Text of 15 Pop-Up Notes for FYI webessay, “Conversations About a Wiser Use of Our Health Care Dollars & Resources”
#1 (of 15)
Cowley’s poem, “To Dr. Scarborough” — Cowley was a metaphysical poet of such celebrity and influence that his posthumously-published Works were printed 14 times between 1668 and 1721. He was only 15 when his first collection of poems (composed even earlier, at ages 10 and 12) was published.
Cowley studied medicine at Oxford (where he was part of William Harvey’s circle), spent time in Kent collecting samples, and proceeded to the degree of doctor of physic in 1657. His scientific interests ranged from pedagogical reform (in 1661, he proposed founding a scientific research institute, with its own college) to botanical studies (his Latin poem, Plantarum Libri Sex, was an early contribution to the literature of medicine, poetizing botany and the physic garden in the Virgilian manner).
The addressee of this particular poem, Sir Charles Scarburgh (1615–1694), was a physician, natural philosopher, and friend to the physician and discoverer of the circulation of the blood, William Harvey (1578–1657), who chose Scarburgh as his successor as Lumleian lecturer in the College of Physicians. Scarburgh met Cowley through Harvey, and after Cowley was arrested as a royalist agent by the Cromwellian regime, it was Scarburgh who stood bail of £1000 for Cowley in 1656. ::
#2 (of 15)
with plenty of name-calling — Richard Whitlock’s vituperative Zoötomia, or, Observations of the Present Manners of the English: Briefly Anatomizing the Living by the Dead. With an Usefull Detection of the Mountebanks of Both Sexes (London, 1654) was exemplary in this regard. His “Medicinall characters” of the “Shee Doctor and Apothecary” — aka “the quacking Hermaphrodite,” “Petticoat Practitioner,” “Doctor Wise-akers,” “our cunning Women,” “Shee Practitioners,” “Shee Empyricks,” “these simple Chapwomen,” “Herbe-women,” the “shee-physitian,” “this Sister-hood of Physitians,” and the grand-daughters of Eve who “kil’d us all at one blow, [while] you kill us one by one” — along with “the Peoples Physitian” and “the Valentian Doctor” and “Selfe-killers, and their Accessories, or of Patients and their Tenders,” makes our online discussions look quite tame in comparison!
The satirist’s goal is the improvement of practice, grounded in an appeal to a shared sense of normal conduct from which vice and folly are seen to stray. As such, Whitlock’s medical satires, while ruthless, were not relentlessly negative or counter-productive in the way that much criticism of Obamacare operates. Rather, Richard Whitlock (b. 1615–16) used ridicule and scorn in order to promote his ideal of the “sober and rationall Physitian” and to improve patient outcomes. In the very same work where he skewered the she-physician by reducing her to a satiric Theophrastan Character in a simplistic morality play, Whitlock also included an essay on the excellence of women. ::
#3 (of 15)
the “sober and rationall Physitian” — Richard Whitlock (b. 1615–16, d. 1666) styled himself “M.D.” on the title-page of his published work, Zoötomia, in which he agitated for medical reform. Historians believe that this medical degree was not acquired in England, but abroad, probably from the universities of Leyden and Padua, both of which played a prominent role in training 17th-century Englishmen seeking medical qualifications.
Whitlock returned to England and practiced medicine during the Civil War and Interregnum periods, after which his zeal for the medical profession apparently waned, and he switched to a different divine calling, that of clergyman, ministering to the souls of parishioners in Stowe, Buckinghamshire and Ashford, Kent, where he served as vicar following the restoration of Charles II.
The poet and physician to the king, Martin Lluelyn (1616–1682), contributed commendatory poems to both William Harvey’s Anatomical Exercitations (1653) and to Whitlock’s Zoötomia (1654), indicating that Whitlock had close ties to the London medical establishment, despite his lack of an English medical degree.
And the College of Physicians clearly modelled Whitlock’s “Congregation of sober, and rationall Physitians” who practiced medicine as both an art and a science: they “understand the order of Art, [and] the Art of order” and “steer by ... those three Sea marks guiding to the Haven of Healths”: i.e., “the compasse of Theory and Reason, [and] Rudder of experience (but broken and imperfect) without either of which, they must necessarily Shipwrack, or float in uncertainties.” (Whitlock, Zoötomia, or a Morall Anatomy of the Living by the Dead, 1654, 65 and 89) ::
#4 (of 15)
iatrochemist — Iatrochemistry, or chemistry applied to medicine, was the forerunner of modern chemotherapy. The use of chemical remedies has a long history: from the 1st century BCE onwards in ancient China; from the 2nd century in India, although iatrochemistry didn’t flourish in Hindu science until c.1300–1550; and from the Middle Ages, c.854–925, in Islamic science. In the Latin West, the therapeutic use of chemicals was introduced during the 16th century by Paracelsus (1493–1541), who argued that health could be restored by ingesting alchemically-prepared mineral drugs. Since many of these chemical compounds were poisonous, contemporary traditionalist physicians who followed Galen (129–c.200) and Avicenna (980–1037) had grounds, beyond professional jealousies, for warring with the Paracelsians.
J. B. van Helmont further refined Paracelsian thought and founded what would become the dominant Iatrochemical School. His medical works, published posthumously by his son, Francis Mercury van Helmont (1618–1698), were enormously popular in revolutionary England (c.1650), where Galenism in medicine was associated with ancient authority which empowered the church and the crown, more than it helped or healed the people. Van Helmont thus played a key role in shaping the new science. According to John Schuster, “Van Helmont stood for a transformed and sanitised alchemical natural philosophy, toning down the potential excesses — religious, psychological and political — of Paracelsianism, without sacrificing its stress on ‘experience’. He, like certain other reformers of the Paracelsian tradition who exploited Ramus’s pedagogical tenets, emphasised a new dispensation of a ‘chemical philosophy’ under the aegis of sober pedagogy and methodology.” (Companion to the History of Modern Science, ed. R. C. Olby et al., 1990, 237) ::
#5 (of 15)
attended by some of the best physicians in Europe — E.g., Cavendish gave a personal reminiscence of her own life-threatening bout with “a Purging Flux” (dysentery), while in Paris at the court of Henrietta Maria, for which she was given laudanum, by the renowned chemist and physician, William Davisson (aka D’Avissone; c.1593–1669): “[I]n all sorts or degrees of Fluxes, there is nothing better than Laudanum, such as is prepared by Doctor Davidson’s Prescription; the Quantity must be from One Grain to Two and Three, but above Four must not be taken, and to put it in a Small Pill of Bread, and so Swallow it down; the time of Taking is, when the Patient goes to Sleep, but the Patient must not Eat nor Drink in Three Hours before the taking of it, and when taken, lie still to Rest; as for this Laudanum I have had Experience, for when I was in France with the Queen of England, I had Died of a Purging Flux if I had not taken Doctor Davidson’s Laudanum, and he gave it to me every Night for a Week together, and I was Cured.” (Cavendish, Philosophical and Physical Opinions, 2nd edn., 1663, 391–2) ::
#6 (of 15)
an argument against “that famous Philosopher and Chymist, Van Helmont” — I.e., Joan Baptista van Helmont (1577–1644). Cavendish’s argument with van Helmont’s theories, as published in his Ortus Medicinae, Opuscula Medica Inaudita, and Tumulus Pestis, was conducted entirely in absentia. The whole of Section 3 of her Philosophical Letters (1664) is devoted to confrontation with van Helmont over topics ranging from earthquakes and meteors to plague and more mundane matters such as what kind of drinks — wine or cooling drinks (juleps) — is better for a fever. ::
#7 (of 15)
“another famous Physician in France, Dr. Davison” — I.e., William Davisson (aka D’Avissone; c.1593–1669). Davisson was born in Aberdeen, but after his mother’s holdings were seized by relatives, he emigrated to France. There he sided with the Paracelsian protestants of Montpellier against the Galenist Catholics of Paris in arguments over medical theory, and as an outspoken advocate of chemical medicine, physician to Louis XIII, and holder of the first chair of chemistry in France (created in 1647 at the Jardin du Roi), Davisson was invited by the Polish Queen Marie-Louise to Warsaw, where he moved in 1651, becoming first physician to King Jan Kazimierz and keeper of the royal garden. In 1669 Davisson returned to Paris, where he died that same year.
Margaret Cavendish, while a Maid of Honour at the court of Queen Henrietta Maria, left England for France with the queen in July 1644. She was resident at Paris from 1644–1647, until she and her new husband moved to Antwerp, so it must have been during this period when she was treated by Davisson for a life-threatening “Purging Flux” and other ailments. ::
#8 (of 15)
continuing threat of revolution — The 17th century was an age of intense political and religious strife. And regime change did come again with the Glorious Revolution of 1688–89, in which James II (and a Roman Catholic succession) was removed from the throne, and Stuart attempts at despotism yielded to the establishment of a constitutional form of government under the protestant William and Mary. ::
#9 (of 15)
the great and splendid nobleman ideal — Edward Hyde (1609–1674), 1st earl of Clarendon, “Late Lord High Chancellor of England, Privy Counsellor in the Reigns of King Charles the First and the Second,” and often critical of Newcastle, described William Cavendish as a “very fine Gentleman” with the following political philosophy: “He lov’d Monarchy, as it was the foundation and support of his own greatness, and the Church, as it was well constituted for the splendour and security of the Crown; and Religion, as it cherished, and maintain’d that Order and Obedience that was necessary to Both; without any other passion for the particular Opinions which were grown up in it, and distinguished it into Parties, than as he detested whatsoever was like to disturb the publick Peace.” (E. Hyde, The History of the Rebellion and Civil Wars in England, Begun in the Year 1641, 3 vols., 1702–4, 2.392) ::
#10 (of 15)
as flanders famous for Itt — Newcastle adds a marginal note for this which reads: “Iper & Gaunte hath been famous above 300 yeares for chaser [i.e., the accomplished civil servant and poet, Geoffrey Chaucer (c.1340–1400), whose best-known work today is probably The Canterbury Tales] speakes off Itt.” ::
#11 (of 15)
the Japanese system of Fueai kippu — The Japanese complementary currency of “Fueai kippu” translates as “caring relationship tickets.”
“Japan currently has the most aged population of any nation, with roughly a fifth of the population already over 65. It also has a strong tradition of family based care, not least in relation to its tradition of ritual bathing. These demographics present a big problem, but one that the system of Fueai kippu greatly helps to address. Imagine I am living in Tokyo, but my elderly parents live 200 miles away so it is difficult for me to care for them. Instead, I care for an elderly person who lives close by, and I transfer my credits back to my parents. They can then use these to ‘buy’ care where they live. But because Fueai kippu are earned through care, not money, the whole transaction feels different and far more acceptable. And the evidence shows that this system leads to more caring activity, not just displacement — just as theory predicts.” (David Halpern, The Hidden Wealth of Nations, 2010, 107) ::
#12 (of 15)
US Elderplan system — Elderplan is a social HMO “within which more able members provide care to others in exchange for credits. Hence someone having fully recovered from a medical procedure might help someone else who has just gone through it, with shopping or getting around. As members age, the type of help that they might offer may change from more physical work towards offering company or advice.” (David Halpern, The Hidden Wealth of Nations, 2010, 107–8) ::
#13 (of 15)
major implications for clinical practice and health care costs — I.e., by changing the way in which some life events, such as dying (often expensive when care is technologically-driven), are managed.
Pellegrino, who has been Professor Emeritus of Medicine and Medical Ethics at the Center for Clinical Bioethics at Georgetown University Medical Center since 2001 and chairs the President’s Council on Bioethics, advocates taking a more philosophical approach to our health care, arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, because such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine.
“Not only has Pellegrino creatively examined the foundations of a philosophy of medicine in the strict sense, but he has also shown how it can redirect the medical humanities and bioethics. In so doing, he has succeeded in articulating a vision of how medicine can meet the challenges of the future.” (Introduction, The Philosophy of Medicine Reborn: A Pellegrino Reader, ed. Engelhardt and Jotterand, 2008, 17)
Although Pellegrino’s work is directed primarily at physicians, the resulting reorientation of medicine within a larger vision of the human enterprise affects patients, too. ::
#14 (of 15)
To locate this title at your bookstore or library, look for:
Day, John D. Patterns in Network Architecture: A Return to Fundamentals. 2008; rpt. Upper Saddle River, NJ: Prentice Hall, 2008.
ISBN-10: 0132252422 and ISBN-13: 978-0132252423.
John is a maverick who wants to see the Internet redesigned. “I am trying to work out the principles by which the innards of networks and other computing systems should work. It turns out the Internet is probably one of the most bungled engineering jobs of the last century. It could be much simpler, more secure, and much more powerful.” (John Day, private e-mail communication, 12/9/2013)
His book “shows how socioeconomic forces derailed progress and led to the current crisis” (publisher’s description) so it is relevant to topics under discussion in this section and elsewhere at Roses. ::
#15 (of 15)
the eminent Danish physician and natural philosopher, Thomas Bartholin (1616–1680) — This identification may be in error. Chambers gives only a surname: “Bartholin complains of the too great number of Apothecaries in Denmark....” But as Wikipedia explains, “Three generations of the Bartholin family made significant contributions to anatomical science and medicine in the 17th and 18th centuries”: Thomas Bartholin (1616–1680); his father, Caspar Bartholin the Elder (1585–1629); his brother, Rasmus Bartholin (1625–1698); and his son, Caspar Bartholin the Younger (1655–1738).
Between them, the four Bartholins published over 20 works, all in Baroque Latin, totaling thousands of pages. It could easily take me several months to locate copies of, and read through, all of this archival material before finding the original source for Chambers’ claim. Unable to devote so much time to this one research project, when I’m already juggling dozens of others, I chose to spend several days on it instead, before I traded in the pedant for the rhetor, and just made an educated guess about which Bartholin — Caspar the Elder, or Thomas, or Rasmus, or Caspar the Younger — had commented on the number of Danish druggists at some point during the 17th century.
In the end, I settled on Thomas, based on my interpretation of the variety of Bartholin citations elsewhere in Chambers’ two-volume Cyclopaedia. But I could well be proven wrong in this hasty identification, which requires more time than I have right now to fact-check properly. ::