Descartes the Doctor: Rationalism and Its Therapies Citation Shapin, Steven. 2000. Descartes the doctor: Rationalism and its therapies. British Journal for the History of Science 33(2): 131-154. Published Version http://dx.doi.org/10.1017/S000708749900391X Permanent link http://nrs.harvard.edu/urn-3:HUL.InstRepos:3219884 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA Share Your Story The Harvard community has made this article openly available. Please share how this access benefits you. Submit a story . Accessibility BJHS, 2000, 33, 131–154 Descartes the doctor: rationalism and its therapies STEVEN SHAPIN* Abstract.DuringtheScientificRevolutiononeimportantgaugeofthequalityofreformednatural philosophicalknowledgewasitsabilitytoproduceamoreeffectivemedicalpractice.Indeed,it was sometimes thought that philosophers who pretended to possess new and more potent philosophical knowledge might display that possession in personal health and longevity. Rene! Descartesrepeatedly wrotethat abettermedical practice was amajor aimof his philosophical enterprise.Hesaidthathehadmadeimportantstridestowardsachievingthataimand,onthat basis,heofferedpracticalmedicaladvicetoothersandadvertisedtheexpectationthat,takinghis ownadvice,hewouldliveaverylongtime.ThispaperdescribeswhatCartesianmedicinelooked likeinpractice andwhat thatpractice owedto the power of modernist Reason. Philosophy and its medical point There are four questions that have historically been put to philosophers and intellectuals that, so to speak, call them to task. ‘If you’re so smart, why aren’t you good?’ That is a Greekquestion,presumingthatthegoalofintellectualenquiryispersonalvirtue,andthat thepresenceorabsenceofvirtueinphilosophersisalegitimatetestoftheknowledgethey profess. ‘If you’re sosmart, why aren’tyou happy?’ Thatis a Greekquestion too, and a related one: it supposes that wisdom should delight, either because it issues in a better manneroflivingintheworldorbecauseitsattainmentfulfilsabasichumanlonging.!Then there is ‘if you’re so smart, why aren’t you rich?’. That is what has been called ‘the American question’, though versions of it can be traced at least as far back as Francis Bacon."Herethepresumptionisthattrueknowledgeismateriallyusefulknowledge,and that individual or collective wealth is a reliable sign that genuine knowledge is at your disposal.# * DepartmentofSociology,UniversityofCalifornia,SanDiego,LaJolla,CA92093-0533,USA.Forcritical comments on earlier versions of this paper I thank Harold Cook, Peter Dear, Charles Rosenberg and the anonymousrefereesforthisjournal. 1 For a better manner of living in the world as a legitimate test of philosophical knowledge, see e.g. A. Nehamas, The Art of Living: Socratic Reflections from Plato to Foucault, Berkeley, CA, 1998; P. Hadot, PhilosophyasaWayofLife:SpiritualExercisesfromSocratestoFoucault,(trans.M.Chase,ed.A.I.Davidson), Oxford,1995;andJ.Cottingham,PhilosophyandtheGoodLife:ReasonandthePassionsinGreek,Cartesian andPsychoanalyticEthics,Cambridge,1998. 2 D.N.McCloskey,IfYou’reSoSmart:TheNarrativeofEconomicExpertise,Chicago,1990. 3 Allthreeofthese‘test-questions’shouldbereasonablyfamiliartomodernhistoriansofideas:thefirstand secondthroughtheworkofsuchmodern‘virtuetheorists’asMarthaNussbaumandAlasdairMacIntyre;the thirdthroughhistoricalstudiesofscience–technologyrelationsandoftherhetoricusedtolegitimatetheplaceof scienceinmercantilesocieties. 132 Steven Shapin The fourth–formally, perhaps, a version of the second and third–is none the less distinctinitsculturalframingandconsequences.Itisfarlessfamiliarthanthefirstthree, yet, I want to show, it was quite important in the early modern period as a way of advertising and gauging the quality of philosophical knowledge. This question was ‘if you’re so smart,how comeyou’re sick?’,or–a variant–‘howcome youdied?’, or, less ambitiously, ‘how come you didn’t live to a hundred-and-twenty?’. Life-and-death matters matter. They matter to every-person and they matter to the learned person as every-person, since even Francis Bacon and Rene! Descartes had vulnerable and, as it disappointingly turned out, mortal bodies about which they cared a greatdeal:viewedattimesasinstrumentstotheirextraordinarysouls,andatothertimes just as everybody else views their bodies, wishing that they would be less painful, more serviceable and more durable. That is one–blindingly obvious–reason why the ability topreventandcuredisease,toalleviatesufferingandtoextendhumanlifehasrecurrently beenusedasapublictestofthetruthandpowerofphilosophicandscientificsystems,and why the learned too might share in that public assessment.$ However,therewerereasonsparticulartothelearnedclasses,andmoreparticulartothe greatphilosophicalmodernizersoftheseventeenthcentury,whymedicinemattered,even to those who were not themselves physicians. In general terms, it was bound to matter because of the close but contested relationship that has historically obtained between natural philosophy and the science of medicine and, through the science, the art of medicine.ForAristoteliansandGalenists,knowledgeofthehiddenmake-upandworkings of the human body was wholly integrated within an overall philosophy of nature. The humours and the temperaments were just a part of the same system of elements and qualities that allowed philosophers to explain what the natural world was made of and why inanimate bodies moved as they did. For Aristotle, Galen and their followers ‘medicinewasthephilosophyofthebody’,or,putanotherway,medicinewasphilosophy inaction,puttothetest.%AndsoitremainedforbothAristoteliansandtheircriticsinthe early modern period. Arslongavitabrevis–thatisHippocraticaphorismnumberone–butitdidnotmatter howlongyouhadtolearntheartofmedicineifthatartwasnotsecurelyfoundedongood philosophical principles. Early modern Aristotelians and Galenists, on the whole, consideredthatmedicalartwassofounded,andthat,correctingforthecomplexityofthe human–environmenttransactionsthatmadeforindividualhealthanddisease,andforthe intractability of patients’ behaviour (even when expertly advised), medical practice did pretty well. And the fact–as they reckoned things–that it did pretty well was powerful testimony to the validity of medicine’s philosophical foundations as well as to individual practitioners’ skill.& 4 Ofcourse,otherconceptionsofphilosophy,e.g.EpicureanandStoic,didnotrunthisruleoverknowledge: thepurposeofphilosophywastoconsoleandtoreconcilepeopletotheirinevitablefate. 5 SeeO.Temkin,HippocratesintheWorldofPagansandChristians,Baltimore,1991,8–9;idem,TheDouble FaceofJanusandOtherEssaysintheHistoryofMedicine,Baltimore1977,187–8. 6 Thereisnospecialepistemologicalproblemassociatedwithrecognizingtherapeutic‘success’inpre-modern medicine.Fromwithinamodernistandrealistperspective,itisnotdifficulttoidentifypre-modernpracticesthat ‘worked’ and plausible reasons that might save cherished intellectual principles when interventions ‘did not Descartes the doctor 133 However, if you were a seventeenth-century modernizing and mechanizing critic of traditional natural philosophy, you tended to take a very different view of the matter.’ Aristotelian natural philosophy was no good–unintelligible, absurd, vacuous–and any practice that was informed by that philosophy was itself likely to be no good. Claims to medical efficacy by Aristotelians and Galenists were deemed largely bogus. Thomas Hobbes was exceptional among the great seventeenth-century philosophical moderns in not developing a frontal assault on the state of medical knowledge and practice, though, to be sure, his explicit applause of the current state of medical knowledge was mainly a rhetoricalvehicletoappropriateWilliamHarveyforthemechanicalcauseandtoironically imply that the London physicians were not as Harveian as they ought rationally to be.( In the main, the rest of the great modernizers took a very dim view of contemporary medicine.Theysaidthatcontemporarymedicinewasjustthatkindofpracticeandbelief thatwaslargelyfalse,mainlybarrenand,accordingly,inneedofsystematicreform.Only whenmedicinewasputonsolidnaturalphilosophicalfoundationswoulditbeofgenuine use in healing, alleviating suffering and extending life. The precise nature of their criticisms differed, but their drift was consistent: we the moderns have reformed natural philosophical knowledge, and a reliable sign and legitimate test of our reformed natural philosophywillbenotjustabetterscienceofmedicinebutavastlymorepowerfulsystem ofmedicalpractice.Whynotbeyourownphysicianwhenexistingmedicinewassofaulty andwhenyoupossessedthephilosophicalmeansforitsreform?)Moreover,andperhaps work’:see,forexample,E.H.Ackerknecht,MedicineandEthnology:SelectedEssays(ed.H.H.Walserand H.M. Koelbing), Baltimore, 1971, 120–34. When that realism is supplemented by a symbolic and cultural framework, ‘working’ is recognized as dramatically visible–as when purgatives, emetics and carminatives visibly,andsometimesspectacularly,‘worked’onthebody:seeC.E.Rosenberg,‘Thetherapeuticrevolution: medicine, meaning, and social change in nineteenth-century America’, Perspectives in Biology and Medicine (1977), 20, 485–506 (reprinted in idem, Explaining Epidemics and Other Studies in the History of Medicine [Cambridge,1992],9–31);and,forsociologicalsensibilitiestowardsknowledgeanditsefficacy,seeM.J.Mulkay, ‘Knowledgeandutility:implicationsforthesociologyofknowledge’,SocialStudiesofScience(1977),9,63–80. 7 For an entry into the large secondary literature on medicine and natural philosophy in the Scientific Revolution,seethefineessaybyH.J.Cook,‘Thenewphilosophyandmedicineinseventeenth-centuryEngland’, inD.C.LindbergandR.S.Westman(eds.),ReappraisalsoftheScientificRevolution,Cambridge,1990,397–436; alsoidem,‘Physiciansandthenewphilosophy:HenryStubbeandthevirtuosi-physicians’,inR.FrenchandA. Wear(eds.),TheMedicalRevolutionoftheSeventeenthCentury,Cambridge,1989,246–71;T.M.Brown,‘The CollegeofPhysiciansandtheacceptanceofiatro-mechanisminEngland,1665–1695’,BulletinoftheHistoryof Medicine (1970), 44, 12–30; idem, ‘Physiology and the mechanical philosophy in mid-seventeenth-century England’,ibid.(1977),51,25–54. 8 The‘Epistlededicatory’toHobbes’s‘Decorpore’(inTheEnglishWorksofThomasHobbes(ed.SirW. Molesworth),11vols.,London,1839–45,i),referred(p.viii)to‘thescienceofman’sbody’as‘themostprofitable partofnaturalscience’,butspecifiedthatthissciencewas‘firstdiscovered’byHarvey.Thatscience,Hobbes continued(p.xi),hasbeenadvancedinourtimes‘bythewitandindustryofphysicians,theonlytruenatural philosophers,especiallyofourmostlearnedmenoftheCollegeofPhysiciansinLondon’.Hobbeshadverylittle tosayaboutmedicineanditisnotincludedinhismapofthebranchesofphilosophyinChapter9ofLeviathan, (ed. C.B. Macpherson), Harmondsworth, 1968 (originally published 1651), 149. For the significance of this omission, see Tom Sorell, ‘Hobbes’s scheme of the sciences’, in idem, (ed.), The Cambridge Companion to Hobbes,Cambridge,1996,45–61,52–4.ForscatteredremarksonHobbes’sdietandregimenofhealth,seeA.A. Rogow,ThomasHobbes:RadicalintheServiceofReaction,NewYork,1986,224–6. 9 Ofcourse,asinantiquity,whilethoseearlymodernsabletoaffordtheirservicesdidemployprofessional physicians,thepracticeofdiagnosingandtreatingoneselfwascommon. 134 Steven Shapin owingtotheintenseindividualismofmodernizingphilosophicalculture,thinkers’personal statesofhealthandthelengthsoftheirindividuallivesweresometimesusedtogaugethe goodness of their philosophical knowledge–both by themselves and by their supporters and critics. The range of medical promissory notes issued by modernizers is one of the fascinating byways of the Scientific Revolution, though, from presentist points of view, the notes do notmakeforedifyingreading:theylookmoreliketestamentstohumanfollythantothe power of reason. Nevertheless, from an impeccably historicist point of view there are inducements to further consider these medical promises, for they offer an intriguing and perspicuous way of reconfronting and reframing some long-standing questions about the relationsbetweentheoryandpractice,andbetweentraditionandchangeinthehistoryof culture and of technique. What did it look like when modern philosophic reason in its purest and most rigorous forms became its own physician? Francis Bacon offered wide-ranging criticisms of the state of medical science and art. ‘Medicine’,hewrote,‘isasciencewhichhathbeen…moreprofessedthanlaboured,and yet more laboured than advanced; the labour having been, in my judgment, rather in a circle than in progression’. Unless medicine were refounded upon a purified register of natural fact and a proper philosophy of nature, we could never hope for the effective treatmentofdiseaseortheprolongationoflife:‘thescienceofmedicine,ifitbedestituted and forsaken by natural philosophy, it is not much better than an empirical practice’.!* Medicalpracticelackedbothevidentialdisciplineandphilosophicalsystem.Butwereitto achievedisciplineandsystem,whatbenefitsmighthumankindexpect?The‘prolongation of life’, Bacon wrote, is the ‘most noble’ of all the parts of medicine, and he wrote extensively about how vast extension of human life might be achieved.!! Robert Boyle was deeply concerned with medical therapeutics throughout his life, and his advocacy of pharmaceutical ‘specifics’ was persistently framed and rationalized in terms of his version of corpuscular natural philosophy. ‘The physician borrows his principles of the naturalist’, Boyle wrote, so he should borrow only the best.!" If you 10 FrancisBacon,‘Theadvancementoflearning[BooksI–II]’,inThePhilosophicalWorksofFrancisBacon, (ed.J.Spedding,R.L.EllisandD.D.Heath),5ivols.,London,1857–8,iii,253–491,367,373. 11 FrancisBacon,‘Ofthedignityandadvancementoflearning,BookIV’,inidem,PhilosophicalWorks,op. cit. (10), iv, 372–404, 390; idem, ‘The history of life and death’, ibid., v, 213–335. See also Graham Rees’s introductoryessaytohiseditionofBacon’sDevijsmortis:Bacon,PhilosophicalStudiesc.1611–c.1619,(ed.G. Rees),Oxford,1996,pp.xvii–cx.Fordocumentationofseventeenth-centuryEnglishmedicalconcernwiththe prolongationoflife,seeC.Webster,TheGreatInstauration:Science,MedicineandReform1626–1660,London, 1975,246–323. 12 RobertBoyle,‘Usefulnessofexperimentalnaturalphilosophy’,inidem,TheWorksoftheHonourable RobertBoyle,(ed.ThomasBirch),2ndedn.,6vols.,London,1772,ii,1–246,66;seealso185–6: itisscarcetobeexpected,thattillmenhaveabetterknowledgeoftheprinciplesofnaturalphilosophy,…it is hard to arrive at a more comprehensive theory of the various possible causes of diseases, and of the contrivanceandusesofthepartsofthebody,themethodwhichsupposesthisknowledgeshouldbeotherthan inmanythingsdefective,andinsomeerroneous. Seealsoibid.,199,quotingCelsus:‘Thecontemplationofnature,thoughitmakethnotaphysician,yetitfits himtolearnphysick.’Boylewenton:‘Adeeperinsightintonaturemayenablementoapplythephysiological discoveries made by it (though some more immediately, and some less directly) to the advancement and Descartes the doctor 135 understoodthehiddentexturesofmatter,youwouldrightlygrasphowdrugsworkedand howtoselectspecificdrugsthattargetedparticularillnessesandconditions.Hesupposed that he knew that better than did the physicians, and, accordingly, that he was more effective than they in treating both his own and others’ diseases. For humours, substitute corpuscular textures and mechanisms: ‘I think the physician…is to look on his patient’s body,asanengine,thatisoutoforder,butyetissoconstituted,that,byhisconcurrence with the endeavours, or rather tendencies, of the parts of the automaton itself, it may be broughttoabetterstate.’!#ItwascommonlysaidthattheDraconianlaws‘werewritten in blood’; in Boyle’s view this would be more accurately said of certain Hippocratic aphorisms, which, slavishly followed by contemporary physicians, cost the lives of countlesspatients.Systematicreforminnaturalhistoryandnaturalphilosophywillallow us to do better: ‘there may be unthought of methods found, whereby, by ways different fromthoseformerlyusedbyphysicians,amanmaybemuchassistedinthewholemanner of ordering himself, so as to preserve health, and to foresee and prevent the approach of many distempers’.!$ Infallible demonstration: Descartes’s medical project Descartes’svisionofthepracticalmedicalgoodsthatwouldcertainlybedeliveredtothose possessedofrightphilosophicalreasonwasmoreclear,coherentandambitiousthanthat of any other seventeenth-century intellectual modernizer. His vision was philosophically systematicandhiscommitmentwaslifelong.TheDiscourseonMethodof1637announced thatarenovatedphilosophywouldmakeus‘asitwere,thelordsandmastersofnature’. This mastery would, of course, be desirable ‘for the invention of innumerable devices which would facilitate our enjoyment of the fruits of the earth and all the goods we find there, but also, and most importantly, for the maintenance of health’. Medicine ‘as currently practised does not contain much of significant use’, and most honest medical practitionerswouldfreelyacknowledgethedisproportionbetweenwhatwenowknowand what remains to be known. But, were medicine to be refounded on proper philosophical principles,‘we might free ourselvesfrom innumerable diseases, bothof the body and the mind, and perhaps even from the infirmity of old age’.!% Descartes publicly committed improvementofphysick.’Alsoibid.,201,on‘theineffectualnessofourvulgarmedicines,notonlyGalenical,but chymical’;andseeM.Hunter,‘BoyleversustheGalenists:asuppressedcritiqueofseventeenth-centurymedical practiceanditssignificance’,MedicalHistory(1997),41,322–61. 13 Boyle’stherapeuticactivismsatalongsideconsiderablestressonthecurativepowerofnature:see B.B. Kaplan, ‘Divulging of Useful Truths in Physick’: The Medical Agenda of Robert Boyle, Baltimore, 1993, especially Chapter 5. What Boyle called the body’s ‘strainers’ (e.g. the liver, spleen and kidneys) can alter a medicine’scorpusculartextureorrecombineitwithothercorpuscles,thusadmittingittocertainbodilysitesand notothers.Orthespecificmedicinemightitself‘restorethestrainerstotheirrighttoneandtexture’(Boyle,op. cit.(12),192).BoylewasscepticalofParacelsianandHelmontiantalkofa‘universalmedicine’(ibid.,196–7). 14 Boyle,op.cit.(12),65,112. 15 Rene! Descartes,DiscourseontheMethod,publishedinThePhilosophicalWritingsofDescartes(hereafter PWD),(trans.J.Cottingham,R.StoothoffandD.Murdoch),3vols.,Cambridge,1985–91,i,111–51,142–3.Note alsothatDescartesclaimedthatmedicinehadthecapacitytomake‘meningeneralwiserandmoreskilful’since 136 Steven Shapin himself to achieving those ends, and even announced that he had already discovered a method that would ‘inevitably’ lead him to such practical knowledge, unless, he added, without evident irony, ‘prevented by the brevity of life’. The essay concluded with Descartes’sresolution‘todevotetherestofmylifetonothingotherthantryingtoacquire some knowledge of nature from which we may derive rules of medicine which are more reliable than those we have had up till now’.!& Descartes came from a medical family–his paternal and maternal grandfathers were bothphysicians–anditispossiblethathestudiedmedicineatPoitiersafterhehadfinished at La Fle"che.!’ In 1645 he told the Earl of Newcastle that ‘the preservation of health has alwaysbeentheprincipalendofmystudies,andIdonotdoubtthatitispossibletoacquire muchinformationaboutmedicinewhichhashithertobeenunknown’.!(Andthereismuch evidencethatDescartes’stheoreticalandpracticalmedicalconcernsdidariseveryearlyin his philosophical career. One of his first biographers traced Descartes’s formulation of medical goals back to 1629, when ‘not being able to forget the End and Scope of his Philosophy, which was only the benefit of Mankind, he seriously undertook the Study of Physick…He imagined that nothing was more capable to produce the temporal Felicity of this World…[and] he thought it necessary to find out some way or other to secure Humane Body from Evils that might disturb its Health’.!) By1630,inanyevent,Descarteswasinearnestpursuitofapracticaltherapeuticsystem foundedonhisrationalreformofphilosophy.InthatyearMarinMersennetoldDescartes that he was suffering from the skin disease erysipelas. Descartes sympathized and told Mersenne ‘to look after’ himself, ‘at least until I know whether it is possible to discover a system of medicine which is founded on infallible demonstrations, which is what I am investigating at present’."* Three months later Descartes still had not discovered such a system,butannouncedtoMersennethathewasthenstudyingchemistryandanatomyin thehopethatthesefundamentalstudieswouldhelp‘findsomecureforyourerysipelas’."! Nine years passed, and still no medical system based on ‘infallible demonstrations’, but ‘theminddependssomuchonthetemperamentanddispositionofthebodilyorgans’,sothatonecouldimagine avirtuouscycleinwhichthepractitionersofreformedmedicinewouldbecomemorecleverand,hence,capable of making even more discoveries, which would in turn make them cleverer still. See also G. Rodis-Lewis, Descartes:HisLifeandThought(trans.J.M.Todd),Ithaca,1998,127–8;andTemkin,Hippocrates,op.cit.(5), 13(fortheancientviewthat‘humanintelligencecouldbechangedbydiet’). 16 Descartes,Discourse,op.cit.(15),143,151.Descartes’smedicalpromises,andespeciallyhisviewsabout theextensionofhumanlife,arebrieflysketchedinG.J.Gruman,AHistoryofIdeasabouttheProlongationof Life,NewYork,1977(originallypublished1966),77–80. 17 Descartes,Discourse,op.cit.(15),113;S.Gaukroger,Descartes:AnIntellectualBiography,Oxford,1995, 20,64(generallyendorsingtheideathatDescartesformallystudiedmedicine),andRodis-Lewis,op.cit.(15),pp. vii,ix,1–2,18–19;andidem,‘Descartes’lifeandthedevelopmentofhisphilosophy’,inJ.Cottingham(ed.),The CambridgeCompaniontoDescartes,Cambridge,1992,21–57,28–9(judgingitunlikelythatDescartesdidstudy medicineanddisputingtraditionalearlydatingsofhismedicalinterests). 18 LetterfromDescartestoNewcastle,October1645,inPWDiii,275(myemphasis);seealsoR.B.Carter, Descartes’MedicalPhilosophy:TheOrganicSolutiontotheMind–BodyProblem,Baltimore,1983,31. 19 Adrien Baillet, The Life of Monsieur Des Cartes…Translated from the French by S.R., London, 1693 (originallypublished1691),79–80. 20 Letter from Descartes to Mersenne, January 1630, in PWD, iii, 17; Baillet, op. cit. (19), 81; G.A. Lindeboom,DescartesandMedicine,Amsterdam,1979,43. 21 LetterfromDescartestoMersenne,15April1630,inPWD,iii,21. Descartes the doctor 137 Descartes was unfazed, convinced that he was on the right lines, having supplemented theory with the dissection of many animal bodies: Ihavespentmuchtimeondissectionduringthelastelevenyears,andIdoubtwhetherthereis any doctor who has made such detailed observations as I. But I have found nothing whose formation seems inexplicable by natural causes. I can explain it all in detail, just as in my Meteorology Iexplained the originof agrainof salt oracrystalof snow."" TheDescriptionoftheHumanBody(composedinthewinterof1647–8andpublished posthumously) began with the Delphic injunction to ‘know ourselves’. But the benefits accruing from that self-knowledge were here identified as specifically medical: ‘I believe thatwewouldhavebeenabletofindmanyveryreliablerules,bothforcuringillnessand for preventing it, and even for slowing down the ageing process, if only we had spent enougheffortongettingtoknowthenatureofourbody’."#Questionedtwoyearsbefore hisdeathabouttheDiscourse’shintsconcerningthephilosophicallymediatedprolongation of human life, Descartes’s confidence remained unshaken: ‘it should notbe doubted that human life could be prolonged, if we knew the appropriate art. For since our knowledge of the appropriate art enables us to increase and prolong the life of plants and such like, why should it not be the same with man?’."$ So there is Descartes’s own testimony, repeated throughout his life and in a variety of settings, that medical prophylaxis, therapeuticsandtheextensionofhumanlifewerecentralgoals–eventhemostcherished goals–of his philosophical reform programme. How did Descartes think these goals could be achieved? And what did he see as the relationshipbetweenproper philosophyand practical healing? ThePreface to the French edition of the Principles of Philosophy (1647) introduced the celebrated metaphor of philosophy as a tree: ‘The roots are metaphysics, the trunk is physics, and the branches emergingfromthetrunkarealltheothersciences,whichmaybereducedtothreeprincipal ones, namely medicine, mechanics and morals.’"% This is how things should be, and, 22 LetterfromDescartestoMersenne,20February1639,inPWD,iii,134.OnDescartes’sdissections,seealso DescartestoMersenne,earlyJune1637,ibid.,59;Baillet,op.cit.(19),80;T.S.Hall,‘Foreword’,inDescartes, TreatiseofMan,(ed.andtrans.Hall),Cambridge,Mass.,1972,pp.xii–xiii. 23 Descartes,DescriptionoftheHumanBody,inPWD,i,313–24,314. 24 J.Cottingham(ed.andtrans.),Descartes’ConversationswithBurman,Oxford,1976,50.Descartesrefused (ibid.)tobedrawnonthequestionofwhether‘manwasimmortalbeforetheFall’.Althoughboththefactand the explanation for Edenic immortality was much debated by Renaissance and early modern physicians, Descartes’sjudgementwasthatthiswas‘notaquestionforthephilosopher,butmustbelefttothetheologians’. FransBurmanwasatwenty-year-oldstudentwhointerviewedDescartesinApril1648atthephilosopher’shome inEgmond.SeealsoLindeboom,op.cit.(20),96–7.The‘Preface’toThePassionsoftheSoulnotedthatGod hadundoubtedlyprovidedpeople‘withallthingsnecessary…tobepreservedinperfecthealthtoanextremeold age’:what was lacking was theknowledge of whatthese necessarythings were: ‘Preface’to Descartes, The PassionsoftheSoul,(ed.andtrans.S.Voss),Indianapolis,1989(originallypublished1649),7.Fortheeditor’s viewthatthis‘Preface’wasprobablywrittenbyDescarteshimself,seeibid.,1,n.1. 25 Descartes, Principles of Philosophy (extracts), in PWD, i, 179–291, 186. As Richard Carter puts it, for Descartes‘physicsdealswiththegeneralbodyoutofwhichparticularbodiesareformed;medicinedealswith particular,mortalbodiesthatarealiveandthathavesoulsunitedtothem’:Carter,op.cit.(8),31.Descartes’s well-knownstipulation–bothinthePrinciplesandintheTreatiseofMan–thathewasgivinganaccountnot of real but of imaginary human bodies did not, in his estimation here, diminish its significance for medical practice.Thecharacteristicsheattributedtotheseimaginarybodiesweresupposedtobe‘suchastocorrespond accuratelywithallthephenomenaofnature’.Andthis‘willindeedbesufficientforapplicationinordinarylife, 138 Steven Shapin followingCartesianreform,howtheywouldbe.Butgiventhepoorstateofcontemporary physics, it was deemed fortunate that matters were now otherwise arranged. So in The PassionsoftheSoulDescartes(or,atleast,acloseassociate)wrotethatmedicine,‘asit’s practisedtodaybythemostlearnedandprudentintheart’,doesnotdependonphysics: ‘theyarecontenttofollowthemaximsorruleswhichlongexperiencehastaught,andare notsoscornfulofhumanlifeastoresttheirjudgments,onwhichitoftendepends,onthe uncertain reasonings of Scholastic Philosophy’."& InthisconnectionRogerFrenchhasnotedhowDescarteswasbiddingtofillaspacein theuniversitycurriculumthensecurelyoccupiedbyAristotle’sOrganon(orbodyoflogical writings). One of the characteristics of this space, French writes, wasthattheartscoursenaturallyledon(forthosewhowishedtofollowthatpath)tomedicine. Not only did the arts course generally end with one of the more biological of the Aristotelian physical works, but the whole theory of medicine was based on the principles of Aristotle’s naturalphilosophy:‘wherethephilosopherfinishes,therebeginsthephysician’wasacommon doctor’s defence of his ownsubject. So if Descartes was going to supplant Aristotle in the university curriculum, a Cartesian medicine was required. It was institutionally and culturally natural for Descartes to associate the new philosophy with a new and vastly more powerful medicine."’ Descartes’smechanisticphysiologywasformallyelaboratedinanumberoftracts–the Discourse,theTreatiseofMan(composed1629–33),theDescriptionoftheHumanBody and The Passions of the Soul (1649). The heart powered the animal machine. Its motion wasthesourceofallotherbodilymotions,anditsnaturalheatwasthenaturalsourceof those motions. The heat of the heart rarefied the blood, ‘and this alone…is the cause of the heart’s movement’."( That is why the explanation of the heart’s motions was offered as the key exemplar of Descartes’s mechanical philosophy in Part V of the Discourse.") ‘Thecardinal tenet’,as T.S.Hall puts it, of Cartesian physiology istheassumption that motionistransferredfromparttopartbycontact,andtheoriginalsourceofbodilymotion is the heat of the heart.#* Having sketched his physiological system in the Description of the Human Body, Descartes declared that ‘this will enable us to make better use both of since medicine and mechanics…are directed only towards items that can be perceived with the senses’ (Descartes,Principles,289[PartIV,section204]).Thatistosay,philosophicallyinformedmedicalinterventions mightworkevenifthephilosophicallypositedunderlyingcausalstructureswerenottherealones.LaterIshall notehowDescartescametoqualifythatoptimism. 26 ‘Preface’toDescartes,Passions,op.cit.(24),7. 27 R.French, ‘Harvey inHolland:circulation and the Calvinists’, inFrench and Wear(eds.), op.cit. (7), 46–86,53–4;alsoBaillet,op.cit.(19),121–2,127–8. 28 Descartes,Description,op.cit.(23),319. 29 AndalsohowDescartesdistinguishedhiscardiacphysiologyfromHarvey’s.SeealsoDescartes,Passions, op.cit.(24),21–2;idem,Description,op.cit.(23),PartII.AlsoT.S.Hall,‘ThephysiologyofDescartes’,in Descartes,Treatise,op.cit.(22),pp.xxvi–xxxiii;idem,HistoryofGeneralPhysiology,2vols.,Chicago,1975, i,250–64;G.Hatfield,‘Descartes’physiologyanditsrelationtohispsychology’,inJ.Cottingham(ed.),op.cit. (17), 335–70; Gaukroger, op. cit. (17), 269–76. For the physiological writings of Descartes’s major medical disciple,theUtrechtprofessoroftheoreticalmedicineHenricusRegius,seeT.Verbeek,DescartesandtheDutch: EarlyReactionstoCartesianPhilosophy,1637–1650,Carbondale,IL,1992,Chapter2. 30 French,op.cit.(27),50–1;T.S.Hall,‘FirstFrenchedition:synopsisofcontents’,inDescartes,Treatise, op.cit.(22),p.xxxvi. Descartes the doctor 139 bodyandofsoulandtocureorpreventthemaladiesofboth’.And,giventhesignificance of cardiac theory in Descartes’s physiology, he insisted that without accurate knowledge of ‘the true cause of the heart’s motion’–which he considered he now had–‘it is impossible to know anything which relates to the theory of medicine’.#! Thegapbetweenthetheoryofmedicineanditspracticalrealizationinbothhygieneand therapeutics was only occasionally bridged in Descartes’s writings. That is, Descartes rarely spelled out exactly how it was that certain dietetic practices or therapeutic interventions worked in mechanical and corpuscular terms or how proper philosophical principles led to new and uniquely effective changes in medical art.#" Despite this largely unbridgedgapbetweentheoryandpractice,thereismuchevidencethatDescartesthought hisphilosophicalachievementsdidputhiminapositiontounderstandandtomanagehis ownbodybetterthanthephysiciansandtoofferadvicetofriendsandcolleaguesthatwas superiortoavailableprofessionalalternatives.IwantfirsttoconsiderhowDescartesacted as his own physician and then to detail and interpret the range of concrete dietetic and therapeutic advice he gave his associates. Descartes his own physician AtleasttwiceinhislifeDescartesexplicitlyendorsedancientcounselthatonebeone’sown physician.Thewiseman(theargumentwent),takingtheadviceofApollo’soracle,ought indeed,afteraperiodoftime,tocometoknowhimselfbetterthananyphysicianpossibly could. This is what he told the Earl of Newcastle in 1645: IsharetheopinionofTiberius,whowasinclinedtothinkthateveryoneoverthirtyhadenough experienceof what was harmfulorbeneficialto behis owndoctor.Indeed it seemsto me that anybodywhohasanyintelligence,andwhoiswillingtopayalittleattentiontohishealth,can betterobservewhat isbeneficialto it than the most learneddoctors.## ThreeyearslaterherepeatedthesamesentimentstoFransBurmanwhentheyoungstudent asked him what foods one ought to eat and how one ought to eat them. We become our ownexpertsonsuchmatters:‘So,asTiberiusCaesarsaid(orCato,Ithink),noonewho hasreachedtheageofthirtyshouldneedadoctor,sinceatthatageheisquiteabletoknow himselfthroughexperiencewhatisgoodorbadforhim,andsobehisowndoctor.’#$Here Descartes was not apparently advertising the special virtues of his new philosophical system;hewasmerelypointingoutthatifyouwereawiseandattentiveman,thenmedical expertise deserved no deference, and noting that he himself was such a man. Descartes’s self-monitoring began at an early age. A sickly and delicate child, he was born(sohelatertoldPrincessElizabethofBohemia)with‘adrycoughandapalecolour’ whichhebelievedheinheritedfromhismotherandwhichremainedwithhimuntilhewas 31 Descartes,Description,op.cit.(23),316,319. 32 ThemostimportantsiteofsuchdiscussionisDescartes’slatewritingsonthepassionsofthesoul(tobe treatedbelow). 33 LetterfromDescartestoNewcastle,October1645,inPWD,iii,275–6. 34 Descartes,Conversations,op.cit.(24),51.ThesourceisinfactSuetonius’lifeofTiberius.SeealsoBaillet, op. cit. (19), 260 (who put Descartes’s age at 19 or 20 when he came to that opinion); Lindeboom, op. cit. (20),94–5;Rodis-Lewis,op.cit.(15),19.