman et al., 1870; pp 101-226). His hypothesis (in the modern sense of that word) is that the state of the body depends on a balance between depredation or decay and repair or refreshment. He makes clear that this notion is integral with the concept of the conservation of matter. 'Non fit consumptio, nisi quod deperditum sit de corpore ('There is no diminution transmigret ;n corpus aZiud.' unless what one body loses passes into another.')
46. Adv. L. 2:10:3. 47. Nov. Org. 1:129. 48.
The plain words of this aphorism do not mean that Bacon's method makes all who use it into equally good investigators, as e.g. Fowler, op. cit. (ref 3), p 327, has averred. The point is that training almost obliterates inborn differences, not that it quite levels all differences. The analogy with craftsmanship is clear, and training does not make craftsmen equal, although it brings them close to a common level when comparison is made with the untrained.
Nov. Org. 1:122.
220
THE MEDICAL PHILOSOPHY OF FRANCIS BACON (1561-1626) Jeffrey Boss.
Department of Physiology, The Medical School, University of Bristol, Bristol, BS8 lTD, U.K. ABSTRACT
Francis Bacon's view of man is dualistic but, although he takes note of mental faculties, he makes the relation between mind and body, rather than the substance of mind, the basis for enquiry into mental processes and, more particularly, for the (He uses 'mind' and 'soul' medically relevant study of mind. The healing of the body requires study as equivalent terms.) of the body, and the ineffectiveness of physicians is due to their failure in this respect rather than to the body's complexity. To learn about the body requires clinical observation and recording, together with the comparison of bodies, experiments on living animals and attention to The aims of medicine should include not pathological changes. only the restoration of health but also the relief of suffering, and they are not to be limited by putting aside a disease as To learn from treatment it must be fixed in its incurable. Bacon has no ordering with controlled and limited variation. separation of medicine from natural science; his philosophy of medicine is his general philosophy of the advancement of knowledge, but limited to a particular field of application. If medicine is separated from natural philosophy it is changed wholly or greatly into empiricism. Key words:
Francis Bacon - philosophy, medical - medicine science - pathology - anatomy, comparative ethics, medical.
208
INTRODUCTION Bacon's medical imuortance Francis Bacon's influence on the development of medicine is threefold. First, his philosophy was an important element in general thinking about the function of medicine in society in the seventeenth century (1). Secondly, Bacon's teaching provided an acknowledged philosophy for natural philosophers such as the founders of the Royal Society (2), who in their turn influenced the history of medical knowledge; Bacon was in fact praised by Huyghens, adapted extensively by Hooke, and regarded by Boyle as by a disciple (3). Bacon's third and most direct influence on medicine was through Thomas Sydenham (1624-1689), the 'English Hippocrates', a professed Baconian (4,5), whose philosophy penetrates clinical science even to-day. Bacon's importance for medicine is not only historical, however. He has three lessons to which we may still listen with profit, even if we do not agree. The first lesson is that, in the practice and advancement of medicine, clinical practice and natural science may not be separated without a great and detrimental change in medicine itself. (Sydenham, it may be argued, did not wholly adhere to this principle.) This point will be taken up again, below. The second, related lesson is that the interpretation of nature requires an attitude to truth and utility such as to preclude any distinction between 'pure' and 'applied' science. The purpose of a particular experiment is to be light rather than fruit (6), but the overall aim of enquiry, for heuristic as well as altruistic reasons, is that human life be endowed with new discoveries and resources (7). Those who make fruitbearing experiments, and those who do not have as the goal of enquiry this endowing of human life, are described by Bacon in very similar terms (8). Thirdly, Bacon offers, by implication, a lesson in practice. If medicine and natural science are not separated, and if there is no distinction between 'pure' and 'applied' science, the scientist and the clinician may perhaps be expected best to achieve their ends by meeting in one and the same person. Sources Francis Bacon's theoretical treatment of the increase of knowledge is in the Novum Organum, while the New Atlantis is concerned with certain social aspects of scientific research. Between these two topics lies the practice and scope of discovery, and this is the field of Bacon's De Augmentis, which incorporates his Advancement of Learning. It may not be surprising therefore that most of what Bacon has to say on medicine is found in the Advancement of Learning, and it is this 209
work which has proved the richest source in the study now presented, as the citations will indicate. (All Bacon's philosophical
works
were
examined.)
Partus Masculinus, were published between the first appearance of the Advancement of Learning (1605) and the time of its re-publication as part of De Augmentis (1623), and there are no contradictions between cited works with respect to any matter raised in this It is, therefore justifiable and convenient to bring essay. together evidence from different works without regard to temporal sequence. The works
to be cited,
other
than Tempo&s
DEFINING MEDICINE The division
study
of learning
The wholeness of man.
of learning
is especially
important
in the
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 content 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 ... 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 phainomenu,yet natural philosophy may So we see also that the science of medicine if it correct. be destituted and forsaken by natural philosophy, it is not much better than an empirical practice (9). Bacon elsewhere makes his general point about empirics, who At the other extreme are spiders, collect and use, like ants. but the bee gathers and, by who spin webs out of themselves; In practice changes what it gathers (10). its own capability, the empiric physician is limited. We see it is accounted an error to commit a natural body to empiric physicians, which commonly have a few pleasing receipts whereupon they are confident and adventurous, but know neither the cause of diseases, nor the complexions of patients, nor peril of accidents, nor the true method of cures (11).
Therefore medicine is not to be separated from natural philosophy. Nevertheless, the nature of man makes possible some division of knowledge by subject-matter, and the first passage quoted (9) continues:
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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 or particular, Humanity particular consisteth of or conjugate and civil. the same parts whereof man consisteth; that is, of knowledges which respect the body, and of knowledges that respect the mind. The terms The soul,
in Bacon's usage (12). 'mind' and 'soul' are synonymous contrary to Aristotle, is a substance (13); indeed,
Aristotle 'made us slaves of words' (14), for 'how could anything solid be expected of a man who created a universe out of categories?' (15). Dualism and the mind Thus Bacon is a dualist. Nevertheless the study of the soul as substance, even when a matter for natural philosophy, is 'bounded by religion' (12), and the faculties of the mind receive consideration in a non-medical context (16). Attention, however, is to be directed not to the mind in isolation but to its correlations with the body. 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 of 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 (9).
Bacon refers to a soul able to gather itself up from being diffused in the organs of the body (17) but he is noting the beliefs of others and it is not clear whether he is in agreement on this point, and whether therefore we may infer his teaching that the soul and body are distributed in the same space. The correlations which Bacon certainly would have us seek are functional, even when they are correlations of mental functions with parts of the body (below). In general, correlations showing the unity of mind and body are of two kinds: 'discovery', enquired into by Aristotle, whereby the lineaments of the body show the disposition of the mind, and 'impressions', enquired into by Hippocrates, whereby imaginations of the mind show the state of the body ('natural dreams') (18). Correspondingly, these principles have two groups of applications (19). Physicians give bodily medicines for mental states, although Bacon is of the opinion that most bodily treatment directed to the mind is through religious dietary laws and fastings, such as those practised 'in the sect of the Pythagoreans, in the heresy of the Manichees, and in the law of Mahornet'. (The omission of Jews may be taken with the
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somewhat unconvincing picture of them in the New AtZantis (20) as evidence that for Bacon Jews were a matter of theory rather than experience.) Conversely, wise physicians consider the power of the mind to help or hinder treatment of the body. Bacon advocates, as the most necessary study of the correlations between mind and body, that of the bodily seats of mental faculties. Such correlations were a major theme of physiology for a century and a half after Bacon (21,22,23), remained important in neurology in the nineteenth century (24), and are of practical importance in our own day (25). The body and medicine The body has four kinds of good: health, beauty, strength and pleasure (26). Thus there are four kinds of relevant knowledge, and it is noteworthy that Bacon's word 'knowledge' comprehends arts, without distinction of knowing and doing; later he expressed this unity in relation to his inductive mode These kinds of knowledge, in corresponding of enquiry (27). sequence, are medicine or the art of cure, cosmetic or the art of decoration, athletic or the art of activity, and what Tacitus calls eruditus Zuxus, or the art voluptuary. (Note that 'cure' is near in meaning to our word 'care', not to 'cure' in its Thus medicine is concerned with the body, but modern sense.) the body and mind are not functionally separate. The body, being complex, is compared with an instrument to be kept tuned. It cannot be denied but that the body of man of all other things is of the most compounded mass ... 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 reduce it to harmony (28).
This last remark could suggest that, since an instrument tends to drift spontaneously out of tune, health is maintained or restored by active intervention rather than by merely creating the best conditions for the uis medicatrix naturae, but it can be misleading to read too much into a metaphor. The complexity of the body makes medicine difficult. last quoted passage continues: So then the subject being so variable, hath made the art by consequence 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 But the physician ... hath no particular acts events . . . 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, ... whether it be art or accident? And therefore many times is the imposter prized and the man of virtue taxed (28). 212
The
But the condition of medicine cannot be blamed on the sutble We recognize a face or a voice, variety of the body's states. despite its indefinite range of variations, and reduce the whole range of words to a few 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 the remedy whereof is, not to is it of the understanding: 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, vavyiabimusartes; MilZe maZi species, miZZe salutis ermnt (28).
Just as elsewhere (29) Bacon tells What is at fault is method. us that experiment is more effective than instruments in overcoming the fallibility of the senses, so here the remedy is 'not to quicken or strengthen the organ, but to go nearer to the object'. The fault, dear Brutus, is not in our material (or our instruments) but in ourselves and our methods. Towards a definition What has been noted thus far may now be summarised: it will be convenient to take the main points in reverse order, and so interpret Bacon's view of medicine in a broadening setting. (i) The art of medicine can become dependable in its effects only when combined with the study of the body. (ii) The mind is to be studied in its correlations with the body, and localisation of mental functions is the most necessary kind of such study. (iii) With a union of theory and practice concerning a united body and mind, what remains is further to break through the partitions between the sciences, and extend and multiply medicine's relationships. THE ADVANCEMENT OF MEDICINE General Medicine considers causes of diseases, diseases themselves and their cures (i.e. treatments) (29). It advances but little, and the remedies for this failure form the basis for the rest of this section of the essay. The defects are of method, of aim and of tactics. Method There is need for diligent recording and observation, as practised by Hippocrates (30). Thus the study of the body, already referred to, includes clinical study. Mere observation
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and recording is not, however, sufficient and, if Hippocrates is commended for these, he is attacked for his general maxims, which are based on no experience; his eyes seem to gaze on experience , being really sunk in stupor (14). Celsus pruned the luxuriance of error but could not nip it in the bud. As for Paracelsus and Severinus, their call for experience is commendable, but what next? That kind of truth which is deduced from scientific analogy is very different from a mere coincidence between experiments and some baseless hypothesis (14).
In fact observation and recording can lead to a further stage of understanding only if carried out rightly. Here Bacon gives three examples of current deficiencies in anatomy (and thus he tells that the study of the body includes more than clinical First, anatomy is not carried out with study) (31). Secondly, it investigation of the differences between bodies. is not carried out on living bodies and, although Celsus rightly objected to human vivisection, beasts might be used to satisfy enquiry despite 'the dissimilitude of their parts'. Thirdly, pathological anatomy is too frequently passed over. And as for the footsteps of diseases, and their devastations of the inward parts, impostumations, exulcerations, . . discontlnuatlons, 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 contributions 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 (31).
Thus we come to right reasons by search and comparisons, unlike Galen, attacked by Bacon for spinning idle theories of causation This requires that we see the unity of human and other (14). nature, again unlike Galen, for he prevented the improvement of medicine by diminishing human power, in that he said that the heat of fire and of the sun were different (14). Aims Galen also shortened the patient's hopes and the physician's On the work by declaring certain diseases to be incurable (14). consequences of this Bacon remarks
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The medical practitioner ... seeks to transform the present limitations of his art into a permanent reproach against nature and whatever his art cannot achieve he artfully declares to be impossible in nature. And of course his art escapes condemnation in a court where it is itself the judge (32). means that physicians are responsible for death and suffering because they are unnecessarily ignorant.
This
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 (33).
Therefore the aims of medicine must be not only the application of existing knowledge to the relief of disease, but also the extension of that knowledge, and this not only for reasons of principle (for it is in accord with Bacon's general philosophy) but also because of the personal responsibility of the physician towards the patient. The aims of medicine must also include, beside the restoration of health, the relief of pain and suffering, and not only when it contributes to recovery but even at the approach to death (34). This breadth of purpose is humane, but it also makes for the advancement of knowledge for, like not putting a disease aside as incurable, it increases the scope and opportunity of enquiry. Tactics Bacon draws attention to three defects in the tactics for (i) Physicians do not try to learn more advancing medicine. about treatments that are known to have a use; for example, they do not attempt to imitate curative natural waters by artificial compounding (35). (Bacon, like Paracelsus, rejects the Galenical doctrine that only nature can produce a compound of (ii) Nothing can be learnt by experience medical value (14).) of the effects of treatment if the treatment is not controlled. Yet physicians neither keep to traditional remedies nor change them according to good learning, but they alter treatments at pleasure, so that empirics and old women may do better than learned physicians, 'because they are more religious in holding their medicines' (36). (iii) It is of little use to attend only to the composition of the medicament prescribed, for there is also 'order, pursuit, sequence, and interchange of application, which is mighty in nature' (37). GENERAL DISCUSSION It is not the purpose of this essay to seek influences on Bacon's medical ideas, nor to trace their own influences, if any, on later medicine. The essay has two aims: to set out
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what Bacon, in his philosophical works, had to say about medicine, and to show the relation of his medical philosophy to his teaching as a whole. The first of these has, I hope, been in some measure fulfilled by the essay thus far. To the second I will now turn. Features of Bacon's method of enquiry will be taken severally and sought in what he writes about medicine. Bacon holds it to be a fault of syllogistic reasoning that it proceeds from the general to the particular rather than conversely (38). From this 'mother of errors and calamity of all science' (39) comes a divorce from particulars which has 'thrown the human family into confusion' (15). Medicine in particular, like the advancement of knowledge in general, must proceed from carefully and accurately recorded instances (30). Since, however, the senses are fallible (39), experiments must be used mediately between sense and the matter to be judged (29). As has been noted, through the anatomising of living beasts experimentation is introduced into medicine; however, it is perhaps more important to note that Bacon lays great stress on the collation of findings, whether of experimental origin or not, rather than on experiment alone, as his examination of heat shows (40); this has a medical parallel in his commendation of Hippocrates (30), already noted. According to Bacon's method it is necessary to derive from the primary data what we would now call an hypothesis, to be tested in action (41). This leads to further hypothesising, and an alternation of 'effects and experiments' with 'causes and axioms' (42) by a road which rises and falls 'uphill to axioms and downhill to effects' (43). That medicine should not rest merely on collected data is made plain in the condemnation, already quoted, of 'empirical practice' (9). But to proceed in this way, that is, by what Bacon terms 'induction', is not to jump to a 'baseless hypothesis', which is not then tested, as the Paracelsians do (14). In Baconian induction the aims are integral with the method, and the sciences progress poorly without their true goal. Again, anothergreat and powerfulcause appearswhy the scienceshould advanceso meagrely. It is in fact this; that true progresscannotbe made in a race when one's goal is not rightlyplaced and fixed. The true goal of the scienceshoweveris none other than that human life shouldbe endowedwith new discoveriesand resources(44). On this ground, at least, medicine need have no quarrel with Baconian science. It may however be argued that, even if in Bacon's philosophy medicine is a natural science, this is only because it alternates between two activities, investigation for its On the advancement and daily practice for the care of the sick. contrary, these two activities, according to Bacon, do not 216
It is true that natural necessarily alternate, but are one. philosophy is held to be separable from medicine, although not without an important effect on the essential nature of the latter, as already noted, and that medicine is to be advanced by the anatomy, physiology and pathology of animals or dead But the two activities can be seen bodies, as the case may be. to be one in Bacon's strictures on uncontrolled variations in Without such control, and observation of treatment (36,37). subsequent events, nothing can be learnt of the effects of a treatment. Further, there is not the slightest suggestion that Bacon, in commending careful observation and recording in medicine, would have his own principle flouted, namely, that this is only the beginning of a rolling road with alternating 'axioms' and 'effects' (45). Nevertheless, if there are these formal resemblances between medicine and the advancement of knowledge generally, is there not a distinction between a 'science' and an 'art', in practice at least, and is not medicine the latter? On this, let Bacon himself give the word or, rather, two words. For in one place he calls medicine 'the art of cure' (i.e. of treatment) (26) and in another declares that medicine is a science which hath been (as we have said) more profesed than laboured, and yet more laboured than advanced; the labour having been, in my judgement, rather in circle than in progression. For I find much iteration, but small addition (46).
Medicine is both art and science. And science itself is an art; for Bacon, discoveries are like creations (47) and discovery, like a craft, has transmissible techniques (48). To-day one hears of 'clinical medicine', 'medical sciences' and (as a hybrid?) 'clinical science'. Bacon did not use these categories. It may or may not be that the present use of them tends to advance medicine; that is another matter. CONCLUSIONS Francis Bacon's medical philosophy is integral with his total philosophy. Nevertheless, Bacon's writings contain direct references to medicine. Mind and body are to be studied in their interactions, and medicine must be founded on the observation of the body in health and disease, with theoretical constructs arrived at by an alternation of hypothesising and testing. The aim of medicine is to increase powers to relieve suffering, even if life cannot be prolonged, this relief of suffering and the advancement of knowledge being two aspects of a single activity. In practice, Bacon notes in particular the importance of controlling treatment and noting its effects, and of seeking greater understanding of treatments already known to have some merit.
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ACKNOWLEDGMENT I am grateful to Dr. Charles Webster for comments leading to improvements in this essay. REFERENCES 1.
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Young RM. Mind, brain and adaptation in the nineteenth century: cerebral localisation and its bioligical context from Gall to Ferrier, Oxford (Clarendon) 1970.
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E.g. Williams M. Brain damage and the mind, Harmondsworth (Penguin), repr. 1973.
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Cf e.g. Nov. Org. 1:73, 1:103 and 1:117.
28.
Adv. L. 2:10:2. At the end of the third quotation from this passage: 'For since disorders vary, we shall vary our arts; for a thousand kinds of disease there are a thousand remedies.' (Ovid, Remediorum Amoris 525; the original has animi not morbi: 'for since natures vary'.)
29.
Nov. Org., p 174 (Distrib. Op.).
30.
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31.
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32.
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34.
Adv. L. 2:10:7.
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Adv. L. 2:10:9.
36.
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39.
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41.
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2:13:4.
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43. 44. 45.
NOV. Org. 1:103. Nov. Org. 1:81. Bacon himself suggests an 'axiom', and trials of its 'effects*, in his Historia vitae et mortis (in vol. 2 of Bacon's Works, ed. J Spedding e-t: aZ., London, Longman et al., 1870; pp 101-226). His hypothesis (in the modern sense of that word) is that the state of the body depends on a balance between depredation or decay and repair or refreshment. He makes clear that this notion is integral with the concept of the conservation of matter. 'Non fit consumptio, nisi quod deperditum sit de corpore ('There is no diminution transmigret ;n corpus aZiud.' unless what one body loses passes into another.')
46. Adv. L. 2:10:3. 47. Nov. Org. 1:129. 48.
The plain words of this aphorism do not mean that Bacon's method makes all who use it into equally good investigators, as e.g. Fowler, op. cit. (ref 3), p 327, has averred. The point is that training almost obliterates inborn differences, not that it quite levels all differences. The analogy with craftsmanship is clear, and training does not make craftsmen equal, although it brings them close to a common level when comparison is made with the untrained.
Nov. Org. 1:122.
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