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...teachers colleagues the medical profession, of the 17th century Hippocratic Oath, and of the reaction to the last recorded outbreak of the bubonic plague in London, shines some light on the subject of Locke's medical ethics. The study of Locke's medical ethics confirms that he was a deontologist who opposed all suicide and abortion through much of pregnancy.
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The works of John Locke remain widely read in the 21st century. As we enter into the tercentennial of Locke's death, we can safely conclude that his works have deserved their three centuries of fame and import. (1) The existence of modern democracy itself is largely a testament to the success of Locke's theories. With this background in mind, it is puzzling that a very important part of Locke's life and thought has received almost no in depth analysis. That aspect of Locke's life is his medical practice. (2) It is even more puzzling in light of the fact that over the last few decades the study of bioethics has been on the rise in America. (3) John Locke opposed suicide and defended liberty and autonomy on philosophical grounds. (4) John Locke practiced medicine. That Locke's medical ethics is worth studying seems clear from these facts. And yet, several of America's most prominent bioethicists have ignored John Locke's medical practice in their writings. (5) As a result, we may have an incomplete view of Locke to this very day.
This article is intended as the first step towards remedying this problem. Although a review of Locke's medical journals, his letters to fellow doctors and his letters to friends in general, do not disclose much that obviously deals with today's questions in medical ethics, (6) that does not mean that no indirect evidence of Locke's views on these subjects can be gleaned from his medical writings. In fact, an analysis of the medical community--including its view of the Hippocratic Oath--that Locke entered upon his graduation from Oxford with a medical degree in 1675, and of the reaction to the great outbreak of the bubonic plague in London in 1665, together shed some light on John Locke's medical ethics. With the benefit of this light we can obtain an even clearer image of John Locke, the healing philosopher. But before we begin on this trek, I must first give a short, somewhat biographical account of Locke's education and of the network of friends and professional associates that he acquired in the medico-scientific community of Restoration England.
I. The Education of John Locke
John Locke began his undergraduate studies at Oxford University in the autumn of 1652. (7) His college in the University was Christ Church. (8) He proceeded to begin the curriculum of what we would call a Classics major. (9) We know on the authority of Maurice Cranston that:
The days were busy. Five o'clock was the undergraduates' hour for rising to attend morning chapel. Breakfast was at six. Four hours' work was done before dinner in Hall at noon. Two hours' work came after dinner, and supper was at seven. The three and a half years' preparation for the B.A. degree were mainly given to logic and metaphysics and the classical languages. Conversation with tutors, or even between undergraduates in Hall, was always in Latin. (10)
in his celebrated Essay [Concerning Human Understanding], whilst ignoring his long experience of medicine and science which provided a constant focus for the growth of his empiricism." DEWHURST, supra note 2, at viii (emphasis added). The implication that these writings have for Locke's moral philosophy are far more subtle.
I can now also prove--to almost apodictic certainty--that Locke knew the rest of the "six" languages. First, as to Locke's knowledge of Greek, let us again look to Cranston:
An account of daily life at Westminster School at the time can be read in a document written by an unnamed boy who was there under Busby a few years before Locke arrived: [At] 5.15 a.m. called up by a monitor, and after Latin Prayers, wash. Between 6 and 8 repeat grammar--Lily for Latin, Camden for Greek--fourteen or fifteen [boys] being selected and called out to stand in a semi-circle before the Master.
CRANSTON, supra note 7, at 20 (emphasis added, words in brackets in Cranston's original, citations omitted). Next, let us turn to Locke's knowledge of Hebrew. Locke wrote this letter to Jean Le Clerc on July 30, 1688:
Your discourse of the Hebrew Poetry I have read with mighty satisfaction, and am so far from having anything to say against your hypothesis that it seems to me as clear as any demonstration can be concerning such matters for so I call such evident probabilities as arising from the things themselves leave no counterbalance on the other side.... If it were necessary to add anything to that full proof you have given of the Hebrew Verses being in rhyme, I think one might say that the other by measure is unnatural....
JOHN LOCKE, SELECTED CORRESPONDENCE 128 (Mark Goldie ed., 2002) (emphases in original) (hereinafter "JOHN LOCKE, SELECTED").
When it comes to Locke's knowledge of French, the evidence is everywhere. I point out in History "Lite" that "Locke must have known French since he spent four years in France from 1675 to 1679." Short, supra note 4, at 55 n.55. "Locke made the acquaintance early in i678 of Nicholas Thoynard, who remained his lifelong friend and his most assiduous correspondent." CRANSTON, supra note 7, at 174 (citation omitted). On May 2, 1679, when Locke began his voyage back to England, he "wrote to Thoynard 'Aujourd'hui,je crois il sacrifiera au Neptune du fond de son Coeur ou estomac.'" Id. at 180 (citation omitted). This sentence is, to borrow Locke's phrase, "englished" as such: "Today, I believe he [Olaf Romer] will make a sacrifice to Neptune [of me, Locke] in the bottom of his [Neptune's] heart or stomach." Olaf Romer, the man in charge of the vessel Locke was traveling to England on, "was a bad sailor," and apparently Locke worried about sinking (i.e. ending up in "Neptune's stomach"). Id. But, as if this was not enough evidence, Cranston's footnote to this sentence reads as follows: "Professor Ollion, who edited for publication Locke's letters to Thoynard, wrote: 'Locke sut assurement assez le francais pour l'ecrire convenablement.'" Id. This may be translated as: "Locke assuredly knew enough French to write it suitably" Thanks to Martin Flaherty for help in translating this passage.
I have asserted that the sixth language might be either Dutch or German. "The fact that Locke also had been appointed 'secretary to a diplomatic mission to Brandenburg [the future Kingdom of Prussia] in 1665' also speaks to his knowing German." Short, supra note 4, at 55 n.55 (citing website entitled John Locke: Biography (Oct. 12, 1998), http://www.anova.org/locke.html). I did not know then that:
In November 1665 Sir Walter Vane was sent on a diplomatic mission to Frederick William of Hohenzollern, elector of Brandenburg.... who was then at Cleves, and Locke accompanied him as secretary The Hohenzollerns had acquired the duchy of Cleves ... in 1609 ... The duchy was remarkable in the Europe of this time for the freedom of worship enjoyed by members of the ... Lutheran ... Calvinist.... and Roman Catholic churches ... The town of Cleves is situated on a high bank overlooking the flat ground of the lower Rhineland.... The inhabitants spoke Dutch.
Esmond S. De Beer, Commentary in JOHN LOCKE, 1 THE CORRESPONDENCE OF JOHN LOCKE 225-27 (Esmond S. De Beer ed., 1976) (emphasis added, citations omitted). Thus, John Locke did go to meet with the future Imperial House of Germany, but he went to the West of Germany, not to the East (i.e. Prussia). Cleves is to this day not a part of the Netherlands, and it is a part of Germany, but it is very close to the border. The Netherlands in 16 THE ENCYCLOPEDIA BRITANNICA 256, 258, 264 (1969). It is natural that this German city spoke Dutch, for Dutch and German were once the same language. See R. R. PALMER & JOEL COLTON, A HISTORY OF THE MODERN WORLD 107 (1967). NOW, what did Locke write in his letter to Robert Boyle from this little Germanic city? He wrote of his interactions with the people of Cleves and thereby implied that he spoke to them in their native Dutch:
The town is little, and not very strong or handsome; the buildings and streets irregular; nor is there a greater uniformity in their religion, three professions [of faith] being publicly allowed: the Calvinists are more than the Lutherans, and the Catholics more than both (but no papist bears any office) ... They quietly permit one another to choose their way to heaven; for I cannot observe any quarrels or animosities amongst them upon the account of religion. This good correspondence is owing partly to the power of the magistrate, and partly to the prudence and good nature of the people, who (as I find by enquiry) entertain different opinions, without any secret hatred or rancor.
JOHN LOCKE, 1 THE CORRESPONDENCE OF JOHN LOCKE 228 (Esmond S. De Beer ed., 1976) (emphases added). Also, Locke was in exile in the Netherlands from 1683 to 1689, during which time he and his manservant, Sylvanus Brownover, traveled through much of the country. CRANSTON, supra note 7, at 178,231-8, 311. Also, Locke's friend, Damaris Cudworth (the future Lady Masham) wrote to Locke on June 16, 1684, asking him to "inform ... [her] a little about your neighbors in Friesland, the L'abadies." Damaris Cudworth, Letter in JOHN LOCKE, SELECTED CORRESPONDENCE 98 (Mark Goldie ed., 2002). Cudworth was looking for "a better sort of people than those where I am." Id. "The L'abadists [were] ... a Quaker-like quietist and communistic community in Friesland." Mark Goldie, Annotation in JOHN LOCKE: SELECTED CORRESPONDENCE 98 n.4 (hereafter "SELECTED CORRESPONDENCE"). Friesland is one of the original seven provinces of the Netherlands. DONALD KAGAN, ET AL., THE WESTERN HERITAGE 457 (1995). When Locke visited the Labadists, he did not like what he saw: "And though I believe they are much separated from the world and are generally speaking people of very good and exemplary lives, yet the tone of the voice, mien, and fashion of those I conversed with seemed to make some suspect a little of Tartuffe amongst them." JOHN LOCKE, POLITICAL ESSAYS 295 (Mark Goldie ed., 2000) (emphasis added). Tartuffe was a "hypocritical pretender to religion, after Moliere's play of 1664." Mark Goldie, Annotation in POLITICAL ESSAYS at 295 n.61. So it looks like Locke spoke with Dutch-speaking people both in Cleves in 1665 and in Friesland in 1684. In the interests of candor, however, I should admit a few things. Locke's account of his meeting with the Labadists is not a letter sent to Cudworth, answering her inquiries. It is an unpublished essay/journal entry, dated: August 22, 1684 (i.e. roughly two months after Cudworth asked Locke the question). Mark Goldie, Commentary in POLITICAL ESSAYS 293-94. Also, the founder of this sect, Jean de Labadie (d. 1674), was French. Id. So too was "Mr. Yvon," who headed the sect when Locke visited it. JOHN LOCKE, POLITICAL ESSAYS 295 (Mark Goldie ed., 2000). It is therefore possible to conclude that, because the Labadists were mainly French emigrants to the Netherlands, Locke--who as I have pointed out spoke French--spoke with them in French. But that does not explain the discussions he had in the streets of Cleves. Also, I assert that after having been in the Netherlands for decades, it is hard to believe that the Labadists had not taken on Dutch as their main language. It is just not credible to assume that Locke, who lived in the Dutch-speaking world twice in his life--both times for a long, protracted period--did not learn Dutch to the point where he spoke it passably. That, I believe, justifies my contention that Locke did know how to speak/read at least "six languages." Locke knew English, French, Dutch, Latin, Greek and Hebrew.
Therefore, we can see that when Locke first came to Oxford, he began studying something that seems--to us at least--to be quite unrelated to medicine and biology And yet, Locke eventually tired of this and went into medicine. (11) Why would a man who had invested years in becoming a scholar in the Classics and in the moral lessons that can be drawn from the ancients give up that field for one so technical? The answer can be found in the regulations of Oxford University during the 17th century.
A. Locke's Evolution from a Classics Scholar to Someone Interested in the Study of the Medical Sciences
Locke graduated from Christ Church with a B.A. in 1656. (12) At that point in his life he was already growing dissatisfied with the conservatism of the Oxford curriculum of Classics, medieval logic, and the like. (13) On June 28, 1658 "Locke qualified as a Master of Arts and was duly elected a Senior Student of Christ Church." (14) Locke was now a teaching fellow at one of the great colleges of Oxford University. (15) This was Locke's employment when he was assigned to a diplomatic mission to the Elector of Brandenburg in 1665.(16) But throughout this decade from the late 1650's to the late 1660's Locke worried about his position at Oxford. If he wanted to remain at Oxford for the rest of his life as a scholar, he would probably have to take holy orders. (17) There were some alternatives however. One of the few ways Locke could secure a "layman's place" at Christ Church, Oxford, was by going into the study and practice of medicine. (18) As I will shortly demonstrate, Locke was becoming more interested in the sciences than in Classics. Since he did not want to become a minister, the choice was obvious.
Nevertheless, the study of medicine in England in the 1660's was also tedious and considered by many to be too traditional. As James Axtell reports:
With these languages at his command the medical student completed his three years for a B.A. and four more for an M.A.... At the completion of this liberal arts course ... he would begin his actual scientific training toward an M.B. and the coveted M.D., a total of another seven years. (19)
Locke, by 1658, had already completed the "Classics halt" of this fourteen year program of study But he did not continue with this conservatively ordered curriculum. He instead continued to discharge his duties as a Student of Christ Church, and used his free time to study Chemistry with Robert Boyle, one of the greatest scientists of all time.
B. Locke's Relationship with Robert Boyle
In 1662 Robert Boyle discovered what is known to this day as "Boyle's Law," which described the relationship between the pressure and volume of any gas. (20) At about the same time Locke was becoming interested in the relationship between chemistry and medicine. Today we are accustomed to the development of fantastic new drugs by chemists for the healing of mankind. But in the 1660's, this "iatro-chemical school" was considered "progressive." (21) So it seems natural that Locke would become a friend and student of Robert Boyle. By 1665 Locke was one of Boyle's close friends. Locke wrote to him on December 22, 1665, from Cleves (where the Elector of Brandenburg was holding court):
I look upon it as the greatest misfortune of my journey hither, that it hath afforded me so little worth your notice.... There is one Dr. Scardius, who, I am told, is not altogether a stranger to chemistry I intend to visit him as soon as I can get an handsome opportunity. The rest of their physicians go the old road, I am told, and also easily guess by their apothecary's shops, which are unacquainted with chemical remedies. (22)
As one can tell from this, Locke was on friendly, familiar terms with Boyle. (23) This letter also shows how Locke, by this point in his life, was quite prone to thinking about medicine and science; he had moved on from Classics. He learned a great deal about both medicine and science from working with, and just being around Boyle.
But it was all nonofficial. Boyle "was not attached to any college" at Oxford, he only lived in the city. (24) Locke could not perform the class-work required for a Bachelor's degree in medicine by studying with Robert Boyle. This was true despite the fact that Boyle and the other iatrochemists were training Locke in methods that were legitimate medical advances. In the end, it is all very ironic. Locke was becoming someone who could practice medicine, but who had no license to practice medicine. We next turn to one of Locke's professional associates who had gone through, and therefore could instruct one in, the traditional medical training.
C. Locke's Relationship with David Thomas
Even though the "earliest extant letter" from David Thomas to John Locke is dated "July 9, 1666," Locke and Thomas already knew each other well when it was written. (25) Thomas was a "proctor" of Oxford University and "general practitioner in the city of Oxford." (26) By February 1667 Locke and Thomas had opened up "a small [iatrochemical] laboratory in Oxford." (27) Thomas must have taught Locke medicine during this period because the operation of such a laboratory demanded that both he and Locke would become more and more well-versed in the two constituent parts of the study of iatrochemistry (chemistry and medicine). But even before that happened one of Thomas' patients changed Locke's life forever. As the late Peter Laslett reported:
Anthony Ashley Cooper, of Wimborne St. Giles in Dorset, later first Lord Ashley and still later first Earl of Shaftesbury, was one of the ablest and most extraordinary men alive in the England of Locke's lifetime.... His disease was a hydatid, an affection of the liver, fatal if it should give rise to an abscess and the abscess not be removed. In July 1666, Lord Ashley, Chancellor of the Exchequer, convalescent after one of his attacks, rumbled down in his great coach to Oxford to try the waters of Astrop. They were to be brought to him in bottles, and the man who came into his presence with the twelve flasks was not the physician he expected, but the physician's friend, John Locke. This was how the two men first met, and at that moment a famous friendship began. (28)
The "physician" Ashley "expected" was David Thomas. (29) But David Thomas could not be there on that day, and he had asked Locke instead to take care of one of England's five (30) chief ministers. (31) Thus, it is through Thomas that Locke made the most powerful friendship of his life.
D. Locke's Relationship with the Earl of Shaftesbury
Anthony Ashley Cooper was born on July 22, 1621, the son of a baronet. (32) He had served both sides in the Civil War; first the King and then Parliament. (33) He supported the restoration of Charles II in 1659-1660. (34) In 1661 he was raised to the status of a nobleman by being made a baron. (35) In the same year he was given "the powerful [office of] Chancellor of the Exchequer." (36) In 1667 the Chancellor of the Exchequer was one of the five ministers who really ran England as something of a proto-cabinet. (37) In 1672 Ashley was made, first, the Earl of Shaftesbury, and then Lord Chancellor of England. (38) And so, it was this mighty statesman who "rumbled down in his great coach to Oxford" in the summer of 1666 "to try the waters of Astrop."
The reason that Ashley needed the waters was, as Laslett stated, the presence of his hydatid. Dr. David Thomas was treating Ashley for this ailment. As luck would have it, on the day that Ashley planned to come to Oxford to pick up the waters, Thomas had to be in London. (39) Thomas therefore wrote to Locke, asking him to give Ashley the waters. (40) Locke, perhaps out of shyness, at first did not want this opportunity to meet the great Chancellor of the Exchequer. (41) Nevertheless, when the day came Ashley still ventured to Oxford for the waters of Astrop, and Locke was the one who handled the situation. That is why when Locke "came into" Ashley's "presence with the twelve flasks," he "was not the physician" whom Ashley had "expected." Ashley expected David Thomas, but instead he met John Locke. Anglo-American civilization has never been the same since.
That their conversation that day went off marvelously is a fact recorded by numerous historians. (42) Locke soon was invited to come to Ashley's house near London in the fall of 1666. (43) He still was without a medical degree. On November 3, 1666 "Clarendon, the Chancellor of the University" gave his dispensation for Locke to take the final "exercises" for both the degrees of Bachelor of Medicine and Doctor of Medicine. (44) For whatever reason, this request was denied, perhaps by the "medical faculty." (45) Nevertheless, Locke was not to be denied. On November 14, 1666 Sir William Morrice, one of the two Secretaries of State, wrote to the highest officials at Oxford that: "[W] e are graciously pleased to grant him our royal dispensation, and do accordingly hereby require you to suffer him, the said John Locke, to hold and enjoy his Student's place in Christ Church, together with all the rights, profits and emoluments thereunto belonging, without taking holy orders...." (46)
Locke finally had the right to stay at Oxford indefinitely without becoming a clergyman. He probably owed it to Ashley, for Secretary of State Mortice was Ashleyg friend. (47) This "royal dispensation" was basically an order from the Government of England itself, which Ashley helped run. Thus, Ashley probably secured for Locke, at Locke's request, the right to stay at Oxford as a layman. (48) Soon thereafter, in 1667, Locke moved into Ashley's household. (49) Locke had spent years thinking about politics and Natural Law (for many of the Greek and Roman classics are political texts). (50) In Ashley's house, presumably Locke would have turned from medicine to politics just as he had turned from Classics to medicine.
In 1668, however, Locke had to turn his attention to Ashley's hydatid. It was killing him. The waters of Astrop only treated it; they did not end the problem. For, in the words of Kenneth Dewhurst: "Lord Ashley had need of Locke's medical services in 1668. He had long been troubled with abdominal pain, recurrent jaundice, and a swelling below the right costal margin ... In May he consulted Francis Glisson, Physician in Ordinary to Charles II, for a recurrence of pain and vomiting." (51) The time for surgery had come, and Locke was to direct it. For, as Laslett eloquently wrote of Locke:
On the body of his noble patron he brought about one of the medical miracles of that age. He advised and directed an operation, an operation at a time when surgery was butchery, to remove the abscess on the liver and to insert a little pipe through the stomach wall as a drain to prevent another abscess from forming.... This operation made Locke famous and it changed the whole course of his life. Ashley was convinced, and he had good reason to be, that he owed his life to Locke. (52)
Locke directed this operation over a period of a period of many days. (53) He had the clearly diseased parts of Ashley's liver cut away. (54) He had "wax candles" put into the abscess which successfully drew out numerous cysts and "a large quantity of purulent matter." (55) Locke had purged Ashley's liver. His success was groundbreaking: "Lord Ashley's illness was one of the earliest instances of a successful operation on a suppurating hydatid abscess of the liver, and Locke's clinical history is the first detailed account of this condition." (56) Dewhurst and Laslett agreed on Locke's prowess as a physician. As for Cranston, his opinion of Locke's ability right before the operation was as follows: "David Thomas, being himself a doctor, encouraged Locke to concentrate on such work, and it was not long before Locke became an outstanding physician." (57)
Unanimity amongst historians is rare. When it comes to the assertion that Locke was one of the greatest physicians in late 17th century England, however, the greatest Locke scholars of the 20th century nodded their heads in the affirmative. Locke's relationship with the future Earl of Shaftesbury enabled him to prove to the whole world that he was a great medical doctor even though he had no medical degree.
Now let us finish the story of Locke's education and professional associates. A short discussion of Thomas Sydenham will enlighten the reader concerning another one of Locke's great friends. This discussion will also take us right up to Locke's final graduation at Oxford University.
E. Locke's Relationship with Thomas Sydenham
After Locke had Ashley's cysts removed, he had a silver pipe inserted into Ashley's body so that his liver would drain and no other abscess would form.58 "Two years [after the operation] ... Lord Ashley was quite well. He still wore a six inch long silver tube which, every other day, was cleaned in warm wine and replaced." (59) In the summer of 1668 Locke could have directed that Ashley only wear the pipe until the operation was over, and then Ashley would have been patched up. After all, most of us would not want to have a surgical opening in our body. But Locke did not advise this, and Ashley did not agree to it. "Ashley wore the pipe for the rest of his life." (60) Indeed, as Dewhurst has recounted:
Ashley was much improved by the beginning of September [1668] when, with Locke's assistance, he drew up a questionnaire to determine the opinions of several leading physicians on his future management. The main point at issue was whether the silver tube should be left in place as long as the wound continued to drain. (61)
As the reader already knows, Locke was in favor leaving the pipe in place, and this is how Ashley ended up governing his body until he died. One of the physicians who, with Locke, voted for the pipe was already his friend. His name was Thomas Sydenham. (62)
Sydenham was eight years older than Locke. (63) Three of his relatives had fought for Parliament in the Civil War, and all three had died in that cause. (64) He too had fought for Parliament and against the future Charles II in the early 1650's. (65) He had, unlike Locke, graduated from Oxford with a Bachelor's degree in Medicine by the time he had turned thirty-one. (66) His views on the epistemology (as opposed to the moral theory) of medicine were likened to those of Hippocrates:
They [Sydenham's critics] were mostly bookish men, these orthodox doctors, whereas Sydenham was essentially a man of action, basing his treatment not so much on the authority of ancient writers as upon his own carefully observed natural...
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