Sense, Sensibility and 18th Century Scottish Medicine
As humans we seem to have a phenomenal burden to acquire the knowledge of the Universe. We also find an astonishing need to understand ourselves. This has been seen from Einstein’s work on universal physics, to Rene Descartes’ work on the self. Yet while our knowledge has been continually growing, there are times when revolutionary ideas come together and change the world forever. Looking back to 18th century Scotland, advances in medicines and philosophy happened in revolutionary leaps and bounds but, unlike today, these two studies were commonly amalgamated into a single form. One was not without the other.
The late 1700’s were unfolding into one of the most profound eras of Scottish History. The country now had three more universities than Britain, and was accommodating changes in the academic system that would change the world. We see many shifts in academia and education occurring in Scotland Universities, especially Edinburgh. Francis Hutcheson begins a new trend of teaching in English and not the traditional Latin; and an even bigger change begins at Edinburgh University with the introduction of academic specialties. Education was “held back by a system known as ‘regenting’, whereby individual ‘regents’ taught every subject to undergraduates. Not until the eighteenth century could lecturers break out of this generalist teaching of often outdated material, and provide specialist courses” (Goodman). This is especially important in the field of medicine. Where before aspiring doctors had only the option of studying a smattering of general sciences, we start to see the formation of medically specific lectures. As the development of specialized higher education spread across academia, it is possible to see how the stagnancy of intellectual tradition fell away and allowed the cultivation of some of the greatest minds to grace the Scottish heritage.
Sensibility, sympathy, and irritability are three terms requisite terms when discussing enlightenment medicine; and therefore necessary to define before doing so. In his work A Sense of Beauty, Irish moral philosopher Francis Hutcheson defines sense/sensibility to be “a determination of the mind to receive any idea from the presence of an object which occurs to us independent of our will.” Therefore, irritability may be defined simply as the inclination of the body to react to upon stimulation, which increases with greater sensibility. Lastly is sympathy, which Christopher Lawrence describes as nothing “more than the communication of feeling between different bodily organs, manifested by functional disturbances of one organ when another was stimulated” therefore making sympathy “a special case of sensibility”. (Lawrence, ‘Nervous System and Society…’, p.27)
The over-arching objective of 18th century medicine was “to provide a physiological and anatomical basis…for overall integration of the body functioning”. They believed this to have been achieved through these definitions of sensibility, irritability and sympathy. The notion of the mind giving rise to ailments of the body was especially revolutionary considering its being based primarily on conjecture due to lack of hard evidence. Yet it allowed the physicians to better treat a growing population of patients whose problems could not be entirely explained physiologically. An important understanding of the relation of environmental impact on body and mind also emerged. Physicians began to offer “Lifestyle advice, formulated within the Galenic framework of the ‘six non–natural things’, [which] included air, food and drink, sleep and wakefulness, exercise, bodily evacuations, and emotions” (Risse).
It was an innovative way of thinking and talking about medicine, but it also brought with it overzealous diagnosis of nervous disorders, “branding famished women as hysterics while lethargic men become hypochondriacs.” Unfortunately nervous disorders “imitate almost every disease and are seldom alike in two different persons, or even the same person at different times.” Due to this inclusivity of symptoms, doctor declared different diagnoses with presentations of identical symptoms. Partly because if this nervous disorders became a trendy disease of the enlightenment’s upper class (Cambridge… Ch.9).
It had already become popular to be perceived as socially sensible and sympathetic, and therefore it was believed a person with increased medical sensibility was actually more socially in tune. Along with this, the upper class would be more likely found within the grimy cities, drinking large amounts of alcohol, and partaking in unhealthy diet. It is no wonder why people such as David Hume complained of feeling so awful, and why the environmental changes stated before seemed to often help.
The nervous system gained importance in Scotland not only from the physiological side of the bridge but from the philosophical side also. In the second quarter of the century Scottish philosophy turned from reason to feeling, both as the basis of morals, and as the mainspring of action. On this foundation was developed a sophisticated theory of society and history, as well as a school of sentimental novel-writing … Scottish social thinkers discerned a relation between social life and the quality of sensibility. History was a process involving a gradual refinement of feeling. (Lawrence, 1979, pp. 28–9)
Luigi Turco states in chapter seven of The Cambridge Companion to the Scottish Enlightenment that there “is a tendency to associate the Scottish Enlightenment with the moral doctrine of sentimentalism… [yet] it is salutary to recall that the predominant philosophy in Enlightenment Scotland was that of common sense”. This rift is important to understand because it fits very closely with then-current medical theory. Whether or not life begins as a Tabula Rasa is found to be extremely important within both fields of study. Through their mental study of the human conception, the empiricists Smith, Hume, and Hutcheson decided our moral sense was founded only in our sensibility. On the other side, Rationalists came to the conclusion humans must be born with at least some innate conception of morality. Unfortunately neither party could provide, through their beloved Newtonian method, any scientific evidence to solidify their argument. It was with medical community’s sudden and intense study of the human nervous system it was discovered it might be possible to anatomically and physiologically prove the foundation of moral sense. Heavy emphasis was now being placed on sensibility, as it was hypothesized, and we now know this to be correct, nerves detect stimuli and cause the body to react in a physiologically determined matter. While this wasn’t much use to the Rationalists, Existentialists finally had scientific facts from which they could extrapolate their theory.
To substantiate some of my conjecture I offer the viewpoint of metaphysician David Hume in his Letter to a Physician.. The letter, in gist, is a plea from David Hume to an undisclosed physician in London. He had been suffering a variety of symptoms, which would wax and wane, and were quite disturbing to him. He had been given medication, and “renewed the bitter and anti-hysteric pills twice, along with anti-scorbutic juice…but without any considerable effect, except abating the symptoms for a little time.” And while some slight pertinence could possibly be contained within the explanatory section of his letter, I find his conclusion, in full, to be most relevant. He writes:
As I am come to London in my way to Bristol, I have resolved, if possible, to get your advice, though I should take this absurd method of procuring it. All the physicians I have consulted, though very able, could never enter into my distemper; because not being persons of great learning beyond their own profession, they were unacquainted with these motions of the mind. Your fame pointed you out as the properest person to resolve my doubts, and I was determined to have somebody's opinion, which I could rest upon in all the varieties of fears and hopes, incident to so lingering a distemper. I hope I have been particular enough in describing the symptoms to allow you to form a judgment; or rather, perhaps, have been too particular. But you know it is a symptom of this distemper, to delight in complaining and talking of itself. The questions I would humbly propose to you are: Whether, among all those scholars you have been acquainted with, you have ever known any affected in this manner? Whether I can ever hope for a recovery? Whether I must long wait for it? Whether my recovery will ever be perfect, and my spirits regain their former spring and vigour (sic), so as to endure the fatigue of deep and abstruse thinking? Whether I have taken a right way to recover? I believe all proper medicines have been used, and therefore I need mention nothing of them.
Within the second sentence, Smith validates my earlier statement concerning doctors learning in a more specialized environment. Whereas before doctors were heralded as scholarly and wise, an obvious shift has occurred, resulting in respect being exclusively shown when medical attention is needed. Yet the most insight comes from his questions at the end. In the first, Hume associates his illness with his lifestyle, asking the doctor if he knows any other scholars who have presented these symptoms. This question, along with his expressing earlier that he believed his illness to be due to a disturbance of nerves, we can see Smith’s assimilation of nervous disorder with both environment (work) and social standing. We might also infer from this that he believes those in his profession are more sympathetic and sensible than the common man. It is in the last line we find Smith’s strangest comment, as he makes a strange shift from asking for help to telling the doctor he doesn’t need mention of medicine because he believes he has them under control.
“It has been the misfortune of those who have study’d the philosophy of the Human Mind, that they have been little acquainted with the structure of the Human Body.” (Gregory)
The above quote summarizes my position very well. While the Scottish Enlightenment brought medicine and philosophy together we are, to this day, having trouble continuing this wonderful feat. To continue in the footsteps of the Enlightenment thinkers we must continue our education in a directional, yet multi-faceted orientation.
Broadie, Alexander, comp. Scottish Enlightenment: an Anthology. Edinburgh: Canongate, 1997. Print.
Broadie, Alexander, ed. The Cambridge Companion to the Scottish Enlightenment. Cambridge [u.a.: Cambridge Univ., 2010. Print.
Dr. George Cheyne, The English Malady: or, a Treatise of Nervous Diseases of all Kinds: as Spleen, Vapours, Lowness of Spirits, Hypochondriacal and Hysterical Distempers (London and Bath: 1733))
Goodman, David C., and Colin A. Russell. The Rise of Scientific Europe, 1500-1800. Hodder & Stoughton, 1991. Print.
Gregory, John. Internet Archive. London: J. Dodsley, 1766. Open Library. 03 Sept. 2008. Web. 26 Oct. 2010. .
Hume, David. Letter to a Physician
Lawrence, Christopher. The Historical Development of Experimental Brain and Spinal Cord
Social Studies of Scienceâ€¨Vol. 14, No. 1 (Feb., 1984), pp. 153-158. Sage Publications
Ltd. Stable URL: http://www.jstor.org/stable/284708
Risse, Guenter B. New Medical Challenges during the Scottish Enlightenment. Amsterdam: Rodopi, 2005. Print.