Stephen Hicks, Ph.D.

The great Renaissance medical bloodletting controversy

Why accurate translation and skilled editing are important:

Bloodletting was a common practice in medieval medicine and did not die out until the nineteenth century.

The practice was encouraged by the belief that the excellent Greek physicians Hippocrates and Galen practiced it. Most phelobotomists followed the Persian genius Avicenna’s editions of the Greek texts, which stated that the bloodletting was to be administered from the side of the body opposite to the disease’s location.

Along came Pierre Brissot (1478-1522), whose reading of the Greek texts argued that the bloodletting was to be carried out on the same side as the illness.

Huge controversy among the phlebotomists! Same side or opposite? This text or that?

The “revulsive” bleeders (opposite side) asked by what right upstarts like Brissot challenged the centuries-old interpretations. The “derivative” bleeders (same side) wondered through what incompetence the original texts were altered.

Name-calling ensued, much of it in the name of the infallibility of the Greeks. Noted Jacobus Sylvius (1478-1555) of Hippocrates and Galen: “they had never written anything in physiology or other parts of medicine that was not entirely true.”

Still, the improved attention to the Greek texts did increase the accuracy of editing and translation and the bitter arguing sharpened logical skills and forced some experimenting.

[The image is Hans von Gersdorff's (ca. 1455-1529) illustration of the appropriate places for phlebotomists to practice their art.]

David Hume’s current influence

David Hume tops this PhilPapers survey of most influential and admired philosophers (scroll down to bottom of the page to “Non-living philosophers most identified with”).

Aristotle comes in second (yeah!) and Kant third (boo!). I’ve been thinking much about Nietzsche and Heidegger recently: eleventh and eighteenth, respectively. Overall, the list is still dominated by thinkers in the Analytic pantheon.

I have mixed feelings about Hume. He is often excellent as a critic of the traditional arguments for religion, and he is often shrewd in applied ethics and political economy. For example, I like very much this early statement of the benefits of money to facilitating free trade and comparative advantage:

“There seems to be a happy concurrence of causes in human affairs, which checks the growth of trade and riches, and hinders them from being confined entirely to one people; as might naturally at first be dreaded from the advantages of an established commerce. Where one nation has gotten the start of another in trade, it is very difficult for the latter to regain the ground it has lost; because of the superior industry and skill of the former, and the greater stocks, of which its merchants are possessed, and which enable them to trade on so much smaller profits. But these advantages are compensated, in some measure, by the low price of labour in every nation which has not an extensive commerce, and does not much abound in gold and silver. Manufactures, therefore gradually shift their places, leaving those countries and provinces which they have already enriched, and flying to others, whither they are allured by the cheapness of provisions and labour; till they have enriched these also, and are again banished by the same causes. And, in general, we may observe, that the dearness of every thing, from plenty of money, is a disadvantage, which attends an established commerce, and sets bounds to it in every country, by enabling the poorer states to undersell the richer in all foreign markets” (“Of Money” 1752).

Hume’s important weaknesses are in epistemology. He is an empiricist, which is great, but his empiricism is extremely atomistic, mechanical, and reductionistic. That approach leads to his skeptical conclusions about the perception of objects, about abstraction and concept-formation, about inductive generalization, and, metaphysically, about the reality of causality and the persistence of identity across space and time.

A sideways connection: It turns out that John Hunter, the surgeon and anatomist about whom I posted The Knife Man and Anatomy and philosophy, examined David Hume when Hume was in his final decline. In 1775 Hume began to suffer terrible abdominal pains, and, unfortunately, was attended “by the most eminent physicians of the day.” As biographer Wendy Moore puts it:

“None of them could offer a satisfactory explanation or effective remedy for Hume’s obvious decline. Though they were very happy to posit elaborate theories and propose assorted therapies, nobody was prepared to examine the patient in order to determine what might be causing his suffering” (italics added). The empiricist philosopher was surrounded by un-empiricist physicians.

John Hunter was called in by happenstance. Hunter and Hume were indirectly related through marriage, and in June of 1776 both men were in Bath. By then, Hume’s condition was very bad and Hunter was invited to examine him. Writes Moore: “Hunter laid his hands on the suffering man’s abdomen and could plainly feel a tumor, which he suspected was cancerous, in the liver” (p. 183). Internal abdominal surgery was not a realistic option, and the philosopher died two months later, back home again in Scotland.

Hume was philosophical in the best sense of the word when he learned, finally, about his condition. Writing frankly and forthrightly to his brother: “This Fact, not drawn by reasoning, but obvious to the Senses, and perceived by the greatest anatomist in Europe, must be admitted as unquestionable, and will alone account for my Situation.”

Eugenics [Section 16 of Nietzsche and the Nazis]

[This is Section 16 of Nietzsche and the Nazis.]

16. Eugenics

Nazi education and censorship attempted to control people’s minds. The Nazis also controlled the bodies of their citizens as much as possible. Milder controls involved new public-health measures such as an aggressive campaign against smoking: the Nazis banned smoking in certain public places, ran an anti-smoking propaganda campaign, and placed restrictions on how tobacco could be advertised.

Stronger controls extended to the sex and reproductive lives of the citizens, and this takes us into darker territory—the Nazis’ embrace of eugenics.

Eugenics was not unique to the Nazi regime or to Germany. As early as 1895, eugenics researcher Adolf Jost had published a book called The Right to Death, which called for state control over human reproduction, and many intellectuals in many countries embraced eugenics. In nature, the argument ran, only the strongest males get to mate with the females; the weaker males get to mate less frequently or not at all; this natural selection of the stronger and de-selection of the weaker serves to keep the species healthy and strengthen it.

The same principle holds for farming. Just as a farmer is concerned to improve the quality of his herd, so the state should be concerned to improved the quality of its citizenry. And just as a farmer will not let any bull mate with any cow, so the state should not let just any male have sex with any female; the farmer will select his strongest and healthiest bulls and have them mate only with his strongest, healthiest cows. Those bulls and cows not up to standard are culled from the herd and not allowed to reproduce at all.

As Rudolph Hess, deputy Führer of the Reich, would say a little later: “National Socialism is nothing but applied biology.”[34]

Before the Nazis came to power, German intellectuals were among the world leaders in eugenics research. In 1916, Dr. Ernst Rudin, the director of the Genealogical-Demographic Department of the German Institute for Psychiatric Research, established a field of psychiatric hereditary biology based on eugenics theory. Rudin became the president of the International Federation of Eugenic Organizations, the world leader of the eugenics movement. In 1920, psychiatry Professor Alfred Hoche and distinguished jurist Karl Binding wrote The Permission to Destroy Life Unworthy of Life. Their book called for the destruction of “worthless” humans for the sake of protecting worthy humans. So-called worthless individuals included the mentally and physically disabled.

Another influential book, The Principles of Human Heredity and Racial Hygiene, written by Drs. Eugen Fischer, Lenz, and Bauer, hailed the superiority of the German race and called for the use of concentration camps for non-Germans and mixed races. Fischer already had experience with this—having planned and executed the forced sterilization of South Africans who were the offspring of German military men and women indigenous to South Africa.

By the time the Nazis came to power, eugenics was an established part of German intellectual life. One striking indication of this is that German universities had twenty-three official Professors of Racial Hygiene.

National Socialism held that the state should take over where natural selection left off. In line with their collectivism and anti-individualism, the Nazis held that medicine and reproduction should serve the interests of the state rather than the individual. Like the farmer, the Nazis wanted high quality Aryan children for the state’s purposes, so they took charge of the mating process of Germany’s citizens. The Reich could not allow individuals to rut with just anyone. Taking away individual choice in reproduction would improve the stock and cleanse the nation of bad genetic elements.

The Nazis also argued that they were thus more strongly socialist than their arch-rivals, the Communists. While the Communists focused almost totally on issues of money, capitalism, and economics, the Nazis argued for a more comprehensive socialism: Every aspect of human life, including family and reproduction, was to be socialized.

The Nazi eugenics program had two faces: positive and negative.[35] The positive face aimed at increasing the number of pure Aryan births; the negative face aimed at eliminating inferior genetic influences in Germany. In order to implement both sides of the program, the Nazis first needed to define racial purity. They decided that there were three racial categories: Full Jew, having three or more Jewish grandparents; two degrees of Mischlinge, or mixed types, having either one or two Jewish grandparents; and Full Aryan, having no Jewish grandparents. The pure Aryan would be the tall, slender yet strong, blond human being.

This led to some serious parody, given that not many of the Nazi leadership met those criteria. Neither Goebbels nor Göring nor Hitler himself obviously met them.

All humor aside, the Nazis set to achieving the positive face of their program in several ways. They provided incentives to encourage racially pure marriages. Incentives included loans to help married couples get established, subsidies for each child produced and official awards and medals for “hero” mothers of four or more children. Childless couples were vilified. The Nazi government also lowered the age of marriage to sixteen, encouraged the birth of illegitimate Aryan children, outlawed abortion for Aryans, outlawed marriage for sterile women, strictly regulated birth control, and initially forbade mothers from working outside of the home.

Heinrich Himmler was in charge of this area of Nazi policy. Himmler was also the Chief of the SS and the Gestapo, and so was one of the top two or three most powerful Nazis in the regime. Under Himmler’s direction, the Nazis also created the Lebensborn, or “Fount of Life,” program in 1935. This project developed group homes for young, unmarried Aryan women impregnated by Aryan men. Once the racial purity of the parents had been established, the young women stayed in the homes and were given free food and medical care. In return, the women signed over all rights to their fetuses, who, upon birth, would be raised by select Nazi families. Between 12,000 and 16,000 infants were born in Lebensborn homes in Germany and Nazi-occupied territories. A few years later, in order to speed up the development of a pure Aryan race, the Nazis began to kidnap Aryan children from occupied territories. An estimated 250,000 children six years of age and younger were taken back to Germany and assimilated into Nazi homes.

The negative face of the Nazi’s eugenics program required the extermination of non-Aryans. In 1935, the Nazis implemented the Nuremberg Laws for the Protection of Hereditary Health. These laws included forcible sterilization of individuals with mental and hereditary physical defects. During the 1930s, the Nazis sterilized approximately 400,000 people. Certification of Aryan descent became a requirement for marriage; interracial marriages were prohibited; and the remaining rights of Jews were revoked.

The Nazis then introduced extermination. In May of 1935, the regime euthanized twelve patients in a mental hospital in Hadamar, Germany. The Nazi Interior Ministry required that all children under three years of age with congenital malformations and mental deficiencies be registered with the state. Those deemed unfit were taken away from their homes for “special treatment.” “Special treatment” meant either being injected with a lethal dose of medicine or simply starved to death. The Nazis were still somewhat cautious about public scrutiny, so part of their strategy was slowly to get the nation accustomed to human extermination before they turned their full attention to the Jews.

The public justification for these deaths was not only the biological health of the state. The Nazis also gave a collectivist economic justification. If the health of the citizenry is the State’s responsibility, then the State must allocate its economic resources responsibly. If money and resources are used to care for the weak, then the stronger humans are forced to sacrifice. But the stronger human beings are the State’s best assets; it is they who are the realization and the future of the Volk. The State accordingly has a moral obligation not to waste economic resources on the weak; and when the weak are destroyed as nature intended, the strong will be enhanced and the species advanced.

This brings us to Nazi economic policy.

References

[34] Richard Walther Darré, Reich Minister of Food and Agriculture from 1933 to 1942, had a crucial role intellectually and administratively in determining Nazi policy: “Just as in the animal world, this committed Social Darwinist proposed a system of racial selection in order to ‘breed’ a new rural nobility and to achieve the ‘breeding goal of the German people.’ Darré suggested marriage restrictions for Jews and ‘less valuable’ non-Jews, strict state control of all marriages and fertility, and sterilization of those members of the community who were considered to be a threat to the ‘racial purity’ of the German people. The Nazis used all of these measures in the subsequent years …” (Gerhard 2005, p. 131-132).

[35] Using “positive” and “negative” here descriptively, not normatively.

[Bibliography.]

[Return to the Nietzsche and the Nazis page. Go to the StephenHicks.org main page.]

Anatomy and philosophy

Following up on The Knife Man and John Hunter, the great 18th-century anatomist and surgeon. In Hunter’s era surgery was brutal, in large part due to surgeons’ ignorance of anatomy, and in that earlier post I wondered why there was still such ignorance given that the 1700s were two centuries after Andreas Vesalius and a century after Francis Bacon.

Here’s my hypothesis: Philosophy has a lot to do with it.

Suppose you’re an early physician — your patients suffer and die, and you don’t know why. One option is not to think much of it: bad stuff happens, people die, accept it. It takes an active mind — curiosity, interest, follow through — for science to get going. Why do people die?

Even if you do decide to think about it, there are further obstacles.

One is the historically common belief that the gods cause things to happen. That metaphysical belief will stop you from looking for natural, anatomical causes.

If you reject religious cause-and-effect and suspect that the cause might be anatomical, there are aesthetic obstacles — think of the sights you will see, the textures you will feel, and (probably the worst) the odors you will smell.

There are moral obstacles: anatomy seems to disrespect the dead or to disrespect the living person the corpse once was. Moral obstacles might also be based on particular religious metaphysical beliefs, such as the resurrection of the body and so wanting to preserve the body intact for that eventuality.

So philosophy — metaphysics, morality, and aesthetics — can stop the impulse that leads to anatomy. And based on some or all of the above, there will be legal obstacles.

To those obstacles, all of which were operative in early modern Europe, let me add the epistemological barriers.

One was the reverence for tradition. Religion emphasized tradition, and the Renaissance respect for the ancients’ accomplishments often meant merely substituting a Greek or Roman authority for a Judeo-Christian one. For the early modern understanding of the inner workings of the human body, Galen’s humor theory was the mostly-unquestioned authority.

To the extent that early scientists were willing to think independently of traditional authorities, many simply speculated and spun theoretical just-so stories. An example here is Albrecht von Haller, a Swiss contemporary of John Hunter, who, based on no observational evidence, argued that every embryo was from day one already a perfect miniature of the mature organism and that embryonic development was merely a matter of increasing size.

And to the extent that anatomy was done, it was most often performed as a demonstration of traditional or speculative theories. Students would crowd around the anatomist while the professor read from the authoritative text telling the students what they were seeing. This usually meant that top-down confirmation bias simply reinforced the traditions and speculations.

So early anatomy was hobbled by three faulty epistemologies:

Tradition — the unthinking acceptance of others’ thinking.
Speculation — thinking independent of observation.
The demonstration method — observation only as the hand-maiden to thinking.

The primacy of observation: that epistemological principle had to be articulated and institutionalized. That is what Francis Bacon did for philosophy in the 1600s and what John Hunter did for anatomy in the 1700s.

Empiricism made anatomy possible. Anatomy made internal surgery possible. Surgery made dramatic live-saving and life-improvements possible. Conclusion: Philosophy is very practical.

Related:

My posts on Aristotle on the aesthetics of the “humbler animals” and Francis Bacon as the founder of modern philosophy.

Wendy Moore’s The Knife Man: Blood, Body Snatching, and the Birth of Modern Surgery [Amazon's site].

Sherwin Nuland’s Doctors: The Biography of Medicine [Amazon's site]. I love the chapter on Vesalius.

The Knife Man

I am reading Wendy Moore’s The Knife Man: Blood, Body Snatching, and the Birth of Modern Surgery. A fascinating book, but not for the squeamish.

The key figure is John Hunter, an 18th-century anatomist and revolutionary surgeon of volatile temperament, with a hunger for knowledge that drove him to rob thousands of graves, record the tastes of corpses’ bodily fluids (”gastric juice,” apparently, “is a little saltish or brackish to the taste”), deliberately infect himself with syphilis, and … well, you should read the book.

Surgery in the 1700s was brutal, in large part due to surgeons’ appalling ignorance of anatomy. Moore puts it this way:

“Although medical students usually learned some rudimentary anatomy, this was considered a useful but not vital adjunct to on-the-job experience. And when patients died on the operating table as a result of ignorance and blundering, as they frequently did, few, if any, lessons were learned from the outcome.”

Antiseptic and anesthesia were not discovered until the 1800s, so the brutality and low success rates of surgery in the 1700s make some sense. But the ignorance of anatomy is odd — after all, the 1700s were two centuries after Andreas Vesalius and one century after Francis Bacon. How slowly things change sometimes.

The revolution in anatomical knowledge pioneered by Vesalius and the epistemological revolution pioneered by Bacon — with its emphasis on observation and experiment — had not yet reached English medicine, or only barely so. As Moore puts it, “treatment regimes still owed their basic principles largely to the theories of the ancient Greeks.” The reverence for tradition and authority was so strong that it took a pugnacious, thick-skinned man like Hunter to be willing to crack heads, literally and metaphorically, with his colleagues to get them to consider new methods.

I’m just starting Moore’s book. Exams are over for me at the end of next week, so I will follow up with more then.

For now, there’s more on John Hunter at the Endocrine Today site.

Follow up: My post on Anatomy and Philosophy.

Why life in America is 40 times better than in 1900

A follow up to my post on Why life is 255 times better now than in 1800.

Some warm-up indicators:

By 1900 the U.S. had recently become the wealthiest economy in the world, slightly surpassing Australia and Great Britain, and it had become twice as wealthy as France and Germany and four times as wealthy as Japan and Mexico, which were then roughly equal.

Percentage of American homes that had electricity: 3
Percentage that had running water: approximately 33
Percentage that had flush toilets: 15
Percentage of infants who died in before age one: 14 (today the percentage is less than 1)
Percentage of students who completed high school: 7
Percentage of men over 65 working full time: over 67 (and the average work week was over 60 hours and 6 days)

But to get to the serious math:

Wealth: Per capita income in 1900 was around $5000, while now it is over five times that amount.

Population: The total U.S. population in 1900 was 76 million people, about one quarter of the current population of of a little over 300 million.

Life expectancy: In 1900 it was 47.3. Currently it is 78.1 or so. So if one is an adult by, say, age 16, the average amount of adult life rose from 31 years in 1820 to 62 years now — a factor of 2.

So people now have 5 times more income; they have 2 times as much time to enjoy it; and there are 4 times as many people.

5 x 2 x 4 = 40.

Iatrochemists: why iron salts cure anemia

A fun anecdote from the history of medicine. (Fun in hindsight, though not necessarily fun for those who lived through the medical history.)

The late-medieval Iatrochemists believed that progress could be made by uniting medicine with alchemy. Their intellectual leader was Paracelsus (1493-1541), a Swiss physician whose goal was to reform medical chemistry by rejecting reliance on traditions based on ancient texts. Symbolically, Paracelsus inaugurated his lecture series at Basel by burning the books of Galen and Avicenna. Alchemy, in turn, was a hybrid practice of experimental chemistry and astrology.

A perfect example of iatrochemical theory in action was the mystery of anemia: Why did iron salts cure it? Practicing physicians knew that it did, but nobody had a good theory explaining why.

So here’s the iatrochemical explanation. Anemia, we believe, is a matter of having weak blood. Clearly, the weak blood needs to be strengthened, which iron salts do, but how? Let’s start with the fact that iron is hard and strong. That is why we use iron to make weapons of war. The Roman god for war is Mars. Mars is also the red planet — and we know that blood is red. Quod erat demonstrandum has been achieved: the strength of iron is astrologically communicated through Mars to the redness of the blood, thereby curing the anemia.

(Up next: How Venus makes those love potions work. Ever notice that Venus and Viagra start with the same letter? Coincidence?)

In class: Semmelweis as epistemological hero

Prior to the discovery of germ theory and antiseptic, women frequently died of puerperal fever in the maternity ward at the University of Vienna Hospital.

Enter Ignaz Semmelweis, a Hungarian-born physician working at the Vienna hospital, one of the world’s leading medical establishments.

Carl Hempel’s account of Semmelweis’s false starts, failed hypotheses, and eventual success can be read on pages 7-9 in my Philosophical Foundations of Education booklet [pdf]. And at History of Antiseptics page, Mary Bellis gives account of the initial chilly reception given to Semmelweis’s discoveries.

For his observation skills, his conceptual flexibility, his rigorous analytic method, his willingness to recognize failure and to start again, and for his persistence and independence over a long period of time while women continued to die — Ignaz Semmelweis (1818-1865) is a hero of modern science.