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Article Excerpt
Blood always speaks beyond itself. A meeting point between the material and the vital, it is a substance suffused with meaning more than physiological. For the ancient writers of Leviticus, life itself was in the blood, and the elaborate blood rituals they described both marked the hierarchies of social relationship and separated the space of the sacred from the profane. For medieval pilgrims to holy shrines in northern Europe, bloody hosts, Eucharist wafers miraculously marked by the blood of salvation, signaled the continuous intervention of the divine into the historical world. Even today, in a world less immediately given to granting meaning to bodily fluids, blood--and our handling of it--continues to exert its symbolic power: as Catharine Waldby and Robert Mitchell have recently shown, the enormous upsurge in blood donation after 9/11 conveyed not only a widespread wish to offer aid in a crisis but also complex ideas about citizenship and national identity. (1)
In early modern England, too, blood's referential range extended beyond the medical: for about twenty years during the Commonwealth and early Restoration, an intense but short-lived debate arose about phlebotomy, the ancient and venerable art of incising veins to let blood from particular parts of the body. Phlebotomy had been a normative practice of Galenic medicine since the earliest centuries of the Common Era. Although over the centuries questions had at rimes arisen about the details of its use--about when precisely to let blood, about how much blood to let, and, especially, about which specific veins were appropriate to cut for which specific conditions (2)--on the whole, the controversies about phlebotomy never questioned the efficacy of the treatment itself. (3) For a short time in the seventeenth century, however, with Galenic physiology under pressure from new anatomical and physiological discoveries, and with the dominance of Galenic medical practice threatened by competing medical practitioners, the efficacy of phlebotomy itself was called into question. Phlebotomists were suddenly recast by their critics as nothing more than "bronchotomists," literally, cutthroats; phlebotomy itself was compared to butchery, an effort akin to amputating an arm just to remove a splinter. (4) One writer claimed that phlebotomy was invented by the devil himself, intended to suck the lifeblood from God-fearing Englishmen. (5) The virulence of such attacks against a practice so ingrained in the daily life of the populace inevitably elicited equally impassioned defense: phlebotomy's supporters ridiculed those who derided the technique as pompous know-nothings, ignorant of the rudiments of physic, thinking to make a revolution in learning merely by dressing up old ideas in new and obscure terms. (6)
Even by the standards of the seventeenth century, a period not known for civilized restraint in printed debate, the energy of the back-and-forth assaults is impressive. In part, and perhaps most fundamentally, these arguments concern the legitimacy of the technique itself and of the Galenic tradition in which it thrived; they debate specifically whether or not phlebotomy, if practiced correctly, works as Galenists claimed as an effective prophylactic against and as cure for a host of particular conditions. But other issues were involved as well.
Raw commercial competition, for example, gave an edge to the insults. By the middle of the seventeenth century, the urban centers of England saw increasing competition among different kinds of medical practitioners. Most of the men who wrote against phlebotomy were chemical physicians, followers of Joan Baptista van Helmont, the early seventeenth-century visionary and medical reformer. Unlicensed by the College of Physicians, these chemical physicians were unable legally to practice medicine in London and its environs. (7) By warning of the dangers inherent to the traditional reliance on phlebotomy, these physicians were challenging the legitimacy of current legal strictures about who got to practice medicine in the most populated and well-to-do areas of England. (8) They advertised themselves as properly English and avowedly Christian healers: eschewing what they scorned as the pagan heritage of Galenic medicine, they advocated what they instead framed as a medicine grounded in Christian charity: safe, chemically-derived pharmacology instead of the cruel assault of the bloody lancet. If the book-buying public could be convinced that the frightful techniques of Galenic medicine were not only unnecessary, but also un-English and unchristian, then perhaps there would be more room for these chemical physicians to sell their services with greater success.
Beyond these immediately commercial concerns, there was in the attack against phlebotomy a more theoretical question of what kind of learning should be deemed most appropriate for medical men to possess. Phlebotomy's advocates were, by and large, university trained physicians, which means both that they were Galenists (since that is the medicine the universities predominantly taught) and that they were educated in medicine as a mode of natural philosophy: they studied authoritative texts along with their accumulated commentaries; they learnt techniques of logic and analysis; they sought to understand and explain the physiological condition of man in the wider context of nature, or phusis--hence their role as physicians. Phlebotomy's detractors, on the other hand, typically derided the education offered at university, and their commitment to chemical medicine was more empirically based. They tended to value practical, experiential knowledge and close observation of events more than reasoned explication of texts and events understood in relation to comprehensive systems of nature. (9) That type of abstract knowledge they deemed pretty much useless when it came to actually doing anything in the world. Thus one writer taunted, "How much do the intricacies of scholarship matter" to a
Sick Man that lies groaning on his bed ... haling for breath as for life? What is this man's Learning to him if he cannot ease him and give him Relief?. If after all [the] learned Argumentation, and Eloquence of the Galenist, some trivial Chymist that hath learnt something by blowing the coals for his Master, shall cure him, without any long preamble, be serious, and tell me ... whether this man ... be not to be encouraged to be had in some estimation in any well-goverened Land? (Galeno-pale, 16)
In this sense, the attack on phlebotomy was part of the general ferment in the late seventeenth century about what constitutes knowledge itself, and about how knowledge was best to be acquired. The medical reformers understood themselves as Bacon's heirs, looking to erase the "tyranny" of the old learning and working to further "the publick good." (10) As Noah Biggs said, "the whole mode, method, and body of physick as it is now prescribed and practiced ... groans for a reformation" (18). To the defenders of phlebotomy, their opponents were mere "Bacon-faced" quacks, sloppy in their logic, rejecting ideas they simply did not understand (Stubbe, 172). (11)
The attack on phlebotomy was thus never only about how to handle blood in the course of medical practice. But as much as it concerned who got to practice medicine and what kind of knowledge was necessary for its success, I want to suggest that the language of the objections, the specific troping of the arguments against phlebotomy and against the Galenic tradition that fostered its use, indicates something more--namely, not just a rejection of traditional medical theory and practice, but a fundamental reconception of how individuals exist in relation to the test of the world. Grounded in the assumptions of the Galenic tradition, the early modern practice of phlebotomy understood human existence in the seamless context of a larger surround; individuals were inextricably embedded in an environment from which they could not be isolated either conceptually or medically. Phlebotomy's detractors, on the other hand, envisioned an almost entirely different individual, a patient not defined idiosyncratically by particular context but rather existing in conceptual self-enclosure, inhabiting an "outside" environment from which he or she must vigilantly be protected, especially from what gets framed as "foreign" invasion. Even as it concerns seemingly narrow questions about a particular medical practice, then, the debate about phlebotomy engages also competing understandings of the individual that co-existed, at least for a moment, at the cusp of the modern world.
In this first part of what follows, I try to establish the individual implicated by traditional Galenic medicine. Though it is now close to a commonplace that Galenism understood the individual in the Latinate meaning of that term--as undivided, in this case, from environment--I want to focus particularly on the means of monitoring and regulating that ail-inclusive system, namely on dietetic medicine, and particularly on the manipulation of the six non-naturals that helped to maintain a homeostatic balance both within the individual and between the individual and the environment of which he or she was a part. (12) Dietetic medicine furthermore provides the appropriate context in which to understand phlebotomy because phlebotomy was one of the standard techniques typically called upon to maintain or restore such balance. This section thus tries to sketch the individual implied in a pattern of medical practice.
The second section turns from Galenic practice to Helmontian prose. Considering the attacks against phlebotomy, I focus particularly on the formulation of arguments, on the language that points toward the kind of conceptual categories that undergird a wide range of the chemical physicians' positions. Because my interest is to educe an underlying assumption that structures explicit arguments, my concern in this section will be less on the local circumstances of each text's production than on particular rhetorical formulations that recur among them. The chemical physicians whose texts I cull were never explicitly concerned with the contours of personhood as such; the debate they engaged in was carried out on a different plane entirely, having to do, as I have indicated, with medical theory and practice, with commercial interest and institutional prestige. But the terms of their arguments, drawn from the reformist discourse of the mid-century and from Helmontian medicine, suggest that other issues were involved, and it is to these that I will attend. From their...
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