intro from old age and disease in early modern medicine

8/8/2019 Intro From Old Age and Disease in Early Modern Medicine

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INTRODUCTION: GERIATRICS TODAY AND

YESTERDAY

‘Old age is not an academic subject’ – thus the Italian legal philosopher and polit-ical scientist Norberto Bobbio, then eighty-ve, began a brutally honest portrayalo his own experience o ageing. In this 1994 essay he speaks out vehementlyagainst the rhetorical glorication o lie’s nal phase that has been commonamong scholars, especially under the inuence o Cicero.1 Tere is no doubt thatthe personal experience o ageing on which Bobbio insists cannot be replacedby scholarly discourse. Nevertheless, universities have devoted a wide range o research and teaching to the topic, and their contribution to the discourse o age-ing is such that modern society can no longer be imagined without it.

Early Western universities also treated the subject o ageing. Te study o Aristotle and Galen was o especial importance. What it indicates, paradigmati-

cally, is1. an almost exclusively theoretical approach based on the scholarly reading,

discussion and organization o accumulated knowledge. In contrast, prac-tical observation (experientia) possessed almost no independent heuristicsignicance, generally serving instead to conrm theory. Teories weredeveloped

2. predominantly through the reception and adaptation o a canon o vener-able writings endowed with the highest authority. Finally, the naturalist and

philosopher Aristotle also represents3. the starting point or the interdisciplinary academic study o old age, as he

was an authority not only or medieval philosophy and theology, but also or

the emerging university discipline o medicine.Te modern university, it is true, is still undamentally characterized by the pri-macy o theory, the ruitul incorporation o available knowledge in teaching and research, and interdisciplinarity. Medicine, however, as an empirical liescience, has distanced itsel rom these basic principles; instead, practical rele-

vance, innovation in knowledge and skills, and progressive specialization are at a



2 Old Age and Disease in Early Modern Medicine

premium. Tese dierences between early and modern universities are in them-selves banal, but they must be recognized and seen as the reason or a central

premise o this study: the oreign character o bygone scientic culture. Teseare essential but di cult presuppositions or the investigation o conceptions o old age in early modern medicine. Modern interests and questions, or exampleabout progress and discoveries, or about the perspective o the patient or client(justly emphasized rom today’s standpoint by Norberto Bobbio), are subordi-nate to these considerations. Ultimately, they can only be taken up secondarily– afer an understanding has been reached o the basic theoretical principles that

were so decisive or the worldview and sel-expression o early modern Europe.

1. Methodological Considerations

Tese preliminary considerations also determine the methodological approacho the ollowing study. Concepts o old age in early modern medicine can onlybe soundly comprehended by reconstructing a representative range o the con-comitant processes o developing, portraying, and communicating theoreticalknowledge. Tis requires o historians o medicine, and o readers as well, anarduous process o adaptation: whilst we are accustomed to the search or thenovel and the spectacular as an intellectual norm o our time, now we mustappreciate the repetition and variation o centuries-old traditional knowledgeas science. Te impartial and comprehensive analysis (to the extent such is

possible) o extant text corpora might be much less spectacular than, say, the

identication and verication o modern science’s theoretical oundations in anarrow selection o sources; still, such ideas’ representativeness or their timeremains unclear, and out o context the sources can only be evaluated partiallyand in extracts. In contrast, the comprehensiveness aimed at in the study o agiven body o texts yields quantitative evidence (e.g., how ofen certain hypothe-ses are made in comparison to others), and this aords above all a valid portrayalo ‘mainstream’ medical concepts o old age. Te power o a study grounded inthis way goes ar beyond the desultory evaluation o works by certain more-or-less amous contemporaries. In act, it takes the next step, tting the apparent

peculiarities o these putatively ‘orward-looking’ individuals into the historicalcontext under consideration. Ultimately, the object o a representative portrayalo medical conceptions also includes recognizing and singling out actual devia-tions rom the norm; they arouse our interest, o course, on account o their

progressiveness or curiosity, but they remain grounded in their historical contextand can be characterized accordingly.

In its search or broadly diused medical views o old age, the present studythus considers a much larger range o written sources rom the sphere o earlymodern medicine than ever beore. In order to give the source-base a certain



Introduction 3

unity, it has been limited or the most part to so-called normative specialist lit-erature written by physicians. Other sources, considerably more ruitul romthe point o view o social history, will have to be disregarded. Letters, tax listsor hospital records could complement traditional medical conceptions o oldage with the essential counterparts o subjective experience and objective prac-tical relevance, but they would go beyond the scope o this book. Tus, only acertain point o view suraces in this study, that presented by the highly-stylizedspecialist literature o the medical proession. Te ormative inuence that thesetheoretical conceptions had on the everyday lie o the time, however, shouldnot be underestimated.

Te decision to ocus on the specialist literature o learned medicine bringsits institutional context equally to the ore: the university, with its above-men-tioned structures o treating and communicating knowledge. Te university,however, will only become the setting or the presentation o knowledge in thesecond hal o the period under consideration. Nevertheless, even beore thistime nearly all the authors treated here underwent a ormative medical educa-tion. Our study must thereore pay particular attention to the typical academicstructures o organizing knowledge that were mentioned at the outset: on theone hand the reception o traditional knowledge, medical and otherwise, aboutold age, on the other interdisciplinary integration with other areas o expertise.In this way it will be possible at the same time to do justice to the polyhistoricideal o the period.

Considerations on the quantitave oundation o concepts o old age andtheir place in the broader context o learned medicine have also determinedthe temporal span o this study: it is essentially identical with the period o theearly modern university (rom ca. 1300) until the French Revolution. exts rombeore the era o printing will only play a marginal role, as only a ew o themdiscretely treated the topic o old age and also made a noteworthy impact. Tesubsequent three centuries, despite dramatic conceptual and heuristic changes,are marked by a continuous intellectual tradition. Teir intellectual ounda-tion was the reception o antiquity, their common medium the lingua rancao learned Europe, Latin. Both come to an end around 1800, thus providing aterminus to the period o study. Limiting the study to a shorter span o time,and thereore to one historically much simpler to dene, would be easy to jus-

tiy; the quantitative distribution o the sources (see below), however, makes itunwise. Speaking against such a oreshortening is also the goal o the method wehave adopted: to provide an overview o the medical discourse o old age, andto reconstruct the currents o reception or proto-geriatric medicine in the earlymodern period.




2. Guiding Questions

A caveat has already been given against anachronistic hypotheses that on theirace appear incongruent with the intellectual tradition o early modern special-ist literature. Nevertheless, it would be inappropriate to approach early modernscience in a theoretical vacuum. Indeed, our methodological considerations giverise to a number o interesting questions dealing with:

1. the sources analysed;2. the concepts discussed, as well as their traditions, discontinuities, and devel-

opment within the period under consideration;

3. underlying tendencies o the medical discourse o old age.1. A whole range o ormal questions relates to the sources under analysis andtheir place in the context o contemporary specialist literature. Here the ques-tions tend to be o a philological nature: Who wrote about the topic o old age,

when and why? What kind o orm and content characterize the kinds o texts2

that deal specically with this topic? Are there any related genres? For whataudience were they (presumably) intended? Does the age or social status o theauthor, patron, or audience play a decisive role? How is the production o spe-cialist literature distributed across the period o study?

2. Regarding content, the conceptions discussed must be investigated acrossthe whole range o texts. What anatomical, physiological and pathological

models o old age and ageing are discussed, and what ideas are developed or prevention and treatment? Does specialist medical literature also assimilateinormation on numerical, psychological and social ageing in its descriptiono biological decline? What relationship do various concepts o old age bear toone another, to scientic theories about growth, involution and death, as wellas to conceptions o illness? What is the meaning o contemporary innovationsin medicine and science? What inuence do older medical and non-medicalsources exert over concepts o old age; what is the extent and the nature o theirreception? What are the possibilities and limits o the interdisciplinary discus-sion o these concepts?

3. Finally, distinctive eatures o the medical discourse o old age can besought afer with regard to the theory o proessions. Are there any indications

o an early modern ‘proto-geriatrics’ or ‘gerontology’ (in the sense o a scienceo longevity), or o a ‘medicalization o old age’?3 Does the nal period o lierst become construed as a separate age on account o the normative power o medicine, and, conversely, are there any signs o a gradual deconstruction o thisarteact? What moral judgment does the medical discourse o old age embodyin comparison to social views o old age, and are the dierences rooted in thenature o the medical proession?



Introduction 5

Tese are only the most important questions arising rom a source-based,reception-historical study o medical concepts o old age. Teir investigation isthe object o the individual chapters o this study. Te most important ndings

will be presented in the Conclusion.

3. Selection o Sources

As explained in the section on methodological considerations, the range o sources is conned to normative texts o learned European medicine between1500 and 1800. Within these limits, all available writings on old age weretreated as objects o inquiry. Teir investigation was acilitated with the help o

bibliographical aids such as printed library and university catalogues4, severalspecialized bibliographies5 and electronic resources (OPACs). Admittedly, thisresearch method brings with it the risk o systematic error in the geographicaldistribution o identied sources, since northern and central German libraries,as well as the Biblithèque nationale de France, have catalogued their old disserta-tion holdings more comprehensively than other repositories have.6

Te search or sources yielded two main groups, namely (1) about 130 medi-cal university texts (predominantly rom the period between 1620 and 1800)and (2) about thirty proto-geriatric texts written without any direct connectionto universities and pertaining predominantly to the dietetic tradition o Galenicgerocomies. In addition, a selection o (3) general medical writings and hand-books and (4) writings on longevity were considered, chosen on the basis o the

range and relevance o their treatment o the topic o old age. Te same criterionapplies to theological, legal, philosophical and philological works, which weregenerally selected and investigated in relation to specic questions (see the ol-lowing section).

4. Plan o the Study

A study that, or reasons o method, takes about three hundred years into its purview cannot be arranged solely according to thematic (e.g., medical) andconceptual criteria. And yet a chronological division into general historical ages(organized, e.g., by centuries or by political or cultural-historical events) wouldobscure the relevant changes that take place in the subject matter and in the his-

tory o science. Looking to the texts themselves, a chronological break appearsin the early seventeenth century (1620-30). Tis period witnesses both the wan-ing o a rst wave o dietetic writings (the true gerocomies) and the beginning o proto-geriatric university texts. Tus the material can coherently be dividedinto two main sections with minimal chronological overlap: one devoted pre-dominantly to gerocomies (Chapter 2), the other to university texts (Chapter3). Both genres are investigated according to the traditional medical specialties




o physiology, special pathology, dietetics and therapy; many o the texts them-selves were arranged along these lines. General medical works are consulted orcomparison in both chapters in order to determine the degree o specicationound in proto-geriatric writings; medical texts on longevity are also discussed.Dierentiating proto-geriatric texts rom those on longevity is complicated byan overlap in subject matter that can at times be considerable; it is thereorenecessary to undertake a combined analysis o ormal and subject-specic char-acteristics as well as o dierences in the way old age is evaluated.

Te central role played by the reception o ancient sources in early moderntexts necessitates preacing the two main sections with a third that assembles therelevant testimony rom Greco-Roman, Islamic and medieval Latin medicine,(natural) philosophy, natural history and literature (Chapter 1).

Tese three main sections provide a comprehensive overview o early mod-ern proto-geriatrics as an academic culture o learning. Tey are complementedby a case study (Chapter 4) that, in light o additional texts some o which arein part unrelated to the eld, investigates the source material or special peculi-arities.7 Here the spotlight is on gender and a nearly orgotten sub-group o theelderly: old women.

5. Te State o Research

Old age has long been the object o historical research, although dierent waveso scholarly interest can be observed in various elds o specialty. O the numer-

ous studies in the history o medicine, as well as those o a more general historicalor philological nature, only the most important can be mentioned here.

Research pertaining more strictly to the history o medicine began dealing with past medical concepts o old age relatively early8, parallel with the begin-nings o modern geriatrics in the 1940s. Te best scholarly study o old ageand ageing is still that published in 1958 by the renowned historian o scienceMirko D. Grmek, which takes a diachronic, systematic, and concept-orientedapproach.9 Paul Lüth’s monograph on the history o geriatrics (1965) is the mostextensive and still the most recent comprehensive account o medical percep-tions o old age in the context o the general history o medicine and intellectualhistory. Afer Lüth, studies in the history o medicine ocus only on specic time

periods or particular topics.10 In summary, it can thus be said that research onold age in this eld, despite achieving a relatively high standard early on, has to alarge extent become antiquated both methodologically and actually (althoughspecialized studies are an exception). Shortcomings are especially clear or theearly modern period.

Te opposite is the case in various elds o general history, where the topic o old age was discovered rather late. One o the impulses was Simone de Beauvoir’s



Introduction 7

voluminous 1970 study denouncing (or the rst time) the repression o old agein modern society; it is a work o popular science written rom an ethnologi-cal and historical perspective. In historical social research, a eld developed byPhilippe Ariès and Jacques Gélis, childhood and old age have been topics since1960.11 Since then the number o studies on old age has continually increased,especially in the elds o historical discourse analysis and people’s history, andit is now nearly impossible to survey. Such studies occasionally address medicalaspects o old age, although naturally without giving them closer consideration.Meanwhile cultural history ( Kulturgeschichte) and the history o mentalitieshave produced numerous surveys.12 More comprehensive research in social his-tory tends to ocus on the nineteenth and twentieth centuries and only payscursory attention to earlier ages;13 it was in this context, or example, that Hans-

Joachim von Kondratowitz was one o the rst to ormulate the important thesiso the ‘medicalization o old age’ (1989). Research in early modern social his-tory, in contrast, still generally takes the orm o micro-studies on account o the kinds o sources it uses. Tis is also the case or the ew studies touching on medical topics.14 Te ndings o historical demography are relevant or thesubject as well.15

Finally, since the present essay is concerned with textual and reception his-tory, certain studies rom the realm o classical philology are also o importance.16

Regardless o its particular method, the ollowing essay can thus clearly ndsupport in available research or what pertains to the historical ramework, the

main eatures o medical concepts o old age, and the selection and interpretationo the most important proto-geriatric texts. Beyond these rudiments, however,the history o early modern geriatric medicine is a vast expanse o unknown textsand authors still requiring discovery, description and analysis.

6. Introduction to the Subject

In their scant instruction in the history o medicine, medical students learn thatgeriatrics was born in the early twentieth century and thus that it constitutesone o the more recent specialties in their uture proession. Tis is ully correctin view o the naming 17 o geriatrics and o its late proessionalization; only inthe 1940s did the discipline begin to develop with the ounding o its own pro-essional associations and journals and nally with its recognition as an area o specialty, including the denomination o its practitioners as geriatricians. Never-theless, it will not be anachronistic to speak o ‘proto-geriatric’ literature o theearly modern period, as the ollowing essay repeatedly does. Specialist medicalliterature o this kind, namely monographic accounts o physiological, patho-logical, therapeutic, preventative and diagnostic issues regarding the elderly, didnot begin with the largely still amiliar works o Max Bürger, Marjory Warren,




Ignaz Nascher or Jean Martin Charcot. On the contrary, it was already devel-oping (under the rubrics just named) at the end o the feenth century, andcertain aspects had ormed a central element o medical literature or two thou-sand years beore that. Despite its astonishing range and sophistication, thisolder specialist literature is barely known today even by experts in the eld, notleast because beore the nineteenth century it was written almost exclusively inLatin – once the language o medicine but now little understood. Te rediscov-ery o this literature is desirable or many reasons: medical historians would gainnumerous new tesserae or lling in the mosaic o earlier medicine; the mod-ern geriatrician, as well as the medical layman, could use the mirror o historyto study current questions and problematic issues in the eld, many o whichare timeless; older approaches could then be compared to modern ones, thusspawning ideas or the uture. Tis is especially the case or ethical questions,

which abound in geriatrics. In addition to these proessional issues, the general portrayal and valuation o old age are also o great interest.

A ew preliminary remarks on the early modern situation remain to be made.It may be assumed as known that the populations o early modern Europeansocieties were marked by an age distribution that diers drastically rom that o today. From the sixteenth to the eighteenth centuries, a newborn had a nearlyconstant average lie expectancy o only about thirty years. Yet this statistic hidesthe act that individuals o that time could also grow old, especially i they livedbeyond ten years o age, beore which at least one-third o all children died.

Afer that point, average lie expectancy rose to nearly fy years, which meantthat quite a ew people reached an age that even by today’s standards would bedeemed old. Regional and temporal dierences aside, less than 10 per cent o

people lived beyond sixty18, and eighty- to ninety-year-olds were a downrightrarity. Te result o these circumstances, on the one hand, was that both thegeneral population and physicians had a dierent notion (rom us) o when oldage began: despite dierent traditions and the lack o benchmarks or a socialdenition o old age (such as a xed retirement age), fy was the age most ofennamed19; seventy rather than eighty was realistically considered the upper limito lie expectancy. Tus the early modern physician saw old people in today’ssense relatively seldom, and even in the eighteenth century he still had only littleoccasion to acquaint himsel with their particular anatomy through the dis-

section o cadavers. On the other hand, the greater physical demands on largesections o the population, as well as decient nutritional and living conditions,led to the earlier deterioration o certain organs (e.g., joints, teeth) and the accu-mulation o certain (e.g., rheumatic) ailments. In contrast, other illnesses thattoday are common in old age, such as malignant tumours and dementia, were or

purely demographic reasons encountered much more rarely.20



Introduction 9

Another peculiarity, nally, concerns the gender neutrality o old age. Inline with the customs o the time, in which the male sex was considered thehuman norm, the texts almost exclusively use the term senex (old man). As anearly modern substantive, senex is, o course, technically masculine, and it willthus be rendered as such in what ollows, but in light o the context it must beregarded as pertaining to both sexes. Female terms ( anilitas, anus, vetula) wereonly used or topics specic to women.21 A parallel to this terminological indi-erence can also be ound, by the way, in the early modern assessment o elderlysex-lie, although women are ascribed ull asexuality even earlier than men. Tection o gender neutrality is abandoned, however, when the alleged lustulnesso the elderly is discussed rom a moral point o view, or their marriageabilityrom a orensic one.22

Tis example arrestingly shows just how highly stylized early modern spe-cialist literature was. Tis ction, however, is ruptured time and again by reality,

which otherwise remains hidden behind equally conventional counter-argu-ments. Te selective use o such arguments highlights their instrumentalization;in addition, they provide important indirect evidence o the individual authors’

views. Ample variations o this phenomenon will appear in the ollowing essay.

intro from old age and disease in early modern medicine

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