Descartes' Bones Page 2

  In the dead of night in the dead of winter in the year 1650, the most solemn rite of passage was playing out on an upper floor of this building. People hurried between rooms, past windows that looked out onto the dark, icy harbor below, exchanging information and worried looks. But if the occasion was grave, it wasn’t quiet. For someone close to death, the man who lay in bed—not quite fifty-four years old, small-boned, ashen, the center of everyone’s attention—was alarmingly active. It was fury that gave him these last bursts of adrenaline. His friend and protégé Pierre Chanut, the French ambassador to Sweden, in whose house he lay dying, was at his side constantly, trying to manage the man’s anger while feeling doubly guilty: it was he who had urged René Descartes to come to this frozen land and he who had first contracted a fever, through which Descartes had nursed him before catching it himself.

  Chanut fervently believed that Descartes was in the process of transforming the world with his revolutionary thinking. In this he was essentially correct. A change took place in the middle of the 1600s. People began to employ a new, sweeping kind of doubt, to question some of their most basic beliefs. The change was in a way more profound than the American and French revolutions, the Industrial Revolution, or the information age, because it underlay all of them and affected the very structure of people’s thought—the way they perceived the world, the universe, and themselves in it. And the person most closely identified with this transformation was the man who lay dying in the Swedish winter. Pierre Chanut couldn’t have known the scope of the future, but he knew, as did many others, that something staggeringly significant was afoot and that Descartes was at its center. It had by now dawned on the diplomat that, in bringing the philosopher here, he had unwittingly engineered a catastrophe.

  The fever had given way to pneumonia; the patient’s breath was ragged, his eyes wandering. Chanut had wanted to call the court physician, but Descartes raged against that idea. Finally, from her fairy tale palace on the other side of the small island in the harbor that was the center of Stockholm, Christina, the twenty-three-year-old queen of Sweden, who would go down as one of the more remarkable personalities in European history (there is, for starters, the centuries-old line of serious speculation that she was infact a king), sent her physician to attend him. It was Christina who, with Chanut, had coaxed the intellectual celebrity northward in the first place.

  The doctor, a Dutchman named Wullens, approached the bed reluctantly. There was a sharp exchange in which the philosopher made it venomously clear he thought the physician an ass. The encounter climaxed when Wullens proposed bloodletting, whereupon the patient erupted with a theatrical cry—“Gentlemen, spare French blood!”—and ordered the man out. Wullens departed, washing his hands of the business, muttering as he went a rather fatuous piece of consolation from the Roman poet Horace: “He who saves someone against his will does the same as to kill him.”

  The rage had two components. First, the philosopher had known Wullens during his long years in the Dutch provinces. One of the early public airings of Descartes’ philosophy had come at Leiden University, and it caused an uproar among those who considered it a challenge to the whole system of education and thought that had been in existence throughout Europe for centuries. Wullens had stood with those who opposed the new philosophy. Descartes never forgot an enemy.

  But there was another reason for the anger. In a peculiar way, much of Descartes’ career had been a kind of chess match with death, and for a long time he had actually convinced himself that he had the upper hand. He had been a sickly child, with a pale complexion and a dry cough that he had inherited from his mother, who died when he was a year old. His father—a jurist and a man of power and ambition—seems to have despised the child’s weakness and favored his older brother. The family doctors didn’t bother to hide from the boy their conviction that he would die young.

  When he was ten, however, Descartes was sent off to the Jesuit college of La Flèche in Anjou, one of the finest educational establishments in Europe. There, to his surprise, he flourished. He became strong, healthy, vigorous, aware of the wider world, and hungry for knowledge. But the early experience remained lodged inside him. When he settled into his mature work, medicine became its central focus. He developed his revolutionary philosophy, with its grounding not in the Bible or ancient writers but in human reason, and became famous and infamous for it. But the heart of it, the deep reason for it, was his desire to solve the puzzle of the body, to cure disease, and to lengthen human life—including his own. At the end of the Discourse on the Method, his epoch-changing work of philosophy, he vowed to the reader not that in the future he would craft a revised metaphysics or a new approach to mathematics but that he would “devote what time I may still have to live to no other occupation than that of endeavoring to acquire some knowledge of Nature, which shall be of such a kind as to enable us there from to deduce rules in medicine of greater certainty than those in present use.” Five years before he lay dying in Sweden he wrote to an English earl, “The preservation of health has always been the principal end of my studies.”

  The same goal was in the minds of many of his contemporaries. When we think of science and the spark of modernity, we tend to think of astronomy: Galileo crafting his telescopes and peering into the skies above central Italy; locating sunspots, moons around Jupiter, craters on the earth’s moon, and other irregularities in a universe that the church had taught was perfect; amassing data that corroborated the theory that the earth revolves around the sun; encountering the systematic wrath of the Inquisition. In our perennial effort to understand who we are and what it means that we are “modern,” we choose astronomy as a starting point in part because it provides a sturdy metaphorical peg for thinking of the massive change that humanity underwent in the seventeenth century, when we—seemingly—left our mythic, biblical selves behind and reoriented ourselves in the cosmos. In 1957—the year of Sputnik and the dawning of the space age, a time when people had a simpler, clearer sense of “modern” than they do today and felt ready to embrace what they thought the word meant—a best-selling book expressed this idea in its title: the change was “From the Closed World to the Infinite Universe.”

  But one could just as easily see modernity springing from the intense interest in the human body that arose in Europe at the same time. If our place in the universe is an elemental marker of who we think we are, our physical being is something more. The magnitude of human suffering down the centuries is somewhat quantifiable. The life expectancy of a child born in Descartes’ France was twenty-eight; in England between 1540 and 1800 it was an estimated thirty-seven. Similar rates—in the twenties and thirties—held for high-born citizens of ancient Rome, forager societies in Africa and South America, and people in rural India and China into the early twentieth century. More than half of all children born in London around the time of the American Revolution could be expected to die by age fifteen. And most deaths in early modern Europe were caused not by war or marauding brigands but by disease. Century upon century, hour after desperate hour, parents watched helplessly as their children succumbed to maladies whose very names—ague, apoplexy, flux, dropsy, commotion, consumption—spoke of the misty ignorance that was a definitive sentence.

  The mists have lifted somewhat in three and a half centuries—we live longer and healthier lives—and still the body remains a touchstone of modernity. Zoloft, Lipitor, Viagra, Botox, ibuprofen, angioplasty, insulin, birth control pills, hormone replacement therapy, anabolic steroids—we don’t merely allow science and technology into our physical beings but insist that they continually do more to better manipulate and aid the brute facts of our flesh and blood and bone selves. Embedded in this outlook is an idea of the body as a machine, so that illness is seen as a breakdown of the machine, healing involves repairing the broken parts, and a doctor is a kind of mechanic with medications as his or her tools. This simplistic view has been changing in the last twenty or thirty years. We have a hankering now to see mind an
d body as deeply connected, to appreciate the way thoughts and the environment influence our physical being. Yet the mechanical model has been very successful, and our medicine is still largely constructed around it. And it was this model that came into being in Descartes’ generation.

  This new way of viewing the human body was bewildering when it was first aired. Many people, in fact, equated it with atheism. It was frankly at odds with the overall approach to knowledge in the period against which modernity arose. Aristotelianism, or Scholasticism, was a blend of Christian theology and thinking derived from Aristotle and other ancient Greeks. These streams of thought had stewed together for centuries and resulted in a worldview that, often spiced with astrology and folklore, treated every subject under the sun, from the story of creation to the roles of men and women. It explained why a stone dropped from a window fell to the earth rather than floating upward (because objects want to move toward the center of the earth, which is the center of the universe); it told what happened when you died; it gave an account of the end of all things.

  The premodern medical establishment—which Descartes had dedicated himself to overthrowing—was built around the teachings of the ancient Greek physician Galen, whose work in turn was dependent on Aristotle’s division of the physical world into the four elements of earth, air, fire, and water. Corresponding to these were the bodily “humors,” or fluids: blood, phlegm, black bile, and yellow bile. Diseases and disorders were seen as the result of a humoral imbalance. This system—augmented by folk medicine, witchcraft, Christianity, and astrology—had the advantage of completeness. My body and its little world of concerns—toothaches and fevers, lovesickness and moodiness—was part of the wide world and the wider universe. This doesn’t mean that the view was that the body was made of the same material as everything else in the universe or that physical forces controlled everything. The ineffable was a genuine and necessary part of reality. Jesus walked on water; miracles happened; the Devil stalked the land. The supernatural—magic—existed within the natural; it was woven into the fabric of the world and the stars, including the sinews of the human body.

  At the same time, the system was practical. As a physician in ancient Rome (with a list of clients that ran from Marcus Aurelius to gladiators), Galen himself had favored close observation of the patient—he was the first to recognize the pulse rate as an indicator of health—so that his approach had much to offer it, which explains why it endured for so long. One problem was that the underlying account of the physical world—Aristotle’s four elements, which combined in different ways to create all the stuff of reality, from mountains to lily pads to manatees to earwax—did not serve as an especially sturdy foundation. Diagnosis and treatment via the system of humors—a melancholic, or “earthy,” illness called for an “airy” compound, and so on—were dodgy if not lethal, as patients well knew and as Molière, for whom the medical profession was a favorite target, suggested with the observation “most men die of their remedies and not of their diseases.”

  And that was establishment medicine. There were many other options that were considered valid. A sufferer from fever or stomach pain or gout or nosebleed might get, by way of professional service, an astrological reading, an amulet to be tied around the neck with a ribbon, or a squinty examination of his or her urine (“uroscopy” was looked to as a general indicator of health, as when Shakespeare’s Falstaff asks a page, “What says the doctor to my water?”). The person administering the attention might be a physician, but astrologers and other sorts of healers were often seen as on a par, and some of the most esteemed medical men, including members of the College of Physicians in London, used astrology as part of their diagnostic tool kit.

  Often, the caregiver was a clergyman. In any event, the procedure would have a religious cast. Illness and health were almost universally related to being in or out of God’s sight, and the language of healing was shot through with theology. It was commonly held that medicine would work only if a prayer was offered to unlock its powers. Relying on physical remedies alone was often seen as downright ungodly: in England, Puritan minister John Sym advised “caution” that people “dote not upon, nor trust, or ascribe too much to physical means; but that we carefully look and pray to God for a blessing by the warrantable use of them.” To do otherwise—to rely on a physic or powder alone—would be to put the material above the spiritual. That was why a strictly mechanical approach to medicine was considered dangerously atheistic.

  Now, it must be said that millions if not billions of people around the world today subscribe to beliefs similar to those of Sym: that the physical and the spiritual—pills and prayers, as it were—are both necessary components to health. They visit specialists and get diagnostic screenings, and at the same time they meditate and pray and ask God for a miracle cure. And these people don’t exactly inhabit the inner recesses of the rain forest; they live modern lives. They are us. What’s more, in the seventeenth century it wasn’t only the premodern Aristotelians who held such views; so, for the most part, did the first generation of modern philosopher-scientists who reacted against them. So, too, did Descartes, who seems to have been as devout a Catholic as anyone of his time and whose whole mechanical account of the universe depended on God to hold it in place. The main challenge in following the story of Descartes’ bones would seem to be understanding exactly what “modern” is. If it means a hard divide between the material and the spiritual, how do we account for the fact that both people of the seventeenth century who brought the modern sensibility into being and people today have managed to bridge this divide? We associate modern with a nonreligious, nonspiritual, purely rational and scientific outlook. Are we wrong to think that? If so, if it’s a false divide, how did it come into being?

  A partial answer is that when, in the early seventeenth century, the premodern worldview built around the received wisdom of the Bible and selected ancient writers began to come apart, and as dissatisfaction with it led to a conviction that the mind’s latent strength could be brought to bear in radically new ways on the body’s weakness, an inevitable result of the new approach was to give greater importance to the physical world and thus, however unintentionally, to devalue theological interpretations. Experimentation was not actually discovered by Francis Bacon in the early seventeenth century, but what Bacon promoted in his No-vum Organum, which was published in 1620, was a commitment to reasoning based on observation of the natural world.

  The most far-reaching application of this approach came with William Harvey’s study of the human heart. Following Galen, the accepted thinking prior to Harvey was that the lungs pumped blood; that there were two kinds of blood, one that was made by the heart and another by the liver; and that both were continually used up by the body. Harvey’s dissections and calculations convinced him that the vast quantity of blood that was pumped out of the heart every minute couldn’t possibly be consumed by the body. The bold theory he published in 1628—that the blood circulated continually throughout the body, that the heart was the central pump, and that the liver did not make blood—was not instantly adopted by one and all. Harvey anticipated hostility—“I tremble lest I have mankind at large for my enemies. . . . Doctrine once sown strikes deep its root, and respect for antiquity influences all men”—and indeed some medical men ridiculed the idea of grounding scientific work on observation, which, given that the real world was rife with errors and exceptions, seemed patently foolish. Others stayed committed to the notion of two types of blood and thus of the value of bleeding a patient. Phlebotomy (bloodletting) was one of the roots of Galenist healing, and doctors and patients alike clung to it. It was tied both to the theory of humors and to the belief that purging the system was a key to healing, whether it was of the contents of the stomach, the bowels, or a portion of “impure” blood. Observation, however, showed that rather than restoring health, bleeding weakened a patient. To advocates of the new medical philosophy, bloodletting was symbolic of all that was wrong with the old ways�
��thus the reaction of Descartes, on his deathbed, to the suggestion of it.

  Steadily, Harvey’s system gained ground in the 1630s; people began to see it as the basis for a whole new approach to medicine, and exploring the recesses of the human body became a fad and an industry and a fascination matching the exploration of the heavens. In Holland, Reinier de Graaf delved into the mystery of birth: he applied his dissecting blade to pregnant rabbits and charted the route the fertilized ovum followed to the uterus. The Dane Nicolaus Steno, working in the hospital of the grand duke of Tuscany, took a step toward demystifying human emotion by laying bare the tear ducts and examining how they functioned. Medical professors created “domestic amphitheaters” in their homes to accommodate the rush of students signing up to observe dissections of human cadavers and vivisections of animals.

  In Amsterdam, the physician Nicolaes Tulp gave public anatomy demonstrations, using the corpses of executed criminals. Far from being branded as an atheist, he was immortalized in a painting by Rembrandt in which, using forceps, he pulls aloft a muscle of the left arm of a cadaver. What’s more, according to A. C. Masquelet, an orthopedic surgeon who has made a study of the painting, Tulp is holding his own left hand in such a way as to indicate how this particular arm muscle—the flexor digitorum superficialis—controls movement of the hand: the lesson isn’t just on the fact of muscles but on the cause-and-effect relationships between parts of the body. The observers in the painting—neatly bearded men with white lace collars—lean in to watch, fascinated by the demonstration. The Anatomy Lesson of Dr. Nicolaes Tulp signals one of those telltale shifts in what is deemed socially acceptable—like women wearing pants or the end of segregation in the American South—which to some spell the downfall of civilization while others view the change as an expression of a new era with a new idea of progress. The recesses of the human body, long kept determinedly shrouded in respectful mystery, had become spectacle.