We continue exploring Moliere’s comic portrayal of doctors by considering the state of medicine in seventeenth century France and features of Moliere’s life that shaped his attitude toward it. His Jesuit education afforded him the tools of a skeptic—critical thinking and a knowledge of natural philosophy. His talent as a playwright, along with Royal protection, afforded him an audience. He was going to mirror, in public, the growing perception that the medical profession had become senile. The medical Faculty of Paris had met their match.
Nothing about our topic escapes the influence of three forces: the evolution of natural philosophy, the reign of the Sun King–Louis XIV, and the follies of man. We discuss the first two here. The follies of man belongs to a discussion of Moliere’s life and his plays in the next installment.
Moliere’s Hall of Mirrors
Moliere held cherished friendships with a number of doctors, some of whom, it is believed, provided him with the fodder for his comedic cannon. His target was clearly the institution of medicine. There is no written record by Moliere other than his plays. But, on stage, his doctors were buffoons, their comic antics mirroring a perception shared alike by author, audience and Royal patrons—they were helpless at the hands of blustering and sometimes dangerous doctors.
Today’s readers (doctors especially) will think it unfair to deride practices of a bygone era. After all, the Imaginary Invalid was written almost 350 years ago. Modern historians, reserve for such anachronistic judgements the pejorative term: ’Whiggish history’.
“Whig history of science tends to divide historical actors into ‘good guys’, who are on the side of truth (as is now known) and ‘bad guys’, who opposed the emergence of these truths because of ignorance or bias.”
If we are to be neutral, we might as easily entertain the notion that Moliere was a social critic, or, alternatively, that he was just pandering to the tastes of the Royal Court. Likewise, Guy Patin, Dean of the (medical) Faculty of Paris, might be thought of as the standard bearer for ‘academic’ medicine, or, alternatively, as a fossilized, vain and vindictive autocrat. We believe, however, that the record indicates that Moliere’s criticism of the practice of medicine was both genuine and personal; and that Patin was indeed a proper villain, ruthlessly suppressing at every turn anything new or different.
Contemporary primary sources attest to what an authoritarian, rigid and pompous profession was that of French doctors of the seventeenth century. The British philosopher John Locke witnessed a typical graduation ceremony. It included ten violins, gold chains and a diatribe against Harvey’s description of blood circulation (the heresy of an Englishman). He wrote amusedly of details in closely congruent to the comic stage ceremony in The Imaginary Invalid.
Le Journal de La Santé du Roi, is a handsomely bound and detailed journal, wherein Louis XIV’s physicians documented in great detail their care of the King. A.M. MD, it thus in Moliere and his Medical Associations:
“Open and consult where you will, it shows a miserable patient at the mercy of the doctors of the Faculty, and in strict conformity with its rules and ordinances, bled, purged, and ptizaned*—in fine, drugged to excess often in spite of himself, and unwittingly made to play the Argan to the Beralde of the comedy**, court etiquette requiring that the world should know that the monarch, who laughed at medicine with his comedian***, was docile as a child in the hands of its professors.”
(*ptizaned (ptisaned): medicinal barley water. **The Imaginary Invalid. ***Moliere.)
Our third primary source is the many letters of Guy Putin. There is an extensive commentary on these in a three part series that appeared in 1922 in the former Annals of Medical History, by Francis R. Packard, MD, Patin and the Medical Profession in Paris in the Seventeenth Century. As Dean of the Faculty of Paris, and throughout his life, his one abiding duty was to defend the Faculty’s dogma against all challenges regardless of merit. As one doctor in L’Amour Medecin says of patients: "it is doubtless better [they] die according to the rules than escape by practically infringing them.” The ‘rules’ being the one true practice of medicine issued ex cathedra by the Faculty.
The Faculty of Paris and its Idols
In Moliere’s Paris, folk remedies were commonplace, from absurdly elaborate rituals to hit-or-miss herbalism. Charlatans were everywhere. As were barbers and apothecaries, classes considered unlearned and self-serving. The Faculty used their Royal license and academic prestige to dictate practice in every aspect of medical care, even to the point of a virtual ‘excommunication’ of their own members, if need be.
As physicians, a sincere devotion to theory separated them from the others who tended the sick. To the misfortune of their patients, this meant a rote learning of Hippocrates and Galen, a legacy dating back to the fourth century BC.
Hippocrates of Kos, ‘the Father of Medicine’, was a Greek in the age of Pericles, and first to declare that disease is a process of nature, not of magic or divine intervention. His theory of disease—the four humors— was an elaborate fabrication that spread to Europe and Persia and endured into the 1800s. It provided the rationale for the preferred treatment of the Faculty—an imbalance of humors was to be righted by bleeding, purging or giving of enemas, (seignare, purgare, clysterium donare).
Galen of Pergamon, also Greek, but practicing in Rome, was a philosopher, anatomist, physiologist and experimental surgeon. A medical maverick, he was warned that conventional practitioners intended to assassinate him. (The Faculty of Paris dealt with medical mavericks by character assassination.) He extended the theory of the humors by assigning temperaments to each one. His influence in sixteenth century Europe grew when reintroduced in Latin translations by the anatomist Vesalius. Galen believed in therapeutic bleeding, controversial even in his time. His authority undoubtedly caused the practice to persist for the better part of two millennia.
And, to be fair, managing fever (an elevated body temperature) by removing blood (warm as it is), makes a certain amount of sense, especially in a proto-scientific era. Francis Bacon’s scientific method, involving induction and observation, was as yet, just a silhouette in the fog of a culture war.
Natural Philosophies at War
In the Natural Philosophies at War in the 17th Century, science historian Schuster outlines the battle amongst three concepts. Nearly extinct by now was Aristotelianism, which denigrated the value of experiment and had no ambition to control nature.
Neo-Platonism held that all objects had varying proportions of matter and spirit. Natural Magic, garnered from a knowledge of matter imbued with spiritual forces, can and should be used to control nature for man’s benefit. For example Paracelsus treated anemia with iron. He conjectured that both blood and iron were endowed with Mars-like spiritual properties (more a matter of semiotics than physiology). Therefore, what blood was lacking, iron could restore.
What won out was ‘mechanical philosophy,' based on mathematics and atomism, and divorced from notions of magic or religion. Its chief proponents of the time included René Descartes, who dabbled in biology, Thomas Hobbes and Pierre Gassendi. Moliere studied at Clermont College, exposed to the iconoclastic thinker, Professor Gassendi—a story for our next installment.
The great event of the time in the evolution of scientific medicine was the discovery by William Harvey of the true nature of blood circulation (De Motu Cordis.) The traditional view was that blood was made in the liver and pushed about by arteries that pulsed on their own accord.
Hearts and Minds
The hearts and minds of the Faculty of Paris were not moved by this argument. The ‘circulationists’ were despised by Guy Patin and most of his Parisian colleagues. So, too, were nearly all foreign doctors, French doctors from the school at Montpelier (older and more prestigious), the barbers and surgeons, apothecaries, the physicians of the Royal Court, Monks (they practiced a sort of medicine), other ecclesiastics, and any one who would either use antimony or not use phlebotomy. They believed in Hippocrates, Galen and a few contemporaries. They busted the careers of non-conformists, humiliated them in court, and deprived their family members of admission to medical school.
Patin never attended a play. It was considered beneath the dignity of the profession. But he did know of Moliere’s satirical attacks on physicians. He thought it was all just fine, content in his belief that the jokes were about the physicians of the Royal Court, about whom he had a low opinion anyway. In fact he would have even been pleased at the scene from Medecin Malgre Lui:
Moliere “puts in the mouth of the young peasant…the remark that an apothecary had wished to give his sick mother some vin emetique [antimony] but that he fears it will kill her, ‘as they say these great doctors kill I do not know how many people with that invention.’” Antimony* brings us to the role in all this of King Louis XIV. (*from ‘anti-monk,' or ‘monk-killer,' the early use by monks tending to the toxic side of dosing).
Revolving around the Sun King
In addition to the sweeping currents of intellectual thought that shaped the practice of medicine in seventeenth century France, was that fountain of influence flowing only from Versailles. The preferences of the King influenced the practice of medicine, surgery and obstetrics.
As to medicine, it was a battle won by the ‘iatrochemists’ in a hundred year war over the medicinal use of antimony. The Galenists were against it and Parlement banned its use in 1566. It was, in fact, not only toxic on its own, but easily contaminated with arsenic. However, it had been championed by Paracelsus. And so, the doctors of Montpelier, ‘notorious’ chemists, took it up as an emetic, useful in purging bad humors. And these doctors of Montpelier were more in the confidence of the court than those of Paris.
When the young King was in Calais, in 1658, he took ill, probably with typhus. He recovered following an administration of vin emetique (wine laced with antimony). The next year Parlement reversed the ban on its use. This did not quell the professional debate, however. The “anti-antimonists” had a point—misused, it was lethal. Guy Patin would publicly accuse several doctors of ‘murder by antimony’. But Antoine Valot (Vallot), who gave the young King the antimony, crowed “how marvelous was our treatment—such is the excellence of our art.” Brown cites Moliere’s epigram on the death of Maria, the Queen of England, sister of Louis XIII: “…and now Henriette dies, by the ignorance of Valot.” So Moliere and Patin were not always at odds, it seems. (And see Medecin Malgre Lui, above.)
As to surgery, Patin writes of the death of Cardinal Richelieu, from a rectal abscess, that ”…a female empiric gave him horses' dung in white wine, and that another charlatan had given him a pill containing opium…”. Richelieu died in short order. The Kings anal fistula faired much better. Brown: “…In 1686 the King suffered from an anal fistula of which he was cured by an operation which was performed by the surgeon, Felix. The happy result brought an immediate change in the status of the French Surgeons, the King interesting himself in improving it.” Such was the servility of some courtiers, that they had their anal region dressed with bandages as a display of like circumstance and medical choice as the King himself.
And with midwifery: (Brown again) “In 1663 when Louis XIV’s mistress, Louise de la Valliere, was confined she was attended by Boucher, a man, a fact which had an immense influence in furthering the cause of male midwifery. It is said that Louis XIV watched the proceedings from the concealment of some curtains.”
The King was a generous sponsor the arts, and protector of his favorite playwright. Thus, Moliere fueled the social satire of his age and the Sun King was the catalyst. Next time we, finally, get to the Man and his plays.
Look for our next post soon: Le Médecin Moliéresque: Act II. Comedy.