ANZ J. Surg.

2003;

73

: 346–351

COWLISHAW SYMPOSIUM

Cowlishaw Symposium

A TRIPLE TIE: THE RELATIONSHIP BETWEEN SCIENCE, RELIGION AND SOCIETY

P

HILIP

S

HARP

Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia

There has always been a relationship between science, religionand society, often with one of these elements holding a moredominant position. An argument could be made that science arosefrom philosophy – an attempt to understand our world.

Plato

(422

BCE

–347

BCE

)

1

is regarded as the first Westernphilosopher and many regard him as the greatest philosopher ofall time. He regarded mathematics and physics as the keys tounderstanding the natural world. He divided total reality into tworealms: the visible world in which nothing is permanent, and atimeless stable reality – our soul. It was quite common for peopleto refer to Socrates (470

BCE

–399

BCE

) and Plato as ‘Christiansbefore Christ’ even though Plato had arrived at his conclusions byphilosophical argument rather than any belief in God.

Aristotle

(384

BCE

–322

BCE

) was the most gifted of Plato’spupils, a tutor to Alexander the Great. Aristotle thought that therewas only one world to philosophize about. He taught that the trueessence of any object is the function it performs not the matterfrom which it is made.

Aristotle’s teaching held sway until the 13th century. Hereoccurred the first flowering of European thought and civilizationsince the collapse of the Roman Empire. Christian and Islamiccultures had fruitful interchanges, the philosophy of Aristotlereturned to Europe from the Arab World, the great French Gothiccathedrals were built, Oxford and Cambridge Universities werefounded, and the Magna Carta and the House of Commons led tothe beginning of constitutional government.

The outstanding philosopher of this era was

Thomas Aquinas

(1225–1274). He produced a vast synthesis of all that had beenbest argued in Western thought up to his time and he showed it tobe compatible with Christian beliefs.

Basing himself on Aristotle, Aquinas argued that all ourrational knowledge of this world is acquired through sensoryexperience, on which our minds then reflect. When children areborn, their minds are like a clean slate (

tabula rasa

). Aquinasdeveloped a theory of knowledge which is uncompromisinglyempirical. The world through which we gain our knowledge isGod’s creation, and therefore it is impossible for this gainedknowledge to conflict with religious revelation.

The system of astronomy that was developed over generationsby the ancient Greeks was known as the Ptolemaic system after

Ptolemy

(

ca

85–165), an astronomer who lived in Alexandria inthe 2nd century. He believed that the earth was a sphere hangingunsupported in space, and the earth was the centre of the uni-

verse, with the planets and stars moving around in circles. Duringthe Middle Ages, the Catholic Church incorporated this theoryinto the Christian view of the world.

In 1543 two seminal texts were published:

Vesalius’s

(1514–1564)

On The Structure of the Human Body

and Coperni-cus’s

On the Revolutions of Celestial Bodies.

Both worksradically transformed our view of ourselves, our understanding ofthe world and our place in the universe.

Copernicus

(1473–1543), a Polish churchman, showed thatplanetary movements that were becoming increasingly difficult toexplain suddenly made good, clear sense when the sun was at thecentre of the Universe rather than the earth. This conflicted withwhat The Church had been teaching for a thousand years andflatly contradicted the Bible itself. As Psalm 23 says

,

‘[t]hou hastfixed the earth immovable and firm’. The Church officially con-demned Copernicus’s theory. Another consequence of his ideawas the removal of man from his privileged position in the Uni-verse – according to his ideas, humans were no longer the centreof everything.

The first of the founding fathers of modern science to comeinto personal conflict with the power-wielding authorities of thisworld was

Galileo

(1564–1642). He was condemned by theInquisition, a tribunal formed by the Roman Catholic Church touncover and suppress heresy – first privately in 1616, and thenpublicly in 1633. His crime was the twofold one of asserting thatthe earth rotated on its axis and that it revolved around the sun.As he came away from the table at which he had signed his recan-tation he muttered under his breath: ‘[b]ut it still moves, justthe same’.

Only 54 years after the Pope had publicly condemned Galileo,

Isaac Newton

(1642–1727) provided mankind with an accurateworking model of the entire planetary system. It was now estab-lished that the workings of the physical universe were indeedsubject to laws. These laws were discernible by human beings,and they were expressible in equations. Because of their con-stancy, these equations gave man, for the first time, the power ofscientific prediction. This led to the idea of ‘natural philosophy’.This began a rapid spread of disbelief in the existence of Godover the next three centuries as more and more people came tothink of man himself as lord of the known universe. The CatholicChurch lost its control over the intellectual and cultural life ofEurope – completely over those countries that became Protestant,but to some degree even in those countries that remained Catho-lic. Newtonian mechanics was put to work in the development ofmachinery that made the Industrial Revolution possible.

Francis Bacon

(1561–1626) was a true Polymath, a mandistinguished in politics, law, literature, philosophy and science.He tried to convince King James 1 to establish a royal institutionthat would advance science and a college for the study of theexperimental sciences; he also wanted to see professorships of the

P. Sharp

FRACS, FACBS.

Correspondence: Dr Philip Sharp, 591 Canterbury Road, Belmore, NewSouth Wales 2192, Australia.Email: pasharp@bigpond.net.au

Accepted for publication 16 January 2003.

TRIPLE TIE 347

new science founded at Oxford and Cambridge. None of thatcame about in his lifetime. When James’ grandson, Charles II,founded the Royal Society in 1662 its members were largelyBaconian in their scientific approach. Bacon systematically sepa-rated science from metaphysics (‘the things we have to assumebefore we can do any thinking at all’), and he saw that scientificexplanations were essentially causal explanations, not explana-tions in terms of purposes or goals. His formulation of scientificmethod for discovering the truth through rational discourse andexperiment makes science perhaps the greatest achievement ofthe human mind.

René Descartes

(1596–1650) posed the question: ‘what can Iknow?’ This led to rationalism, which is based on the belief thatour knowledge of the world is acquired by the use of reason, andthat empiricism (knowledge derived from the senses) is inher-ently unreliable. He, more than anyone else, ‘sold science to edu-cated Western man’.

From the 16th Century, the fog, which from time immemorialkept the lives of most of humanity hidden from history, parted alittle when parish clergy in many kingdoms were ordered to keepregisters of births, marriages and deaths. This led to the develop-ment of demography and epidemiology.

Natural theology said that God had wrought perfect harmoni-ous adaptation between structure and function. It was prominentfrom the 17th to 19th centuries and drew heavily upon anatomyfor proof.

The message of natural theology is epitomized at more thansufficient lengths in the eight Bridgewater Treatises.

2

This serieswas commissioned by the will of the

Reverend Francis HenryEgerton,

eighth Earl of Bridgewater (1756–1829) (Fig. 1), anoble clergyman who had always neglected his parish assidu-ously and who died in 1829. He preferred dogs to people. He hadno time for women, and he declared that dogs were betterbehaved than gentlemen. The dogs ate with him every day. Ahuge table would be laid for 12 and the dogs led in, each with aclean white napkin around its neck. Servants would serve themoff silver dishes, one servant to each dog. Boots were his otherobsession. He wore a new pair every day and at night he arrangedthem round his walls and used them as a calendar. His forbears

3,4

– who included the originator of British inland navigation whohad commissioned Milton to write

The Masque of Comus

as wellas the lord chancellor of King James 1 – were involved with theonly official gold coinage minted and circulated in Ireland.

Lord Bridgewater

5

charged his executors – the Archbishop ofCanterbury, the Bishop of London and the President of The Royal

Society, with the duty of selecting eight scientific authors capableof demonstrating:

the Power, Wisdom, and Goodness of God, as manifested in theCreation; as illustrating such work by all reasonable arguments,as for instance the variety and formation of God’s creatures in theanimal, vegetable and mineral kingdoms; the effect of digestion,and thereby of conversion; the construction of the hand of man;and an infinite variety of other arguments; as also by discoveriesancient and modern, in arts, sciences, and the whole extent ofliterature

Of the men assigned to this task, four were clergymen and fourwere physicians. Three of the eight had lectured on geology atone of the universities.

The series was intended to offer a working summary of eachof the main branches of natural science. Its final impact wasexpected to demonstrate the higher meaning of the order of natureand, in Sedgwick’s phrase, to ‘ennoble empirical discovery intomorality’.

The argument began with triumphant illustrations of the utilityof natural arrangements, organic and inorganic.

Next came the evidence for unity of design. Upon this waserected the contention that so single minded a universe could nothave arisen by chance, that it was statistically impossible for suchan infinity of occurrences to work together for good withoutdivine direction.

Necessity established, it remained only to demonstrate ben-evolence: the providence that ordained that the vegetable cycleshould coincide with the solar year and the sublime goodness thatfurnished man with a hand.

Sir Charles Bell

(1774–1842; Fig. 2) drew that old favourite,the human hand

6,7

(Fig. 3). He was one of three sons of a ministerof the Church of England who died when Charles was five yearsold.

8–12

The personality and career of Charles Bell reflect theinfluence of his mother. Widowed, she assumed the respon-sibilities of rearing and educating her sons. She was a remarkablewoman, intelligent and artistic, who instilled in her sons highideals, ambition, cultural interest and a devotion that boarded onreverence. It is not surprising then that Charles was a sensitiveaesthetic person and an accomplished artist.

Charles Bell was the younger brother of

John Bell

(1763–1820) who was to become a well-known surgeon, teacher,author, and the owner of a well-appointed library.

Charles Bell was tutored in art and attended EdinburghHigh School for 3 years. Spurred by the example of his olderbrother he studied medicine at Edinburgh, attending John’sanatomical lectures and together they developed their artistictalents. While still a student he taught anatomy and published

A System of Dissection Explaining the Anatomy of the HumanBody

.

13

In 1799 he graduated and was admitted to the Royal College ofSurgeons of Edinburgh.

The success of John Bell’s anatomy classes aroused thejealousy of members of the faculty of medicine who succeededin barring him and Charles from practice at the Royal Infirmaryand from positions at the University.

In 1804, his career in Edinburgh blocked, Charles Bell wentto London. His book,

Essays on the Anatomy of Expression inPainting

(1806),

14

was the first textbook of anatomy for paint-ers. It gave an anatomical and physiological basis of facialexpression for artists and included much philosophy and criticalhistory of art.

Fig. 1.

Medallion depicting bust of the Reverend Francis HenryEgerton, eighth Earl of Bridgewater.

348 SHARP

In 1809, following the retreat from La Corunna

15

whereWellington had fought the French on the Iberian Peninsula, thewounded were brought to London. Here Charles Bell cared forthem. Bell opened a private school of anatomy, and in 1812 tookover the Great Windmill Street School of Anatomy

16

foundedby William Hunter (1718–1783) and made famous by him andhis brother, John Hunter (1728–1793). Here he proved to be anexcellent teacher while continuing his research on the anatomyand function of nerves. He ran this until 1825.

In 1814 he accepted the position as surgeon at the MiddlesexHospital and was instrumental in the founding of the MiddlesexHospital and Medical School in London in 1828.

At the Battle of Waterloo (18 June 1815), Bell operated on thewounded until ‘his clothes were stiff with blood and his armspowerless with the exertion of using the knife’.

17

It was at Water-loo that he produced the oil paintings and etchings of gunshotwounds now on display at the Royal College of Surgeons ofEdinburgh (Fig. 4).

Bell’s most important works were in the fields of research onthe brain and the nerves. His book

An Idea of a New Anatomy ofthe Brain

(1811)

18

has been called the Magna Carta of Neurology.In this book he discusses the functions of the brain, he describes

the double roots of the spinal nerves and how he, the first todo so, experimentally investigated their different functions on aliving animal – a donkey.

In Bordeaux in the early 1820s,

François Magendie

(1783–1855), who had heard of Bell’s work from John Shaw,Bell’s assistant at the Great Windmill Street anatomy school,

Fig. 2.

Bust and signature of Sir Charles Bell.

Fig. 3.

Title page from Bell’s

The Hand

.

Fig. 4.

Bell’s painting of a gunshot wound sustained in the Battleof Waterloo.

TRIPLE TIE 349

demonstrated that the ventral roots of the spinal nerves weremotor and the dorsal roots were sensory. Bell had missed thelatter fact because of his dislike of vivisection – he had alwaysstunned the animal with a blow to the head. The function of thespinal nerves became known as the Bell-Magendie law.

In 1824 Bell became the first professor of anatomy and surgeryat the College of Surgeons of London where he was well knownfor his well-prepared and elegant lectures. In 1828 he becameprofessor of physiology (at the University of London). However,he was not satisfied with the conditions at the University andresigned from his position. He then made a living from clinicalpractice, which he did not like.

He was a kindly man and somewhat a dandy in dress. In 1829,Bell received the first medal awarded by the Royal Society and50 guineas. King William IV (1765–1837) knighted him in 1831.In 1835 he accepted an invitation to become Professor of Surgeryin Edinburgh. In 1836 he left London, because ‘London was agood place to live in but not to die in’. Another reason for hisreturn was his love of fly fishing (Fig. 5)! In England he wasconsidered the foremost physician and scientist of his day.

However all is not as perfect in the Garden of Eden as thenatural theologists would have us believe. Let me illustrate. Grosstopographical anatomy

19

combined with an understanding offunction has always been the best contribution to anatomicalscience. Surface anatomy may be studied at all times and in allplaces. There are very few parts of the human body in health or indisease that repay observation better than the hand. The casualway that some artists depict the hand may lead to impreciseanatomy. Rembrandt himself is among the culprits, wonderfulanatomist though he was, for in his famous

Lesson in Anatomy

Nicholas Tulp is represented displaying the superficial flexormuscles of the fingers arising from the radial condyle of thehumerus. It would appear that Rembrandt must have drawn thedetails of anatomy from a right arm, and then have transferredthem to the left arm of his wonderfully realistic subject.

The hand as the expressor of emotional states affords a study initself; it is a study that the physician cannot afford to neglect, and

it is one to which some artists have given insufficient attention.The ‘expression’ of the hand is a thing impossible to define, andyet it is a very real factor.

Before the Battle of Agincourt in 1415, the French, anticipat-ing victory over the English, proposed to cut off the middle fingerof all captured English soldiers.

20

Without the middle finger, itwould be impossible to draw the renowned English longbow and,therefore, the archers would be incapable of fighting in the future.This famous weapon was made of the native English Yew tree,and the act of drawing the longbow was known as ‘plucking theyew.’ Much to the bewilderment of the French, the English won amajor upset and began mocking the French by waving theirmiddle fingers at the defeated French, saying, ‘See, we can stillpluck yew!’

Are we to assume the presence of five digits in the hand of ver-tebrates represents the most primitive type, or has the numberfive been evolved by the reduction, or the increase, of some moreprimitive formula? Upon this point there is a great diversity ofopinion. Before we reach agreement upon the precise number, itis necessary to review the facts that lend support to any belief inthe theory of ancestral polydactylism.

(1) In addition to the larger bones of the hand, there are othersmaller bones that occur on the radial and ulnar sides of the wrist.These bones, though commonly termed the radial and ulnar sesa-moids, are often regarded as true carpal bones despite the fact thatthey are associated with the tendons of the radial and ulnarflexors of the wrist.

(2) The normal digit may be split longitudinally into two. Thepuzzling additional toe that is present in the Dorking fowl

21

andwhich was previously thought to be a real prehallux,

22

has beenshown conclusively to be due to the cleavage of a normal digit.

23

(3) Palaeontology clearly shows a reduction from five digits toa single digit in the evolution of the horse. Has there been areduction from an even larger number than the maximum of fivein the evolution of the higher orders of the vertebrates? So farpalaeontologists have unearthed no such evidence. It might bebecause of a secondary specialization.

Fig. 5. Etching done by Bell ofhimself fly fishing.

350 SHARP

For example, when the Giant Panda (

Ailuropoda melanoleuca

)was observed in captivity, it was reported that it possessed anopposable thumb with which it could grasp shoots of bamboo. Ittherefore seemed incredible that a bear like creature of ancientpronograde (walking with the body parallel to the ground) lineageshould possess a range of thumb movement that is otherwiseconfined only to the higher primates. The truth is that the GiantPanda has a first digit of the usual pentadactylous pronogradetype. It has no specialized thumb, but has a first digit of the sametype and of the same degree of mobility as the other digits. Theapparent added digit was mistaken for a grasping thumb.

The supposed extra digit of the Giant Panda is far more inter-esting than any hypothetical prepollex. It is a development that iscaused entirely by the demands of function and one that illus-trates a great biological truth.

24

When the Giant Panda pulls a bamboo shoot, or grasps it duringthe process of eating, it holds it very tightly between its normalbear-like and passive first digit and its mobile added ‘digit’. Thegrasp is a forceps grasp rather than an opposing grasp, for theadded ‘digit’ is approximated to, rather than rotated against, itsnext-door neighbour. Anatomically, the added member is inreality no true digit, for it is developed from an added carpalelement known somewhat inaptly as the radial sesamoid (Fig. 6).The pseudo thumb of the Giant Panda is an obvious functionaldevelopment, and it is of especial interest that many of themuscles that are attached to the first digit in normal mammalshave shifted their insertion to the radial sesamoid in this animal.Functionally, this member is a thumb, a mobile, independent andpartially opposable thumb. Structurally, it is a mere makeshift.

Moving on from natural theology. The past century has beendominated intellectually by a coming to terms with science.

25

This has involved the invention of new products which havetransformed all our lives. In addition to changing what we think,science has changed how we think.

The 20th century was different from the 19th century andearlier centuries in three crucial respects.

Firstly, about 100 years ago science was a diverse set of disci-plines and not yet concerned with fundamental concepts – theelectron, the gene, the quantum and the unconscious.

Secondly, various fields of inquiry came together powerfullyand convincingly, to tell one story about the natural world. Thisstory includes the evolution of the universe and of the earth itself,

the origins of life, the peopling of the globe and the developmentof different races and civilizations. The framework is the processof evolution by natural selection.

The third area lay in the realm of psychology. The 20th centurywas a psychological age, in which the self became privatized andthe public realm – the crucial realm of political action on behalfof the public good – was left relatively vacant. The decline offormal religion and the rise of individualism made the centuryfeel different.

Science has no real agenda. To succeed, to progress, the worldmust be open, endlessly modifiable and unprejudiced. Sciencethen has a moral authority as well as an intellectual authority.

The advances in technology are one of the most obvious fruits ofscience, but too often the philosophical consequences are overlooked.

Firstly technology addresses specific issues and provides theindividual with greater control and/or freedom.

Secondly it is becoming clearer that we are living through aperiod of rapid change in the evolution of knowledge itself notmatched by comparable advances in the arts. Some may arguethat artistic culture – creative, imaginative, initiative and instinc-tive knowledge – is not and never can be cumulative as science is.Philosopher Roger Scuton commented, ‘without tradition, origi-nality cannot exist: for it is only against a tradition that it becomesperceivable’. In the 19th century Watters Pater said ‘in order toknow what is new, you need to know what has gone before;otherwise you risk just repeating earlier triumphs’. The arts andhumanities in the 20th century often revealed an obsession withnovelty for its own sake, rather than originality that expanded onwhat we knew and accepted.

Also science is a cumulative story, because later results modifyearlier ones, thereby increasing its authority. The arts and humani-ties were overwhelmed and overtaken by science in the 20th centuryquite unlike anything that happened in the 19th century or before.

A lot has been written about modernism as a response to thenew and alienating late 19th century world of large cities, fleetingencounters, grim industrialism, and unprecedented squalor. Moreimportant was the modernist response to science per se, ratherthan to the technology and social consequences it spawned. Thedifficulty of much of modern science has been detrimental to thearts. Artists have avoided engagement with most sciences leadingto a ‘third culture’ after C. P. Snow’s idea of the two cultures –literary and scientific – at odds with one another. The thirdculture is a new kind of philosophy of man’s place in the world,in the universe, written predominantly by physicists and biolo-gists. Surely this is exemplified by today’s heated debate on therole of stem cells in treating disease.

REFERENCES

1. Magee B.

The Story of Philosophy

. London: Dorling Kindersley,1998.

2. Some great British eccentrics: Man’s best friend. Available fromURL: http://www.worldzone.net/family/johnanderson/index20.shtml.Accessed on: 25 February 2003.

3. Bridgewater, Francis Henry Egerton, 8th Earl of. Available fromURL: http://3.1911encyclopedia.org/B/BR/BRIDGEWATER_FRANCIS_HENRY_EGERTON_8TH_EARL_OF.html.Accessed on: 25 February 2003.

4. 1829, Paris mint, AE medal by Donadio on Death of the Earl ofBridgewater. From Durand series of celebrated men of all cen-turies. Available from URL: http://www.rustypennies.com/catalogue/pix@catalog/pix/ae915.jpg. Accessed on: 25 February2003.

Fig. 6.

Bones in a Giant Panda’s hand. (a), prepollex; (b), pisiform.

TRIPLE TIE 351

5. Gillespie CC.

Genesis and Geology

, 1st edn. New York: Harperand Row, 1959.

6. Spector B. Sir Charles Bell and the Bridgewater Treatises.

Bull.Hist. Med.

1942;

12

: 314–22.7. Bell C.

The Hand. Its Mechanism and Vital Endowments, Evinc-ing Design

, 1st edn. London: William Pickering, 1833.8. Dr Charles Bell. Available from URL: http://www.uic.edu/Dpts/

mcne/founders/page0007.html. Accessed on: 25 February 2003.9. Charles Bell (1774–1842): An exposition of the natural system

of the nerves of the human body. Available from URL: http://www.uic.edu/depts/mcne/founders/page0007.html. Accessed on:25 February 2003.

10. Sir Charles Bell. Available from URL: http://www.whonamedit.com/doctor/cmf/2103.html. Accessed on: 25 February 2003.

11. Essays on the anatomy of expression in painting, London1806. Available from URL: http://arch.rwth-aachen.de/kunst/ww/gerlach/Physiognomik/Archiv/1896.html. Accessed on: 25February 2003.

12. Frankenstein: the modern prometheus. Available from URL:http://www.nlm.nih.gov/hmd/frankenstein/frank_modern_2.html. Accessed on: 25 February 2003.

13. Bell C.

The Anatomy of the Human Body

, 4 volumes, Edinburgh:Cadell & Davies, 1797–1804.

14. Bell C.

Essays on the Anatomy of expression in Painting

,London: Longman, Reese, Hurst & Orme, 1806.

15. Military subjects: organization, strategy and tactics. the Britishbattalions of detachment in 1809, by Robert Burnham. Availablefrom URL: http://www.napoleon-series.org/military/organization/c_detach.html. Accessed on: 25 February 2003.

16. Hunterian School of Medicine. Available from URL: http://www.ph.ucla.edu/epi/hunterian.html. Accessed on: 25 February 2003.

17. Pichot A.

The Life and Labours of Sir Charles Bell.

London:Bentley, 1860.

18. Bell

C. An Idea of a New Anatomy of the Brain; submitted for theobservations of his friends

, London: Strahan & Preston, 1811.19. Wood-Jones F.

Principles of Anatomy as Seen in the Hand

, 2ndedn. London: Baillière, Tindall and Cox, 1946.

20. The origin of the middle finger. Available from URL: http://www.aginc.net/battle/. Accessed on: 25 February 2003.

21. The Dorking Club of North America. Available from URL:http://cyborganic.com/People/feathersite/PoultryClubs/Dork/DorkHome.html. Accessed on: 25 February 2003.

22. Cowper J. On the pentadactylous pes in the Dorking fowl.

J. Anat. Phys.

1886;

20

: 593.23. Howse GB, Hill JP. On the pedal skeleton of the Dorking fowl.

J. Anat. Phys

1892;

26

: 395.24. Gould SJ.

The Panda’s Thumb: Man’s Reflections in NaturalHistory

, 1st edn. New York: W.W. Norton Inc, 1980.25. Watson P. The New Engine of History.

Sydney Morning Herald:Spectrum

2001 September 8.