Descartes the doctor: rationalism and its therapies

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Descartes the Doctor: Rationalism and Its
Therapies
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Shapin, Steven. 2000. Descartes the doctor: Rationalism and its therapies. British Journal for the
History of Science 33(2): 131-154.
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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.