SOURCE: “Introduction,” in The Angel of Bethesda by Cotton Mather, Barre, Mass.: American Antiquarian Society and Barre Publishers, 1972, pp. xi-xxx.

[In the following excerpt, Jones discusses the significance of Cotton Mather's medical writings and traces the influences on his thinking.]

PART I

Cotton Mather (1663-1728) represents a landmark in the development of the American mind, the first long step in the series from Benjamin Franklin (whose boyhood studies he encouraged) and Thomas Jefferson to Robert McCormick and Henry Ford. His background was essence of English Puritan. One grandfather was the Reverend John Cotton (1584-1652) of the First Church of Boston, and the other was Richard Mather (1596-1669) of the First Church of Dorchester, Massachusetts. His father, Increase Mather (1639-1723), was minister of the Second Church of Boston, president of Harvard from 1685 to 1701, the author of 175 published works, and, having been sent to England by an alarmed Colony, the political agent who obtained the Second Charter which carried Massachusetts over the shoals between colony and province times.

These Puritans did not share the medieval belief that this world does not matter. They were insatiably curious about it and they gave science a long start in both England and America. Cotton Mather was a climax in this development and the great popularizer in New England of the new discoveries being made in Europe. Among the nearly 500 books which he published was The Christian Philosopher (London, 1721), which provided a “new science for the millions” and proposed to show that “Philosophy is … a mighty … incentive to religion.” More interesting has been the discovery over the last century that his experiments and speculations which appeared first in letters to correspondents in England have great significance. More than two centuries after his death, the 1936 Year Book of the United States Department of Agriculture carried his portrait and a discussion of him as the first observer of natural hybridization in plants. He was far ahead of the body of medical science in thinking that diseases might be seperate ills, that they might be caused by the living “animalcula” which he saw in his microscope. No one else in America commented on this possibility, in print, until John Crawford did so in 1811, nearly a century later. One is still discovering his footprints in the most unexpected places.¹

The impact of his advanced thinking on his fellow colonials was probably not great. In part this may have been caused by the considerable personal unpopularity which he endured during his lifetime. This was due largely to the way in which he identified himself with the causes and interests of his father (whom he survived by only five years), but also in part to his own volatile temper and occasional imperiousness. In 1688 Increase Mather was chosen by the churches to carry to England the colonists' plea for the restoration of the Old Charter, abrogated by Charles II in 1684, under which the colony had been practically an independent state. Two years later the General Court, ignoring the Puritan axiom that the clergy must never hold political office, appointed him official agent. As such he obtained the New Charter of 1692. For this the Mathers were never forgiven by the very orthodox, by the popular politicians, and by the isolationists. Yet, their unpopularity was far from total. Remember the fact that in small Boston their congregation at the Second Church numbered 1500 souls.

Religion played small part in the differences which Cotton Mather had with his contemporaries. They all lived in a world of profound religiosity, a world about half way between that of the sailors of Columbus and ours. They saw themselves as a part of a generalized European Protestantism with minor local differences. Increase, when in the old country, attended services of the Church of England, and Cotton recorded with pleasure the day when members of five different denominations took communion at his hands. The Mathers were Calvinists in that they accepted the doctrines of Original Sin, Predestination, and Eternal Damnation. The Mathers preferred not to preach on these subjects, but like all of their contemporaries they lived under the shadow of death, particularly that of the terrible infant mortality. Thus great emphasis was laid on the preparations for holy dying, and some children were so well trained that they actually welcomed death as an early progress to Jesus.

The Angel of Bethesda cannot be understood if not read with this religious orientation in view. Cotton Mather constantly sought communion with God. He found fasting a good means, and during his life he spent hundreds of days in this manner. While fasting he spent much of his time praying or singing psalms in the privacy of his study or library. Sometimes he prayed on his knees, and sometimes he lay prone for hours mortifying his flesh on the hard floor, often dampening the boards with his tears as he prayed.

Next to fasting and prayer came doing good deeds, daily if possible. One sees here a reaction gainst Calvin's Grace versus Works. His pastoral visits were inexorable. Indeed, he is credited with having been the originator of this ministerial duty. He began, or joined, more than a dozen religious societies created for the better instruction of both youth and elders, for the wealthy and for black slaves. Among the many resolutions for good deeds in his diary is this, “I would alwayes have about me some little Matters, (as Pennies, or Fruits, or Paints) proper to be bestow'd on little children.”

A personal Devil was an essential to all of the Christianity of these centuries, a Devil working ceaselessly in many forms to foil God. Mather's contemporary and correspondent, the great English scientist, Robert Boyle, sent a circular letter to the miners of England asking them to describe the devils whom they encountered in the underground works. And, of course, cooperating with the Devil was witchcraft. In the next generation Chief Justice Sir James Mansfield and the Wesleys declared that to deny the reality of witchcraft is to deny the reality of God.

Cotton Mather believed in witchcraft, and he gathered records of it as he did of the aurora borealis, two-headed snakes, and the like. In 1688 he took charge of two Boston girls who could produce the most amazing parapsychological phenomena seen in his region from that day to this. He described the phenomena as aspects of witchcraft, treated the girls as ill, and cured them. In most parts of the civilized world they would have gone directly to the stake. There is not the slightest evidence that he ever preached a sermon or did anything else to bring on or promote the Salem outbreak of 1692, but after it he took up his pen to vindicate the judges. The popular party coupled this with its attacks on the New Charter and distorted his writings on witchcraft into a weapon with which to beat the establishment. Their side of the story prevailed in history for two centuries, obscuring his sincerity and integrity, his gentle private life, and his passion to do good. They did not need to exaggerate his hot temper, his own over-estimation of his great intelligence, and his sometimes unfortunate attitude toward lesser men.

Without his religiosity Mather could not have come well through his unhappy life. His sickly childhood foretold his neurotic adulthood. A child prodigy, he was fitted for college by his father in the fine family library and by some private schooling. At the age of twelve he entered on the four-year Harvard course with the class of 1678, one of a total enrollment of twenty-three. It may well be true that he was a very unpopular undergraduate, but the usual evidence cited to prove this point simply is not pertinent.

In his years at Harvard he studied arithmetic, geometry, logic, ethics, politics, astronomy, Greek, and Hebrew. Apparently he gained a reading knowledge of French, Spanish, German, Italian, and good knowledge of at least one American Indian language privately, then or later. Science at Harvard was only encouraged after Increase Mather assumed control of the college. Of Mather's college contemporaries, a majority entered the ministry. A few graduates became physicians. Some of the presidents were medical men. Perhaps this only emphasizes the close relationship between medicine and the clergy in early America. In the Harvard Library catalog of 1723 (few books had been added after 1701 when Increase lost the presidency) there were about 2200 theological works listed and only about 200 medical and scientific ones. We shall examine the list a little more thoroughly later.

Despite his preparation for the ministry, Cotton Mather's dearest ambition to follow his father into that field promised to be frustrated by a stammer which he had had since childhood. The question might be asked if this psychological problem might have been due to the dominance of a strong father. At any rate, he did manage to overcome this disability “through prayer” and diligent practice so that he could be ordained in 1685. He developed into an effective preacher.

During the time that he was combating his stammer he turned to the study of medicine as a possible alternative calling. Evidently this took the form of reading. No mention is made in the sources of any apprentice training, which was the usual avenue to medical practice. Indeed, in his diary he only mentions one of the many medical books in his father's library, William Salmon's Pharmacopeia. He never lost his interest in medicine and science which was aroused in these months of study.

Unlike many New England preachers, Cotton Mather never practiced medicine despite his extensive bookish knowledge of it. When in trouble he usually called the physician. In this he was unlike his contemporary, William Byrd II of Virginia. That medically well-read gentleman little trusted medical practitioners. Mather's great interest appears in many of his writings. There are medical notes all through his diary. In many of his sermons he mentioned medical matters. In his huge unpublished Biblia Americana he tried to diagnose the diseases of the Ancients. Like many, then and now, who read medicine, Mather was an intense neurotic. He had many minor illnesses and constantly, year after year, sensed the approach of death. Only after sixty-five years of living was he correct.

Well he might worry. He certainly knew first-hand much about illness and death. Thirteen of his fifteen children pre-deceased him. It is not certain what killed them all. A son, Joseph, died shortly after his birth because of an imperforate anus. Cotton reported the autopsy in his diary. A daughter died suddenly in its nurse's arms. Another son died after many “fits.” Three children died of measles, one of tuberculosis, one in childbed. Another son drowned at sea.

Not only children but wives died. The first died in 1702, probably of cancer of the breast. The second wife died of measles. His third wife became so mentally deranged as to be a torment the rest of his life.

Despite his troubles he retained always his intense interest in all things: one of the marks of a genius. He wrote much and well. In 1712 he resolved to write “a book a month” for publication. He read very widely. He corresponded with the Royal Society, sending it eighty-two letters between 1712 and 1724 concerning his scientific observations. In 1713 he believed that he was elected a Fellow of that Society, to the disgust of some in Boston.² Partly from reading accounts in the Transactions of the Royal Society he learned of smallpox inoculation, the more dangerous fore-runner of vaccination. When a smallpox epidemic threatened Boston he proposed to the local physicians that they practice the method and save the town. Only one, Zabdiel Boylston, to his undying fame, agreed to try. The only man in town with a medical degree, Dr. William Douglas, was much opposed. There was also violent opposition on the part of the laity, largely because it was a method learned from the heathen Turks and pagan Negroes and not fit to be used on Christians bent on salvation. Mather gives a graphic description of his troubles in Chapter XX of The Angel of Bethesda.³ This episode and the various disappointments of his life, including failure of election as president of Harvard to succeed his father, embittered him against his city and he finally called Boston “a miserable and detestable town.” It was the only town he knew. He had hardly traveled more than twenty miles from it in his entire lifetime, despite the fact that he took an active interest in all New England. Yale College greatly interested him.

In his last years this man who had seen the deaths of so many loved ones, who had struggled so fiercely for what he considered in his somewhat autocratic way the best, had worked so hard, had seen so much disappointment, had felt the malice of so many, often noted in his diary that he welcomed death. But he kept on writing. He finished his Angel in 1724. This remarkably well-written book shows no diminution of powers, shows an advanced and liberal mind.

A friend of Baptists and Quakers, he deprecated the controversies of his father's generation, and although he could not agree with the Brattle Street reformers, he held the normal theological position of a New Englander of his age. His theological contribution was nil. The great interest of his mind to us lies in its explorations of science, including its speculations upon the still unseen world.

PART II

WORLD MEDICINE IN THE TIME OF MATHER

One of the striking impressions which one gets from the reading of Mather's Angel of Bethesda is of the wealth of contemporary, and ancient, medical literature available to him in Boston. He, and undoubtedly a number of his friends, were both aware of and greatly interested in medical science as it was evolving in the old world. This interest in the new is markedly reflected in the Angel as well as in The Christian Philosopher. Thus, a cursory view of medicine in Mather's day will form, for some at least, an important background for an appreciation of his book. In such a short essay as this errors of interpretation of such a huge and varied subject may be inevitable. Many scholars have produced an enormous literature concerning the medical history of this period. Naturally, they often differ somewhat in viewpoint, but all seem to agree in placing the rather tenuous base of our medicine in the changes of view and in the experiences of the seventeenth century. That century saw something of a struggle between those who favored the teachings of the score or so of Ancients and those who espoused new ideas. The ancient reputations of Galen and Aristotle suffered, especially late in the century. Some men spun arm-chair theories and proved them in their own minds, but not by experiment. Others ridiculed them. A few conceived correct ideas, as proven two hundred years later, for the wrong reasons. Others who criticised their ideas for the right reasons were eventually proven wrong. But out of all the disputation, often acrimonious, there did come forth some light. As Lester King wrote recently, the most significant feature of the medical advance of the seventeenth century was “the growth in critical acumen rather than the accumulation of facts.”⁴ Our well-being today is based on that.

Cotton Mather showed occasional flashes of it; he also spun arm-chair theories (see his Chapter V). He was born and reared in the seventeenth and died in the eighteenth centuries. He remained in many respects a seventeenth-century man. He is recognizable as such in both his portrait and in his handwriting. But he showed many signs of an ability to grow, a characteristic of the intellectual elite of that century. His fervent Calvinism was tempered by a gentleness in his personal life, by a perhaps non-Calvinist desire to “do a good deed daily.” This led to his interest in German pietism, an eighteenth-century development. However, the liberal swing of New England religion after his death probably would have annoyed him. He seems to have felt that the fact of the existence of the Devil and of his assistants, the witches, was biblically and “scientifically” proven. In this belief he was of the century of his birth. Yet, in the non-religious field he was able to grasp and push ideas not at all in vogue. He expressed very well the idea of the germ theory of disease.⁵

Doubtless his convictions about the animalicular cause of disease made him intellectually capable of his passionate, and wonderfully correct, advocacy of inoculation for smallpox prevention. Certainly the well-received report of the Boston experiment, given by Zabdiel Boylston in London, was one of the several important contemporary contributions which prepared the world for the fairly prompt acceptance of Jenner's far safer vaccination discovery late in the eighteenth century (1798).⁶ And Boylston would never have dared try the experiment without the suggestion and backing of Mather. This was enough advanced thinking, apparently. Except for his Chapter VII and the appendix of his Chapter XX, The Angel of Bethesda presents only a fascinating summary of the medical practice, beliefs, and theory of the seventeenth century.

That century was one of the most stirring in history. For England it was the century of the Stuart romance and the Civil War, of the “martyrdom” of Sir Walter Raleigh, of the defeat of the doctrine of the divine right of kings, of the last days of Shakespeare, of Ben Jonson, of Milton, of Inigo Jones and the new architecture, of Bacon, Harvey, Boyle, Newton, Sydenham, Locke, Willis. And continental Europe, in the midst of its misery, knew Louis XIV, but also Molière, Malpighi, Galileo, Spinoza, Rembrandt, Leeuwenhoek, Racine, Descartes. It was the century of the discovery of cinchona. That alone would have made it distinguished.

It was not a comfortable century. There was peace in all Europe in only two years of the hundred. Religious strife was the rule. Witches were still being burned in Europe and hanged in New England. Care of the sick was poor. Molière does not let us forget that. Disease was as terrible as it had been in previous centuries.

Life was short. The people of Europe were just as wretched and devoid of hope as the pathetic citizens of today's most deprived nations. But it was a century of great minds who began building the scientific base upon which our marvellous health structure is built. It is not necessary that misery and poverty stifle intellectualism. Some of the fine minds came from poor families. Even the very rich did not approach in luxury the lower middle class Americans of today.

The sixteenth century had seen the beginning of modern anatomy. This science of gross anatomy really flowered in the seventeenth century. A great number of individuals made many discoveries. Physiology began in the seventeenth century: Sanctorius created the study of metabolism in 1614, Harvey published the proof of the fact that the blood circulates in 1628. Mather spends little time on such basic science in his Angel, since that is, after all, largely a text of the practice of medine. However, as proven by his statements in The Christian Philosopher (London 1721), he was cognizant of the new science of his age. He was the first American to discuss it.⁷

The seventeenth century has always been viewed as the century of the rebirth of science in general. It had been more or less dormant since the time of Galen (c.130-200 a.d.). Francis Bacon first urged the study of science. Collect facts, he said, and from these facts assembled you can create scientific truths. This inductive method was rather less popular than the deductive one of arguing from the general to the particular. Bacon first outlined his scientific proposals in his The Twoo Bookes … of the Proficience and Advancement of Learning (London, 1605). His last book, Sylva Sylvarum (London, 1627), was a vast collection of facts, observed facts and facts determined by experiment. His most famous experiment was his last. With his bare hands he packed a freshly dressed fowl with snow to see if the meat would be preserved by the cold. He died a few days later of pneumonia.

Bacon apparently made no great impression on his contemporaries but he did influence Robert Boyle (1627-1691), the “father of modern chemistry,” who won perhaps the greatest reputation of the century. Independently wealthy, he spent his days in chemical experimentation and in dabbling in medical practice. His Skeptical Chymist (London 1661) is an intellectual landmark, but most readers of the day missed the point. It was bought by Virginians, for instance, seeking the practical advice it might yield in their efforts to exploit their natural resources.⁸ Mather was apparently much more interested in his Medicinal Experiments (London, 1692), a little book full of “receits,” an uncritical collection of ancient popular remedies. It is hardly a work which one would expect from the pen that wrote the Skeptical Chymist and Of the Reconcileableness of Specific Medicines to the Corpuscular Philosophy (London, 1685).⁹ But that is the contradiction of the century. Great men had a few advanced ideas, but the firm grip of early religious training and the heritage of centuries of medieval lore and tradition even influenced a Boyle. This was found in Cotton Mather, too. He could grasp the essentials of the germ theory of disease, could introduce inoculation, and at the same time believe in witches.

Isaac Newton (1642-1727) was just as deeply religious as Boyle. Both wrote much on biblical subjects. Newton, unlike Boyle, had no direct influence on medicine, but his mathematical and physical discoveries helped create the fundamental scientific substratum upon which scientific medicine is based.

Galileo Galilei (1564-1642), who died in the infancy of Newton after having partially anticipated some of the latter's discoveries is not considered a medical man either, though the study of medicine was his first ambition before mathematics, physics, and astronomy captured his imagination. We physicians are indebted to him for his introduction of mathematics as one of the fundamental tools of science and for his contributions to the development of the microscope, an instrument apparently first invented by the Dutchman Zacharias Jenssen in 1590.

That instrument, so precious to medicine, was eagerly developed during the century. Some of the finest models were made by Anton Leeuwenhoek (1632-1724) of Delft, largely as a hobby. The lenses which he ground were marvellous and he must have attained magnifications of 300-500X. He was quite secretive and only a handful of the hundreds of microscopes he made are extant. He used these in furthering his studies of “animalcules” (bacteria and protozoa), muscle fibres, nerves, blood vessels, etc. His reports of his findings endeared him to the Royal Society of London, which published many of them. Cotton Mather was well aware of these studies. They may have influenced the formulation of his ideas about the cause and dissemination of disease. He owned a microscope.

Another notable figure of the century, the Frenchman René Descartes (1596-1650), also contributed a little to the development of the microscope. His book De Homine, published posthumously in 1662, has been called the first textbook of physiology. In it he established the iatrophysical or iatromechanical school of thought. He looked upon the body as a machine, divinely created to be the habitation of the soul. At the same time he was sufficiently cognizant of the chemical processes in the body to have been respected by the group called iatrochemists who looked upon the body as a mass of chemical processes rather than a machine. We shall notice these two ideas again later.

The upsurge of interest in science during the seventeenth century stimulated the development of several scientific societies. First in the century was the Accademia dei Lincei of Rome (1603), which is still in existence. There followed the Accademia del Cimento in Florence in 1657, the Academie des Sciences in 1665, and the German Academia Caesarea-Leopoldina which began publishing its Ephemerides in 1670. Mather had access to this publication. All of these seem to have been inspired by the “secret academy” of Porta, started in Naples in 1560. Directly descended from the last was the “invisible college” founded by Robert Boyle and others in 1645 at Oxford. In 1662 this became, by grace of Charles II, the world famous Royal Society of London. Its Philosophical Transactions became so prestigious that it published many of the important scientific works of the century. It was widely read in the colonies. Mather sent many contributions, a few of which were published. One was on rattlesnakes. Another was concerned with the effect of lightning on the compass of a ship at sea. Many of the men quoted by Mather in his Angel published articles in the Transactions.

The members of these societies were the first internationally minded scientists. By correspondence as well as by their publications they shared eagerly their observations of natural phenomena, medical affairs, mathematics, etc. The correspondence of Henry Oldenburg, secretary of the Royal Society, was so voluminous, in fact, that he came under a cloud: the government suspected that he was a spy. Despite science's findings, gropings, and slow building of the scientific base, it was not until the nineteenth century that people began to glimpse the possible wonders of scientific medicine in actual practice.

Most of us tend to remember first the builders of the base, Bacon, Galileo, Boyle, Newton, and so on. But there were great physicians in the seventeenth century also. The greatest of them, and one of the greatest base-builders too, was William Harvey (1578-1657) who died only a few years before Mather's birth. He was a practitioner, a teacher of anatomy in London, and an active research scientist. He established experimentally the fact that the blood circulates, pumped about the body by the force of the heart. His Exercitatio Anatomica de Motu Cordis et Sanguinis (Frankfort, 1628) is one of the half dozen great books in medicine if not in all world history. It made possible all future advances in physiology by proving the basic fact of the circulation. His teaching was not accepted at once. When Mather mentions the circulation of the blood in a matter-of-fact way we should remember that it had been generally accepted as fact amongst a conservative profession hardly more than a decade before his birth.

No such experimenter was Thomas Sydenham (1624-1684), the “English Hippocrates,” who must be considered one of the founders of modern clinical medicine. He was a great observer. He was not much impressed by “science.” He believed that the important advances in medicine could only come through the careful studies of sick people at the bedside. He considered each disease an entity. He discarded the vague notion, prevalent then and for some time in the future, that disease is really all one condition, the result of an improper bodily function, which is merely manifested in different ways. After Sydenham the realization grew that just as there are many different kinds of plants, so there are many different diseases.

Almost as great a clinical observer as Sydenham was Thomas Willis (1621-1675). He is often credited with having discovered the sweetness of diabetic urine. The ancient Hindus, however, wrote of it as “honey urine.” He first described the conditions which we know as myasthenia gravis, puerperal fever, and typhoid fever as found in troops. Unlike Sydenham he was an anatomist and a fair neurophysiologist. Both of these men left books important to their fellows and to posterity.

The seventeenth century was a time of many medical theories. For an appreciation of Mather's medicine it is important to recognize some of them. The idea of the body as a machine seemed to appeal to him. Thus, he might be labeled an iatromechanist. Adherents of this “school” or theory delighted in rather futile theoretical exercises in comparison. Georgio Baglivi (1668-1706) of Ragusa, well thought of in England, liked to compare the teeth to scissors, the lungs to bellows, and so on. This man whom Mather often quotes, did not, however, let these fancies interfere with his being a shrewd bedside clinician. Perhaps anticipating this iatromechanical group was the founder of the science of metabolism, Santorio Santorio (1561-1636), known as Sanctorius, a professor at the University of Padua. He spent a lifetime measuring the results of all bodily processes. He often slept, ate, and rested on a steelyard and recorded all observations and variations.

Distinguished from these were the adherents of the iatrochemical school. This originated with Jean Baptista van Helmont (1577-1644), a Belgian, who believed that all bodily processes are chemical in nature, and that each such process is controlled by its special archeus. This notion he probably got from the writings of Paracelsus (1493-1541), the part quack, part mystic, part true medical reformer of Swiss birth, with whose work Mather was acquainted. Van Helmont believed that the whole organism is presided over by a sensory-motive soul.

Georg Ernst Stahl (1660-1734) of Germany extended Helmont's ideas. He felt that the body is a machine activated by a soul which directs all the processes. He believed that when the soul is improperly channeled disease develops. If we wish to be charitable we may say that his system is an ancestor of our field of psychosomatic medicine. His idea was perhaps the forerunner of eighteenth-century vitalism which maintained that all depends on the impulse of living things to grow and to reproduce. Stahl's view seems to be rather like Mather's, although the latter does not mention Stahl. See Chapter V of the Angel, where Mather discusses his Nishmath-Chajim, or Breath of Life. All these theorizers owed something to the ancient metaphysical theory or concept of the pneuma or universal spirit.

Accepted without real question by most theorists were the likewise ancient doctrines of the humours and qualities. One does get the impression that frequently ‘humours’ was used as an abstract term rather than one referring to the classical four. These were phlegm, blood, black bile, and yellow bile. Phlegm, or pituita, was supposed to drip down from the brain via the pituitary gland. This notion was attacked by van Helmont and later disproved by Konrad Schneider (1610-1680) in his publication De Catarrhis (Wittenberg, 1660). These attacks were long ignored by practitioners. The origin of the blood is obvious. Black bile was thought to arise in the spleen; an excess caused melancholy. Yellow bile had its origin in the liver; an excess caused jaundice.

The qualities were hot and cold, dry and moist. Each organ and each plant of pharmacological significance was noted for a combination of these qualities. The stomach, they said, is cold and moist. Mint is warm and dry. Mint, quite logically, soothes the stomach.

The elements of the ancients were also four: air, earth, fire, and water. Paracelsus had tried to discard these and proposed three: sulfur (it burns), mercury (it volatilizes), and salt (it stays as a residue in all chemical processes). Boyle, and others, of the seventeenth century harked back to the fifth century b.c. Democritos of Abdera and began the trend of believing that matter is composed of corpuscles, approximately our atoms and molecules, in motion.

No matter what the theory or notion or archaic beliefs they held, all practitioners used practically the same treatments. And those treatments were generally more or less adhered to until fairly late in the nineteenth century when more rational methods of treatment, based on science, came to the fore.

Treatment was all worked out logically and systematically, with faithful reference to theories and humoral doctrines.¹⁰ Most believed that disease is characterized by a change in the quality, quantity, and motion of the humours. Thus, cure must be based on evacuating some of the abnormal quantity, altering the quality, and moderating the motion. The first was treated with evacuant methods, the second with alterants, the third with moderants. Seemingly less complicated was the treatment scheme of those who adhered to the belief of the “Methodists” of ancient times that there are only two states of disease, tension and relaxation. But the evacuants cured the former and the alterants and moderants the latter. So, I repeat, physicians tended to come up with the same prescriptions for the same conditions for different reasons.

Evacuant methods were the most abundant and widely used. They were relaxant also, even to the point of shock, I might add. The means was either surgical or medical, or both for that matter. Among the surgical, venesection comes first to mind. Even slashing of arteries was sometimes employed. As late as our Civil War venesection was still occasionally done. To us it is incredible how extensively the method was used. But before we criticize too harshly we must realize that even today there is an occasional justification. When the pressure in the great central veins of the body is high, as determined by a rather delicate test perfected only relatively recently, the patient is in some danger. Recently, a bled-out accident patient was over-transfused. As a result of too much blood volume she developed pulmonary and cerebral edema. Her central venous pressure was 35 instead of 6-10. She made a rapid recovery (48 hours) after the removal of somewhat less than a pint of blood. This accounts for the temporary relief venesection gives to patients in heart failure. It lowers the central venous pressure for a while. We know that the older doctors were keen observers. Their practice depended on their senses, not on the laboratory tests. When a man like Dr. Thomas Watson claimed speedy relief when a patient in the early stages of pneumonia was bled, we cannot doubt him.¹¹ Perhaps there had been an element of heart failure in his observed cases. Most of the older experienced doctors had seen a few dramatic benefits from venesection, or at least had been told about them by their preceptors. If a given treatment works in a few cases it should work in all. Such would be the reason—if a knowledge of basic physiology and hemodynamics is a science of the future. Physicians of old treated symptoms and hoped to cure disease. We more generally treat the disease and trust that the symptoms will disappear. We must always remember to judge physicians of other times by how well they used or advanced the use of tools then available, and not exercise our twentieth-century amused superiority.

Blood was let in other ways, by scarification, by cupping, by leeches. Cupping involved setting fire to a little alcohol in the bottom of a cup and slapping the cup mouth against the skin. This raised a blister which made the method a counter-irritant or tonic treatment. If the blister was then lanced a fair amount of blood might flow. This made the method evacuant. Leeches as blood-letters were applied until recently at least in France.

“Issues,” consisting of serum and sero-purulent material, were encouraged by means of setons. A piece of skin was raised with a knife and kept raised with a thread left in place. Issues were also caused by means of a moxa. Here, tow was allowed to burn down onto the skin over an affected part. This was a Japanese invention. Western observers have marveled at but have been unable to reproduce the benefits claimed for it in arthritis. Faith! Edematous legs were lanced to let the water out. Mather mentions all these methods. Trephination of the skull was done rarely. Paracentesis and thoracentesis were performed on appropriate occasions.

Medical evacuant methods were used with great enthusiasm. Mather constantly notes them in chapter after chapter. Emetics and cathartics were the favorites. Drugs thought to produce sweating and increased production of urine were tried. Irritants like cinnamon or snuff might be placed in the nose or on the gums to produce an increase in the production of “phlegm.” Salivation by means of mercury was tried in the seventeenth century in the treatment of syphilis and was used as the generations went by with increasing enthusiasm for many conditions.¹² We still use expectorants in cough medications. This, again, may be a matter of persistent faith. The promotion of natural bleeding was considered wise in many cases. Such drugs as black hellibore were thought to be effective in increasing menstrual flow. Violent laxatives often promoted the benign development of bleeding hemorrhoids.

Some alterants thickened too-fluid humours, others thinned too thick ones. The physician decided according to his experience or imagination. Correctives were used to reform peccant or bad humours. Constrictives corrected relaxation, relaxants corrected too much constriction. As examples we may mention the use of figs and well-cooked bread in thickening humours. Rhubarb powder and nasturtium leaves thinned thick humours. Mercury compounds reformed. Rhubarb and mercurials also relaxed constrictions. They are laxative. Fruits promoted the constriction of too-relaxed tissues. All this is confusing simply because it is so foreign to present-day training.

On the basis of these ideas complicated prescriptions composed of several different herbs were compounded for each indication. Sydenham liked very complicated prescriptions, especially when he thought the patient's condition was “mixed,” as when there might be peccant humours in the presence of thick ones. Most physicians thought likewise. In practice, the physician had to rely on his observation and experience to determine which of the many vague and varied conditions were present. He might get a consultation with another physician and have a great wrangle. Then he would choose several out of hundreds of possible pharmacological preparations. Mather mentions more than 175 such. Of these only a few are still used in some form or other, cinchona (quinine), senna for instance. We are fortunate in that it is much easier to practice using experimentally proven facts instead of imagination and “impression.”

This polypharmacy was blessed by antiquity. From quack to physician, all used it. Ingenious men of that century did try to think up new treatments. The first tentative experiments in intravenous therapy were made. Dr. Richard Lower was apparently the first to transfuse blood from one animal to another.¹³ He transfused blood from dog to dog, from calf to sheep, from a wether to a horse, all without notable ill effects. He transfused the blood of a sheep into a man, again without mortality. However, about this time the same procedure tried in Paris led, predictably, to disastrous results. At once transfusions were outlawed and not attempted again on human subjects until the nineteenth century.

Various substances injected into the veins of dogs usually killed the animals.¹⁴ Nevertheless, one “Dr. Fabritius” of Danzig injected a small amount of laxative medicine into a man “heavily infected” with venereal disease. There was considerable pain, but in about five hours the man began to have many stools. The observer thought that the patient had been improved.¹⁵ Other such injections were occasionally mortal in their effect. The method was dropped. It is only in this century of ours that transfusions and infusions have become safe and widely used.

Two great new treatments did arise in Mather's lifetime. With one of them, inoculation for smallpox, Mather was greatly involved, as we have seen. The other benison was the introduction of cinchona bark or Jesuit's bark, under somewhat mysterious circumstances, from Peru. From ancient times malaria has been a terrible scourge, causing death and debility to countless millions, rendering great districts uninhabitable. We are now relatively safe because of quinine, and mosquito control. Cinchona bark was the first great specific. It cures malaria and nothing else. It became generally recognized as such a cure in the last third of the seventeenth century. It is significant as a great drug but also as the very proof that disease is not all one great vague condition of ill-health. Cinchona cures one disease and one only. Thus, there must be distinct diseases with distinct characteristics and different causes. That was a very important concept to establish. It was thought in the early years of its use that the bitterness (qualities, again) of the drug was the essential element in effecting the cure, and some time was wasted trying “the bark” for other conditions in the hope that the famous bitterness would be of avail there too.

General medical practice, then, saw two great advances in the century. That was praiseworthy, but advances did not accelerate. Just as importantly for the future was that basic medical science, including chemistry, got its essential start. Harvey proved the circulation of the blood. The Dutch Leeuwenhoek, the Italian Marcello Malpighi (1628-1694), and the English Robert Hooke (1635-1703) established microscopy. The scientific societies began.

Nothing new and brilliant happened in surgery. Boils were lanced, bones were set, and dislocations were reduced as in previous millennia. Surgeons treated wounds, usually with ointments and washes. In a pre-antiseptic era wound, healing was necessarily usually by second intention. Scars were ugly. Skilled men cut quickly for stone while the patient was being held securely by strong assistants. Breasts were amputated for cancer. Ligatures were not used. Bleeding from such major work as breast surgery was stopped by means of the cautery. “I secured the artery by the touch of the hot iron,” reported Richard Wiseman (1622-1676), the greatest English surgeon of the period.

In obstetrics, François Mauriceau (1637-1709) knew fame and did much good with his great treatise Des Maladies des Femmes Grosses (Paris 1668). However, it was not he but Pierre Chamberlen (1601-1683) who made one of the three or four greatest discoveries in the history of obstetrics, the forceps. The knowledge of it was retained in his family for several generations, but once the secret was well out (about 1732) it became a boon to millions. Mather's New England did not know it. Retention of secret remedies was not considered unethical then. Now a doctor with a new idea rushes into print sometimes too quickly out of a fear that someone will beat him to the credit. The Chamberlens retained their secret for at least six decades. It took Harvey many years to put in print his revolutionary De Motu Cordis.

The sources of care, the administrators of these methods of cure were varied and of different rank in London. At the top of the list were the well-educated physicians who had much more professional and social prestige than did the surgeons who ranked next. Then came the apothecaries, the compounders of medicine, who practised on the side, rather to the dismay of the physicians, and who finally in the nineteenth century became the general practitioners of England today. Outside London this hierarchy was by no means rigid; the same man might combine all three functions. Especially in the provinces of England there were the “empyricks” as Boyle called them. There were the only source of help for the sick in a great many communities. They administered whatever drugs they or their preceptors had unscientifically observed to help. They were often wisewomen or midwives. These empirics can be thanked for foxglove and its digitalis. But it was a physician named William Withering (1741-1799) who was shrewd enough to pay attention and educated enough to study scientifically the drug and promote it. We learned about ergot from the midwives who did most of the obstetrics. But foxglove and ergot were not seventeenth-century victories. Lastly there were the quacks, the anathema of all physicians. They were incredibly numerous in the seventeenth century. Ben Jonson in his Volpone gave a splendid portrayal of the quack or mountebank of his day. Undoubtedly the quacks of that long past day did some good. They sold drugs cheaply to folk who could not afford the prices of the apothecaries, often the very same drugs, admittedly ineffectual. It was a quack, Robert Talbor, who introduced Jesuit's bark to England secretly. There was a prejudice against anything discovered by the Jesuits and so no one else had used it. He even denied it himself, to protect his secret. He became rich despite the opposition of the physicians. He even cured King Charles II of malaria. For this he was knighted. He was not the only quack knighted in our period. Queen Anne thus favored William Read, a quack oculist who pleased her. About 1704 he wrote a little tract about his “famous receipts.”¹⁶

These, then, were the people who treated the incredible amount of illness which afflicted the folk of the seventeenth century. Age-old methods had to suffice for the treatment of all diseases except malaria. Prevention of smallpox became possible, but the treatment was, and is still, unsatisfactory. It was both endemic and epidemic in Europe where it carried a mortality of fifteen or twenty per cent. In America it appeared in epidemics whenever a sufficient number of non-immunes developed. Among the Indians its mortality approached one hundred per cent. It was most disfiguring. President John Adams once called it the King of Terrors. We know it not. Malaria still made parts of Europe desert. Typhus was rife. Typhoid ignored all social barriers. It killed the most promising of the Stuarts, Prince Henry. His case was well described by Sir Theodore de Mayerne (1573-1655) whom Mather quotes frequently. There were all the diseases of filth, malnutrition, and of tainted unrefrigerated food. Worm infestation was common. Tuberculosis was everywhere. Bubonic plague was endemic and occasionally terribly epidemic. Many died of it each year in the London slums. Only when the whole city was affected did people flee in terror, as during the great plague of 1665.

With death on every side life was held cheap, as cheap as in the Orient today. Wars showed the ultimate in personal brutality. Whole provinces were rendered deserts. With poverty so widespread the laws against crime were especially savage. A nursing mother might be hanged for the theft of a loaf of bread.

All this misery was endured by a people who seem, perhaps out of desperation, to have been ready to believe anything. Thousands sincerely believed in the efficacy of the King's touch in the cure of scrofula. Mary Toft of Surrey, England, had no difficulty in persuading her neighbors and much of her nation that she was having a glorious and fascinating time giving birth to rabbits. What bothered the one astute observer was the fact that there were hay and corn in the digestive tracts of the dead-born rabbits which he autopsied. He pricked the bubble. This was in 1726. Few doubted the marvelous then. Yet, may I add, less than twenty years ago I was asked by an apparently intelligent young woman if it was true that a college girl had given birth to a puppy at the hospital recently.

Few doubted, less few dared express doubts about, religion. Wars were fought over the interpretation of the Bible but not over the face of God and Christ. An intense religiosity was perhaps the sole recourse of a people beset with the misery of war, hunger, poverty, dreadful diseases, and early death. The Bible is the word of God. And no one believing this statement could doubt the existence of an anti-Christ, the Devil. And if you believed in the Devil you had to believe that the Devil had servants, the witches. People died for the offense of witchcraft all over Europe, not just in Salem, Massachusetts. The great champions of these poor victims, Reginald Scot (1538-1599) and Johann Weyer (1515-1588), who showed to the satisfaction of nearly none of their contemporaries that the witches were merely mad, did not actually deny the existence of the Devil. Perhaps they dared not. As it was, poor Scot received a stern “counter blast” from his king, later James I of England. The Mathers were in good company, though, if I may repeat, they opposed the harsh penalties the witches received. …

Notes

1. Mukhtar Ali Isani, “Cotton Mather and the Orient,” New England Quarterly, XLIII (March 1970), 46-58. Mather was intensely interested in all things Oriental. He often referred to Oriental politics, religion, society, literature in his books and sermons. He corresponded with missionaries in India.

2. There is no evidence in the Society's records of such an election, but he had so been led to believe, wrote to thank the Secretary, and apparently was never disabused of the idea. He was awarded the degree D.D. by the University of Glasgow in 1710. Amusingly, John Lowthrop in the index of his abridgement of the Philosophical Transactions makes Mather M.D. instead of D.D.

3. See the excellent discussion of this inoculation controversy in Otho T. Beall, Jr. and Richard H. Shryock, Cotton Mather, First Significant Figure in American Medicine (Baltimore, 1954), pp. 93-123. (Hereafter cited as Beall and Shryock).

4. Lester S. King, The Road to Medical Enlightenment, 1650-1695 (New York, 1970), p. 160.

5. See Chapter VII. Dr. Richard H. Shryock (personal communication) has been unable to find any other American reference to the germ theory until that of John Crawford in his Lectures on the Causes, Seat, and Cure of Disease (Baltimore, 1811).

6. See Chapter XX. John B. Blake, “The Inoculation Controversy in Boston: 1721-22,” N.E.Q. XXV (1952) 489-506. Beall and Shryock, pp. 93-122.

7. On pages 226-304 of the 1721 edition Mather discussed man, his anatomy, and some physiology. He was well read in the whole of medical literature. The Angel was a sequel, really, to his Christian Philosopher.

8. Richard B. Davis, ed. William Fitzhugh and his Chesapeake World (Chapel Hill, 1963), p. 50.

9. Gordon W. Jones. “Robert Boyle as a Medical Man,” Bull. Hist. Med. XXXVIII (1964), 139-152.

10. In this discussion I have leaned heavily on Johannes Juncker (1679-1759), Conspectus Therapiae Generalis Cum Notis in Materiam Medicam (Halle, 1725). It is strictly contemporary with the Angel. Juncker was a follower of Stahl.

11. Thomas Watson (1792-1882), Lectures on the Principles and Practice of Physic Delivered at King's College, London (Philadelphia, 1844), p. 512.

12. Surgeon General William Hammond, of the Union Army, lost his job in large part because of the anger of the army surgeons at his order forbidding the use of calomel.

13. John Lowthorp, The Philosophical Transactions and Collections … Abridged (London, 1731), III, 226-231.

14. Ibid. p. 232.

15. Ibid. p. 234.

16. Gordon W. Jones. “A Relic of the Golden Age of Quackery: What Read Wrote.” Bull. Hist. Med., XXXVII (1963) 227-238.