Part Two
Mind and Body in Practice: Physiology, Literature, Medicine

Four
Thomas Willis and His Circle:
Brain and Mind in Seventeenth-Century Medicine

Robert G. Frank, Jr.

In the autumn of 1663, a middle-aged, and now moderately successful, Oxford physician took up his pen to write an "Amico Lectori Praefatio." He wanted to explain to his prospective readers how he had occupied his two years past, and how he had come to write the more than 450 quarto pages of Cerebri anatome that followed. Academic responsibilities and a disillusionment with his own speculativeness had led him to publication. His position as Sedleian Professor of Natural Philosophy demanded that he lecture twice a week on, as he put it, "the Offices of the Senses, both external and also internal, and of the Faculties and Affections of the Soul, as also of the Organs and various provisions of all these." He had, he said, thought of "some rational Arguments for that purpose, and from the appearances raised some not unlikely Hypotheses, which (as uses to be in these kinds of businesses) at length accrued into a certain System of Art and frame of Doctrine." Yet "when at last the force of Invention [had been] spent," the lecturer reconsidered these things seriously, and "I awaked at length sad, as one out of a pleasant dream." He realized that "I had drawn out for my self and auditors a certain Poetical Philosophy and Physick."^[1]

Indeed, if this Clark Library series promises to show us anything, it

[1] Thomas Willis, Cerebri anatome: Cui accessit nervorum descriptio et usus (London, 1664), sig. a1v. This and all subsequent citations to the Cerebri anatome are to the quarto edition of 1664, not to the octavo printing in the same year. Quotations in English are based upon the translation by Samuel Pordage, "Of the anatomy of the brain" [separately paginated], in Thomas Willis, Practice of physick (London, 1681), 53. In all cases the English translation has been checked against the Latin original, since there are occasional discrepancies.

is that problems of "mind and body" have exercised the "force of Invention" of numerous thinkers in the Enlightenment, and that "rational Arguments" derived from "appearances" do most certainly "accrue" into systems of "Doctrine."

Yet our physician, Thomas Willis, felt that there was a way out of this dilemma. The contemplation of the mind and its faculties need not lead invariably to "Poetical Philosophy." He felt that he himself had entered upon a "new course," independent both of the "Received opinions of others," and of the "guesses" of his own mind. He would believe only "Nature and ocular demonstrations."

Therefore thenceforward I betook my self wholly to the study of Anatomy: and as I did chiefly inquire into the offices and uses of the Brain and its nervous Appendix, I addicted my self to the opening of Heads especially, and of every kind, and to inspect as much as I was able frequently and seriously the Contents; that after the figures, sites, processes of the whole and singular parts should be considered with their other bodies, respects, and habits, some truth might at length be drawn forth concerning the exercise, defects, and irregularities of the Animal Government; and so a firm and stable Basis might be laid, on which not only a more certain Physiologie than I had gained in the Schools, but what I had long thought upon, the Pathologie of the Brain and nervous stock, might be built.^[2]

This was a bold enterprise indeed: to believe that systematic anatomy of the brain, especially of the comparative sort, would lead to discovering patterns of function and dysfunction, and that these in turn would illuminate the cluster of subjects that launched Willis in the first place—the nature of senses and the faculties of the soul.

Yet it turned out to be an enterprise that, in the eyes of Willis's contemporaries and successors, was both highly productive and very successful. Cerebri anatome (1664) was just the first of Willis's books on the nervous system and its attributes. Following soon thereafter was the Pathologiae cerebri (1667),^[3] then a defense of his views on the neural origins of hysteria and hypochondria (1670),^[4] and De anima brutorum

[2] Willis, Cerebri anatome, sig. a2r; "Anatomy of the brain," 53.

[3] Thomas Willis, Pathologiae cerebri, et nervosi generis specimen: In quo agitur de morbis convulsis, et de scorbuto (Oxford, 1667); translation by Pordage as "An essay of the pathology of the brain and nervous Stock: In which convulsive diseases are treated of," in Willis, Practice of physick [separately paginated].

[4] Thomas Willis, Affectionum quae dicuntur hystericae & hypochondriacae pathologia spas-modica vindicata, contra responsionem epistolarem Nathanael Highmore, M.D.: Cui accesserunt exercitationes medico-physicae duae. 1. De sanguinis accensione. 2. De motu musculari, (London, 1670). The response to Highmore has not been translated; the other two tracts appear as "Of the accension of the blood" and "Of musculary motion" in Willis, Practice of physick [separately paginated].

(1672).^[5] These more than 1,400 quarto pages all arose explicitly out of his work at Oxford. The neurological works were embedded in, and made up the largest part of, an oeuvre that occupied an honored place in late-seventeenth- and eighteenth-century medicine. Willis's individual treatises went through numerous editions in his own lifetime. His works were rapidly translated into English in the 1680s, and his Opera omnia went through eleven editions between 1676 and 1720.^[6] They continued to be highly influential through the 1770s, and in the 1820s the neuro-anatomist Karl Friedrich Burdach had many good things to say about Willis's work on the brain.^[7] In the twentieth century, even after his investigations have ceased to have an active scientific influence, Willis is still widely known among neuroscientists, and he attracts a steady stream of biographers and commentators.^[8] Certainly then, in any discussion of "mind and body" in the Enlightenment, Willis should command our attention.

Here I wish to examine, not effects, but origins. How is a highly im-

[5] Thomas Willis, De anima brutorum quae hominis vitalis ac sensitiva est, exercitationes duae. Prior physiologica ejusdem naturam, partes, potentes & affectiones tradit. Altera pathologica morbos qui ipsam, & sedem ejus primarium, nempe cerebrum & nervosum genus afficiunt, explicat, eorumque therapeias instituit (Oxford, 1672); the Pordage translation is Thomas Willis, Two discourses concerning the soul of brutes, which is that of the vital and sensitive of man. The first is physiological, shewing the nature, parts, powers, and affections of the same. The other is pathological, which unfolds the diseases which affect it and its primary seat; To wit, the brain and nervous stock, and treats of the cures (London, 1683).

[6] Consider for a moment the numbers and distribution of Willis's individual writings: Diatribae duae, fifteen editions in the period 1659-1687, published at London, Amsterdam, Geneva, Paris, The Hague, and Middelburgh; Cerebri anatome, eight editions in 1664-1683, published at London, Amsterdam, and Geneva; Pathologiae cerebri, eight editions in 1667-1684, published at Oxford, London, Amsterdam, and Geneva; Affectionum, four editions in 1670-1678, published at London, Leiden, and Geneva; De anima brutorum, eight editions in 1672-1683, published at Oxford, London, Amsterdam, Lyon, and Cologne; Pharmaceutice rationalis, parts I and II, eleven editions in 1674-1680, published at Oxford, London, Amsterdam, The Hague, Lyon, Geneva, and Cologne. After Willis's death the most common way of bringing out his writings was as an Opera omnia or an edition abridged from it, either in Latin or in English; between 1676 and 1720 there were sixteen such editions, published at London, Geneva, Lyon, Amsterdam, Cologne, and Venice.

[7] Cf. the praise for Willis in Antoine Portal, Histoire de l'anatomie et de la chirurgie (Paris, 1770-1773), 3:86-105, and A. Meyer, "Karl Friedrich Burdach on Thomas Willis," Journal of the Neurological Sciences 3 (1966): 109-116.

[8] Since the 1920s, articles on Willis have appeared at the rate of about four to eight per decade; the exception is the 1960s, in which thirty-three articles and books on Willis were published, many of them prompted by the tricentennial of Cerebri anatome.

portant set of results and ideas created? Specifically, how does one work on the problem of brain and mind in the context of seventeenth-century medicine and culture? I use the phrase "work on" quite deliberately, because my primary focus is the process of creation, not the results.

I would like to explore this creative process by asking three interrelated sets of how questions. How biographically? What is the trajectory of a man's life that brings him to a point of creativity, and what is the constitution and integration of the elements of that life such that he creates a product in a unique way? How operationally? What are the social and scientific circumstances under which the work is carried out, and how do these circumstances relate to the essential nature of the product? How intellectually? In what ways does a scientist approach his subject, and deal with it, so as to produce new ideas and results? Since the object of Willis's inquiry was the brain and nervous system, neuro-anatomy necessarily enters into the discussion; but its entry is subservient to my larger aim of showing Willis and his circle at work. I am not concerned here with a complete description of Willis's neuroanatomy and neurophysiology. Nor do I wish to judge in what ways his work anticipates, or fails to anticipate, the concepts of the twentieth-century neurosciences. I ask, rather, how one constructs a system of brain and mind, three hundred years ago, in the absence of what we flatter ourselves by calling the necessary tools and insights of modern science.

WILLIS'S PATH TO THE BRAIN

Willis is in many ways very apt for such purposes of exemplification. He was no great genius. Rather, he was an ordinary man in extraordinary times. He lived through a revolution and a reaction. His life straddled the transition between late-Renaissance and early-Enlightenment England, and he lived it successfully in two contrasting spheres of academic reclusion and worldly bustle.

Willis was born in 1621 near Oxford, and stayed in the shadow of its spires for almost half a century, moving to London only in 1667, where he died in 1675.^[9] In his early life he was surrounded by the traditional

[9] To date, the only full-length biography is Hansruedi Isler, Thomas Willis: Ein Wegbereiter der modernen Medizin, 1621-1675 (Stuttgart: Wissenschaftliche Verlagsgesellschaft, 1965); this was translated, with additions, by Islet, Thomas Willis, 1621-1675: Doctor and Scientist (New York: Hafner, 1968). The late Kenneth Dewhurst has been the scholar most active in writing about Willis over the past two decades. Much biographical material is contained in the long introductions to his editions of Willis manuscript material: Thomas Willis's Oxford Lectures (Oxford: Sandford, 1980), 1-49; Willis's Oxford Casebook (1650-52) (Oxford: Sandford, 1981), 1-59. A useful synoptic view of Willis's life and scientfic ideas is Robert G. Frank, Jr., "Thomas Willis," in Dictionary of Scientific Biography (New York: Charles Scribner's Sons, 1970-), 14: 404-409.

verities of crown and church; then, when King confronted Parliament, the world was, in Christopher Hill's phrase, turned upside down. Like many, he fought for the Royalist cause between 1643 and 1646, main-rained a secret opposition through the Commonwealth period, and was elated at the Restoration. Nor did Willis possess unusual qualities of personal magnetism. He was merely honest in speech and conservative in mentality. With typical earthiness, John Aubrey tells us that Willis was of "middle stature: darke red haire (like a red pig)," and "stammered much."^[10] Antony Wood called him simply "a plain man, a man of no carriage, little discourse, complaisance, or society."^[11] What was there about his life that brought him to the enterprise of grounding mental phenomena in neural tissue? His biography, which has been reasonably well explored, contains scattered bits of evidence that bear upon the origins of his neurological work.

Willis was first and last a clinician. He began practicing medicine at Oxford about age 24, and continued his profession daily until the week of his early death at age 54. The greater part of his first book in 1659 applied ideas of fermentation to explain fevers,^[12] and his last, the Pharmaceutice rationalis of 1674, was an omnium-gatherum of his clinical judgments and prescriptions.^[13] He was a successful practitioner, but this came only slowly. As a young doctor in the late 1640s he hustled for pa-

[10] "Brief Lives," Chiefly of Contemporaries, Set Down by John Aubrey, between the Years 1669 & 1696, ed. Andrew Clark (Oxford: Clarendon Press, 1898), 2: 303.

[11] Anthony Wood, Athenae Oxonienses: An Exact History of All the Writers and Bishops Who Have Had Their Education in the University of Oxford, new ed., ed. Philip Bliss (London: Rivington, 1813-1820), vol. 3, col. 1051.

[12] Thomas Willis, Diatribae duae medico-philosophicae, quarum prior agit de fermentatione sive de motu intestino particularum in quovis corpore; altera de febribus, sive de motu earundum in sanguine animalium. His ascessit dissertatio epistolica de urinis (London, 1659). The three treatises are paginated separately, so I shall refer to them as De fermentatione, De febribus, and De urinis. All were translated by Pordage as "Of fermentation," "Of feavers," and "Of urines" [separately paginated], in Willis, Practice of physick. In this, as in other works of Willis for which more than one edition was published in Willis's lifetime, one must exercise caution in using the Pordage translation; it sometimes contains intercalated sentences, paragraphs, or even sections that are not found in the first edition.

[13] Thomas Willis, Pharmaceutice rationalis. Sive diatriba de medicamentorum operationibus in humano corpore [Pars I] (Oxford, 1674); translation by Pordage as "Pharmaceutice rationalis, Part I," in Willis, Practice of physick. Thomas Willis, Pharmaceutice rationalis... Pars secunda (Oxford, 1675); translation by Pordage as "Pharmaceutice rationalis, Part II," in Willis, Practice of physick.

tients on market days in neighboring towns, and a clinical notebook kept in 1650 shows a practice that was certainly not booming.^[14] But by 1657 he had acquired enough skill, patients, and financial security to marry, and the Restoration set his career firmly on the upward path. By the early 1660s he was buying properties in Oxford, and just before his departure from there he had the highest income in the town.^[15] The move to London brought more success and, as Wood noted, "in very short time after he became so noted, and so infinitely resorted to, for his practice, that never any physician before went beyond him, or got more money yearly than he."^[16]

But Willis was successful in more than simply monetary terms. He was a remarkable clinical observer. His characterizations of epidemics were particularly acute; he reported in detail the first English outbreak of war typhus among the Oxford troops in 1643, cases of plague in 1645, measles and smallpox in 1649 and 1654, and influenza in 1657. He also recorded what seems to be the first reliable clinical description of typhoid fever. For a variety of other clinical descriptions, his works contain in each case the locus classicus: myasthenia gravis; the distinction between acute tuberculosis and the chronic fibroid type; the first clinical and pathological description of emphysema; extrasystoles of the heart; aortic stenosis; heart failure in chronic bronchitis; emboli lodged in the pulmonary artery; the first European to note the sweet taste of the urine in diabetes mellitus.^[17] Overall, he was a moderate in therapy^[18] and seems—at least as reflected by his writings—to have had no great knowledge of Galen or Hippocrates. Throughout his life, his abiding interest was his patients, not learned medicine.

In addition to being an acute but conservative physician, he was also

[14] Aubrey, "Brief Lives " 2: 303. Cf. Dewhurst, Willis's Oxford Casebook, where Willis notes seeing only forty-six separate patients in 1650; many, however, were seen more than once, and it seems most likely that Willis did not record all of his cases.

[15] On Willis's growing wealth and acquisition of properties, see Dewhurst, Willis's Oxford Lectures, 9-12, 14-18, 20-26; Willis's Oxford Casebook, 41-42, 55-56.

[16] Wood, Athenae, vol. 3, col. 1051.

[17] See, for example, the selections from Willis's writings in Ralph H. Major, Classic Descriptions of Disease (Springfield, Ill.: Charles C. Thomas, 1932), 121-124, 133-136, 192-194, 534-536, 541-545, 591-593. A good overview of Willis's clinical accomplishments is R. Hierons, "Willis's Contributions to Clinical Medicine and Neurology," Journal of the Neurological Sciences 4 (1967); 1-13.

[18] Willis's practice, as it appeared to his contemporaries, is reflected in the diary-like commonplace books of his younger Oxford contemporary, John Ward; see Robert G. Frank, Jr., "The John Ward Diaries: Mirror of Seventeenth-Century Science and Medicine," Journal of the History of Medicine and Allied Sciences 29 (1974): 147-179.

a staunch churchman. He seems originally to have been destined for holy orders, but the Civil War derailed his clerical career. He maintained his strong Anglicanism throughout the interregnum, and his residences at Oxford, both when he lived in Christ Church and in Beam Hall, were used regularly for sub-rosa worship. His friends during this period included John Fell (whose sister he married), Gilbert Sheldon, John Dolben, and Richard Allestree; after the Restoration these four became, respectively, the Bishop of Oxford, the Archbishop of Canterbury, the Archbishop of York, and the Regius Professor of Divinity as well as the Provost of Eton.^[19] Willis was especially close to Fell and Allestree; not only did Richard Allestree take a course in chemistry from Willis, but his brother James, the printer, brought out Willis's first four books.^[20]

Willis's religion, although not at all theological, was more than merely a matter of friends and politics. He gave to the poor all the fees he earned on Sundays. He went to church daily, and when he found that his London practice precluded midday worship, he paid a priest at St. Martin's in the Fields to read prayers early and late, for such as he, who could not otherwise attend. Characteristically, he endowed this position in his will. As Wood said, he "left behind him the character of an orthodox, pious, and charitable physician."^[21]

This orthodoxy squared with his early philosophical education. He had matriculated at Oxford in the boom years of the mid-1630s, proceeding to the B.A. in 1639, and to the M.A. in 1642.^[22] At that time the colleges were throwing up new buildings with abandon to accommodate the thousands who, largely for social reasons, wanted a traditional uni-

[19] Wood, Athenae, vol. 3, cols. 1049—1050; Anthony Wood, The History and Antiquities of the University of Oxford, ed. and trans. John Gutch (Oxford: For the editor, 1796), 2: 613; Cf. the brief obituary by John Fell which was appended to the Pharmaceutice rationalis... Pars secunda, sig. b3v-b4r; "Pharmaceutice rationalis, Part II," sig. A2v-A3r.

[20] Richard Allestree was reputed to be the author of The causes of the decay of Christian piety (London, 1668), and on the copy in the Bodleian Library is the anonymous note that "Dr. Allestree was author of this book, and wrote it in the very same year wherein he went thro' a course of chymistry with Dr. Willis, which is the reason why so many physical and chymical allusions are to be found in it": Dictionary of National Biography 15: 87, under entry "Pakington". Other than purely conventional figures of speech, there are medical or chemical references in Causes at pp. 4-5, 29, 58, 75, 118-119, 122, 253. James Allestry, Richard's brother, published Willis's Diatribae duae (1659), Cerebri anatome (1664), Pathologiae cerebri (1667), and Affectionum (1670).

[21] Wood, Athenae, vol. 3, col. 1053.

[22] Joseph Foster, ed., Alumni Oxonienses: The Members of the University of Oxford, 1500 -1714 (Oxford: Parker, 1891-1892), 4: 1650. Willis matriculated from Christ Church, 3 March 1636/7; B.A., 19 June 1639; M. A., 18 June 1642.

versity education.^[23] The curriculum was still highly Scholastic, and was organized around the two medieval elements of lectures and disputations.^[24] Especially in the years between the B.A. and the M.A., Willis would have studied traditional natural philosophy, geometry, and astronomy. He would have dutifully read his Aristotle, absorbing what he was later to call "those vain figments," the Peripatetic forms and qualities.^[25] Although Willis is often—and rightly—portrayed as one of the new breed of savant that the seventeenth century created, he was certainly perceived by his contemporaries as intellectually reliable enough that, in 1660, through the influence of Sheldon, he was elected Sedleian Professor at £120 per annum.^[26]

Physician, pillar of the church, Scholastic—described thus far, Willis would hardly seem an innovator. How did he come to his reputation as a master of brain anatomy and theoretician of the soul? His portal of entry, I would argue, was originally not anatomy, as one would expect, but a subject more appropriate to the humble prescribing medico: chemistry. As early as 1648, when he still lived in bachelor rooms in Christ Church, he joined with another Anglican perforce turned physi-

[23] On the growing popularity of the English universities see Mark H. Curtis, Oxford and Cambridge in Transition, 1558-1642 (Oxford: Clarendon Press, 1959); Kenneth Charlton, Education in Renaissance England (London: Routledge and Kegan Paul, 1965); Hugh Kearney, Scholars and Gentlemen: Universities and Society in Preindustrial Britain, 1500-1700 (Ithaca, N.Y.: Cornell University Press, 1970); Lawrence Stone, ed., The University in Society (Princeton: Princeton University Press, 1974). In the 1540s Oxford admitted about 40 B.A.s and 20 M.A.s each year; by the 1620s this had grown to the extent that about 400 new students came to Oxford each year, of whom an average of 240 would proceed to the B.A., and about 150 to the M.A.; see Robert G. Frank, Jr., "Science, Medicine and the Universities of Early Modern England: Background and Sources," History of Science 11 (1973): 194-216, 239-269, especially 213. For the physical growth of the colleges in the pre-Civil War period, see the Victoria History of the County of Oxford, ed. H. E. Salter and M. D. Lobel (London: Institute of Historical Research, 1954), 3:96, 102, 115-116, 127-128, 169-170, 216-217, 240-242, 272-274, 283-285, 289.

[24] The relation between statutory forms and scholastic content at an English university is brilliantly set forth in William T. Costello, The Scholastic Curriculum at Early Seventeenth-Century Cambridge (Cambridge, Mass.: Harvard University Press, 1958). On the relation of science to the scholastic format, see Frank, "Science, Medicine and the Universities," 200-207.

[25] For a description of the arts curriculum at Oxford in the late sixteenth and early seventeenth century, see Andrew Clark, Register of the University of Oxford, vol. 2 (1571-1622), part 1 (Oxford: Oxford Historical Society, 1887).

[26] The documents on Willis's election are in the Oxford University Archives, "Regis-trum Convocationis, 1659-1671," reverse codex f. 4r-v.

cian, Ralph Bathurst, in preparing chemical compounds.^[27] His case notes of 1650, although largely Galenic in framework, show him edging toward chemical explanations of blood composition. Take, for example, the phenomenon of diffused pains; Willis thought they were due to an "acrid salt."^[28] By 1652 Willis was one of an inner circle of eight Oxford virtuosi who, according to Seth Ward, had "joyned together for the furnishing an elaboratory and for makeing chymicall experiments wch we doe constantly every one of us in course undertakeing by weeks to manage the worke."^[29] Willis's neat accounts of money "laid out at Wadham coll" for chemical apparatus and supplies, written in the back of one of his surviving casebooks, no doubt dates from his rota of managing "the worke." It was no mean operation; the expenses up to that point totaled almost twenty-five pounds, at a time when a college fellow was paid three pounds a years to tutor a young gentleman in Oxford.^[30] As Willis came to know other virtuosi, such as John Wilkins and Robert Boyle, his reputation as a chemist spead.^[31] The London projector Samuel Hartlib recorded in November 1654 that

Dr. Wellis [sic] of Dr. Wilkins acquaintance a very experimenting ingenious gentleman communicating every weeke some experiment or other to Mr. Boyles chymical servant, who is a kind of cozen to him. He is a great Verulamian philosopher, from him all may bee had by meanes of Mr. Boyle.^[32]

[27] See the letters of John Lydall from Oxford in 1649 referring to "Mr. Willis our Chymist," extracted and explicated in Robert G. Frank, Jr., "John Aubrey, F.R.S., John Lydall, and Science at Commonwealth Oxford," Notes and Records of the Royal Society of London 27 (1973): 193-217, especially 196-198, 213.

[28] Dewhurst, Willis's Oxford Casebook, 109; other references of a chemical bent are on pp. 82, 83, 98, 110, and 119.

[29] Seth Ward to Sir Justinian Isham, 27 February 1652, in H. W. Robinson, "An Unpublished Letter of Dr. Seth Ward Relating to the Early Meetings of the Oxford Philosophical Society," Notes and Records of the Royal Society of London 7 (1949): 68-70.

[30] Dewhurst, Willis's Oxford Casebook, 153-154.

[31] Wilkins was installed as Warden of Wadham in April 1648 (Wood, History and Antiquities 2: 570), although given their difference in politics, they may not have gotten to know each other until their common experience in William Petty's club about 1650. Cf. Robert Boyle to Ralph Bathurst, 14 April 1656, where he sends his service "to Dr. Willis, Dr. Ward, and the rest of those excellent acquaintances of yours, that have been pleased to tolerate me in their company" (Thomas Warton, The life and literary remains of Ralph Bathurst, M.D. [London, 1761]. pp. 162-164).

[32] Samuel Hartlib, "Ephemerides" [diary-like commonplace books], 1654, ff. WW-WW 7-8, Harlib Papers, Sheffield University Library. The Hartlib Papers are quoted by the kind permission of their owner, Lord Delamere.

By June 1656 Willis had completed his first chemical work, "De fermentatione"; he circulated it among his fellow scientists in Oxford, and word of it even reached London.^[33] In late 1658 he appended to it some additional tracts on fevers and on urines, and published the whole as Diatribae duae medico-philosophicae (1659).^[34] The book attracted much attention not only in Willis's coterie but in London and abroad.^[35] To his local reputation as an adept, Willis thereby added an international one as a theoretician of the spagyric art.

Since Willis's ideas about the animal and human body were built upon his chemistry, one must understand something about it in order to see how he approached problems of brain function. All bodies, he believed, were composed of five "principles": spirit, sulphur, salt, water, and earth. The last two were traditional Aristotelian "elements," while the first three were modifications of Paracelsian "principles"—in his chemistry, as in most other things, Willis was always the compromiser between ancients and moderns.

But unlike Aristotelians and Paracelsians, Willis did not believe that the five principles were names for homogeneous substances; rather, they were labels for categories of particles. All spirit particles, for example, shared the property of being highly subtle and active. They were always

[33] Hartlib, "Ephemerides," 1656, f. 48-48-3, where Hartlib noted that Willis was "a leading and prime man in the Philosophical Club at Oxford," who "hath written a treatise De Fermentatione," which John Aubrey commended highly. Robert Wood, who was at Oxford from 1640 to 1656, and a year younger than Willis, wrote to Hartlib: "If the Booke you write of de Fermentatione be Mr Willis his of Oxford, I am confident it is an excellent peece, having formerly seen some sheets of his upon ye subject, when we met at a Club, at Oxford" (Wood to Hartlib, 9 February 1658[/9], Hartlib Papers, Bundle XXXIII (1)).

[34] Cf. A Transcript of the Registers of the Worshipful Company of Stationers, from 1640-1708 (London: Privately printed, 1913-1914), 2: 207, where the Diatribae duae was licenced on 26 November 1658.

[35] On 16 December 1658, Hartlib thanked Boyle for sending a copy of Willis's Dia-tribae duae from Oxford, and noted of the London chemist Frederick Clodius that his "chemical son's head and hands are much taken up with animadversiones on Dr. Willis's book, he having very clear reason and experiences to dislike very many particulars in it: but, no doubt, of this he will write himself" (Hartlib to Boyle, in The works of the Honourable Robert Boyle, ed. Thomas Birch, 2d ed. [London, 1772], 6: 115-116). Three months later Robert Wood wrote from Dublin: "A frend from Oxford has sent me Mr. Willis his much approved Booke de Fermentatione, so yt though I shall not now need yours... yet I shall still value your intentions as highly as I do the booke it selfe" (Wood to Hartlib, 2 March 1658[/9], Hartlib Papers, Bundle XXXIII (1)). Boyle also passed on a copy to John Beale in Herefordshire: cf. Samuel Hartlib to John Worthington, 26 June 1659, The Diary and Correspondence of Dr. John Worthington, ed. James Crossley (Manchester: Chetham Society. 1847), 1: 135.

attempting to fly out of an object, and had to be bound to other, heavier particles. But because not all spirit particles were of identical size and activity, they could not all fly away at the same time. "Spirit," for Willis, described a population of particles with common characteristics and activities, but which, like individuals that made up a species, were not necessarily identical.

The other four elements were conceived in a similar manner. Sulphureous particles were rather less active than spirit, but they too were capable of flying away. Less subtle than spirit, they were more vehement and unruly. With a little motion, they produced maturation and sweetness; with more motion, heat; with the maximum motion, the body dissolved into flames. Salt was of a more fixed nature than the previous two; it bestowed solidity on things, and retarded their dissolution. The two last principles served as passive matrices for the active ones. If particles of earth predominated, then the substance was solid; if those of water, it was liquid. Willis could, then, look at a biological substance like blood, or a part of the brain, and conceive of it as a heterogeneous population of particles, of varying types, and varying motions. Particles of different principles could combine with each to produce "copula"—spirito-sulphureous, salino-sulphureous, and so forth—which combined the chemical properties of their constituent parts.^[36]

Note, though, what Willis had done. He had created a corpuscular matter-theory, and its correlate chemistry, in a way that differed from classical atomism, which did not allow matter to have properties in and of itself. His youth, the 1630s and 1640s, had been a time of revival, and reworking, of Epicurean corpuscular theories.^[37] René Descartes had made particles of matter in motion the basis of his supremely influential Principia philosophiae (1644)^[38] Although Descartes's mechanistic explanations applied to animal bodies appeared only in his posthumous De l'homme (1664), many of his physiological ideas were expounded earlier by his Dutch disciples, Henrik de Roy (Henricus Regius) in his Fundamenta physices (1646) and Fundamenta medica (1647), and Cornelis

[36] Willis, De fermentatione, 1-17; "Of Fermentations," 1-8. The Pordage translation includes material added in later editions.

[37] On the problems and sources of early modern atomism and the corpuscular philosophy, see Kurd Lasswitz, Geschichte der Atomistik vom Mittelalter bis Newton (Hamburg: Leopold Voss, 1890); Marie Boas, "The Establishment of the Mechanical Philosophy," Osiris 10 (1952): 412-541; Robert Hugh Kargon, Atomism in England from Harlot to Newton (Oxford: Clarendon Press, 1966).

[38] René Descartes, Discours de la méthode (Leiden, 1637); Principia philosophiae (Amsterdam, 1644); De l'homme (Paris, 1664).

Hooghelande in his Cogitationes (1646).^[39] Marin Mersenne's brand of mechanism was most clearly delineated in the Cogitata physico-mathematica (1644).^[40] Pierre Gassendi's massive three-volume Animadversiones in decimum librum Diogenis Laertii (1649) established him as the leading spokesman for, and interpreter of, Epicurean atomism as applied to science.^[41] Gassendi's was the most highly ramified of the corpuscularian philosophies. According to him, there was only matter and the void. Matter was of one type, and it was only the varying size and figure of the atoms, and their concretion into second-order particles called moleculae, that constituted perceived differences in matter.^[42] In page after doublecolumned page, Gassendi went on to show how light, color, sound, odors, rarity, density, perspicuity, opacity, subtility, hardness, smoothness, fluidity, humidity, and ductility—all could be transposed out of the Aristotelian categories of essences and substantial forms, into the matter-and-motion categories of the atomistic conceptual scheme.^[43]

Willis was familiar with much of this literature, and explicitly cites Descartes, Regius, Hooghelande, Mersenne, and Gassendi. Yet he preferred a corpuscularian chemistry in which particles, although of possibly differing activities, had inherent properties by which they could act. In this version, he said, chemistry could demonstrate the principles of natural philosophy, whereas the "Epicurean hypothesis" only supposes them.^[44]

However, Willis did not come by his corpuscularianism merely in the library. It was nonexistent in his casebook of 1650, well established in the De fermentatione of 1656, and grew into efflorescence in his works written in the 1660s. Whence came such an intellectual trajectory? I

[39] Henrik de Roy, Fundamenta physices (Amsterdam, 1646) and Fundamenta medica (Utrecht, 1647); Cornelis Hooghelande, Cogitationes, quibus Dei existentia et animae spiritualitas, et possibilis cum corpore unio, demonstrantur; necnon brevis historia oeconomiae corporis animalis proponitur, atque mechanice explicatur (Amsterdam, 1646).

[40] Marin Mersenne, Cogitata physico-mathematica in quibus tam naturae quam artis effectus admirandi certissimis demonstrationibus explicantur (Paris, 1644). On Mersenne see the excellent study by Robert Lenoble, Mersenne; ou, La naissance du mécanisme (Paris: Vrin, 1943).

[41] Pierre Gassendi, Animadversiones in decimum librum Diogenis Laertii (Lyon, 1649); on Gassendi's atomism see Bernard Rochot, Les travaux de Gassendi sur Epicure et sur l'atomisme, 1619-1658 (Paris: Vrin, 1944), and Lasswitz, Geschichte der Atomistik 2: 126-188.

[42] Gassendi, Animadversiones 1: 222-236.

[43] Ibid., 236-362.

[44] Willis, De fermentatione, 4; "On fermentation," 2. The English translation includes a remark that if anyone were to say that the chemical and atomical schemes can be brought together, he would not disagree; but he will leave it to those more clever than he to devise or dream philosophy.

would argue that it was rooted in Willis's experiences in informal scientific groups that met at Oxford in the 1650s and 1660s. Among the participants in these groups were men like William Petty, Robert Boyle, and John Wallis, all of whom we know were, from their Continental contacts and reading, particularly interested in Gassendian atomism.^[45] Willis worked with men like these by being a member of no fewer than five such groups that met over the period from about 1648 to 1667.^[46] The first was a small chemistry group with Ralph Bathurst and John Lydall that worked at Trinity and Christ Church about 1648-1649.^[47] The second was organized by William Petty from late 1649 to early 1652, at his lodgings over an apothecary shop in the High Street. The third convened, from the early 1650s to about 1657, at Wadham College under the auspices of John Wilkins, its Warden. It was by far the largest and most well-organized of the groups, and provided part of the nucleus for the founding of the Royal Society in London in 1660. The fourth group met rather more sporadically at Robert Boyle's lodgings in the High Street, from late 1657 to late 1659, and from July 1664 to April 1668. And the last was Willis's own, largely of physicians and chemists, that met at Beam Hall, in Merton Street, from the late 1650s up to Willis's departure to London in 1667.^[48]

Through each of these groups in which Willis participated there were continuities and discontinuities of membership. Younger men became interested in scientific topics, and were brought into activities, while

[45] For evidence of the popularity of the French and Dutch mechanists among Oxford scientists, see Robert G. Frank, Jr., Harvey and the Oxford Physiologists: Scientific Ideas and Social Interaction (Berkeley, Los Angeles, London: University of California Press, 1980), 92-93·

[46] For a survey of Oxford scientific groups in the 1650s and 1660s, see ibid., 43-89; also Charles Webster, The Great Instauration: Science, Medicine and Reform, 1626-1660 (New York: Holmes and Meier, 1976), 153-178.

[47] Frank, "John Aubrey," 196-198.

[48] On the venues, membership, and activities of the Petty, Wilkins, and Boyle clubs, see Frank, Harvey and the Oxford Physiologists, 52-57, and the sources cited in the notes on pp. 312-314. Willis's membership in these groups is recorded in the following sources: Bodleian Library, MS. donat. Wood 1, pp. 1-3; John Wallis, A defence of the Royal Society (London, 1678), 8; John Wallis's autobiography (1697) in Peter Langtoft's chronicle, ed. Thomas Hearne (Oxford, 1725), 1: clxiii-clxiv; Wood, History and Antiquities 2: 633; Thomas Sprat, The history of the Royal-Society of London, for the improving of natural knowledge (London, 1667), 52-58; Aubrey, "Brief Lives " 2: 141; participant in the "resurrection" of Anne Green, see [Richard Watkins], Newes from the dead, 2d ed. (Oxford, 1651, 1-8; Walter Pope, The life of the fight reverend father in God Seth, Lord Bishop of Salisbury (London, 1697), 29.

others moved away from Oxford or lost interest. Most of all, these shifting constellations gave rise to numerous cooperative research projects. The ethos was one not of discussion and debate but of experimentation, trial, and manual exploration. Again and again, clusters of investigators served as helpmates, audience, and witnesses in one another's scientific work.

This then was the constellation of elements in Willis's life at the time of the Restoration, the six kinds of conceptual and social raw material out of which one shaped an approach to the relation of brain and soul. They reflected the many sides of the newly elected professor of natural philosophy: Willis the clinician of increasing acuity and fame; Willis the staunch Royalist and devout Anglican; Willis the man of traditional philosophical education, recently placed into an endowed professorship; Willis the enthusiastic experimental chemist; Willis the afficionado of corpuscular philosophies; and Willis the ever-active member of Oxford scientific circles.

ORIGINS OF A NEUROLOGICAL RESEARCH PROGRAM

Yet even given all of this, in 1660 there was no inevitability to Willis's future interest in the brain; it arose as a fortuitous concourse—a phrase beloved by the atomists—of incitement and opportunity.

As he himself noted in his "Praefatio," the incitement was his new responsibilities as a teacher. What were those duties? The Laudian statutes, adopted in the 1630s but codifying the practices of previous decades, specified them quite clearly. During the Michaelmas, Hilary, and Easter terms, each about eight weeks in length, Willis was to read to the bachelors of arts at 8:00 A.M. on Wednesdays and Saturdays. For failing to read a lecture, the professor incurred a fine of ten shillings (about $200 proportionally today), whereas the B.A.s were to be fined four-pence (perhaps $6) for failure to attend. His lectures were to be drawn from a list of Aristotle's works: De physica, De caelo, Meteorologica, De generatione et corruptione, De anima, and the Parva naturalia.^[49] The first four fall into the category of the physical sciences, while the last two might properly be called psychology. It was not a modest province of knowledge; Willis's teaching obligations covered two of the eight cate-

[49] John Griffith, ed., Statutes of the University of Oxford Codified in the Year 1636 under the Authority of Archbishop Laud, Chancellor of the University (Oxford: Clarendon Press, 1888), 36-37.

gories into which Aristotle's total surviving works could be distributed.

Such were the statutory injunctions. But in good English fashion, at Oxford the statutes were venerated more in the breach than the observance. By the 1650s the Savilian Professors of Astronomy and Geometry—Willis's fellow club members John Wallis and Seth Ward—were teaching the ideas of Copernicus and Kepler, defending the "Atomicall and Magneticall" hypotheses, and in general feeling free, as Ward and John Wilkins put it, to "discent" from Aristotle, "and to declare against him."^[50] Willis did no less. He was naturally drawn more to the psychological side of his bailiwick than to the physical, so he chose to honor the statutes by lecturing within the general subject area with which De anima and the Parva naturalia dealt: the principles animating vegetable and animal life, the senses and sensation, memory, sleep and dreams. That he exercised his freedom from the very beginning can be seen in a passing reference in a commonplace book of a medical student; John Ward, of Christ Church, noted in February 1661 that "Dr. Willis is now reading about ye succus nervosus," and that the professor doubted that the nerve juice actually exercised its reputed nutritive function.^[51] Willis's lectures went on to include the nature of life, sensation, movement, narcotics, nutrition, convulsions, epilepsy, hysteria, sleep and wakefulness, nightmare, coma, vertigo, paralysis, delirium, phrensy, melancholia, mania, stupidity, the cerebrum, the cerebellum, and nerve fibers. In fact, it seems that wherever Willis encountered an interesting observation or result, it might well end up as part of his teaching; in 1664 his protégé, Richard Lower, observed an interesting anatomical arrangement in the stomach of a ruminant, and Willis was, as Lower reported to Boyle, "so taken with it" that he wanted to "make a lecture of it the next term."^[52] Such freedom within statutory constraints allowed Willis to shape his teaching to reflect his own interests, which were largely chemical and medical. Exactly the opposite happened once he left Oxford, and paid a deputy to discharge his obligations as Sedleian Professor; in 1669 George Hooper was overseeing disputations on such subjects in the physical sciences as "Whether the Medicean stars are

[50] [Seth Ward], Vindiciae academiarum (Oxford, 1654), 2, 28-30, 32, 45-46; quotation from p. 2, which was written by John Wilkins.

[51] John Ward, diary-like commonplace books, 16 vols., in the Folger Shakespeare Library, Washington, D.G. MSS. V.a. 284-299; hereafter cited as Ward, "Diary." Quotation is from Ward, "Diary," VIII, f. 39v. See also Frank, "The John Ward Diaries," 153-154.

[52] Richard Lower to Robert Boyle, 24 June 1664, in The works of the Honourable Robert Boyle, ed. Thomas Birch, 2d ed. (London, 1772), 6: 474.

the moons of Jupiter? Affirmative," and "Whether a vacuum can exist? Negative."^[53]

We know Willis took such a biological approach and covered such neurological subjects, because abstracts of some of his lectures have survived in the form of student notes—notes that are of particular interest and significance both for their content and for their auditors. Most probably in the late 1661 or early 1662, Lower attended some of the Sedleian lectures and wrote out notes on them. In November 1662 Lower then made a transcription of some of the topics and sent it on to Robert Boyle, who was in London at the time.^[54] About 1664 Lower also lent his notes to his fellow member of Christ Church, John Locke, who abstracted them into a commonplace book.^[55] Even though Lower's notes themselves have not survived, we have, therefore, overlapping extracts among the Boyle Papers at the Royal Society,^[56] and in John Locke's manuscripts at the Bodleian Library.^[57] The link between the two became clear to me in 1969. I had read the extracts in Locke's commonplace book at Oxford. A few weeks later, while paging through thirty volumes of Boyle Papers in London, I came across an anonymous fascicle of Latin notes on medical topics. As I glanced through them, it struck me that they covered some of the same topics as the Locke notebook. A few hours' work comparing the text with the Locke extracts, and the handwriting with known samples of Oxonians, yielded the answer: this was Willis's work, and Lower was the writer.^[58]

Clearly the Sedleian lectures, although Willis expressed some dissatisfaction with the early versions of them, were not treated by his circle of friends simply as a réchauffé of old ideas for adolescents. Nor were they.

[53] The Life and Times of Anthony Wood, Antiquary, of Oxford, 1632-1695, Described by Himself, ed. Andrew Clark (Oxford: Clarendon Press, 1891-1900), 2: 161.

[54] Lower to Boyle, 26 November 1662, Works 6: 465.

[55] Bodleian Library, Oxford, MS. Locke f. 19, PP. 1-68 passim.

[56] Royal Society of London, Boyle Papers, XIX, ff. 1-35.

[57] The Locke manuscripts are described in P. Long, A Summary Catalogue of the Lovelace Collection of the Papers of John Locke in the Bodleian Library (Oxford: University Press, 1959) and in "The Mellon Donation of Additional Manuscripts of John Locke from the Lovelace Collection," Bodleian Library Record 7 (1964): 185-193. The existence of Locke's notes from Willis's lectures was first discovered by Kenneth Dewhurst, "Willis in Oxford: Some New MSS," Proceedings of the Royal Society of Medicine 57 (1964): 682-687.

[58] When the late Dr. Dewhurst expressed an interest in editing the Willis lectures in MS. Locke f. 19, I called his attention to the complementary MS in Boyle Papers. Dewhurst's edition and translation of, and commentary on, the merged MSS appeared as Dewhurst, Willis's Oxford Lectures. I cite the lectures in that form unless there is a particular reason to refer back to the original Locke and Boyle manuscripts.

They contained many original and stimulating ideas—ideas that not only provided a program for neurological research but represented significant changes from Willis's very much more conventional earlier concepts. For example, in his casebook of the early 1650s he had attributed hypochondria to a faulty spleen and accepted the uterine origins of hysteria.^[59] By the time he began lecturing, however, he had come to trace both to the brain.^[60] Similarly with mania and "phantasy"; in the case-book Willis's descriptions reflect the traditional medical explanations,^[61] whereas a decade later he had brought both of these conditions into the orbit of the nervous system.^[62] In the lectures, then, Willis clearly outlined neurological explanations that, with only a few exceptions, he was to flesh out over the succeeding decade.^[63] But one must also be aware of how skeletal this corpus originally was. The corpuscular details were very rudimentary. But even more significantly, Willis's explanations for brain function were insufficiently grounded in a firm and detailed knowledge of anatomy.

It is important, therefore, that we see clearly the academic, philosophical, and rather traditional origins of Willis's neurological research program, as well as its original incomplete state, because together they explain why a set of medical treatises should show a seemingly unmedical concern with the soul and its properties. Willis's medical practice over the previous fifteen years had provided him with an ever-increasing wealth of clinical experience, but no incentive whatsoever to analyze that experience systematically with respect to a long-standing tradition of thinking about the mind/body problem. But Willis, sincere in all things, took seriously his professorship, and the statutory injunctions about its subject matter. He confronted his own medical experience and ways of thinking about the physical world with the distinctly nonmedical and nonanatomical tradition of Aristotelian psychology—and these lectures were the result. Perhaps as important for the end result, Willis had to deliver his thoughts to an audience that included a number of his scientific cronies. One can hardly imagine a stronger incentive to casting the old psychology into new terms.

[59] Dewhurst, Willis's Oxford Casebook, 67, 93, 95.

[60] Dewhurst, Willis's Oxford Lectures, 87-92; Willis, Pathologiae cerebri, 144-193; Willis, "Pathology of the brain," 76-102.

[61] Dewhurst, Willis's Oxford Casebook, 127, 145.

[62] Dewhurst, Willis's Oxford Lectures, 66, 82, 96, 98, 122, 130-134.

[63] Dewhurst, Willis's Oxford Lectures, has correlated the topics of the lectures with the treatment of the same subjects later in Cerebri anatome, Pathologiae cerebri, and De anima brutorum.

I wish to argue further, however, that incitement was not of itself sufficient to get this new research program off the ground. Opportunity was needed as well. In the midst of an ever-busier practice, and lecturing responsibilities, Willis would most likely have had little chance to remake the speculations expressed in his Sedleian lectures, had he not been helped by a near-perfectly complementary collaborator: Richard Lower.^[64] Ten years younger than Willis, Lower had come from both a higher social background and a better preliminary education than his mentor: respectively, the Cornish gentry and England's best public school of the period, Westminster School in London. In 1649 Lower had come up to Willis's old college, Christ Church, collected his B.A. and M.A. in due order,^[65] and supervised students as the college's Censor in Natural Philosophy from 1657 to 1660.^[66] He became interested in medicine in the early 1650s and started practicing about 1656. He soon thereafter began to work "under the directions of Dr Thomas Willis, to whose favour he recommended himself, by assisting him in his anatomical dissections."^[67] Lower continued to practice as Willis's junior medical partner until he left Oxford in 1665.^[68]

[64] For Lower's life and scientific activities, see Frank, Harvey and the Oxford Physiologists, passim, but especially 64-65, 174-220, and the sources therein cited. The best brief overview of Lower's life is Theodore Brown, "Richard Lower," Dictionary of Scientific Biography 8:523-527.

[65] Lower was elected into a Studentship from Westminster in 1649 and seems to have come to Oxford then, although he did not actually matriculate until 27 February 1651; he proceeded to the B.A. on 17 February 1653 and to the M.A. on 28 June 1655 and accumulated his degrees of B. and D.Med. on 28 June 1665, just before leaving Oxford: Foster, Alumni Oxonienses 3: 943. It was not unusual for fellows of colleges to practice before formally taking their degrees.

[66] Chapterbook (1649-1688), pp. 77, 88, 104, Chapter Archives, Christ Church, Oxford. Lower also served as Praelector in Greek for 1656-57. Occupying one of the positions as a Student (the equivalent of a Fellow in other colleges), he rose in seniority within Christ Church until about 1662, when he reached the top of those not in orders. Then, having as he said to Boyle insufficient "favour or friendship" to obtain one of the two physician's places in the college, he could not keep his Studentship. He did, however, continue to occupy rooms in the college. See Richard Lower to Robert Boyle, 24 June 1664, Works 6: 474.

[67] Biographia Britannica (London, 1747-1766), vol. 5, col. 3009.

[68] For example, in September 1662 Willis and Lower treated one of John Locke's tutees; Willis got a one-pound fee, and Lower ten shillings: Bodleian Library, MS. Locke f. 11, f. 24r. Lower was sent out to the country—once as far as Cambridgeshire—to attend Willis's patients: Richard Griffith, A-la-mode phlebotomy no good fashion (London, 1681), 171. On the return journey of one such trip into Northamptonshire in April 1664 Lower discovered the medicinal character of the waters of Eastrope, Oxfordshire, near King's Sutton, which he and Willis then promoted as a local spa: Wood, Life and Times 2: 12.

But Lower's real interest, as suggested by the activity that brought him together with his mentor, was not so much clinical medicine as anatomy and physiology. He seems to have had an inveterate itch to cut things up. The first surviving piece of evidence about his scientific interests, written by John Ward in his commonplace book about October 1660, pictures him vividly: "Mr. Lower cut a doggs windpipe and let him rune about: hee had a week so: he could note smell but would eat any thing I was told."^[69] Lower's curiosity naturally expressed itself in exploring the detailed structure, the precise workings of a living thing. As his later work on the heart, Tractatus de corde (1669), showed, he had little interest in broader questions of matter-theory and principles of life. His was a reputation as a dissector and vivisector; his friend, Anthony Wood, was not at all surprised to arrive at Lower's rooms in Christ Church one Sunday morning and find him busily dissecting a calf’s head.^[70] Lower's personality fit his avocation. He seems to have been anti-High Church, politically a Whig, temperamentally exacting, and—if later testimony is to be credited—inclined to be arrogant about his scientific knowledge.^[71]

Willis, a contrast in personality and background, equally contrasted with Lower in having no such eager knife. Before 1660 he actively pursued chemistry but did little anatomy. Of fifty patients whose treatment is recorded in his casebook from the early 1650s, ten died, and on only one was a cursory postmortem performed; even in that case the phrasing of the notes seems to hint that it was a surgeon, not Willis, who did the necropsy.^[72] Although the only official university teaching post in anatomy, the Tomlins Readership, changed hands several times during Willis's residence in Oxford, there is no indication that he sought the position.^[73] His first book, the Diatribae duae medico-philosophicae of 1659, reports no postmortems, and of the numerous scattered references to Willis to be found in published works, diaries, and correspondence be-

[69] Ward, "Diary," VII, f. 83r.

[70] Wood, Life and Times 2: 4.

[71] Frank, Harvey and the Oxford Physiologists, 283 and sources cited there.

[72] In Dewhurst, Willis's Oxford Casebook, deaths are recorded on pp. 74, 80, 91, 97, 100, 105, 118, 122, 127, 132. The only postmortem was carried out on F. Symmons (118); the phrasing seems to imply that Willis only did the chemical examination of fluids:

In the dead body it was found that the lungs were floating in a large quantity of water which was enclosed in the saepta of the thorax.

Moreover when we evaporated some of this water with slow heat on sand there was, in the bottom of the vessel, a residuum like mucus or flour porridge and whites of egg, viscous and smelling adominably.

[73] On the Tomlins Readership, see Wood History and antiquities 2: 883-884.

fore 1660, only one links him to an anatomical proceeding. This is the renowned "resurrection" of Anne Green in December 1650, in which Petty, Willis, Bathurst, and others assembled to dissect the body of a hanged convict, only to find the proposed cadaver very much alive.^[74] But on this occasion it was not Willis but Petty, a skilled dissector trained in Leiden, who took the lead.^[75]

But Lower's presence at Oxford, and especially in Willis's coterie, provided the opportunity. Lower reported the start of the project in a letter to Boyle in January 1662:

The doctor was not at leisure till of late to make those dissections of the brain, which he hoped; but at length we have had the opportunity of cutting up several, and the doctor, finding most parts of the brain imperfectly described, intends to make a whole new draught thereof, with the several uses of the distinct parts, according to his own fancy, seeing few authors speak any thing considerable of it.^[76]

Thus began an intense period of dissections in which "no day almost past over without some Anatomical administration; so that in a short space there was nothing of the Brain, and its Appendix within the Skull, that seemed not plainly detected, and intimately beheld by us."^[77] Entire "hecatombs" of animals, Willis said, were slain in the anatomical court.^[78] They dissected not only human cadavers but horses, sheep, calves, goats, hogs, dogs, cats, foxes, hares, geese, turkeys, fishes, and even a monkey. The indefatigable worker was Lower, the "edge of whose Knife and Wit" Willis gratefully acknowledged for assistance in "the better searching out both the frames and offices of before hidden Bodies."^[79] Others of the club helped out. John Wailis, the mathematician, and a longtime club member, participated in some of the initial dissections.^[80] The physician Thomas Millington and the mathematician Christopher Wren, both con-

[74] The incident is described in [Watkins], Newes from the dead, 2d ed. (Oxford, 1651), 1-8. Petty also described the resurrection in a letter to Samuel Hartlib, 16 December 1650: Hartlib Papers, Bundle VIII (23).

[75] Petty was appointed Tomlins Reader on 31 December 1650, about two weeks after the Anne Green affair. His anatomical work at Oxford is reflected in volume 3 of the Petty Papers (now at Bowood House, Clan, Wiltshire), which contain his medical and anatomical lectures at Oxford c. 1650-1652. For details, see Frank, Harvey and the Oxford Physiologists, 101-103.

[76] Lower to Boil, 18 January 1661[/2], Works, 6: 462.

[77] Willis, Cerebra anatome, sig. a2v; "Anatomy of the brain," 53.

[78] Ibid., sig. A4r and 51.

[79] Ibid., sig. a2v and 53.

[80] Wallis's presence at a brain dissection is mentioned in Lower to Boyle, 18 January 1661[/2], Works 6: 463. Cf. also John Wallis to Henry Oldenburg, 17 February 1673, The Correspondence of Henry Oldenburg, ed. and trans. A. Rupert Hall and Marie Boas Hall (Madison: University of Wisconsin Press, 1965-), 9:466, in which Wallis shows an intimate knowledge of Willis's Cerebri anatome.

temporaries of Lower's at Westminster, and by then at All Souls, "were wont frequently to be present at our Dissections, and to confer and reason about the uses of the Parts." Millington especially was Willis's sounding board, to whom he proposed almost daily his "Conjectures and Observations."^[81] Within ten months Lower could send to Boyle the extracts of Oxford lectures, and report that the "doctor hath now perfected the anatomical part likewise, but being not satisfied in some things," might not soon be induced to publish.^[82] By April of 1663, however, Willis and Lower were "wholly diverted" with more dissections, which were "very near finished" because Willis intended to put the book into the press by midsummer.^[83] Within the next few months Wren had, as Lower reported to Boyle, "drawn most excellent schemes of the brain, and the several parts of it, according to the doctor's design," and Willis was resolved "to print his anatomy forthwith."^[84] Lower carried the same news personally to London in July. He missed presenting Willis's service to Boyle, but told his old Westminster schoolfellow Robert Hooke that Willis's book "is within a little while to come forth, and he added, that Dr. Wren had drawn the pictures very curiously for it."^[85] A "little while" and "forthwith" were faster in the seventeenth century than today, and the book came out six months later.

To those wishing to assign credit for the Cerebri anatome, the role of Lower especially has posed some problems. Anthony Wood, in his capsule biography of Willis, noted of the Cerebri anatome : “Whatsoever is anatomical in that book, the glory thereof belongs to the said R. Lower, whose indefatigable industry at Oxon produced that elaborate piece."^[86] Twentieth-century scholars have noted that Lower was a frequent drinking chum of Wood,^[87] that Wood later had a land dispute with Willis,^[88]

[81] Willis, Cerebri anatome, sig. a3r: "Anatomy of the brain," 54.

[82] Lower to Boyle, 26 November 1662, Works 6: 465·

[83] Lower to Boyle, 27 April 1663, Works 6: 466.

[84] Lower to Boyle, 4 June 1663, Works 6: 466.

[85] Robert Hooke to Robert Boyle, [3 July 1663], Works 6: 487.

[86] Wood, Athenae, vol. 3, col. 1051; see also the comment to similar effect in Wood's biography of Lower, ibid., 4: 297.

[87] Dewhurst, Willia's Oxford Lectures, 13, 32. Wood's references to eating or drinking with Lower are in Wood, Life and Times, vol. 1: (1657) 30; (1658) 259; (1659) 266, 267, 279, 284; (1660) 313, 318, 321, 327; (1661) 405, 410; (1662) 428, 430, 444, 450; (1663) 471, 474,477, 486, 487, 501, 503, 507; vol. 2: (1664) l, 2, 4, 6, 8, 12, 14, 15, 23, 24; (1665) 27, 31, 33, 35, 37, 40, 43; (1666) 71, 73, 76; (1667) 99.

[88] Dewhurst, Willis's Oxford Lectures, 33.

and finally that Wood's judgment was taken almost word for word from one of Henry Stubbe's blasts against the Royal Society.^[89] They have therefore tended to discount Lower's participation in the research and to credit Willis with everything.^[90] Such a judgment is untenable and unnecessary. Stubbe and Wood were admirers of both Willis and Lower and merely wished to recognize the interdependence of the two.^[91] In reality, the collaborative relationship was quite complex. Clearly Willis provided the impetus; from the very beginning Lower's letters remarked how "the doctor" suggested, and participated in, this or that aspect of the brain dissections.^[92] Moreover, Willis's concepts seem to have directed the interpretation of the findings, as for example when Willis showed Lower "several times" how the dissections supported "his opinion of the use of the cerebellum for involuntary motion." Similarly with the medullary and cortical parts of the cerebellum, and the origins of the optic nerves.^[93] The degree of collaboration could vary from day to day. Lower often wrote in letters of dissections, postmortems, and experiments that

[89] The argument of the biased testimony of Wood was first made by Sir Charles Symonds, "The Circle of Willis," British Medical Journal (15 January 1955), i, 119-124, especially 121. It has been accepted by: William Feindel, "Thomas Willis (1621-1675)—The Founder of Neurology," Canadian Medical Association Journal 87 (1962): 289-296, especially 289; and Islet, Willis [1968], 33-34. Wood's phrase was taken almost verbatim from Henry Stubbe, The plus ultra reduced to a non plus (London, 1670), 95, where Stubbe is attempting to refute Joseph Glanvill's claim of anatomical novelties to be found in Willis's Cerebri anatome. Stubbe wrote further that Willis did not lack abilites but that because of his great practice, he did not have leisure to attend the dissections. All that Willis contributed, Stubbe heard, was the "discourses and conjectures" upon Lower's anatomical deductions; these were ingenious, but they were not inventions in the sense that Glanvill wished to claim.

[90] Dewhurst, Willis's Oxford Lectures, 13.

[91] For most of his career, Stubbe was a great admirer of Willis. See for example, his praise for, and use of, Willis's ideas in: The Indian nectar; or, A discourse concerning chocolata (London, 1662), dedication to Willis, sigs, a2r-v, whom he calls second only to Harvey, pp. 124-125; The miraculous conformist (Oxford, 1666), prefatory epistle to Willis, sigs. A2r-A3v, pp. 14, 18-19, 29; Legends no histories (London, 1670), 64-65, 79; An epistolary discourse concerning phlebotomy ([London], 1671), 8, 44-48, 110, 114-115, 119, 172-240. Moreover, even in The plus ultra reduced, 178, Stubbe was willing to grant that Willis did "propose new matter for improving the discoveries, and put Dr. Lower upon continued investigation, thereby to see if Nature and his Suppositions did accord; and although that many things did occur beyond his apprehension, yet was the grand occasion of that work, and in much the Author." Stubbe had an excellent collection of medical books, which included all the works of Willis and Lower, and many of Boyle's: cf. British Library MS. Sloane 35, ff. 6r, 8r, 9r, 12r-13r, 15r' 16r, 17r-18v, 20r.

[92] Lower to Boyle, 18 January 1661[/2], Works 6: 469,463; Lower to Boyle, 4 June 1663, ibid., 467, 468; Lower to Boyle, 24 June 1664, ibid., 470-471.

[93] Lower to Boyle, 18 January 1661[/2], ibid., 462, 463.

"we" did. In other circumstances he mentioned times when "I tried an experiment for Dr. Willis."^[94] On yet other occasions he reported instances of his own dissections and experiments, although these are almost invariably not on the nervous system. Willis and Lower, at least, seem to have been quite clear about the mutually distinct, but symbiotic collaborative roles that they occupied. Willis needed Lower's results and continuing efforts as much as Lower needed Willis's direction, facilities, and literary follow-through. And both needed Wren's drawings, which visualized and encapsulated the highly detailed written description in the text.

It is important to realize this cooperative nature of the Cerebri anatome, and to a lesser extent Willis's later work, because such origins explain the recurring puzzlement that commentators have felt when confronted with his books. They are vocal in their praise of the accuracy of the anatomy and the quality of the illustrations, are intrigued by the localizations proposed, are repelled by the fancifulness of the hypothetical mechanisms described, are befuddled by the corpuscular language in which they are expressed, and are bemused by the therapies counseled.^[95] It always seems as if Willis is trying to do too much. But if one views Willis's neurological works as products rather of many minds, each with a different forte, then the reason for this synthetic quality becomes clear. Indeed, given the history of small-scale cooperative ventures in research at Oxford, the very model upon which the Royal Society was originally founded, this synthetic quality should be expected.

THE SOUL ON THE DISSECTING TABLE

Thus far I have characterized the biographical trajectory from which Willis's neuroanatomy and neuropsychiatry arose, and the process through which his research program was launched and carried forward within his Oxford circle. What did Willis and his confreres do once they attempted to put the animus under the dissecting knife? What were the axioms, the assumptions, the heuristic principles—the moves, or tactics —through which a new view of brain and soul was worked out? By assumptions or principles, let me reiterate, I do not mean his specific conclusions in neuroanatomy, neurophysiology, or neuropsychiatry, although I will have occasion to look closely—albeit selectively—at these

[94] Lower to Boyle, 24 June 1664, ibid., 470.

[95] Even one of Willis's admirers, Isler, speaks of "the combination of epoch-making scientific ideas and discoveries with reckless speculation and overt nonsense which is typical of Willis' books " (Thomas Willis [1968], 106).

concepts.^[96] I mean instead his ways of reasoning in order to reach those conclusions. Seldom does Willis set these out explicitly, with a full and clear explanation. They must rather be extracted from his actual processes of reasoning, as they are laid out in his lectures and books.

The first such principle was a methodological one: the initial and seemingly thoroughgoing separation of what later generations would call "mind" into two kinds of soul, the rational and the animal.^[97] Willis took the outline of this distinction most immediately from Gassendi, although he argued that it had also been held by St. Jerome and St. Augustine among the ancients, and Henry Hammond among his own

[96] For detailed discussions of one or another aspect of Willis's ideas in neurology and neurophysiology, see the following (arranged chronologically); Jean Vinchon and Jacques Vie, "Un maître de la neuropsychiatrie au XVII siècle: Thomas Willis (1662[sic]-1675)," Annales médico-psychologiques 86 (1928): 109-144; Donal Sheehan, "Discovery of the Autonomic Nervous System," Archives of Neurology and Psychiatry 35 (1936): 1081-1115, especially 1085-1089; Paul F. Cranefield, "A Seventeenth-Century View of Mental Deficiency and Schizophrenia: Thomas Willis on 'Stupidity or Foolishness,'" Bulletin of the History of Medicine 35 (1961): 291-316; Raymond Hierons and Alfred Meyer, "Some Priority Questions Arising from Thomas Willis's Work on the Brain," Proceedings of the Royal Society of Medicine 55 (1962): 287-292; Alfred Meyer and Raymond Hierons, "A Note on Thomas Willis's Views on the Corpus Striatum and the Internal Capsule," Journal of the Neurological Scierices 1 (1964): 547-554; Raymond Hierons and Alfred Meyer, "Willis's Place in the History of Muscle Physiology," Proceedings of the Royal Society of Medicine 57 (1964) 687-692; Raymond Hierons and Alfred Meyer, "On Thomas Willis's Concepts of Neurophysiology," Medical History 9 (1965): 1-15, 142-155; Edwin Clarke and C. D. O'Malley, The Human Brain and Spinal Cord (Berkeley and Los Angeles: University of California Press, 1968), 158-162, 333-390, 388-390, 472-474, 582-585, 636-640, 723-726, 775-779; Isler, Thomas Willis [1968], 88-141, 148-182; Kenneth Dewhurst, "Willis and Steno," Analecta medico-historica 3 (1968): 43-48; Elvira Aquiola, "La lesion nerviosa en la obra de Th. Willis," Asclepio 25 (1973): 65-93; Yvette Conry, "Thomas Willis, ou la premier discours rationaliste en patholgie mentale," Revue d'histoire des sciences 31 (1978): 193-231; John D. Spillane, The Doctrine of the Nerves: Chapters in the History of Neurology (New York: Oxford University Press, 1981), 53-107; Kenneth Dewhurst, "Thomas Willis and the Foundations of British Neurology," in Historical Aspects of the Neurosciences, ed. F. C. Rose and W. F. Bynum (New York: Raven, 1982), 327-346; Adolf Faller, "Die Pr paration der weissen Substanz des Gehirns bei Stensen, Willis und Vieussens," Gesnerus 39 (1982): 171-193; Richard U. Meier, "'Sympathy' in the Neurophysiology of Thomas Willis," Clio medica 17 (1982): 95-111. Hierons and Meyer [1965] has a very full bibliography and provides the best entrée into the older literature on Willis's neuroanatomy and neurophysiology.

[97] Although the notion of the corporeal soul was adumbrated partially in the Sedleian lectures, it was not stated clearly until the Cerebri anatome. See Dewhurst, Willis's Oxford Lectures, 125-129; Willis, Cerebri anatome, 133-134, 253; "Anatomy of the brain," 95, 130; Willis, De anima brutorum, sig. A2r-v, b1v-b4v, pp. 1-16; Soul of brutes, sig. A2v, A3v-A4v, pp. 1-6

[98] Willis, De anima brutorum, sig. A2v, pp. 7-8. 115-119; Soul of brutes, sig. A2v, pp. 4, 40-42.

contemporaries.^[98] According to this distinction, the characteristics of the rational soul were relatively straightforward: it reasoned and judged; it was immortal and possessed by man alone.^[99] The animal soul, which he also called the corporeal soul, or anima brutorum, was possessed by both man and the animals, and in the case of man was subservient to the rational soul.^[100] Logically, the distinction between the two was sharp and clean. In actuality, as we shall see, the corporeal soul came to take on a complexity of meaning and function such as to infringe significantly on the autonomy of the rational soul.

Was this supposition of a corporeal soul merely a ruse, a quasi-Cartesian device to avoid confrontation with church authorities? The very piety of Willis's life should refute any implication of devious intentions. Nor did the church see danger; his three major neurological works, the Cerebri anatome, the Pathologiae cerebri, and De anima brutorum, were dedicated to Sheldon, his good friend, patient, and Archbishop of Canterbury. Each book carried the "Imprimatur" of the highest scholarly and religious official of the University of Oxford, the Vice-Chancellor; in two of these cases, that was Willis's brother-in-law, John Fell. Willis's attachment to the distinction between the rational and the corporeal soul arose rather, I believe, from his pressing desire to see man in a way that squared with his own experience as a clinician and scientist. For years he had looked at patients and seen bodies capable of multifarious derangements, of which the most interesting seemed to stem from the brain. Yet to see most of these functions and dysfunctions as proceeding from the traditional, unitary, soul was repugnant to his belief that anatomy could be pictured in chemical, corpuscular terms and could be manipulated by treatment for the benefit of the patient. Moreover, if one ascribed all human mental phenomena to the rational soul, then diseases of the body could be thought to derange that which was immortal in a human being: his reason and will. This verged on blasphemy. Indeed, Willis felt strongly that the dignity of the rational soul was actually vindicated by believing in its corporeal servant.^[101] I am led to conclude that the anima brutorum, if it served as a device for any purpose, functioned to give meaning to Willis's integrated life as devout churchman, clinician, and scientist.

Willis conceived the corporeal soul, in its turn, to be composed of two parts: the vital soul lodged in the blood, and the sensitive soul seated in

[99] Willis, De anima brutorum, sigs. b3v-b4r, pp. 96-99, 110-124; Soul of brutes, sig. A4r, pp. 32-33, 38-44·

[100] Willis, De anima brutorum, 87-109; Soul of brutes, 29-38.

[101] Willis, De anima brutorum, 2; Soul of brutes, 2.

the nervous system.^[102] For our purposes here we need know about the vital soul only that Willis conceived it as a kind of "flame" in the circulating blood, which was fed by the nitrous, active particles from the air absorbed in respiration. Through a mutual agitation of these nitrous aerial particles with the sulphureous, spirituous, and saline particles of the blood—a process which Willis more and more firmly identified as a "fermentation"—the vital soul generated heat, assimilated digested food, and maintained the body parts.^[103] In contradistinction, the sensitive soul consisted of the movement and agitation of particulate animal spirits within the brain and nerves. It was linked to the vital soul because these particles of animal spirits in the nervous system were extracted from the most subtle and active spirits of the blood.^[104] The sensitive soul lodged in the nervous system was the part of the corporeal soul most directly subservient to the rational soul, since it was only through the sensitive soul that sensation and movement could take place.

The second implicit axiom of Willis's neurological reasoning related these subtle and active particles of animal spirit to the perceived differences of anatomical texture in the nervous system, and in turn correlated these textural differences with differences in function. Willis emphasized, as few did before him, that the substance of the nervous system was of three distinct types: the gray cortical masses (both cerebral and cerebellar), the white medullary structures, and the long, thin peripheral nerve bundles. He and his collaborators noted the consistent way in which blood vessels encased both cerebral and cerebellar cortices, running inward, and deduced that this first type of texture, cortex, must therefore serve to separate animal spirits from the blood for use by the nervous system.^[105] The image that recurred again and again in interpreting this anatomical relationship was the chemical alembic: the cortex "distilled" the finest spirituous particles out of the blood.^[106] The second set of neural elements, the deeper, white, medullary structures, whether

[102] Willis, Cerebri anatome, 133-134; "Anatomy of the brain," 95; Willis, De anima brutorum, 9-33, 69-70; Soul of brutes, 4-7, 22.

[103] The concept of the vital soul was mentioned briefly in Cerebri anatome, 133; "Anatomy of the brain," 95, but was not developed fully until De sanguinis accensione in 1670, and De anima brutorum, 12-72; Soul of brutes, 6-23.

[104] The sensitive soul seems to have been the first of these linked concepts to emerge in any clarity: Dewhurst, Willis's Oxford Lectures, 67, 125-129, 132; Willis, De anima brutorum, 72-77; Soul of brutes, 23-24.

[105] Dewhurst, Willis's Oxford Lectures, 63; Willis, Cerebri anatome, 109 -113, 125-126, 187-194; "Anatomy of the brain," 87-89, 92, 110-113; Willis, De anima brutorum, 72; Soul of brutes, 23.

[106] Willis, Cerebri anatome, 83-84; "Anatomy of the brain," 79.

of cerebrum, brain stem, or cerebellum, received the animal spirits and provided the tracts and labyrinths within which these particles exercised their functions.^[107] The third part of the nervous system, the peripheral nerve structures such as cranial nerves, spinal nerves, and the nerve plexi linked to the brain, all served as grand highways for the action of the spirits to be propagated over a long distance. Although all three textures of the nervous system were solid, this was no impediment to the movement of subtler particles. They could flow through the liquid/ solid matrix that was created by the grosser classes of particles, such as earth and water. Although Willis himself does not use the image, one can visualize the relationship as a stream of water flowing through a solid mass of gravel. Certainly Willis had this picture in mind when he thought of the peripheral nervous system; he had examined cut cross-sections of nerves and always found them solid, but felt that spirits could percolate through the nerve none the less.^[108]

The image of spirituous particles residing in a differentiated neural matrix has a link to Willis's third underlying principle of neurological explanation: the belief—one that became more and more explicit through the sequence of his writings—that effects within the nervous system could be carried out by two different, and complementary, kinds of activity, mechanisms that I wish to designate as "particle flow" and as "wave propagation." Although Willis nowhere explains these mechanisms in a systematic way, they were assumed again and again in his explanations of function and dysfunction.

In the first, particle flow, he pictured spirits physically moving, streaming from one part of the nervous system to another. The net movement was from center, where the spirits were generated, to the periphery, where they were slowly consumed in muscular motion.^[109] But within this net flow there could be transitory local reversals. What was sleep, Willis asked in his lectures of the early 1660s, but the movement of spirits to their proper places in cerebral and medullary tissues, where they rested; he used an elaborated version of the same explanation a decade later in De anima brutorum.^[110] This overall flow of particles also

[107] Dewhurst, Willis's Oxford Lectures, 65-66; Willis, Cerebri anatome, 126-130, 153-155; "Anatomy of the brain," 92-94, 101; Willis, De anima brutorum, 72-73; Soul of brutes, 23·

[108] Willis, Cerebri anatome, pp. 236-244; "Anatomy of the brain," pp. 125-128.

[109] Dewhurst, Willis's Oxford Lectures, 54-55, 72; Willis, Cerebri anatome, 248-251; "Anatomy of the brain," 129-130; Willis, Pathologiae cerebri, 1-21; "Pathology of the brain," 1-12.

[110] Dewhurst, Willis's Oxford Lectures, 96, 100; Willis, De anima brutorum, 234-244; Soul of brutes, 87-91.

accounted for how derangements within the blood could eventually make themselves felt in the brain. For example, beginning with his Sedleian lectures, Willis argued quite consistently that hysteria was caused by heterogeneous particles in the blood that infected the animal spirits in the brain with unstable and explosive copula; these wayward particles were then carried through the nerves to muscles and to visceral organs, and rendered the movements of those organs convulsive. He denied that the womb had anything essential to do with hysteria. Indeed, this neural rather than uterine cause for the disease explained why men could suffer it also, and why postmortems showed the wombs of hysterical women to be perfectly normal.^[111]

Willis's second mechanism of neural effects, wave propagation, depended equally on the particulate nature of the animal spirits. How, one might ask, were sensations carried so quickly into the brain, and incitements to movement carried so rapidly out to the periphery? Willis solved this problem by proposing that such messages traveled as propagated percussion waves within the fluid mass of particulate animal spirits which, when the brain was active, was maintained at a certain requisite tension. Originally in the lectures the notion appeared simply as a suggestion that spirits in external senses, when agitated by some object, communicated their motion through the nerves to the brain, "just like a stone thrown into a pond causes ripples."^[112] But by the De anima brutorum the concept had developed into a highly ramified and clever device capable of explicating complex phenomena of touch, hearing, sight, and triggering of muscle contractions.^[113] The concept could explain why, although sensation and movement required their own proper end organs, the same nerves, and hence the same animal spirits, could carry out communication between center and periphery; the wave fronts going into and out of the brain passed through each other unimpaired, like intersecting ripples on a pond.^[114]

The image of messages coursing through nerves brings us to Willis's fourth working principle: that the remarkable spatial differentiation of the brain must be correlated with an equally deep differentiation of function. Willis clearly conceived of all brains as composed of three parts: 1) the cerebrum, with its underlying medullary mass, which he called the corpus callosum; 2) the medulla oblongata and the spinal

[111] Dewhurst, Willis's Oxford Lectures, 77-78, 87-91; Willis, Pathologiae cerebri, 144-165; "Pathology of the brain," 76-87.

[112] Dewhurst, Willis's Oxford Lectures, 100.

[113] Willis, De anima brutorum, 154-165; Soul of brutes, 55-60.

[114] Willis, De anima brutorum, 156; Soul of brutes, 56.

marrow; and 3) the cerebellum with its associated structures. His ideas for the functions of these structures, especially the cerebrum and the cerebellum, appeared first in his lectures, and although elaborated in the three subsequent books, did not change greatly. He believed that the cerebrum and its underlying structures served the voluntary functions, especially those of memory and imagination. Memory, being largely a matter of storage, was the province of the cerebral cortex. The huge, seemingly irregular mass of the cortex in man, with its many gyri and sulci—the mounds and recesses—was well suited to the capacious memory and free association of images that was characteristic of humans.^[115] The cerebellum, in contrast, had an orderly, determinate, and almost clock-like structure, which would seem to be designed for some function distinct from that of the cerebrum. This function, he concluded, was the supply and direction of animals spirits for involuntary acts, like heartbeat, respiration, and digestion. Therefore the cerebellum had close access to cranial nerves, especially to the vagus, which went out to all parts of the body.^[116]

In the elaboration of Willis's ideas on the differing functions of the cerebrum and cerebellum one can see clearly at work a further axiom: that the comparative anatomy of the nervous system could be a powerful tool in explicating its functions.^[117] This anatomia comparata, as Willis called it in Cerebri anatome, was not only a philosophical desideratum but a practical and technical one as well. Human heads were difficult to find. Moreover, the large bulk of the human cerebrum was a hindrance to seeing the true relations of structures. Animals, in contrast, especially the dog, calf, sheep, and hog, made for easier dissections. More important, the study of animal brains threw the essential features of human brains into clear relief.^[118] Willis noted, for example, that the shape, size, and laminar structure of the cerebellum was very much the same in many animals. This fitted neatly with the notion that any animal,

[115] Dewhurst, Willis's Oxford Lectures, 66, 138-143; Willis, Cerebri anatome, 123-126; "Anatomy of the brain," 91-93.

[116] Dewhurst, Willis's Oxford Lectures, 66-67, 102-103, 145-149; Willis, Cerebri anatome, 41-48, 176-233; "Anatomy of the brain," 67-69, 108-125; Willis, De anima brutorum, 346-348; Soul of brutes, 142-143.

[117] Willis, Cerebri anatome, 3-5; "Anatomy of the brain," 56.

[118] Remarks on Willis's use of comparative anatomy are scattered throughout the secondary sources, but see Robert S. Dow, "Thomas Willis (1621-1675) as a Comparative Neurologist," Annals of Medical History, 3d series, 2 (1940): 181-184, and especially William F. Bynum, "The Anatomical Method, Natural Theology, and the Functions of the Brain," Isis 64 (1973): 444-468, which contains an acute and penetrating analysis of Willis's use of anatomical findings.

whether fish or man, had an irreducible set of involuntary functions that had to be directed by the cerebellum.^[119] Conversely the cerebrum. It had many fewer gyri in quadrupeds, indicating less capability for memory and learning. In cats, Willis noted, the cerebral cortex showed a fixed and simple pattern of foldings, which indicated that the animal did not learn easily, remembered little, and lived largely by instincts. In even lesser animals like fowl or fish, the cerebral surface was plain and even, indicating action even more dominated by instinct, and an inability to learn activities of more than one type.^[120] A similar kind of argument could be constructed regarding the underlying cerebral medullary parts—all of which Willis comprehended under the term "corpus callosum." They were, he noted, much more highly developed in man. This served to provide ample paths for the movement and interaction of spirits that carried memory, and which thereby gave rise to imagination and appetite.^[121]

These kinds of comparative reasoning occurred again and again in Willis's writings. It was a form of argument which was made possible only by accumulating a rich trove of evidence, from which one could then pluck out the specific set of comparisons to make a point. Here Willis could make the fullest use of Lower's talents while they were both at Oxford, and those of his later anatomical collaborators in London: Lower's younger Christ Church contemporary, John Masters, and the more rough-and-ready surgeon, Edmund King. King was one of Willis's favorite consulting surgeons, and Masters was a medical protegé and younger associate much as Lower had been a few years earlier.^[122] These latter two provided many of the animal dissections—including those of such invertebrates as an earthworm, oyster, and lobster—that Willis used to bolster his arguments in De anima brutorum.^[123]

Moreover, the comparative argument was one based firmly in the tradition of natural theology, which was very strong in the Oxford clubs. Again and again in their works, John Wilkins, Robert Boyle, and Willis himself had argued that dissecting a wide range of animals conduced to

[119] Dewhurst, Willis's Oxford Lectures, 64, 148-149; Willis, Cerebri anatome, 74, 181-182, 223-226; "Anatomy of the brain," 76, 109, 122.

[120] Dewhurst, Willis's Oxford Lectures, 138; Willis, Cerebri anatome, 125; "Anatomy of the brain," 92.

[121] Dewhurst, Willis's Oxford Lectures, 97-98, 134-135; Willis, De anima brutorum, 81 -82, 249-253; Soul of brutes, 26-27, 93-95.

[122] Willis, De anima brutorum, sig. b4v; Soul of brutes, sig. A4v. John Master was about fifteen years younger than Lower: see Foster, Alumni Oxonienses 3:986.

[123] Willis, De anima brutorum, 33-56; Soul of brutes, 7-17.

knowing more fully the power and majesty of the Creator.^[124] Whether one beheld "a Flea, a Louse, or a Mite" through a microscope, or like Boyle, spent many hours "conversing with dead and stinking Carkases," one had joy "in tracing in those forsaken Mansions, the inimitable Workmanship of the Omniscient Architect."^[125]

Willis's use of comparative anatomy to assign functions to the cerebrum and cerebellum illustrates a sixth underlying heuristic principle of Willis's neurology: he tended to explain function as sequential processing—or at the least, sequential action—within the nervous system. Consider, for example, his scheme for the main flow of information between cerebrum and the rest of the body. Sensory impressions—whether they were optic species, sound vibrations, or the sense of touch—were, he thought, carried to the area under the cerebrum that he called the corpora striata. There an inward perception arose. If the impression was carried farther forward into the corpus callosum, then imagination resulted. If the impression went on even farther to the cortex, and impressed its character there, then a memory of that sense impression was created; this memory could be recalled by having the image carried back to the corpus callosum.^[126]

In most cases Willis saw this sequential action as corporeal changes taking place under the direction of the rational soul. The particles, in their movements and vibrations, could be guided by will. But in some cases, portions of the chain could be activated without other parts. For example, in an oft-cited passage, Willis remarked that impressions could strike the corpora striata, and cause a reciprocal action of the animal spirits out toward the periphery, without the brain—and therefore consciousness—being aware of it. When we have a pain or irritation in our sleep, we move our hand to it and rub, even though we have no consciousness of the event. Willis was describing what was later to be known as the scratch reflex—a description that contains a better and clearer idea of the general notion of a reflex than the earlier hypothetical

[124] On the natural theology of Wilkins and Boyle, see Frank, Harvey and the Oxford Physiologists, 56, 93-97; cf. Willis, Cerebri anatome, sigs. A3v-a1r; "Anatomy of the brain," [51-52]; Willis, De anima brutorum, 98-99; Soul of brutes, 34.

[125] Matthew Wren, Monarchy asserted (London, 1659), sig. A7v-8r, for the quotation about microscopy in the Wilkins group; Robert Boyle, Some considerations touching the usefulnesse of experimental naturall philosophy (Oxford, 1663), First Part, Essay I [written c. 1648-1650], 5.

[126] Dewhurst, Willis's Oxford Lectures, 65-67, 134-135, 138-139; Willis, Cerebri anatome, 133-139; "Anatomy of the brain," 95-96; Willis, De anima brutorum, 76; Soul of brutes, 25.

mechanism of Descartes.^[127] Or, he wrote, if an impression was carried beyond the the corpus callosum, striking the cortex, it could raise not only the appropriate memories but associated ones as well, giving rise to fantasies that combine memories in ways not intended by the will.^[128]

Both localizations of functions, and determinate processing paths, were in turn grounded in Willis's belief that the nervous system acted only through defined tracts within its solid parts. Such a principle was obviously true in the peripheral nervous system; no message could be carried outside of the clearly delineated nerves that went to muscles in arms and legs. But Willis seems to have felt that a similar principle was true within the brain and spinal cord as well. Beginning with his lectures, he wrote often of the animals spirits "carving out" tracts by their movements, or repetitive actions being caused by spirits flowing along the same paths.^[129] This belief had several implications. For one, he could vigorously reject the idea that any path-directed functions could take place in a watery medium. He thereby dismissed out of hand the classical notion that sensation, imagination, and memory could be lodged in the set of ventricles deep within the brain, and therefore in the cerebrospinal fluid with which they were filled.^[130] Such a traditional physiological belief was possible when the soul was thought to exercise its functions through unitary and spatially nondifferentiated faculties. But such a scheme could not work when a corporeal soul consisted, as Willis believed it did, in the orderly movement of particles, which had to act in a given place, at a given time. Even assuming that the traditional Galenic localizations in the ventricles had been based on a corpuscular philosophy, such particles within a liquid would not have any constraints upon their motions, so they could not carry out any directed actions. Thus, they could not constitute a soul.

In applying all these principles to construct a picture of the relationship between brain and soul, postmortem examinations occupied an important and interesting, although sometimes anomalous, position. Once he and Lower started their systematic dissections in 1662, Willis was quite anxious to find as many cases as he could in which visible brain

[127] Dewhurst, Willis's Oxford Lectures, 74, 134; Willis, Cerebri anatome, 137; "Anatomy of the brain," 96.

[128] Dewhurst, Willis's Oxford Lectures, 119, 134-135; Willis, Cerebri anatome, 137; "Anatomy of the brain," 96.

[129] Dewhurst, Willis's Oxford Lectures, 55, 67; Willis, De anima brutorum, 72-74, 77; Soul of brutes, 23-25.

[130] Dewhurst, Willis's Oxford Lectures, 139-141; Willis, Cerebri anatome, 139-143; "Anatomy of the brain," 96-98; Willis, De anima brutorum, 325; Soul of brutes, 133.

pathology could be correlated with symptoms, and hence the defective function could be localized. The surviving Sedleian lectures mention about eight such postmortems,^[131] and in one letter of Lower to Boyle in mid-1663, he reported the results of four recent ones.^[132] More were mentioned in Cerebri anatome and Pathologiae cerebri, and Willis was most successful in bringing them into De anima brutorum. In other words, it seems that the more seriously and precisely he explored the mind/brain interaction, the more he was led to seek confirmation of his speculations in postmortem examinations.

Such evidence was most unequivocal and useful when the findings dealt with the cerebral circulation. In a number of cases, for example, Willis and Lower found an obstructed carotid artery going to the brain. Yet because of the anastomosing ring of arteries at its base, which still goes by the name of the "circle of Willis," the flow of arterial blood to neural tissue had been maintained.^[133] Similarly in apoplexy. Although many medical writers attributed such symptoms to an obstruction of blood flow to the brain, Willis could show that the postulated postmortem findings did not always occur.^[134]

Postmortems could also be used to show that diseases which Willis believed were neurological, and which traditional medicine attributed to other organs, were not due to the widely reputed causes. Willis opened a "noble gentleman" who was "much afflicted with scurvy," a disease thought to be caused by the spleen. Yet the postmortem showed that organ free from fault, which Willis took to vindicate his own notion that a taint in the blood had been distilled into the nervous juice and thereby been carried throughout the man's system.^[135] In his lectures Willis rejected the notion that phrenzy was caused by an inflammation of the meninges, and paraphrenzy by a similar sepsis of the diaphragm. He had, he said, found inflamed meninges in three or four necropsies, and inflamed diaphragms in two, but in all these cases the patients had shown no signs of phrenzy or paraphrenzy during their lifetimes.^[136]

The most logically desirable cases—those in which a clear brain lesion correlated with impaired function—were also the hardest to find. In his lectures Willis argued for the corpora striata as the primary sensorium by noting that in those "who suffer or have died from paralysis, I have

[131] Dewhurst, Willis's Oxford Lectures, 86, 108, 115-116, 120, 141.

[132] Lower to Boyle, 4 June 1663, Works 6:466-468.

[133] Ibid., 467; Willis, Cerebri anatome, 95; "Anatomy of the brain," 83.

[134] Willis, De anima brutorum, 372-391; Soul of brutes, 153-161.

[135] Willis, Pathologiae cerebri, 219; "Pathology of the brain," 177.

[136] Dewhurst, Willis's Oxford Lectures, 120.

often observed that these corpora are affected: they become flaccid and their striae are almost obliterated."^[137] In the Pathologiae cerebri he reported opening the body of a gentlewoman who had been troubled with hysterical distempers; the womb seemed faultless, but her nerve plexi—Willis meant here the sympathetic ganglia—appeared pathologic.^[138]

Just as pathological findings allowed Willis to deduce the function of a part from its visible malfunctions, so might he and his colleagues have approached the functions of the brain by using experimentation—one investigates the functions of structures by intervening manually to create a new circumstance, even an artificial pathology. Certainly there was no lack of experimental skill in one or another of the Oxford groups; Lower, Boyle, Hooke, and Wren were among the best, as their contemporaneous work on circulation and respiration showed.^[139] Yet the only experimental work on the brain that Willis and his coterie carried out was to investigate the cerebral circulation by injecting ink, and other colored materials, into the blood vessels.^[140] Why not, one is tempted to ask, test the proposed functions for parts of the brain by performing ablation experiments on animals? Such experiments, performed routinely throughout the nineteenth century, required no technology that could not have been found in seventeenth-century Oxford.^[141] But it would have required both a more finely honed set of operative skills, and a laboratory environment in which dozens of such experiments could be carried out, the animals nursed back to health, and the results observed and evaluated in a systematic way. Seventeenth-century physicians, even skilled dissectors like Lower, were not surgeons; and surgeons were not scholars interested in such questions as the functions of various parts of the brain. Nor were back rooms in an Oxford college, or in a prac-

[137] Dewhurst, Willis's Oxford Lectures, 141; Willis, Cerebri anatome, 158-159; "Anatomy of the brain," 102.

[138] Willis, Pathologiae cerebri, 84; "Pathology of the brain," 45.

[139] See Frank, Harvey and the Oxford Physiologists, 90-223 passim.

[140] Cf. the experiments on cerebral circulation described in Lower to Boyle, 4 June 1663, Works 6:467; also the similar experiments in Willis, Cerebri anatome, 13-14, 60-63, 94-95; "Anatomy of the brain," 59, 72-73, 82-83. For commentary on the discovery of the circle of Willis, see: Sir Charles Symonds, "The Circle of Willis," British Medical Journal (15 January 1955), i, 119-124; Alfred Meyer and Raymond Hierons, "Observations on the History of the 'Circle of Willis,'" Medical History 6 (1962): 119-130; Charles N. Swisher, "The Centripetal and Centrifugal History of the Circle of Willis," McGill Medical Journal 33 (1964): 110-124.

[141] By far the best introduction to experimental techniques of ablation, and what they were capable of revealing, is Max Neuburger, The Historical Development of Experimental Brain and Spinal Cord Physiology before Flourons, translated and edited, with additional material, by Edwin Clarke (Baltimore: Johns Hopkins University Press, 1981).

titioner's house, true laboratories. Experimental neurophysiology had in large part to wait for the time of men like Magendie and his successors, skilled operators within institutional settings where they did not have to squeeze their science into the odd or slack moments of a practitioner's career.

Finally, I should like to point out the very noteworthy way in which Willis systematically attempted to convert diseases that had long been thought to be caused by the blood, viscera, or even supernatural agents, into diseases of the nervous system. Hysteria, hypochondria, headache, lethargy, somnolency, coma, nightmare, vertigo, apoplexy, paralysis, delerium, phrenzy, melancholy, mania, foolishness, epilepsy and a wide array of convulsive diseases, even gout, scurvy, and colic—all were seen by Willis as diseases of the nervous system. For each he constructed an explanation using the assumptions and heuristic principles that I have tried to tease out in the foregoing pages. On each he brought to bear his collection of case descriptions and—especially in the later works—recommended medicaments. In a very real sense, this last of Willis's intellectual tactics brought him back full circle, back to the concerns of practical medicine with which he had begun his career as a young physician of twenty-four.

The foregoing list of approaches and assumptions could quite easily be expanded to include a half a dozen more, each used by Willis in an idiosyncratic and creative way to construct his own explanations of brain function. It is worth reviewing the ones I have chosen to illuminate, just to see how powerful and attractive they are: the concept of the corporeal soul, divided between its vital and sensitive functions; the assignment of different categories of functions to different neural textures; the proposed mechanisms of communication within the nervous system both by particle flow and wave propagation; the concept that spatial differentiations were correlated with functional differences, especially a division between voluntary and involuntary functions; the clever use of comparative anatomy; the conceptual device of sequential processing; the assumption of defined tracts within the brain; the multifaceted use of postmortem findings; and the way in which he orchestrated all of these to bring large numbers of disease states into the neurological orbit. In his intellectual bag of tricks, Willis had more than enough tools to fit together the collection of evidence in the way that he wanted.

Within his own particular circle of natural philosophers in Oxford, such a synthetic approach was appreciated by physicians and nonphysicians alike. In 1666 Samuel Parker, a close friend of Ralph Bathurst, managed to work into such an unlikely topic as the preexistence of souls

an account of Willis's findings on the linkage of brain and heart via the intercostal nerves.^[142] Robert Sharrock, in a sermon on the resurrection, digressed to discuss Willis's neurological theories, especially the functions of the corpus striatum and the corpus callosum.^[143] Beyond Oxford, Willis's books were touted in the Europe-wide correspondence of Henry Oldenburg,^[144] and extolled in reviews in his newly founded Philosophical Transactions, the world's first scientific journal.^[145]

But I suspect that after Willis's death in 1675, and those of his colleagues in the 1680s and 169os, Willis's books exerted their direct effects primarily upon doctors. They were, after all, fundamentally anatomical works, unlikely to draw the casual attention of the gentleman, litterateur, or academic philosopher. They contain a massive amount of detail, and a plethora of conjectural mechanisms that the passage of time might easily render suspect. Hence, I would venture, their relative lack of prominence in nonmedical writings. Willis—then, as now—was a writer whose reputation was greatest among those whose professional or technical backgrounds most fitted them to understand the details that he tried to synthesize.

There is, however, an indirect route through which Willis's influence may have been carried forward well into the late eighteenth century. In a widely read article, G. S. Rousseau has suggested not only that Willis's findings served as an important background source for Locke's Essay concerning human understanding but that his assumption of sensory phenomena delimited to the brain and nerves was, as filtered through Locke, an important trope in the development of the fiction of sensibility

[142] Samuel Parker, A free and impartial censure of the Platonick philosophie, 2d ed. (Oxford, 1667), 194-195.

[143] Robert Sharrock, De finibus virtutis Christianae (Oxford, 1673), 114-115.

[144] From 1659 to 1674 Oldenburg recommended Willis's books to savants such as Pierre Borel, Samuel Sorbiere, Henri Justel, Adrien Auzout, and Jean Baptiste Duhamel in France, Christiaan Huygens in the Netherlands, Johann Hevelius, Johann Michaelis, and Martin Vogel in Germany, Erasmus Bartholin in Denmark, and John Finch, Lorenzo Magalotti, Marcello Malpighi, and Francesco Travagino in Italy; in some cases he even arranged to send on copies. See A. Rupert Hall and Marie Boas Hall, eds. and trans., The Correspondence of Henry Oldenburg, 13 vols. (Madison, Wis., and London: [various publishers], 1965-1986), 1:225-227, 230-231, 240-242, 266-267, 355; 2:142-143, 301-305, 632; 4: 135-137, 148-149, 173-174, 537-539; 8:17-20, 168-170, 430, 529-531, 548-549; 9:36-39, 108-109, 499-500; 10:6-8, 283-284, 296-297, 337, 432, 540-541.

[145] Willis's Diatribae duae and Cerebri anatome appeared before the Philosophical transactions was started by Oldenburg in March 1665. Pathologiae cerebri was reviewed in Philosophical transactions 2 (6 January 1667/8): 600-602; Affectionum, ibid. 5 (25 March 1670): 1 1178; and De anima brutorum, ibid. 7 (20 May 1672); 4071-4073.

and sentiment within English literature from the time of Samuel Richardson in the 1740s.^[146] It is a fascinating insight that is still, to my knowledge, unexplored—perhaps because it falls between the stools of the literary historian, the medical historian, and the historian of philosophy.

MEDICINE, MATTER, SOUL, AND BRAIN

I have focused my attention upon the origins of Willis's neurological oeuvre. In looking at that body of work from three different perspective—biographical, social/institutional, and intellectual—I have tried to distinguish those elements in each picture that most account for the peculiar ensemble of characteristics that his neurological writings ended up displaying. Mine is an activity akin to that of some scientists who study the nervous system itself. Twentieth-century neuroanatomy and neurophysiology have come to see the brain as an amalgam of structures and functions, accreted by evolution over hundreds of millions of years: a mammalian brain is layered upon a reptilian brain, upon which in turn has overgrown a primate and human brain. Much about that human brain and its action can be learned, it is believed, by probing those structures and functions that lie hidden both by the depths of neural space and the continuum of evolutionary time. So does a developmental, or "genetic" (in the old sense of that word), explanation tell us much about Willis's work.

His elaborate system of facts and ideas was clearly driven by medicine. Willis's clinical practice provided him with the basic conundrums that had to be solved. Solve them he did, at great length and, seemingly, to the satisfaction—or at least stimulation—of the physicians of his own and succeeding generations. Moreover, I would argue, it was the very richness of that experience that forced him to conceive of more and more of the mind's functions in neural terms. For a philosopher, it was relatively easy to conjure with terms such as "reason," "judgment," "passion," "sensation," or "volition," because a philosopher need take into account only his own introspective experience, and the rationalized accounts of other individuals' similar introspective experience. He has a purified universe of normal phenomena with which to deal. Not so the physician. Because the clinician must cope with derangements, the

[146] G. S. Rousseau, "Nerves, Spirits, and Fibres: Towards Defining the Origins of Sensibility," in Studies in the Eighteenth Century, Ill: Papers Presented at the Third David Nichol Smith Memorial Seminar, Canberra, 1973, ed. R. F. Brissenden and J. C. Eade (Toronto and Buffalo: University of Toronto Press, 1976), 137-157; reprinted with a postscript in The Blue Guitar (Messina) 2 (1976): 125-153.

pathological rather than the normal, his universe of phenomena is in no way so delimited. Every neurological or psychiatric patient is beyond the normal in his or her own particular way. Moreover, the doctor must react to these derangements, and not merely just study them. To react, he must have reasons for his therapies. And to have reasons, he must believe that the processes he treats exist in an objective and deterministic way. Willis's hundreds of pages of conjectural mechanisms provided that basis for the clinician. Indeed, they were intended to do so; both the Pathologiae cerebri and the De anima brutorum were consciously arranged so that, after the anatomical and physiological explanations of each disease, there were almost interminable discussions of useful therapies and recommended medicaments.

Such a system of medicine was bound together by Willis's picture of the nervous system seen in corpuscular and chemical terms. I use the term "picture" advisedly, because Willis seems to have had an extraordinarily visual apprehension of the conjectural mechanisms he spun out at such great length. He could almost see the particles of spirit, sulphur, and salt arrayed through nerve tracts, combining and disjoining, migrating and percussing. His intense interest in practical chemistry had, over the years, created in him an intellectual eye that really saw what his own biological ones could not. The fact that his matter-theory was both chemical and corpuscular made this possible. When needed, he could conceive of "heterogeneous copula" that gave rise to convulsions or fantasies, and whose atoms had real, and differing properties, from a similar copula made up of other sorts of atoms. Classes of matter could be seen as having inherent chemical properties and resultant forms of action. Conversely, when he needed his particles to act like so many billiard balls as they transmitted an impulse up or down a nerve, that property of mere mass and incompressibility was also open to him. The two sides of corpuscular chemistry not only met the methodological desiderata of fashionable philosophy but squared with the diversity and reality of those messy, colorful, smelly, and indisputably real properties of substances that the kitchen chemist could pulverize, mix, melt, crystallize, sublime, distill, and otherwise manipulate with his own very dirty hands.

The initial outline of conceptual categories that bound together brain and mental phenomena was taken from Scholastic philosophy. The notion of sites for perception, imagination, memory, and the concept of the common sensorium that mediated them, were standard issue in early-seventeenth-century Oxford. Willis knew them and had been trained up on them—the more so since he was originally destined for the church, and completed much of his preparation for that career at a

time before political ideology and philosophical innovation called Scholastic philsophy into doubt. But by temperament he was no philosopher. Speculator, yes; metaphysician, no. Only the impetus of standing in the Natural Philosophy room in the Schools Quadrangle twice a week, and having to say something about the soul, forced him to do so in a way that was consistent with his clinical background and chemical beliefs. He could elaborate a vision of the soul—or rather of many souls—that had probably been gestating through the 1650s, when he was both toiling physician and clandestine high churchman.

But speculation, if it was not to be "poetical philosophy," had limits. Willis knew already the boundaries imposed by clinical experience and chemical/corpuscular matter-theory. He had still to seek the limits imposed by anatomy. To find them, he had to use hands other than his own. Whereas Willis took the lead in clinical experience and chemical expertise, Lower did so in sheer anatomical exuberance. He reveled in the messy details of human and animal structure in a way unexcelled in the Europe of his time, much less in Oxford. Lower could do so because he had neither extensive practice, nor chemical agenda, nor systematizing incentives or inclinations—the very elements that were to give organization and structure to the multitudinous facts that his knife laid bare. It was Lower's anatomy that provided the basis for that handful of clever ways in which Willis, using this device and that, one trick now and yet a different one later, constructed a system of relations between brain and mental phenomena.

In the scientific terms of the late twentieth century, almost all of those detailed constructions end up being judged wrong. In standard accounts, Willis is remembered for his positive contributions to neuroanatomy, not for his "fantasies" about how the brain worked. Yet his ideas are "wrong" in ways which, to me as a historian, are highly appealing. They are beguiling because, once one digs down under the particular explanations of particular diseases or functions, one sees at work a person capable of coordinating large amounts of detailed information, while trying to find general patterns in the chaos.

In the end, Willis is appealing because most of all he wanted to understand. He wanted to feel that when he saw a patient in hysteria, or participated in a postmortem, or discussed an animal dissection, or performed a chemical experiment, he was seeing simply different aspects of the same unified world. Not for him the more limited and austere satisfaction of knowing merely that he had contributed some small part to knowledge. Willis, like so many other thinkers in the seventeenth century, wanted to encompass a total set of explanations. He started from

a position of differentiating sharply between the independent rational soul and the corporeal soul. Yet by the time he was through, he had explored a multitude of ways in which perception, apprehension, understanding, memory, and their relations to the entire body, were dependent in seemingly most complex ways upon that body itself, and preeminently upon its nervous system. The rational soul, by contrast, remained that aloof and—at least in Willis's thought—undifferentiated piece of internal immortality, almost completely and sometimes even woefully dependent upon the environment of information and preconditions created for it by the nervous system. Indeed, when one started with clinical experience, seasoned it with a large portion of corpuscular chemistry, and mixed it with generous quantities of anatomical inquiry, it would be hard to imagine any other outcome.

Yet for all its mistakes in retrospect, Willis's system was a concoction with great appeal to the medical practitioners of succeeding generations, precisely because of this mixture. He has been condemned by some twentieth-century psychologists for having so firmly started medicine down the road of seeking behavioral explanations in neurological terms. But perhaps that was exactly what the early modern physician felt he most needed. And before one dismisses such medical influence as trivial, it is well to remember that in the Enlightenment, as even today, it was the physician, not the philosopher or litterateur, who was confronted almost daily with practical problems in the relations of body and "mind." In many ways, Anthony Wood spoke on Willis an epitaph of more complex meaning than he knew, when he wrote:

When at any time he is mention'd by authors (as he is very often) it is done in words expressing their high esteem for his great worth and excellency, and placed still, as first in rank, among physicians. And further also, he hath laid a lasting foundation of a body of physic chiefly on hypotheses of his own framing.^[147]

[147] Wood, Athenae, vol. 3, col. 1051.

FIVE
Running Out of Matter: The Body Exercised in Eighteenth-Century Fiction

Carol Houlihan Flynn

To save Samuel Richardson from his hypochondriac tendency "to Rotundity and Liquor," the tireless and by now notorious Dr. George Cheyne prescribed a wonderful machine called "a chamber horse." Actually a chair "set on a long board, which must have acted like a joggling board, supported at both ends and limber in the middle, with hoops to brace the arms and a footstool to support the feet," the horse promised "all the good and beneficial Effects of a hard Trotting Horse except the fresh Air." Since the horse "rides double better than single," Cheyne suggested that Richardson hire "an Amenuensis and dictate to him riding on the new Chamber Horse."^[1] The image of plump Richardson, that sentimental traveler of the imagination, jogging cautiously back and forth in a motion designed to get precisely nowhere is a fascinating one.

[1] T. C. Duncan Eaves and Ben D. Kimpel, Samuel Richardson: A Biography (Oxford: Oxford University Press, 1971), 63-64; The Letters of Doctor George Cheyne to Samuel Richardson (1733-43), ed. Charles F. Mullett (Columbia, Mo., 1943), 26-27. In "Mysticism and Millenarianism: The 'Immortal Dr. Cheyne,'" in Millenarianism and Messianism in English Literature and Thought, 1650-1800, ed. Richard Popkin (Leiden: Brill, 1988), 81-126, G. S. Rousseau considers the shape of Cheyne's life as England's leading "nerve doctor" in light of his millenarian and mystical activities. Lester King finds Cheyne to be the "Mirrot of Eighteenth-Century Medicine," in the Bulletin of the History of Medicine 48 (1974): 517-539.

I would like to thank Sheila Emerson, Miriam Hansen, Peter Linebaugh, Felicity Nussbaum, and Claude Rawson for their readings of this essay. Richard Wolfe and his staff at the Countway Library, Harvard Medical School were especially helpful to me. I am particularly grateful to George Rousseau for his careful interest in this subject, and his bibliographic and critical advice.

The chamber horse, a most material hobbyhorse designed to exercise the all too solid flesh as well as the "hyppish," depressed spirits, would appear to be just the thing to satisfy the writer's need to escape from himself. ("As to my health," he confessed in a letter, "I write, I do anything I am able to do on purpose to carry myself out of myself; and am not quite so happy, when, tired with my peregrinations, I am obliged to return home.")^[2] The exercise would also provide a physical stimulation, a pleasant sensation accompanying the imaginary peregrinations. As Francis Fuller, a passionate advocate of the "Power of Exercise," noted, riding increases the velocity of circulation and exalts the spirits while it "gives the Solid and Nervous Parts a grateful Sensation, which in some cases is not contemptible," as well as a "Sence of Tingling and Heat."^[3]

Cheyne also recommended an "imaginary" vehicle to exercise Richardson's generally low spirits. Since Richardson was a "hyp" who exacerbated his physical disorders by worrying, he needed a "hobbyhorse" to occupy and divert his tortured mind. Diversion, mental as well as physical, was essential to the treatment of nervous disorders. "It seems to be absolutely impossible," Cheyne argued in The English Malady, "without such a Help, to keep the Mind easy, and prevent its wearing out the Body, as the Sword does the Scabbard; it is no matter what it is, provided it be but a Hobby Horse, and an Amusement, and stop the Current of Reflexion and intense Thinking, which Persons of weak Nerves are aptest to run into."^[4]

[2] Correspondence of Samuel Richardson, ed. Anna Laetitia Barbauld (London, 1804), 3: 190-191.

[3] Francis Fuller, Medicina Gymnastica: or, A Treatise Concerning the power of Exercise, with Respect to the Animal Oeconomy; and the Great Necessity of it in the Cure of Several Distempers (London, 1705), 43-44, 260. Fuller's book went through nine editions by 1777. Addison recommends him in The Spectator, no. 115, 12 July 1711 (ed. Donald F. Bond [Oxford, 1965], 1: 473-474), for his description of the mechanical effects of riding, adding that "for my own part, when I am in Town, for want of these Opportunities, I exercise my self an Hour every Morning upon a dumb Bell that is placed in a Corner of my Room, and it pleases me the more because it does every thing I require of it in the most profound Silence." George Cheyne mentions Fuller in The English Malady; or, A Treatise of Nervous Diseases of All Kinds (London, 1733), 176.

[4] The English Malady, 181-182. Cheyne is using the word "hobbyhorse" to denote "a favorite pursuit or pastime," but the word itself also suggests more literal, physical play as "a stick with a horse's head which children bestride as a toy horse" and as the figure of a horse employed in morris dancing or on the stage. The word was also used throughout the seventeenth century to suggest foolish, wanton, and lustful behavior, and connoted wanton prostitution (see the Oxford English Dictionary ). Michael DePorte, in Nightmares and Hobbyhorses: Swift, Sterne, and Augnastan Ideas of Madness (San Marino, Calif.: Huntington Library, 1974) writes at length on the idea of the hobbyhorse.

Cheyne's faith in both machines, material and imaginary, testifies to a widespread interest in the ways body and spirit intersect. While investigating the possibility of treating disorders of the soul mechanically and externally, writers against the spleen approached the body as a physical space affected by a spirit in need of diversion. Cheyne and his numerous medical colleagues set out to treat a disease known as the English Malady, that psychosomatic disorder also known as the Hypochondriack Disease, the Hyp, Hysteria, Melancholy, and the Spleen.^[5] Their theories, however, had significant implications not only for medical and psychiatric practitioners but for creative writers in the process of developing the novel. Medical theorists and early English novelists were committed in their different ways to sustaining, and at times inventing, modes of feeling to sustain vitality and to cheat, if not conquer, death.

Writers against the spleen concentrate on the necessity for provocation, stimulation, and diversion in their ironically fatal battles against closure. In his recent study of narrative "design and intention," Peter Brooks argues that "plot is the internal logic of the discourse of mortality." Like so many commentators on the novel form, Brooks prefers to begin his studies with the "golden age of narrative," when "the advent of Romanticism and its predominantly historical imagination"^[6] ex-

[5] An early helpful survey of literature of melancholy is C. A. Moore's "The English Malady," in Backgrounds of English Literature, 1700-1760 (Minneapolis: University of Minnesota Press, 1953), 179-235. L. J. Rather provides an excellent discussion of the idea of hypochondria in Mind and Body in Eighteenth-Century Medicine: A Study Based on Jerome Gaub's De Regimine Mentis (London, 1965). In his edition of John Hill's Hypochondriasis: A Practical Treatise on the Hypo (London, 1776; reprint, Los Angeles: William Andrews Clark Memorial Library, University of California, 1969, as no. 135 of the Publications of the Augustan Reprint Society), George Rousseau provides a useful introduction to the melancholy disease and makes significant connections between "nerves" and the discourses of sensibility in "Nerves, Spirits, and Fibres: Towards Defining the Origins of Sensibility," in Studies in the Eighteenth Century, III, ed. R. F. Brissenden and J. C. Eade (Toronto and Buffalo: University of Toronto Press, 1976. Reprinted in The Blue Guitar (Messina) 2 (1976): 125-153; continued by Rousseau's invaluable theoretical study of "Discourses of the Nerve," in Literature and Science as Modes of Expression, ed. Frederick Amrine (Dordrecht: Kluwer, 1989), 29-60. John Mullan productively discusses the relationship between melancholy and the cult of sensibility in "Hypochondria and Hysteria: Sensibility and the Physiclans," The Eighteenth Century: Theory and Interpretation 25 no. 2 (1984): 141-177.

[6] Peter Brooks, Reading for the Plot: Design and Intention in Narrative (New York: Alfred Knopf, 1984), 22, xii. Swift proleptically treats the "modern" condition of the writer who cannot stop writing in A Tale of a Tub, where his hack confesses to be "now trying an Expcriment very frequent among Modern Authors; which is, to write upon Nothing; When the Subject is utterly exhausted, to let the Pen still move on; by some called, the Ghost of Wit, delighting to walk after the Death of its Body. And to say the Truth, there seems to be no Part of Knowledge in fewer Hands, than That of Discerning when to have Done .... The Conclusion of a Treatise, resembles the Conclusion of Human Life, which hath sometimes been compared to the End of a Feast; where few are satisfied to depart." Not ready to leave his reader, Swift's writer will only agree to "pause awhile, till I find, by feeling the World's Pulse, and my own, that it will be of absolute Necessity for us both, to resume my Pen" (ed. A. C. Guthkelch and D. N. Smith [New York, 1968], 208, 210). The classic "modern" discussion of closure can be found in Frank Kermode, The Sense of an Ending (Oxford: Oxford University Press, 1966). More to the point of the "providentially patterned" eighteenth-century novel is Melvyn New's "'The Grease of God': The Form of Eighteenth-Century Fiction," PMLA 91, no. 2 (1976): 235-243.

pressed itself through relatively well made plots. By determining the nineteenth-century novel with its emphatic devotion to regularized form as the model, the critic can then read into the twentieth century's suspicion of plot and its short-circuiting of the satisfying ending a tragicomic progress toward the modern condition. A reading of the eighteenth-century novel, however, makes such an analysis highly problematic, for from the start, the novel resisted the sort of determinancy, the "sense of an ending" modernists like to depart from.

Early novelists, like medical writers against the spleen, were searching for ways to come to terms with a mortality becoming all too pressing in a secularized world. While the medical therapists warn against the dangers of solidification, for to allow one's juices to grow stiff and solid is to harden into death itself, the writers of fiction resist ending their narratives, often fictionalized peregrinations, with digressions, anachronistic disruptions, parodic tailpieces that turn upon themselves, and metaleptic misspellings. In novels and treatises alike, their authors frequently locate themselves in their texts as sufferers of the malady they are trying to control; indeed, the writing becomes the cure as long as it goes on. And since to end it is textually, and sometimes literally, to die, writers against the spleen are most reluctant to lay down their pens. Sterne most notoriously refuses to end his Sentimental Journey, which doesn't even get his narrator to Italy and collapses his Life and Opinions of Tristram Shandy into a "COCK and a BULL," but he merely exaggerates a tendency for strategic digression shared by his less obvious colleagues. Cheyne issues and reissues compulsive directives designed to alter most radically his reader's diet, Nicholas Robinson rewrites his prescription against consumption to cure the spleen, while Smollett resumes his adventures of picaresque Ferdinand Count Fathom within the sentimental pages of Humphry Clinker. Richardson, when not astride his hobbyhorse, writes and rewrites the longest works of fiction in his language, taking each new edition of his novels as an occasion to "improve" most compulsively novels that by virtue of their fluid state never really end.

This essay will first examine the protean nature of "the Spleen" itself, both organ and condition, and follow this exploration with a discussion of the therapeutic "Power of Exercise" so celebrated by most writers on the spleen. I will then consider in some detail the significance of mental and physical exercises in the work of Smollett and Sterne, while intimating the broader theoretical implications of their literary attempts to run, jump, and swing out of matter. Usually regarded as formidable opposites, the splenetic Dr. Smelfungus provoking sentimental Yorick into postures of sweet benevolence, they both address the same problem, the dilemma of the spirit being contained by matter that will inevitably betray. Their narrative strategies are designed to frustrate the logical end of their discourse, fictional closure that represents physical death. Since both writers suffered from the same fatal condition, consumption, their attempts to run out of matter take on an urgency less obviously shared by their contemporaries. Attempting to escape the logic of plot, they pushed metaphors into a reality charged with an all-too-under-standable desire.

In his Essay of Health and Long Life, George Cheyne announces "The Grand Secret and Sole Mean of Long Life." It is

to keep the Blood and Juices in a due State of Thinness and Fluidity, whereby they may be able to make those Rounds and Circulations through the animal Fibres wherein Life and Health consist, with the fewest Rubs and least Resistance that may be.

Unfortunately, Cheyne complains, in spite of all effort, in a process “Mechanical and Necessary "

Time and Age will fix and stiffen our Solids. Our original Frame and Make renders this unavoidable and necessary. As in the greater World, the Quantity of the Fluids is Daily lessening and decreasing; so in our lesser World after a limited Time, the Appetite and Concoctions failing, the Fluids are lessened and spent on the continual Repairs of the Solids, and thereby lose their Nature, and become firm and hard.^[7]

Cheyne's model man, contained by the limitations of his own frame, is a familiar one to readers of eighteenth-century medical texts. Radical practitioners would try to revitalize the fluids themselves through blood transfusions. In his History of Health and the Art of Preserving It, James MacKenzie reports tales of "old, decrepid and deaf animals" that "had their hearing, and the agility of their limbs, restored by the transfusions

[7] George Cheyne, An Essay of Health and Long Life (London, 1724), 220-221.

of young and healthy blood into their veins," and cites the cure of a young man "of an uncommon lethargy" restored to health by the blood of a iamb. Another thirty-four-year-old man was cured "of an inveterate and raging phrenzy" by transfusions of calves' blood, but when the bowels of Baron Bond, son to the first Minister of State in Sweden, mortified after a transfusion, MacKenzie's enthusiasm dwindles. Let us cheerfully submit to "that happy state for which we were originally intended," he suggests, echoing the necessarily philosophical conclusions other physicians were drawing. In his attempt to understand the "hardening process," Claude-Nicolas Le Cat decided that our growth turned inward. The only way to escape solidification would be to continue to grow outward, becoming in the process a giant. It is growth itself, Marat acknowledged, that destroys life.

It is one thing to be philosophical, to shrug with grudging acceptance at the wisdom of Buffon's aphorism that "La vie est un minotaure... elle devore l'organisme,"^[8] but it is another thing entirely to be human—that organism being devoured. All the while medical writers chasten themselves for seeking relief from their impossible condition, they tend to play, nonetheless, at improving it. To do this effectively, they need the proper material, a place that allows room for at least imaginary relief. The spleen provided just the place: that shadowy mysterious organ with no obvious function offering a locus of anxiety and of hope, a place both real and unreal to theorize over, a place to exercise the imagination. The spleen's significance depends upon its obscurity, its subtle texture "remote not only from the Senses but likewise from the Reach of human Understanding... Eternally hid[den] from us."^[9] Just this obscured quality lends to the subject of melancholy its fascination. Its remote inaccessibility creates poetic license for fantastic speculations about the true nature of the cave of the spleen. Not until the time of Freud's unconscious would a place both imaginary and real receive such attention.

Bernard Mandeville, a physician as well as moral philosopher, is most blunt about the instability of the "meaning" of the spleen in his Treatise on Hypochondria. His dialogue format opens up his discourse to the con-

[8] James MacKenzie, The History of Health and the Art of Preserving It (Edinburgh, 1758), 432-436; John McManners, Death and the Enlightenment (Oxford: Oxford University Press, 1981, 113-114. Gerald J. Gruman discusses the century's interest in blood transfusions m A History of Ideas about the Prolongation of Life: The Evolution of Prolongevity Hypotheses, Transactions of the American Philosophical Society, vol. 56, pt. 9 (Philadelphia, 1966), 82-83.

[9] B. Mandeville, M. D., A Treatise of the Hypochondriack and Hysterick Diseases in Three Dialogues, 3d ed. (London, 1730; 1st ed. 1711), v.

tradictory opinions about a disease that he purports to treat. Thus, when his melancholy sufferer Misomedon, inspired by the works of Thomas Willis, compares his model of the body to a still that "exalts in the nature of a Ferment" the earthy and muddy part of the blood that must be "cooked" in the spleen before it rises to circulate, his physician Philopiro listens to his theory only to deride it. "These Similes ...are very diverting for People that have nothing else to do," he sneers. "We are altogether in the Dark, as to the real use" of the spleen, he argues, quite sensibly, but then contradicts his skepticism by offering his own rather poetic theory of animal spirits to explain Misomedon's attacks of hypochondria. Nimble, volatile messengers "fly through all the Mazes and Meanders " and "beat through all the Paths, and hunt every Enclosure of the Brain in quest of the images we want." Philopiro can almost feel their labors as he calls them up in his own imagination, those obliging sylphs darting between mind and body sometimes bewildered in the search until they light by chance upon the looked-for image. Overly active spirits produce too much cogitation, causing scholarly melancholia and a bad case of indigestion.

Philopiro's airy discourse irritates Misomedon, who reminds his doctor that animal spirits are just as metaphoric as his own disparaged model of the body and as Willis's still. Hedging at first, arguing that their existence has never been "controverted," Philopiro suddenly gives up his argument by acknowledging that truth is not the point. The animal spirits are not necessary "real," but they are useful metaphorically "to express the Instruments of Motion and Sense." As long as the body guards its secrets, the abstraction of body can be manipulated through a discourse that actually depends upon speculation and ambiguity.^[10]

Just this ambiguity complicates medical treatment of a condition both imaginary and real. The disease manifests itself physically in palpably understood symptoms; yet these symptoms, also attributed to the mind, become part of a larger system that defines its sufferer's idea of his or

[10] Mandeville, Treatise, 95-98, 115, 136, 160-162. In Ideas of Life and Matter: Studies in the History of General Physiology (Chicago: University of Chicago Press, 1969), Thomas Hall discusses Thomas Willis's idea of "Life as a Subjugated Flame" (1: 312-325). Cheyne expresses a similar, rather pragmatic skepticism about the existence of the animal spirits in The English Malady, seeming to dismiss the likelihood of their being more than an idea based upon "the readiest Resemblance the Lazy could find to explain Muscular Motion by.... On such a slender and imaginary Similitude, the Precarious Hypothesis of Animal Spirits seems to be built." Cheyne ultimately suggests that "the Notion of animal Spirits is of the same Leaven with the substantial Forms of Aristotle, and the colelestial System of Ptolemy " (74-75, 85).

her culture. The spleen becomes for the eighteenth century the inevitable disease resulting from the complexities of urban, "civilized" life that literally makes people sick. It becomes part of the neurotic discontent Freud would find impossible to disconnect from the civilization he would not be able to live without. Even as he enumerates the pains of London, that "greatest, most capacious, close, and populous City of the Globe, " stinking with the "Ordure of so many diseased, both intelligent and unintelligent Animals; the crouded Churches, Church-yards and Burying-places, with putrifying Bodies, the Sinks, Butcher-Houses, Stables, Dunghils, & c., " Cheyne nonetheless depends upon the impossible system that makes his profession necessary. As he observes, it was, after all, the luxury and disease of the Egyptians, Greeks, and Romans that provoked them to study sacred Physick to remedy their own evils. Once a people cultivate the polite and ingenious arts, they follow by developing "Physick to any tolerable Degree of Perfection" to cure their most civilized ills.

Melancholy becomes therefore a responsibility, but also a privilege, a sign of the status of its sufferer. It is not even clear that melancholy can—or should—be resisted. "Virtue and Happiness are literally and really Cause and Effect,"^[11] Cheyne remarks, suggesting that health is something the gentle reader can achieve through labor and learning. Yet ironically, most treatises insist upon the over-determined nature of the melancholy "type." Lively, quick-witted, acutely sensitive, profoundly obsessive sufferers of the spleen are cursed with imaginations that certify their worth. Even while the reader is exhorted to break out of the splenetic condition, the end result, health, looks at best dull and unattractive. Naturally "healthy" people are the laborers, the poor, doltish owners of "callous" organs of sensation, "Ideots, Peasants and Mechanicks, " incapable of wit.^[12] "Slow and heavy thinking" secures "drowsy thick-scull'd Fellows... from becoming hypochondriacal, as those, who cannot Write, from being pillory'd for Counterfeiting other People's Hands,"^[13] Mandeville suggests, making melancholy a condition as natural and as personal as one's signature, a privileged symbol of class. To lose the morbid sensitivity in question is to lose a certificate of worth. Cheyne, celebrating his own delicate sensibility, wonders how "One shall suffer more from the Prick of a Pin, or Needle, from their extreme Sensibility, than others from being run thro' the Body; and the first Sort,

[11] Cheyne, The English Malady, 55-56, 26.

[12] Cheyne, Essay of Health and Long Life, 160.

[13] Mandeville, Treatise, 237-238.

seem to be of the Class of...Quick-Thinkers. " More ominously, he believes that "some rational Creatures" of the hardy variety "would suffer less in being finely butcher'd than a strong Ox, or red Deer. "^[14]

Cheyne, particularly, in tract after tract, edition after edition, seems dedicated to dwell on the condition that he resists yet calls up each time he describes it. His own personal story, "The Case of the Author," borden on farce as he painstakingly describes his own fall into and out of varying degrees of health always precarious. Cheyne's narrative violently alternates between complacency and self-loathing as his body "swell'd to an enormous size" when it was not "melting away like a Snow-ball in Summer." Cheyne seems driven to illustrate the irremediable nature of a body he is still determined to cure as he keeps trying to find an impossible balance between states of excess. Wasted away by fever, he suffers from an appetite so insatiable that "I suck'd up and retained the Juices and Chyle of My Food like a Sponge," growing in the process "plump, fat, and hale to a wonder; but indeed too fast." An "extreme Case," Cheyne balloons up at one point to over thirty-two stone and is "forced to ride from Door to Door in a Chariot even here at Bath; and if I had but an Hundred Paces to walk, was oblig'd to have a Servant following me with a Stool to rest on," while he is curing others of his own radically unstable disease. Cheyne considers himself recovered through "extraordinary Remedies," but his discourse, lurching between states of extremity, dwelling obsessively upon the times that his body became "tumified, incrusted, and burnt almost like the Skin of a roasted Pig, " suggests a fundamental instability that preoccupies writer and reader alike. Characteristically, in closing his "case," to demonstrate his sound health, Cheyne describes exultantly his latest disaster. After being thrown out of a chariot and falling on his head, suffering a dreadful wound in the temple, after his eyebrows are shaved off, after being bled, Cheyne reports with enthusiasm his miraculous recovery, an event that barely survives the violence of his prose.^[15]

In writing their attacks against the spleen, our authors almost guarantee their splenetic states, for axiomatically those most prone to attacks of melancholy are scholars, those weak, sedentary, and studious martyrs who wear away their eyes and their digestive tracts in their pursuit of

[14] Cheyne, The English Malady, 366; George Cheyne, Essay on Regimen (London, 1740), 71.

[15] Cheyne, "The Case of the Author," in The English Malady, 330, 342-343, 351, 360-361.

phantom truth.^[16] Ramazini, a physician who carefully categorized the industrial diseases typical of professions as various as the cleaners of jakes, the bearers of corpses, nurses and footmen, horse coursers and midwives, addressed with great seriousness the diseases of "learned Men," as "slothful and idle in their Body, as they are active in their Mind and Brain." Suffering from bad digestion and constipation, "hard students... by Reading and Writing with their Head and Breast bent, compress the Stomach and Pancreas," strain their eyes, cripple their hands, and deprive their brain of its tone.^[17] Forgetful of their bodies, scholars abuse it through neglect while they spend too much time thinking on subjects—like melancholy—that seize their imagination. While "People of lower Fortunes labour under such a Variety of Necessities... that they have not time stedfastly to think on one thing," scholars, relieved from tedious "Necessity," demonstrate "strong Symptoms of a labouring Imagination" as they "revolve long upon the same Ideas."^[18]

To cure the spleen, practitioners prescribed diets, vomits, purges, and empiric courses of physick. One course of advice often contradicted another, but most treatises agree on one principle: the power of exercise. To move the animal spirits, to open up the great sensorium, one must move the body itself. "The difference between the lowest, most abject, and the highest, most elevated natural Capacities must depend upon the different Degree of Motion coming to the Seat of the common Sensorium," Nicholas Robinson argued. Robinson wonders just why the solids need to be roused, why they grow sedentary and effete, incapable

[16] In The History of Health MacKenzie advises the studious and contemplative to "endeavour to repair by their temperance, regularity, and care, what is perpetually impaired by their weakness, situation and study" (416-417). In Essay of Health and Long Life, Cheyne suggests that the "Weak, Sedentary and Studious, should frequently shave their Head and Face, wash and scrape their Feet, and pare the Nails of their Toes" (228). In "The Art of Preserving Health," John Armstrong advises the scholar "to stand and sit by turns / As Nature prompts," warning that "o'er your leaves / To lean for ever, cramps the vital parts, / And robs the fine machinery of its play" (bk. IV, 11. 80-83, Poetical Works [Edinburgh, 1781], 67).

[17] Bern. Ramazini, A Treatise on the Disease of Tradesmen, to which they are subject by their particular Callings, trans, and ed. Dr. James (London, 1740), 269, 273. Ramazini finds that mathematicians, "abstracted from the Senses, and cut off in a manner from all Commerce with the Body," are "almost all stupid, slothful, lethargic, and perfect Strangers to human Conversation, or the Business of the World," while writers tend to suffer most from constant sitting, "perpetual motion of the Hand in the same manner," and constant attention and application of the mind (286, 400).

[18] Mandeville, Treatise, 220; Nicholas Robinson, A New System of the Spleen, Vapours, and Hypochondriack Melancholy: Wherein All the Decay of the Nerves, and Lowness of the Spirit, are Mechanically Accounted for (London, 1729), 22.

of sending the precious fluids to the extreme parts of the body, and decides that it all has to do with the Fall. God makes good in every case "that Sentence he pronounc'd against disobedient Man, that in the Sweat of his Face, he should eat his Bread."^[19] Since "civilized" melancholics do not literally need to labor for food that their servants gather and prepare, they needed to be forced into a course of bodily exercise.

Mandeville presents a typical course of exercise in his prescription for a greensick, melancholy maiden. After being awakened before 6:00 A.M.,

let her be swung for half an Hour, then eat her Breakfast and get on Horseback for at least two Hours, either gallopping or trotting as much as her Strength will permit her. Immediately after this let her be undrest, and by some Nurse or other chafed or dryrubb'd for a considerable time, 'til her Skin looks red and her Flesh glows all over: Let her begin to repeat the same Exercise about Three in the Afternoon, and after supper keep upon her Legs two Hours before she goes to Bed. The Swing I speak of may be made after what manner your Daughter fancies most; that which they call a Flying-horse, makes a very agreeable motion, but if she be apt to be giddy, she may swing in a Chair, or other Seat to which she is fasten'd; otherwise a Rope tied with both Ends to a Beam is sufficient.^[20]

Mandeville outlines here the course of exercise promoted by Francis Fuller, M.A., author of Medicina Gymnastica, once a sufferer from "giddiness" but now grown hale and hearty after following Dr. Sydenham's regimen of exercise.^[21] Fuller argues that the body "improves by Exercise, and acquires by frequent Motion an Ability to last the longer." Exercise particularly increases the animal spirits, aids the digestion, enriches the blood, and stimulates an increased velocity of the circulation.

The idea of exercise was not in itself new or startling for the eighteenth-century reader. Considered one of the six "non-naturals" fundamental to proper health, it, like civilization and its discontents, went back at least to the Greeks. Fuller defers to Hippocrates and Galen

[19] Robinson, System of the Spleen, 32-33; see also Nicholas Robinson, A New Method of Treating Consumptions: Wherein all the Decays Incident to Human Bodies, are Mechanically Accounted for (London, 1727), pt. l, 202. In Primitive Physick: or, An Easy and Natural Method of Curing Most Diseases (London, 1747), John Wesley argued that exercise was "intimated by the Great Author of Nature, in the very Sentence that intails Death upon us. 'In the Sweat of thy face shalt thou eat bread till thou return unto the Ground'" (v). John Dussinger provides an excellent introduction to the idea of the sensorium in "The Sensorium and the World of A Sentimental Joumey, " Ariel 13 (1982): 3-16.

[20] Mandeville, Treatise, 305

[21] Fuller reported that he suffered from "Giddiness," and in an attempt to recuperate drank Bath Waters so long that he was "scarce able to go about without Staggering like a Drunken Man" (Medicina Gymnastica, 256).

when he recommends his "modern" method to lovers of the ancients, and alludes to Asclepiades, inventor of the "Lecti Pensiles," hanging beds, which served as swinging cradles to soothe ancient hysterics.^[22] But while the benefits of exercise had become a commonplace, once the body became matter difficult if not impossible to transcend, exercise itself offered a more urgently sought solution to the problematic mortal condition. Emphasizing the mechanical nature of the body, theories of exercise could appeal to a materialistic sensibility, while at the same time offering a way to achieve "Sympathy betwixt the Soul and Animal Spirits." Thus a therapist like Richard Browne, in his Medicina Musica: Or a Mechanical Essay on the Effects of Singing, Musick, and Dancing, on Human Bodies, might argue for mechanical results, but he promises as well a rhapsodic response to the "mighty Power and Energy of Musick" and movement that should displace fears of bodily containment. Fuller more prosaically, but no less confidently, prescribes horseback riding for the vigorous victim of melancholia. The "true Hysterick Colick" is best soothed by the "Use of a Chaise, or light Calash... convenient for Women... wherein the sick Person may at once enjoy the Convenience of a Cradle, and the Vehemence of Exercise."^[23] Cold baths, swinging, and applications of the "flesh-brush"—wielded by a vigorous servant—should enliven the most debilitated.

The ideal goal of exercise is to strengthen the constitution. By stimulating the "animal spirits," one "may come to the strength of a Tartar. "^[24] But in fact, most of the exercises recommended depend more upon the health and vigor of surrogate bodies "moving" their master or mistress. Motion becomes that which is done to one's body by the agency

[22] Fuller, Medicina Gymnastica, 13-21, 236-237. As James Work notes in glossing Sterne's use of the term, "Non-Naturals" is "A term formerly used by physicians to indicate the six things which because they do not enter into the composition of the body are not 'natural' yet which are essential to animal life and health and which by accident or abuse often cause disease: air, meat and drink, excretion and retention, sleep and waking, motion and rest, and the affections of the mind" (Laurence Sterne, The Life and Opinions of Tristram Shandy, Gentleman, ed. James Work [New York: Odyssey Press, 1940], 76). Melvyn New's note on the non-naturals is very helpful: The Life and Opinions of Tristram Shandy, Gentleman, ed. Meivyn New and Joan New (Gainesville: University Presses of Florida, 1978-1984), 2:121-122. (All further quotations will be from the Florida edition.) In "The 'Six Things Non-Natural': A Note on the Origins and Fate of a Doctrine and a Phrase," Clio Medica 3 (1968): 337-347, L. J. Rather suggests that by the eighteenth century the term itself would seem inappropriate, certifying Tristram's own complaint that "the most natural actions of a man's life should be call'd his Non-Naturals" (TS 1:84).

[23] Richard Browne, Medicina Musica (London, 1729), 7, 121; Fuller, Medicina Gymnastica, Fuller, 50-52.

[24] Fuller, Medicina Gymnastica, 118.

of another. Adam's curse, to earn daily bread by the body's daily sweat, seems to have been redistributed to fall more often than not upon the stronger, coarser backs of his poorer children. As the proverb went, We are all Adam's Children, but Silk makes the Difference.^[25] While exercise was valued for its benefits, it was also distrusted for its coarsening, often debilitating side effects. In An Account of the Effects of Swinging, James Carmichael Smyth, measuring the effect swinging has on pulmonary cases, makes a clear distinction between exercise and motion. Exercise is muscular action, an exertion of the locomotive powers of the body "to increase the force and frequency of the heart's contraction, the velocity and momentum of the blood, the quickness of the breathing, and the heat, irritability and transpiration of the whole body." While exercise may temporarily increase strength and vigor, "when continued beyond a certain time, [it] induces lassitude, debility, and languor."^[26] (Ramazini had earlier observed the running footmen's tendency to "have a Swelling in the Spleen: for the loose Substance of this Organ receives more Blood, upon the violent Motion, than it discharges." Even more alarming was the tendency for "Horse-Coursers or Grooms, and those who ride Post" to become frigid and impotent: "the Strength of the Loins and the genital Parts is dissolved by the continual Shaking and Jogging.")^[27] Motion, however, rather than exercise, can provide the benefits of exercise without the "agitation, or succession of the body." Smyth considers three sources of motion beneficial to pulmonary patients: sailing, swinging, and aerostation. The last-named is "a method of conveying an animal with great velocity through the atmosphere, without the smallest exertion of its own powers, or even consciousness of motion." The advantage of this violent form of transportation is that it would provide the maximum opportunity for a "change of air," since a quick succession of air so necessary to health depends upon the "velocity with which the body moves through it." But Smyth prudently forbears catapulting pulmonary patients through the air: as "the expence and hazard attending such experiments precludes this from being applicable to the

[25] A London Proverb of 1732 as cited by Peter Linebaugh in his forthcoming study of eighteenth-century social and criminal history, The London Hanged.

[26] James Carmichael Smyth, An Account of the Effects of Swinging, Employed as a Remedy in the Pulmonary Consumption and Hectic Fever (London, 1787), 17-18. Smyth argues that swinging offers the benefits of sailing recommended so highly by the ancients in cases of consumption, without the detrimental effect of sea air. "The change of air... a quick succession of air, owing to the velodty with which the body moves through it, is best obtained by swinging" (12).

[27] Ramazini, Disease of Tradesmen, 224 (misnumbered 252), 229.

purposes of medicine or of common life, they must always remain more a matter of curiosity than of use."^[28]

When Fuller and Smyth prescribe their jogging and swinging machines, they are attempting to work externally on the spirit as well as the body, by diverting and disrupting the natural tendency of their patient's progress toward depression, toward "solidification," toward, not just metaphorically, death itself. If, as Robinson suggested, "the labouring [melancholic] Imagination revolve[s] long on same Ideas," it must be interrupted from its obsessive revolution. As Fuller noted, briskness of motion "must take a Man off from close Thinking," for "there is nothing like Hurrying the Body, to divert the Hurry of the Mind." Even "the Perception of a Pain, may be in some Measure interrupted by a swift Motion, for that Perception cannot strike so strong at such a time." Motion becomes displacement, a way of staving off perceptions that turn morbid, since "a Man that should set himself to Muse on a full Gallop, would think but very incoherently."^[29] Just this planned incoherence generates narrative strategies of digression, disruption, and disjunction in the eighteenth-century novel.

Eighteenth-century novels are, as a rule, scrambled, jogging, rocking narratives that resist interiority while refusing to end. They tend, in fact, to embarrass critics dedicated to the rise of a more regularized generic form. Sterne is the greatest violator of what formalists like to think of as generic imperatives to close a matter that has been opened. But he just makes obvious what Defoe, Richardson, Smollett, Cleland,

[28] Smyth, Effects of Swinging, 17-19.

[29] Fuller, Medicina Gymnastica, 162-163, 272. Sterne provides a good example of the therapeutic benefits of equestrian diversion in Sentimental Journey when Yorick, pensively considering the dead ass he has just seen on the road, is jostled out of his lamentation by his postillion, who will "go on tearing my nerves to pieces till he has worked me into a foolish passion, and then he'll go slow, that I may enjoy the sweets of it. The postillion managed the point to a miracle: by the time he had got to the foot of a steep hill about half a league from Nampont,—he had put me out of temper with him—and then with myself, for being so" (A Sentimental Journey through France and Italy by Mr. Yorick, ed. Gardner Stout [Berkeley and Los Angeles: University of California Press, 1967], 143).

[30] Answering his own provocatively posed question, "Did Sterne Complete Tristram Shandy ?" Wayne Booth argued that Sterne consciously and coherently completed his text, carefully tying his major episodes together: Modern Philology 48 (1951): 172-183. R. F. Brissenden disagrees with his argument in "'Trusting to Almighty God': Another Look at the Composition of Tristram Shandy, " in The Winged Skull: Papers from the Laurence Sterne Bicentenary Conference, ed. Arthur H. Cash and John M. Stedmond (Kent, Ohio: Kent State University Press, 1971), 258-268.

Goldsmith, and even Fielding were doing.^[30] Various "sources" of the novels are often successfully invoked to explain the road trips that most fictional characters seem to be taking. Pilgrimages, heavenly and familial, picaresque assaults on bourgeois sensibility, romance quests, post-Edenic forced marches through life into death are all, with good reason, appreciated for their bearing on the early English novel. I would like, however, to consider the disruptive principle of motion itself as prod and brake, as a principle of narrative progression sustaining a movement whose logical ending is narrative closure, physical death. Like medical theorists writing against the spleen, the novelists are grappling with the same materiality, the same "limitations of frame" that force the most well-plotted life to end.

This principle of motion disallows sustained interiority. To avoid closure, one must keep moving and keep on the superficies of things. Inside is where the maggots lurk, where the vital spirits solidify, harden, and die. Do not loll in bed too long, warns Robinson writing on the spleen, for "these overlong Interruptions with Self, so weaken the Springs of the finest Animal Fibres, on which the Exercise of [intellectual] Faculties depend."^[31] To escape and to conquer self, one must keep moving, but ironically to move with purpose is to reach one's destination. Enter the swing, the chamber horse, the journey itself as disruptive agents of motion that exercise the body and soul physically and sentimentally, extending feeling to text that sustains vitality and displaces matter.

Swinging doesn't get you anywhere. That is its point, illustrated with great delicacy by Fragonard,^[32] whose erotic appreciation of that moment of desire when all is possible, when body itself has not inserted its own unidealized and often contradictory demands, makes clear just what the swing can and cannot do. In a swing, one enters new air only to be drawn back into the old, and while it is theoretically possible to escape the power of gravity itself between states of up and down, the swinger is nonetheless forced into another just as demanding rhythm that only looks effortless. A certain urgency enters into the most idyllic scene of swinging from the awareness that to stop moving is to fall into the matter at hand.

[31] Robinson, System of the Spleen, 335. In Essay of Health and Long Life, Cheyne also warned against the dangers of "lolling and soaking in Sheets, anytime after one is distinctly awake." The practice “thickens the Juices, enervates the Solids, and weakens the Constitution" (84).

[32] "The Swing," The Wallace Collection.

After Mandeville's physician prescribes his course of exercise to cure the greensick maiden, her father asks, quite sensibly, "But might not Marriage be as effectual as all these Exercises?"^[33] His question gets to the masturbatory point of swinging, its eroticized avoidance of conjugal connections that indeed get you somewhere, get you married, get you pregnant, get you tied to complications of matter itself. When Fragonard's lady of the swing stops moving between yes and no, she will fall into that matter which is, pictorially, her destiny, just as when Smyth's pulmonary patients step down from their swings, their pulses will reassert their tedious talent at measuring an illness better evaluated on the ground. Fuller compared quite tellingly the motion of the soothing chaise to that of a cradle, for the cradle, simulating the undulating motion of the womb itself, keeps its fragile occupant safe from the real motion outside that will, naturally, propel it into life leading into death. To swing is figuratively not to die.

The swinger also engages in a mock death, by flirting with the idea of falling off. Recall Mandeville's warning against giddy daughters mounting their lofty flying horses, as well as Fuller's appreciation of the "Vehemence of Exercise" the undulating chaise could provide.^[34] Even as therapists describe the safety features of their apparatus, they seem to be introducing elements of danger. And on occasion, the apparatus is designed to be dangerous, to induce—therapeutically—terror.

Jerome Gaub discusses the therapeutic uses of pain in his two essays on regimen, De regimine mentis. In the first essay (1747), he refers obscurely to the power of stimulants "that stir up the humors, excite the nerves, and inflict pain," and calls attention to the benefits of water therapy in hysterical cases. "The frightful torment that the near loss of life from suffocation inflicts on the mind" might be a "terrible remedy indeed but one hardly to be exceeded in efficacy by any other when an unsound mind is to be helped by the effects of a bodily change." Gaub becomes more specific in his prescription of "Terror as a Therapeutic Agent" in his second essay (1763), where he calls for "a machine that will inspire extreme terror, and submersion of such duration and frequency that life itself is put in hazard and doubt arises when the man is withdrawn whether he is quite dead or can still be revived." Even arthritis can be relieved by terror. A certain gouty patient "whose hands

[33] Mandeville, Treatise, 307. Philopiro answers, Yes, but adds that the marriage might fail, making two people unhappy instead of one, and "may but half Cure the Woman, who lingering under the Remainder of her Disease, may have half a dozen Children that shall all inherit it."

[34] Mandeville, Treatise, 305; Fuller, Medicina Gymnastica, 50.

and feet had been covered with poultices of milk, flour and turnips in order to relieve the pain," was left unattended. Disastrously, a pig forced its way into the patient's room, and "Attracted by the odor it began to devour the poultice." This rough assault "threw the man to the floor, not without the greatest emotional disturbance but with the result that his pains abated from then on and shortly thereafter entirely disappeared, never to return again."^[35] As Fuller noted, "Torture will rouse the Spirits for some time very much,"^[36] while Robinson cited with approving wonder the case of an idiotized woman in Cheshire "that had been subject to Fits of Lunacy for near twenty Years," who recovered "the perfect Use of all her Senses" after fortuitously slipping 150 feet "from the Ridge of a steep Hill."^[37]

Through the power of exercise, in bouts of swinging, jogging, bouncing, more radically through shock therapy designed to divert depressed spirits by dunking, whirling, and plunging mad matter into consciousness, writers against the spleen work to create irritation to stimulate the spirits into action, forming "those vivifying secretions" so necessary to sexual and mental vigor.^[38] The benefit of irritation is invoked parodically

[35] Quoted in Rather, Mind and Body, 109-110, 188-189. Rather's commentary is particularly valuable. He cites many examples of remarkable therapeutic procedures. Boerhaave, for instance, described the practice of a practitioner in Holland "so successful that some of the highest men in the country were committed to his care." The patient was treated with consideration and leniency, "but the moment the disorder asserts itself he is seized and soundly beaten…. at last his fear of a beating is so great that he puts his mad-ness aside" (193).

[36] Fuller, Medicina Gymnastica, 9.

[37] Robinson, System of the Spleen, 67.

[38] Wesley recommended that the deranged suffering from raging madness "Keep on the Head a Cap fill'd with Snow, for two or three Weeks." Alternatively one could "Set the Patient with his Head under a Great Water-Fall, as long as his Strength will bear" (Primitive Physick, 79). Illustrations of Joseph Guislain's more orderly methods of shocking his patients into consciousness dramatically extend these earlier ideas, especially those found in Traité mr l'aliénation mentale et mr les hospices des aliénes (Amsterdam, 1826). The idea of "irritability" and "sensibility" was particularly significant in the work of Albrecht yon Hailer, who reported experiments with hundreds of animals to determine which parts were irritable and which sensible. He decided that a part was irritable if it contracted when stimulated, and sensible, if when stimulated the organism demonstrated that it felt pain. Hailer concluded that only nerves or organs containing nerve endings were sensible. The preface to the English translation of Hailer (taken from Simon Tissot's French translation) discusses the extreme irritability of hysterics and refers the reader to the Medicinae compendium (Leiden, 1735-1737) and the Praxis medicae systerna (Padua, 1752) of "the celebrated Dr. Gorter, to whom the practice of physic is so much obliged," and "the first who has treated expressly of mobility, a disease so frequent and so little known" (On the Sensible and Irritable Pans of Animals [London, 1755], xv). Thomas Hall discusses the debate over Haller's concept of irritability (Ideas of Life and Matter 1:396-404). R. F. Brissenden considers Haller's influence on the sentimental movement in Virtue in Distress: Studies in the Novels of Sentiment from Richardson to Sade (New York: Barnes and Noble, 1974). In her forthcoming study of sensibility, Ann Van Sant makes compelling connections between the language of scientific experimentation and the language of the sentimental novel.

by Sterne in his definition of "True Shandeism." Quizzing the readers on the state of their heads—"my own akes dismally"—Tristram boasts that Shandeism "opens the heart and lungs, and like all those affections which partake of its nature, it forces the blood and other vital fluids of the body to run freely thro' its channels, and makes the wheel of life run long and chearfully round" (1:401).^[39] Less sanguine, but cursed with the same "akeing head," bent on opening up the same heart and lungs, Smollett notes in a letter to Dr. William Hunter, foremost surgeon of the age as well as Smollett's physician and friend, that were it not for the "Stings" of his Grub Street Friends, his "Circulation would have stopped of itself" to leave him "stupefied with ill Health, Loss of memory, Confinement, and Solitude."^[40] Eager to "increase the motion of the machine, to unclog the wheels of life and now and then to take a plunge amidst the waves of excess,"^[41] Smollett clarifies more than Sterne the mixed nature of "excess" and motion in his delineation of a search for health that depends as much upon cranky irritation as it does upon Sterne's voyeuristic sentimental moments. But significantly, in their sentimental quests, both writers disrupt, digress, and mobilize narratives to "move" readers into keeping their fictions, through the exercise of reading, alive.

Their desire to extend their lives through paper into a community of feeling readers is not surprising. Both suffered from consumption, a physical condition often connected specifically to the melancholia feared

[39] Roy Porter discusses Sterne's medical history as a consumptive in "Against the Spleen," in Laurence Sterne: Riddles and Mysteries, ed. V. G. Myer (London: Vision; Totowa, N. J.: Barnes and Noble, 1984), 84-98. Porter's extensive footnotes are particularly helpful. Max Byrd is sensitive to Sterne's splenetic race against death in his critical study, Tris tram Shandy (London, 1985). Sterne specifically discusses his method of writing "against the spleen" in volume 4, "in order, by a more frequent and a more convulsive elevation and depression of the diaphragm, and the succussations of the intercostal and abdominal muscles in laughter, to drive the gall and other bitter juices from the gall bladder, liver and sweet-bread of his majesty's subjects, with all the inimicitious passions which belong to them, down into their duodenums" (TS 1:360).

[40] The Letters of Tobias Smollett, ed. Lewis M. Knapp (Oxford: Oxford University Press, 1970), 133.

[41] The Expedition of Humphry Clinker, ed. Lewis M. Knapp (Oxford: Oxford University Press, 1966), 339.

Pl. 1. From Joseph Guislain, Traité sur l'aliénation et sur les hospices des aliénés (Amsterdam, 1828).

Pl. 2. From Joseph Guislain, Traité sur l'aliénation mentale et sur les hospices des aliénés (Amsterdam, 1828).

Pl. 3. From Joseph Guislain, Traité sur l'aliénation mentale et sur les hospices des aliénés (Amsterdam, 1828).

Pl. 4. From Joseph Guislain, Trait é sur l'aliénation mentale et sur les hospices des aliénés (Amsterdam, 1828).

Pl. 5. From Joseph Guislain, Trait é sur l'aliénation mentale et sur les hospices des aliénés (Amsterdam, 1828).

to depress the necessary animal spirits;^[42] both wrote, in critically different ways, against the spleen; and both died of their "natural" condition shortly after completing (or rather refusing to complete) their most obvious attempts to run out of the matter that finally contained them. It is time to look at their fictional strategies.

"Fabricating at great rate" his Sentimental Journey, Sterne guarantees a correspondent that the work "shall make you cry as much as ever it made me laugh—or I'll give up the Business of sentimental writing—& write to the body."^[43] He reveals in this boast the edgy, nervous relationship he has to a method of writing that ironizes the tears he wrings from his subject, the body he is always displacing in language. To write "to the body" is to approach it directly and follow its course into death. Its progress is sure, Sterne makes clear as he quantifies the blood he coughs up while tracing the source of his discontent. Engaging in "hectic watchings" (1:104) (the term is a tubercular one), born into a "scurvy world" (1:8), Sterne turns body into a text that must be interrupted to keep it from ending, for the straight plot line of gravity can only lead into closure most fatal.

The act of writing itself creates physical communion with problematic flesh. Preparing to describe Walter Shandy's grief over Tristram's crushed nose, the writer enters this part of his story "in the most pensive and melancholy frame of mind, that ever sympathetic breast was touched with," his "nerves relax" and he feels "an abatement of the quickness of [his] pulse." His cautious composure, so different from "that careless alacrity with it, which every day of my life prompts me to say and write a thousand things I should not," seems to be associated with the seriousness of his subject. More typical are

the rash jerks, and harebrain'd squirts thou art wont, Tristram, to transact it with in other humours,—dropping thy pen,—spurting thy ink about thy table and thy books,—as if thy pen and thy ink, thy books and thy furniture cost thee nothing. [1:254]

Is the ink Sterne's blood, costing indeed something, sign of his tran-substantiated text? Or merely ink? Flesh and blood, paper and words

[42] Nicholas Robinson seems to treat the two conditions as one, offering the same advice to sufferers of the spleen that he gives to consumptives. Most works addressing the melancholy condition make continuous connection between "low" spirits and consumption, while often linking the psychosomatic attacks of the spleen to the physical manifestations of scurvy and consumption.

[43] Sentimental Journey, 19-20.

commingle violently as Sterne throws fair sheets of text into the fire and, for relief, "snatch[es] off [his] wig" to throw it perpendicularly upward, defying the gravity he writes against (1:350).

Writing against the spleen to extend, in the process, his own life, Sterne, through exertion, comes up against the very problem he is trying to solve, for in exercising his vital animal spirits, he is also, in his rash transactions, spurting his ink, his energy, his life's blood about the room. "In writing," Ramazini noted, "the whole Brain with its Nerves and Fibres are highly tense, and a Privation of their due Tone succeeds."^[44] Writing, like study, is, after all, bloody work. Witness the trials of Uncle Toby, displacing his wound through hard study guaranteed to feed the flames of melancholia as he pursues the intricate mazes of the labyrinth promising "this bewitching phantom, KNOWLEDGE... O my uncle! fly—fly—fly from it as from a serpent.—Is it fit, good-natur'd man thou should'st sit up with the wound upon thy groin whole nights baking thy blood with hectic watchings?" (1:103-104). And how can Toby fly from the knowledge threatening to consume him, a knowledge, not of javelins and bridges and sentry boxes, but the deeper knowledge of "whole nights baking thy blood with hectic watchings" after death? In the text, the answer is clear. Toby must mount his hobbyhorse and ride away from the wound itself.

A hobbyhorse. Not an overlooked vehicle to be sure, but one, I think, more directly connected to Sterne's narrative strategies and one closer to Cheyne's chamber horse than to "hobbies" emptied of the physicality they promise. Sterne employs his hobby to move, lurch, jerk, and jog the matter of his text across a page that is alarmingly substantial, and he does so to exercise spirits that are too active for a badly decomposing "real" body.

Sterne's own mythologized equestrian escapades suggest a violent propensity for movement, just what, after all, the doctors prescribe. Writing from Montpellier, he complains that the "Thiness of the pyrenean Air brought on continual breaches of Vessels in my Lungs, & with them all the Tribe of evils insident to a pulmonary Consumption—there seem'd nothing left but gentle change of place & air." "Gentle," however, is a word that becomes altered by the movement itself, and once Sterne puts himself into motion, "having traversed the South of France so often that I ran a risk of being taken up for a Spy, I... jogg'd myself out of all other dangers."^[45] Wildly excursing with a mad wife who thinks she

[44] Ramazini, Disease of Tradesmen, 401.

[45] The Letters of Laurence Sterne, ed. Lewis Perry Curtis (Oxford: Oxford University Press, 1965), 205.

is the Queen of Bohemia, demoniacally racing across Crazy Castle sands,^[46] he violates therapeutic prescriptions for moderate exercise just as thoroughly as his morbidly energetic race against death flaunts Nicholas Robinson's sound admonition to his consumptive patients. "All the dejecting Passions should be banish'd," Robinson advises, "and Objects only admitted that may create gay, merry and chearful Scenes.... I should think it highly detrimental, too much to play with the gloomy Prospects of Death, unless manifest Symptoms appear of his approaching Dissolution."^[47] It would be, I imagine, difficult not to gag on such banal bromides. Sterne shows no signs of swallowing the discourse of cheerful moderation. His gaiety will crack at its edges as he perversely calls up "gloomy Prospects of Death" (37-38), two of them, impenetrable black monuments to Yorick's mortality, only to flaunt them, to exorcise their spirit through a brisk, cracked energetic course of exercise.

Resurrecting "poor Yorick" at will, Sterne jerks his invincible because already dead—character across fictive landscapes that strain beneath the weight of curvetting, frisking hooves. Sentimental travelers "Crack, crack—crack, crack—crack, crack," across France (2:599), and on domestic ground are prone to take "a good rattling gallop," to risk routinely life and limb in order to arouse the appropriate spirit:

Now ride at this rate with what good intention and resolution you may,—'tis a million to one you'll do some one a mischief, if not yourself—He's flung—he's off—he's lost his seat—he's down—he'll break nis neck—seel [1:356]

[46] In Scrapeana (York, 1792),John Croft reports that Elizabeth Sterne imagined herself the Queen of Bohemia. To amuse her, "and induce her to take the air," "Tristram, her husband... proposed coursing, in the way practised in Bohemia; for that purpose he procured bladders, and filled them with beans, and tied them to the wheels of a single horse chair. When he drove madam into a stubble field, with the motion of the carriage and the bladders, rattle bladder, rattle; it alarmed the hares, and the greyhounds were ready to take them" (22, as cited in David Thomson, Wild Excursions: The Life and Fiction of Laurence Sterne [New York: McGraw-Hill, 1972, 123). Arthur Cash finds this to be "one of the least trustworthy stories about Sterne" (Laurence Sterne: The Early and Middle Years [London: Methuen, 1975], 286), but something in it rings true. Wilbur Cross states that of all the pastimes that "took Sterne out of doors, none pleased him quite so much" as "racing chariots along the sandy beach" near Crazy Castle "'with one wheel in the sea'" (The Life and Times of Laurence Sterne [New Haven: Yale University Press, 1925], l:121).

[47] Robinson, Consumptions pt. 2, 48.

Motion, not ripeness, is all. Ripeness must, in fact, be interrupted, for to ripen is to rot. Growth becomes in nature death—unless the natural channels are diverted. Tristram knows that, as he compulsively displaces his origins, pushing them always beyond his own comprehension, short-circuiting in the process his logical narrative end.

To escape the real problems of body, the quarts and gallons of blood that Tristram decides not to measure, Sterne sets up several diversionary strategies. To escape being "killed" by kind questions addressed to the nature and location of his wound, My Uncle Toby displaces his corporeal state through military maneuvers. Trim, his surrogate, in love and war, one of those accommodating "body servants" so necessary to exercise the vital spirits, makes it possible for Toby to swing between states of benevolence and bloody gore as he races his hobbyhorse from the Bowling Green to Dunkirk and back again without getting anywhere at all. Walter, less tactile, depends upon auxiliary verbs to move the soul, that great sensorium of verbal connections:

Now the use of the Auxiliaries is, at once to set the soul a going by herself upon the materials as they are brought her; and by the versability of this great engine, round which they are twisted, to open new tracks of enquiry, and make every idea engender millions. [1:485]

Aided by the auxiliary yet active parts of speech not unlike accommodating servants willing to administer brisk rubbings of the flesh-brush for their mistress's own good, Walter sets the great white bear dancing across the page to not quite end another book:

A WHITE BEAR! Very well. Have I ever seen one? Might I ever have seen one? Am I ever to see one? Ought I ever to have seen one? Or can I ever see one?

Would I had seen a white bear—(for how can I imagine it?) If I should see a white bear, what should I say? If I should never see a white bear, what then?

If I never have, can, must or shall see a white bear alive; have I ever seen the skin of one? Did I ever see one painted?—described? Have I ever dreamed of one?

Did my father, mother, uncle, aunt, brothers or sisters, ever see a white bear? What would they give? How would they behave? How would a white bear have behaved? Is he wild? Tame? Terrible? Rough? Smooth?

—Is the white bear worth seeing?—

—Is there no sin in it?

Is it better than a BLACK ONE? [1:487]

Waiter's final question exposes the absurd limits to his own system, promising endless discourse, newly opened tracks of inquiry that would "make every idea engender millions" of words going absolutely nowhere, ending up in tautological exercises that, nonetheless, "set the soul a going by herself" and keep, in the process, the wheel of life running "long and chearfully round" (1:401).

Tristram compulsively pursues motion for its own sake. "So much of motion, is so much of life, and so much of joy... that to stand still, or get on but slowly, is death and the devil," he claims, rejecting Bishop Hall's desire for heavenly rest. "Make them like unto a wheel " becomes not a "bitter sarcasm" made against the restless spirit of fallen man, but a benediction allowing, however mechanically, transcendence. "I love the Pythagoreans... for their... 'getting out of the body, in order to think well. ' No man thinks right whilst he is in it" (2:592-593).

Tristram travels by coach, by hobbyhorse, and by sentimental chance, depending, when particularly weary, upon sturdy surrogates to move his dangerously hardening soul. To get out of the body, Sterne depends upon moving his and his reader's soul mechanically, but also pathetically, by allowing a sentimental escape from the hard realities of life. Auxiliary agents of feeling, body servants as indispensable as Trim, will become in Sentimental Journey necessary for the sentimental commerce Yorick conducts.^[48] Just as the White Bear carried into and out of Waiter's discourse calls attention to the arbitrary, fragmentary nature of any discourse, so the isolated, often inconclusive sentimental tales filling both novels emphasize their transitory, yet necessary, quality. Tristram, in fact, highly recommends the pitiful Maria piping her sorrows as a good sentimental side trip to Yorick, the sentimental traveler in search of emotional and motional diversion. Maria's madness and pathos is just the thing to exercise the spirits and rouse the soul.^[49] Feelings, the property of patients genteel enough to suffer from the spleen, are expensive to sustain and will continue to depend, sentimentally, largely upon the sufferings of other, hardier souls valued for their compliance and visibility.

[48] In his "Preface" written in the Desobligeant, Yorick decides that "the balance of sentimental commerce is always against the expatriated adventurer: he must buy what he has little occasion for at their own price—his conversation will seldom be taken in exchange for theirs without a large discount—and this, by the by, eternally driving him into the hands of more equitable brokers for such conversation as he can find, it requires no great spirit of divination to guess at his party" (Sentimental Journey, 78-79).

[49] The pitiful condition of LeFevre also serves to rouse Toby from his sickbed. Most of the sentimental incidents in both TS and SJ seem designed to elicit a short, strong response that will invigorate its feeling spectator.

All these side trips, all this openness to the pleasing sensation of disruption, prohibits narrative coherency. That is, in fact, the point. Tristram "so complicate[s] and involve[s] the digressive and progressive movements, one wheel, within another, that the whole machine, in general, has been kept a-going;—and what's more, it shall be kept a-going these forty years, if it pleases the fountains of health to bless me so long with life and good spirits" (1:82). In the hectic spirit, he sets out to move through time and space Dr. Slop, Obadiah, Uncle Toby, Corporal Trim, Yorick, Walter, and himself—and on occasion, that inveterate lover of coach travel, Aunt Dinah, players all in his "dance... song... or... concerto between the acts" of birth and death.

Compulsively calling attention to the seams and struts of his narrative, Sterne makes clear with cloying irritation the effort it takes not to be splenetic. If I were to choose a kingdom, Tristram muses, let it be filled with "hearty laughing subjects." The Rabelaisian dream of a "body politick as body natural" as body laughing is poignantly undermined by his salute to the reader he takes leave of "till this time twelve-month, when (unless this vile cough kills me in the meant time) I'll have another pluck at your beards" (1:402). Not only does his own body natural intrude upon his vision of "subjects" with the "grace to be as WISE as they were MERRY," but his assertion of authority reveals even more the unlikely nature of his fictional structure. His hearty subjects must laugh, humorists subject to a regimen of joy that strains against its impera-five. Crack, crack—crack, crack—crack, crack—watch the "characters" prance and paw as they course across a narrative designed to get them nowhere. The less nimble need to be occasionally carted off the stage, for movement, not direction, is all. "Getting forwards in two different journies together, and with the same dash of the pen," playing parlor tricks with time and space as he walks across the marketplace of Auxerre with my father and my uncle Toby just as he enters Lyons with a "post-chaise broke into a thousand pieces... moreover this moment" rhapsodizing on the banks of the Garonne (2:621-622), Sterne exhausts the reader with his frantic attempts at capering in the Shandy manner.

By denying his vehicle, his text, stability, by "breaking it up into a thousand pieces," Sterne collapses it finally in a "COCK and a BULL." Strategies of interruption and digression energize—hectically—a discourse that can even mobilize "auxilary verbs" to "open new tracks of enquiry, and make every idea engender millions." But in the case of the wonderful dancing bear, such multiplication is essentially nongenerative. The bear moves through the text, but doesn't get anywhere—he doesn't even make sense. New tracks of inquiry lead to dead ends that require yet another detour. Thus Tristram multiplies his own activity

textually: "I have three hundred and sixty-four days more life to write just now, than when I first set out; so that instead of advancing, as a common writer, in my work with what I have been doing at it—on the contrary, I am just thrown so many volumes back" (1:341). Advancing, and then "thrown back," the writer swings back and forth between birth and death, between those "acts" that threaten closure. The swinger escapes time, escapes death, as long as he can sustain movement ultimately as sterile as Waiter's recalcitrant bull. For there is, within the text itself, a resistance to the cracks and jerks and jogs and pokes that creates a hectic, masturbatory exhaustion of the "animal spirits" Sterne tries to resuscitate. The irritability that Sterne wants to transform into "good humor" reveals the strains of sublimation. Smollett, less rarefied, makes more apparent the pains and pleasures of exercising a body resisting inevitable consumption.

As a practicing physician as well as a splenetic patient, Smollett knew too well his "bad state of health." Smollett describes his condition in terms that would be found in most texts dealing with not only "the spleen" but "consumption." He suffers from "an asthmatic cough, spitting, slow fever, and restlessness, which demands a continual change of place, as well as free air, and room for motion."^[50] It may very well be that his professional knowledge inspired his most professional defenses against his own disease. His desire for displacement, his attempt to turn matter into text, can be seen most vividly in his letter to Dr. Fizes, noted professor of medicine at the University of Montpellier. Although he was actually staying at Montpellier, Smollett, however curious to "know the opinion" of the celebrated doctor, could not bring himself to consult the local "Boerhaave" in the flesh. The "great lanthorn of medicine is become very rich and very insolent; and in proportion as his wealth increases, he is said to grow the more rapacious," he reports, deciding that such unsavory demonstrations of both character and deportment "left [him] no desire to converse with him." Instead, Smollett resolved "to consult with him on paper" (88). On paper, Smollett retains control of his case, his story of a disease that can be only what he allows into his

[50] Tobias Smollet, Travels through France and Italy, ed. Frank Felsenstein (Oxford: Oxford University Press, 1981), 64. Further references will be cited in the text. Felsenstein suggests that the "the abrasiveness and bad temper which characterize many of Smollett's remarks seem to have had a more immediately therapeutic effect than the medicinal remedies proffered him. There is something positively curative to be found by venting his spleen" (xi). John Sena considers "Smollett's Persona and the Melancholic Traveler," Eighteenth-Century Studies 1 (1965): 353-369.

text. Body disappears altogether while Smollett anachronistically resists the growing medical practice of hands-on examination.^[51] By refusing to see—and be seen by—his physician, Smollett hides behind words to remain free to invent his adversary's response to his condition. "The professor's eyes sparkled at the sight of the fee," he reports (93), imaginatively invading the consulting room he refuses to visit.

Smollett scrupulously reports the symptoms of his hectic, perhaps consumptive constitution—in Latin. The language of medical discourse is perfectly appropriate, but its utilitarian generality is precisely what allows him to quibble about Fizes's diagnosis. For when Fizes answers Smollett's letter—in French—to diagnose Smollett's condition as a slow fever with probable tubercules in suppuration on the lungs, "a circumstance which we should have ascertained, had the nature of the spitting been described in the case" (96), suggesting a consumptive condition, the patient turns a medical consultation into a linguistic contest. Forget Smollett's ailing body, the professor does not "understand Latin." Promising not to make any remarks upon "the stile of his prescription, replete as it is with a disgusting repetition of low expressions," Smollett nonetheless feels the need to "point out to [Fizes] the passages in my case which he had overlooked" in his original Latin descriptions. His objections reveal his understandable desire to arrest in prose the course of his disease.

I cannot think there are any tubercules on my lungs, as I never spit up purulent matter, nor anything but phlegm or pituita in colour and consistence like the whites of eggs. Sputum albumini ovi simillimum. I imagine, therefore, that my disorder was originally owing to a sudden intermission of bodily exercise, intense application of the mind, and a sedentary life which hath relaxed the whole fibrile system, and that now it may be called a pituitary, not a purulent consumption. [English italics mine]

Imaginings aside, Dr. Fizes read Smollett's revised description, stood by his diagnosis, and invited him to come the next morning to his house "if [he] had any doubts... and he would resolve them." Still avoiding contact, Smollett sent in his place twelve livres wrapped in a note most equivocal:

[51] Stanley Reiser, Medicine and the Reign of Technology (Cambridge: Cambridge University Press, 1978), discusses the ways that the modern medical technology affected the patient's sense of autonomy. Once the physician was able to examine the patient's body as material disconnected from its owner's narrative, the patient became less the subject than the object of examination.

It is not without reason that Mons.r Fizes enjoys such a large reputation. I have no doubts remaining; thank Heaven and monsieur Fizes. [98-101]

Not surprisingly, the doctor pocketed the livres, proving to Smollett his venality, allowing him even further room to rage against the diagnosis. Besides, Fizes did not prescribe exercise, Smollett's favorite remedy against the spleen. For that lapse in therapy alone, Fizes's interpretation of Smollett's shadowy, Latinized body could be disregarded.

Smollett's real body was another matter. "I was not at all pleased with the famous statue of the dead Christ in his mother's lap, by Michael Angelo," he reports, projecting onto a statue the symptoms he vigorously denied at Montpellier. "The figure of Christ is as much emaciated, as if he had died of a consumption" (255). Consumption must be resisted with energetic jolts of motion triggered by jerks, jolts, and splenetic bursts of irritation. Searching for health, Smollett follows a course of exercise violently charged. His travelers seldom jog along complacently. Here is his description of the difficulty he encounters "pulling off" a companion's boots after a day on the road:

the marquis's boots... were... so loaded with dirt on the outside, and so swelled with the rain within, that he could neither drag them after him as he walked, nor disencumber his legs of them, without such violence as seemed almost sufficient to tear him limb from limb. In a word, we were obliged to tie a rope about his heel, and all the people in the house assisting to pull, the poor marquis was drawn from one end of the apartment to the other before the boot would give way: at last his legs were happily disengaged, and the machines carefully dried and stuffed for next day's journey. [306]

Reducing body to mechanized matter, Smollett turns his subject man into the objectified "homme machine,"^[52] an entity possessing, and being possessed by, detachable parts that need to be "dried and stuffed" overnight. In the process, he also calls attention to the pains of movement, and paradoxically, the pleasures those pains afford. He seems to delight in such fleshly battles. Sentimental battering only increases the animal spirits. Here he is splenetically approaching Florence, certain he is being waylaid by villainous servants to a solitary, "bad" house only five miles from his appropriate destination. Enraged, he and his wife, "up to the ancles in mud," set out against prudent advice to walk to Florence:

[52] The classic discussion of man the machine can be found in Aram Vartanian's edition of Julien Offray de La Mettrie, L'Homme Machine: A Study in the Origins of an Idea (Princeton: Princeton University Press, 1960).

Behold us then in this expedition; myself wrapped up in a very heavy great-coat, and my cane in my hand. I did not imagine I could have walked a couple of miles in this equipage, had my life been depending; my wife a delicate creature, who had scarce ever walked a mile in her life.... The night was dark and wet; the road slippery and dirty; not a soul was seen, nor a sound was heard: all was silent, dreary, and horrible. I laid my account with a violent fit of illness from the cold I should infallibly catch, if I escaped assassination, the fears of which were the more troublesome as I had no weapon to defend our lives. While I laboured under the weight of my great-coat, which made the streams of sweat flow down my face and shoulders, I was plunged in the mud, up to the mid-leg at every step; and at the same time obliged to support my wife, who wept in silence, half dead with terror and fatigue.

Not only does Smollett reach Florence, but he arrives "with great saris-faction... from a conviction that my strength and constitution were wonderfully repaired... fully persuaded that the hardships and violent exercise... had greatly contributed to the re-establishment of my health" (286-289).

When Smollett "increase[s] the motion of the machine, to unclog the wheels of life; and now and then take a plunge amidst the waves of excess in order to case-harden the constitution" (HC, 339), he practices a harder version of the sentimentality Sterne plays at. His sentiments can, indeed must, hurt to be felt, and provoke in the process a motion that depends upon irritability. "It was happy for me that I had a good deal of resentment in my constitution, which animated me on such occasions against the villainy of mankind," Roderick Random crows, "and enabled me to bear misfortunes otherwise intolerable." His, and Smollett's other frequent travelers could not drag their bodies across his pages without "inveigh[ing] with great bitterness" and "boiling with indignation."^[53]

The spleen pushes traveler Smollett across France, invigorating his discourse on the trials of hazarding "cold, damp, dark, dismal, and dirty" inns where one inevitably encounters "disobliging and rapacious... awkward, sluttish and slothful... lazy, lounging, greedy, and impertinent" churls along the way. His version of "sentimental commerce" works on the principle of underpayment. While Sterne explains complacently that properly distributed livres smooth the roughest, stoniest path, Smollett provokes the hardships that reward his notorious resistance to accommodation.

[53] The Adventures of Roderick Random, ed. P. G. Boucé (Oxford: Oxford University Press, 1979), 242.

The best method I know of travelling with any degree of comfort is to allow yourself to become the dupe of imposition, and stimulate their endeavors by extraordinary gratifications. I laid down a resolution (and kept it) to give no more than four and twenty sols per post between the two postillions; but I am now persuaded that for three-pence a post more, I should have been much better served, and should have performed the journey with much greater pleasure. [328-329]

But what is the point of comfort and pleasure? Resentment, not pleasure, animates and "case-hardens" the constitution.

The animating principle of irritation and hardship is most vividly illustrated in Roderick Random's encounter with the marching regiment of Picardy. He meets a party of soldiers and their wives and children dancing together, "unbending and diverting themselves... after the fatigue of a march."

I had never before seen such a parcel of scare-crows together, neither could I reconcile their meagre gaunt looks, their squalid and ragged attire and every other external symptom of extreme woe, with this appearance of festivity.

Random joins their band only to learn that it is the hunger, thirst, and fatigue that drives them forward. "So much chased with the heat and motion of my limbs that in a very short time the inside of my thighs and legs were deprived of skin," he proceeds "in the utmost torture." The plumpness of his constitution inhibits his progress, and he envies the withered condition of his comrades "whose bodies could not spare juice enough to supply a common issue, and were indeed proof against all manner of friction." The "miserable wretches, whom a hard gale of wind would have scattered through the air like chaff," bear toil that his softer, juicier flesh cannot endure. Literally marching and dancing "out of matter," the soldiers have refined their flesh into an efficient marching machine that runs not on the "onions, coarse bread, and a few flasks of poor wine,"^[54] but on motion itself.

Smollett's texts depend upon this principle of motion. His heroes are notorious for pushing through episodes so random that endings, when they turn up, seem suspiciously parodic. Even Humphry Clinker, with its "country dance" of weddings, moves past closure toward an unstable text studded with "turds," "crutches," "mattermoney," slick with the "grease of God" (333, 335, 352). Tabitha and Win have the last words

[54] Roderick Random, 244-245. Significantly, when Yorick witnesses a farmer's family dance after their simple meal of lentil soup, bread, and wine, he beholds "Religion mixing in the dance" of "Grace" (Sentimental Journey, 283-284).

in language that unravels the "fatal" conjugal knots (346) ostensibly designed to tie up loose ends. Matthew Bramble begins his first letter to his physician "as lame and as much tortured in all my limbs as if I was broke upon the wheel" (5), and ends, like Sterne's sentimental wheel, rolling through a narration designed to circulate the spirits and strengthen the constitution. Such exercise, however, depends upon agents of exercise and feeling to free Bramble from his sedentary, vaporous, claustrophobic state.

Searching for health, Bramble struggles for strategies against the melancholia threatening to overwhelm him. Bramble suffers from a spleen that does not animate so much as it depresses his failing spirits. "When his spirits are not exerted externally," Jery notes, "they seem to recoil and prey upon himself" (49-50). The narrative by prescription demands exteriority, and, as Robinson, Cheyne, and Fuller recognized, depends upon a constant disruption designed to displace morbid consciousness. Painfully aware of the therapeutic benefits of exercise, Bramble nonetheless cannot free himself from the "vapour-pit" of his "inchanted" condition. If he "take[s] the air a-horseback" the way Fuller would have him do, he will be "stifled with dust or pressed to death in the midst of post-chaises, flying machines, waggons, and coal-horses," while climbing the Downs would only fatigue him to death. Having "made divers desperate leaps at those upper regions," he always falls "backwards," swinging dangerously between states of nervous despair (64).

Enter Humphry Clinker, physical surrogate, whose bare—lily-white—posteriors guarantee his physical strength while testifying to his ultimate gentility as well as Matthew Bramble's potency. As bastard auxiliary, Clinker literally moves Bramble through the text. An invigorated Bramble becomes persuaded "that in a raw, moist climate, like this of England, continual exercise is as necessary as food to the preservation of the individual" (327). To reach this point, however, Bramble must be taken up in the faithful Clinker's arms "as if he had been an infant of six months," carried ashore out of a violent stream, and bled "farrier style" back into life (313). A firm believer in the efficacy of cold-water baths and plunges into the sea,^[55] Smollett, in spite of his own muscular assertions, falls back on the agency of a sentimental agent of feeling, a "staunch auxiliary,"

[55] Felsenstein discusses Smollett's "pet theory" of the benefits of cold-water bathing, expressed in An Essay on the External Use of Water (1752), in his introduction to the Travels, xi. G. S. Rousseau considers Smollett's interest in cold-water bathing in his chapter "Smollett and the Eighteenth-Century Sulphur Controversy," in Tobias Smollett: Essay s of Two Decades (Edinburgh, 198 2), 144-157.

who rouses him into sensibility. Yes, "plunge amidst the waves of excess," yes, "unclog the wheels of life, " but whilst moving the constitution, be sure to have a hardy surrogate standing by to resuscitate waterlogged bodies and repair broken chaises. Affirmation swings back into an ironic awareness of the cost of living, of assigning the body and mind to a course of exercise that requires two bodies—one to be moved and one to do the moving.

In this last novel, close to death, Smollett splits himself into various characters designed to displace his own end. Mr. S., for instance, a sweeter Smollett, dispenses solid tokens of benevolence to a circle of dependents that only certify his patience and tolerance. His remarkable presence extruding from the real matter of Smollett's historically doctored reality disrupts the narrative almost as violently as Ferdinand Count Fathom's appearance, an extraliterary event that breaks out of the confines of Smollett's last novel. Both characters radically confuse conventions of narrative order as they insist upon their right to invade fictional time and space. Dr. S. forces his reader to regard Smollett the writer of splenetic fictions as a man of feeling; Ferdinand Count Fathom interrupts the narrative of HC to unsettle in the process the fictional notion that novels actually have a beginning and an end, for if their heroes keep turning up, where is the form designed to contain them?

Of all of Smoilett's last characters, Lismahago, the disaffected Scot who cannot go home again, seems to speak for the once and perhaps always Scottish Smollett exiled to die in Leghorn from the disease he would not name. He is alienated not only from his homeland but from his body, representing most violently an attenuated physicality, pieced together as he is with parts not worn down but pared away by Indians after his scalp. A "caricatura" of his mortality, "the limbs and the muscles—every toe denot[ing] terror" (300), Lismahago enters the novel so dead to the present that his Scottish relations think he is an ancestral ghost. Yet through sheer, relentless energy enlivened by splenetic argumentation for and against almost every opinion Matthew Bramble holds dear, he triumphs over death itself in tableau. Adopting "the impressions of fear and amazement so naturally, that many of his audience were infected by his looks," he plays Pierot pursued by a Harlequin Skeleton, his horror endowing him "with such praeternatural agility as confounded all the spectators" in "a lively representation of Death in pursuit of Consumption" (347). In this dramatization, running out of matter becomes comically, and triumphantly, imperative.

The imperative, however, costs something, the cost of the spectacle of irritations that must be "felt" by the reader if it is to be sustained.

Sentimentality seems to require larger and grander "theatres of pain" on which to exercise the vital animal spirits necessary to set the soul in motion. Sterne's voyeuristic contemplation of spectacles of suffering, Smollett's splenetic dependence upon irritation, suggest a need for pain sensationally realized that becomes even more excessively apparent in more intentionally erotic texts. Richardson's teasing, extended modesty in offering over the course of one thousand pages Clarissa's rape to his reader only to withhold for almost two hundred pages more the victim's own shadowy version of the spectacle itself is completely and almost immediately overturned by Cleland's use of Fanny Hill's body as an always reliable theater of pain and pleasure, and culminates in the mass tableaux of orgiastic mayhem Sade designs to provoke the most exquisitely numbed feelings. The more spectacular the sexual encounters, the more fragmented and episodic their diverting, provocative representations. Experience becomes in these narratives something essentially incomplete, depending upon the instantaneous force of a feeling that becomes so painful that it must be denied, for to be experienced fully, it kills. Ironically, the sentimental quest for feeling may interrupt and divert the "natural" process leading into death only to offer more dramatically felt alternatives that might prove fatal. The dangers implicit in attempts to move the soul can be seen in two last sentimental episodes, one fictional, one factual, both dedicated to the sensationalism required to rouse the animal spirits.

The first sentimental episode comes from Cleland's Memoirs of a Woman of Pleasure. Fanny Hill and her friend Louisa, "loitering away the time," in search of stimulation, come across the gentle idiot, "Goodnatur'd Dick, " selling his nosegays for a livelihood. Dick is such a perfect changeling that he can only stammer out "animal ideas." The women, ostensibly testing the rule that idiots are the most well-endowed, enter into a teasing relationship with the idiot Dick that reveals their own desires to provoke consciousness passionately and mechanically. Dick reveals a member astonishing enough to surprise his mistresses, "its enormous head seem'd in hue and size, not unlike a common sheep's heart." More significantly, the idiot Dick, entering the compliant Louisa, feels "the sting of pleasure so intolerable" that he assumes a character of furious consciousness:

his countenance, before so void of meaning, or expression, now grew big with the importance of the act he was upon... his face glowing with ardours that gave all another life to it... his whole frame agitated with a raging ungovernable impetuousity, all sensibly betraying the formidable fierceness with which the genial instinct acted upon him.

While he awes the onlooking Fanny into respect, he rends the "torn, split, wounded" Louisa into "the utmost extremity" with "nothing either to fear, or to desire," until she goes "wholly out of her mind... now as meer a machine as much wrought on, and had her motions as little at her own command, as the natural himself." Once the "delicious delirium" has past, the idiot loses consciousness to take on an air of "droll, or rather tragi-comic... air of sad, repining foolishness, superadded to his natural one of no meaning, and ideotism."^[56]

Consciousness, for a time, is made acessible through pain, in this case, Louisa's, transferred—terribly—to the idiot Dick. Cleland would seem here to be extending earlier theories of the therapeutic value of terror into an exchange that is both reciprocal and exploitative. While the lady from Cheshire regains her lost senses after falling 150 feet off a cliff, while Gaub's theoretical patients should benefit from the terrors of water therapy applied to their own minds and bodies, Louisa's idiot Dick gains consciousness from experiencing the pain he inflicts upon a mistress who "true to the good old cause" suffers "with pleasure" and enjoys "her pain." A veritable flesh-brush, an auxiliary designed to move her partner into consciousness of his pleasure, she extends the sentimental moment that depends upon her own pain, more palpably demonstrating the pliability that Sterne would exploit in his portrait of the mad Maria, an only slightly more decorous agent of feeling. Cleland makes even more obvious the role of the flesh-brush in Fanny's adventure with Mr. Barvile, a gentleman "under the tyranny of a cruel taste... not only of being unmercifully whipp'd himself, but of whipping others." In this painful encounter in which Fanny is "like a victim led to the sacrifice," Fanny becomes a "theatre of [Barvile's] bloody pleasure," feeling the lashes that Barvile requires to experience potency. Fanny, written into a role of compliance that threatens to be, ultimately, ironic, bears witness to the exertions required to exercise the animal spirits.^[57]

Both Barvile and the idiot Dick require strong measures to rouse their sluggish animal spirits, to be provoked into escaping a state of "no meaning" that Dick eventually, with a "droll, or rather tragi-comic" air,

[56] John Cleland, Memoirs of a Woman of Pleasure, ed. Peter Sabor (Oxford: Oxford University Press, 1985), 160-66. Sabor discusses Cleland's depiction of the "physiology of sexual reactions" in his introduction, particularly mentioning Leo Braudy's study of the connections between Cleland and La Mettrie, "Fanny Hill and Materialism," Eighteenth-Century Studies 4 (1970): 21-40. The use of the female body as feeling agent is not surprising in the light of Mandeville's rather early discussion of its particularly sensible properties. He found women "more capable Both of Pleasure and of Pain" (Treatise, 246).

[57] Cleland, Memoirs, 143, 152. I consider this phenomenon at length in "What Fanny Felt: Cleland's Experiment in Sentimental Form," Studies in the Novel, 19, no. 3 (1987): 284-295.

resumes. The fear of falling into such a sluggish state generated enthusiasm for the most radical therapies. By the late eighteenth century, the auxiliary proved, with a certain degree of danger, to be completely mechanical. In 1791 Franz Kotzwara was discovered "hanging in a house of ill fame in Vine Street, Covent Garden," suspected of having "been making experiments in hanging in the company of some half-drunken women." An anonymous pamphlet, apparently inspired by his predicament, Modern propensities; or, An essay on the art of strangling, & c., warns against, yet celebrates, a mechanical strangulation device designed to stimulate the animal spirits in elderly and antiquated males who might otherwise suffer the disagreeable effects of their mortal condition. Since the natural fear of death vitalizes lagging animal spirits, the author of the pamphlet offers an "external expedient," to suspend his clients "near death" until certain vital emotions are awakened. Promising relief, the advocate of strangulation almost parodies the tracts written against the spleen. In all cases, the vital spirits must be aroused, the great sensorium must be stimulated, and motion becomes a principle of redemption, for to sit still is to die. What is desired is

that everything which produced irritation in the lungs and thorax [from the sensation of strangulation] produced also titulation in the generative organs: that the blood by such means being impeded in its regular velocity, rushed to the centre, and there formed, by sudden and compulsive operations, a redundancy of those vivifying secretions which animate an invigorate the machinery of procreation.^[58]

When the practice of mechanically induced strangulation proved fatal to at least one seeker after vital juices, public curiosity and outrage prompted the trial of the prostitute, Susannah Hill, who was found with Kotzwara's all too material body. (She was acquitted.) Swinging between life and death, fullness and emptiness, motion and closure, Kotzwora violently and radically illustrates the dangerous temptations of the sentimental movement, and reason enough why, at least in the narratives, the motion must never cease. The blood must be kept circulating, the vital vivifying secretions rushing, but if the machinery truly works, animation can lead directly into death. Sterne knew this in his masturbatory deferral of sexual experience, and Smollett seems to have suspected as much as he parodically unravels "fatal" knots to disrupt an inevitably mortal progress. For the uninterrupted narrative becomes, fatally, closed, producing that ultimate end of the plot that must be resisted. At least on paper.

[58] Richard J. Wolfe, "The Hang-up of Franz Kotzwara and Its Relationship to Sexual Quackery in Late 18th-Century London," Studies on Voltaire and the Eighteenth Century, no. 228 (1984): 53.

Six
Of Masks and Mills:
The Enlightened Doctor and His Frightened Patient

Antonie Luyendjk-Elshout

Fear is the most interesting of the passions.
—TOBIAS SMOLLETT, Ferdinand Count Fathom, 1753, 1:21

Of all the sufferings to which the mind of man is liable in this state of darkness and imperfection, the passion of fear is the severest, excepting the remorse of a guilty conscience, which however has much of fear in it, being not solely a tormenting anguish of reflection on the past, but a direful foreboding of the future.
—JAMES BOSWELL, "On Fear," London Magazine, November 1777

In a letter form Antonio Sanches in 1747 the distinguished Leiden professor Hironymus David Gaub learned that his friend was ill. Sanches complained about his health^[1] and described his deplorable disease, which was intensifying, twisting around like a snake, producing terrible symptoms like a pudor vitiosum —a consuming timidity—which curtailed his activities as a court physician in Moscow. Gaub was already aware of Sanches's disease. In a previous letter, written in December 1746, he had advised Sanches to try Peruvian bark, which Gaub, among others, considered to be salutary in nervous diseases. Sanches, however, had tried the bark in vain, and Gaub thought it better for him to leave Moscow and find refuge in a warmer, drier climate. "I am afraid," Gaub wrote, "that the loneliness you are enforced to endure will increase this symp-

[1] Letter from Sanches to Gaub, without exact date but probably written in 1747. See S. W. Hamers-van Duynen, Hieronymus David Gaubius (1705 -1780): Zijn correspondentie met Antonio Nunes Ribeiro Sanches en andere tijdgenoten (Assen and Amsterdam: Van Gorcum, 1978), 84-91. Sanches (1699-1783) was a Portuguese Jew, recommended by his teacher Boerhaave in 1731 to the Empress Anna Ivanovna. For political reasons he was obliged to leave Russia in 1747, since Anne's successor Elisabeth Petrovna suspected him of practicing his Jewish religion secretly. See David Willemse, "Antonio Nunes Ribeiro Sanches, élève de Boerhaave et son importance pour la Russie," Janus, suppl. 6 (1966).

tom and finally it will prevent the daily intercourse with people, even ending into misanthropy. Finally, this illness will destroy the power of the herbs."^[2] Loneliness, fear, misanthropy: this was the psychological sequence Gaub suspected, yet fear was a common symptom in patients during the eighteenth century. But for Sanches, fear was a consequence of seeing Russia as a hostile foreign environment, and this uneasy situation left him perpetually anxious and uncertain.

This study explores the various roles played by fear in both the theory and practice of medicine in the eighteenth century. Of particular concern is the presentation of fear by patients to physicians, and the varying interpretations of that fear. I will also review the vast repertoire of serious and experimental therapies employed to cope with fear, the state of the patient's mind and body (considered separately and in union), which few physicians understood.

Not even the medical world could be isolated from the ordinary speculations they had engendered. Preachers and philosophers, painters and actors, physicians and authors: all suffered their own concept of fear and anxiety—and these fears were reflected in their behavior: preacher to congregation, actor to audience, and surely, patient to physician. Frightened people have been variously described in a wide body of eighteenth-century literature. What were people afraid of? Did their fears focus on other things than death, poverty, and war? How did they handle stress and anxiety and how did they express their emotions?

My answers to these questions trace the opinions of young physicians who, even in their earliest dissertations, studied and evaluated anxiety and fear. We shall see how their attention and concern created a revolution in the practice of medicine. These studies have a certain fraîcheur, an open-mindedness not often found in accepted textbooks. Moreover, they lead us directly to the important medical opinions of the time delineating fear, and they both reflect and betray the influence of the school and the philosophy that followed. The essence of fear is not easily captured in a brief confession of patient to doctor, and there were few wealthy enough to spend time and money for in-depth consultation. But a few case histories survive, written in the traditional manner and language, and they are most revealing.

By the early eighteenth century, anxiety and extraordinary fear were among the symptoms of insanity, albeit the presence of anxiety in itself was not sufficient to declare a patient insane. Coupled to the physician's

[2] Hamers-van Duynen, Gaubius, 86. Gaub was attempting to keep the power of the bark from public derogation. Since there were no proven drugs, all forms of placebo needed reinforcement and constant postive feedback.

difficulty in weighing the degree of fear and anxiety is the philosophical (and even semantic) category of madness, a category whose history Michel Foucault brilliantly described almost two decades ago.^[3] Foucault's work, as is well known, has been developed and refined by a worldwide flood of publications on the history of lunatic asylums, on the treatment of the insane, and on the biographies of those persons concerned.^[4] Thus, my interest concerns not the "grande peur" of madness, as so eloquently described by Foucault, but the fears of ordinary people who suffered from ordinary and common somatic diseases and emotional disturbances, from the perturbationes animi, as they were called in the parlance of the time.

One must recognize that the eighteenth-century physician saw as many anxious patients as the physicians of today. He was trained to listen to their complaints, suggest diet and exercise, and prescribe medicines to calm them down. More often it was the surgeon who dealt with truly scared patients—those who had to undergo amputation or other major surgery. Since possibilities of anesthesia were limited, reactions to pain and panic were mixed, and no clear distinction was made between the variety of sensations in the reports of the operation or in learned treatises on the passions of the mind. We would expect to find important answers to our questions about fear in medical treatises, written by either physicians or surgeons who practiced in densely populated areas and major cities of Europe. Medical practice was more limited in the rural districts, where a local surgeon or apothecary more typically kept an open shop, and patients could come for treatment. The complaints of patients from these rural districts rarely reached a doctor of medicine. Peasants often used drugs prepared in the tradition of folk or domestic medicine; a surgeon was visited only in cases of trauma or, if he practiced obstetrics as well, in cases of problems with a delivery. In the country each surgeon had a self-compiled list of medicines. In the Netherlands, for example, the surgeons were not obliged to follow the pharmacopoeia until 1805.^[5] There were some books in the vernacular

[3] Michel Foucauh, Histoire de lafolie a l'âge classique (Paris: Gallimard, 1972).

[4] Small research societies in many countries are active in the history of psychiatry, in part as the consequence of this paradigmatic Foucaldian work. In Belgium and the Netherlands, for example, vast inventories have been made of archives and collections dealing with psychiatric hospitals and lunatic asylums. In Belgium, p. van der Meersch has edited studies on psychiatry, religion, and authority; see Psychiatric, Godsdienst en gezag: De ontstaansgeschiedenis van de psychiatrie in Belgie als paradigrna (Leuven: Amersfoort, 1984).

[5] D.J.B. Ringoir, Plattelandschirurgijns in de 17 e en 18e eeuw (Diss. Amsterdam; Bun-nik, 1977), 101. See also G. B. Risse, R. L. Number, and J. W. Leavitt, Medicine without Doctors (New York, 1977).

during the eighteenth century for rural surgeons, some of these being translated pharmacopoeias, but rather little is known about the solitary frightened patients deep in the country. Especially lacking is an understanding of that fear which stems from isolation—the relationship of personal anxiety to the environment.

If we proceeded in this vein, we should soon find ourselves investigating outbursts of mass hysteria, witchcraft, suicides, and riots. Despite the Enlightenment and the rationality it brought with it, a great part of the European population—the poor in the cities and the peasants in the country—was illiterate and hopelessly attached to medical superstition.^[6] An example of fear among peasants was recorded by the members of the Académie de la Rochelle in France. In February 1784, only a few months after Montgolfier's experiment, the townspeople were invited by the Academy to be present at a balloon fair, arranged by the local pharmacist. The balloon went up and stayed aloft for about thirteen minutes. When it came down in the open fields where workers were unaware of the event, it was cut to pieces by farmers, who attacked the balloon with their pitchforks. To assuage panic, the town published a pamphlet to explain that the balloon was an experiment, due to natural causes, and not the work of the devil.^[7]

PIETY, PATIENTS, AND PASSIONS OF THE MIND

It was early believed that pathological phenomena, such as a state of anxiety, might be a consequence of sin. Metaphysical causes were considered as well: a punishment by God or retribution of debt, which brought the patient into a situation that he needed the assistance of the Church. These interactions between the physical and the metaphysical, between the mind and the body, belonged foremost to the field of moral theology.^[8] Doctors were only permitted to give their opinion on the

[6] An impressive study of this problem can be found in Michael MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England (Cambridge: Cambridge University Press, 1981).

[7] Jean Torlais, "I'Académie de la Rochelle et la diffusion des sciences au XVIII siècle," Revue des sciences 12 (1959): 111-135.

[8] G. S. Rousseau, "Psychology," in The Ferment of Knowledge: Studies in the Historiography of Eighteenth-Century Science, ed. G. S. Rousseau and Roy Porter (Cambridge: Cambridge University Press, 1980), 175. Rousseau wisely pays attention to religious treatises on the soul by English clergymen, adapted by physicians. The French school of historians (especially Annales and the social historians) has been very active in their search for traces of fear in last wills and prayers; see for instance Jean Delumeau in La pent en occident, XVIe au XVIIIe siècle (Paris, 1978).

temper of the patient; they were not free to venture upon the psychological analysis of his fear.^[9] It would be fruitless to search medical treatises for such psychological evaluation. Instead of analysis, doctors were trained to substantiate evidence on the four tempers, the choleric, melancholic, phlegmatic, and sanguine temper, and to respond to the predisposition of patients for emotional reactions such as fear. They explained the physiology and pathophysiology of these emotional reactions, they described various case histories, but they refrained from explaining the "spiritual fears," in terms of guilt and remorse.

The pious had a different attitude in the acceptance of the emotionally disturbed patients, different in that they invoked religious agents as antecedent to physiological causes. They did not neglect anatomy or physiology: they rather blended the two into an original pietistic model.^[10] This was especially true in Halle, Germany, where Pietism was the leading religion. Michael Alberti (1682-1757) rejected any materialistic explanation of disease, certainly for disease in which the mind was involved. Alberti was the son of a pietist minister. After studying theology and afterwards medicine, he became a devoted pupil of Georg Ernst Stahl (1659-1734), the leading professor of medicine in Halle. Alberti's Specimen Medicinae Theologicae (1726) was an attack against the Cartesian concepts of Friedrich Hoffmann (1660-1742), who discussed the passions of the mind in his Medicina Rationalis Systematica (1716). In the Netherlands, physicotheology became an important field of interest of enlightened Protestantism. It allowed ratio et experientia as a tool for searching the causes of natural phenomena, for emotional disturbances as well as for other diseases.^[11] So it is likely that we find more open discussions of the emotions in medical treatises written in the Netherlands at the time of Herman Boerhaave (1668-1738) and Hieronymus David Gaub (1705-1780). The differences between the Leiden and Halle Schools will be discussed later in this essay.

[9] K. Rothschuh, Konzepte der Medizin in der Vergangenheit und Gegenwart (Stuttgart: Hippokrates Verlag, 1978), 67-70.

[10] Rothschuh, Konzepte. An excellent discussion on the attitude of the patient in pietistic centers in Germany has been given by Johanna Geyer-Kordesch, "Cultural Habits of Illness: The Enlightened and the Pious in Eighteenth-Century Germany," in Patients and Practitioners: Lay Perceptions of Medicine in Pre-industrial Society, ed. Roy Porter (Cambridge: Cambridge University Press, 1986), 177-204.

[11] J. Bots, Tussen Descartes en Darwin: Geloof en Natuurweteuschap in de achttiende eeuw in Nederland (Assen and Amsterdam, 1972), especially 49-60; J. van den Berg, "Theologie-beoefening te Franeker en te Leiden in de achttiende eeuw," It Beaken: Tydskrift fan de Fryske Akademy 47 (1965): 181-191.

Fear is one of the most important passions of the mind, as the great novelist quoted in the epigraph intuited at mid-century. These passiones animi were a subject of study for philosophers from Aristotle onward, who reduced all passions to pleasure and pain.^[12] The philosophers of the seventeenth and eighteenth centuries paid sufficient attention to the emotions and their interaction with the body in order to bring these phenomena into agreement with the new philosophy of René Descartes and the discoveries in anatomy and physiology.^[13] This newfound classical series of passions attached to pain and pleasure were ira (wrath), terror (fright), metus (fear), moeror (grief), pudor (timidity), spes (hope), gaudium (joy), and amor (love). These passions, like the group of six non-naturals, were most popular in medical literature and had been described by Galen.^[14] The nine passions received more attention in the course of the eighteenth century, especially through the contribution of Arnulfe d'Aumont in the Encydopédie of Diderot on health and hygiene.^[15] A well-balanced mind was important, not only for the pious and the patients but also for the politicians, to keep the people peaceful and in a state of mental health. Although medical students were primarily engaged in the physical bodily changes accompanying the passions, they referred to John Locke's An Essay concerning Human Understanding (1690)^[16] and to Hume's A Treatise of Human Nature (1739), the chapter " On the Passions," for their philosophical backgrounds and understanding of fear. Neither author believed in an inborn ability to reason but accepted experience by way of the external senses at the main source of knowledge. For Hume (1711-1769), the passions were sense perception intercepted by its idea.^[17] Hume considered fear a direct passion, an

[12] L. J. Rather, "Old and New Views of the Emotions and Bodily Changes: Wright and Harvey versus Descartes, James and Cannon," Clio Medica 1 (1965): 1-25.

[13] Ibid. Descartes's Les passions de l'âme was translated into Dutch in 1659 by J. L. Glazemaker.

[14] Air, motion and rest, food and drink, sleep and watch, evacuation and retention, and the passions of the mind. For a contemporary definition see John Harris, Lexicon Technicum, or, An universal English Dictionary of Arts and Sciences: explaining not only the Terms of Art, but the Arts Themselves (London, 1736). He describes them as the Non-Natural Things, or the Non-Natural Causes of Diseases. See n. 15.

[15] William Coleman, "Health and Hygiene in the Encyclopédie: A Medical Doctrine for the Bourgeoisie," Journal of the History of Medicine and Allied Sciences 29 (1974): 399-421. See also L. J. Rather, "The Six Things Non-Natural: A Note on the Original Fate of a Doctrine and a Phrase," Clio Medica 4 (1968): 337-347.

[16] Sylvana Tomaselli, "Descartes, Locke and the Mind/Body Dualism," History of Science 22 (1984): 185-205.

[17] David Hume, A treatise of human nature, being an attempt to introduce the experimental Method of Reasoning into Moral Subjects, vol. a, Of the Passions (London, 1739).

impression that arises immediately from good or evil, from pain or pleasure.^[18] He also attached great value to the power of imagination in this passage from the perception of the virtue or vice to the impression he considered almost identical with the passion. Furthermore, Hume used the term "probability" to change a passion:

Throw in a superior degree of probability to the side of griet, you immediately see that the passion diffuses itself over the composition, and tinctures it into fear. Encrease the probability and by that means the grief, the fear prevails still more and more, till at last it runs insensibly, as the joy continually diminishes, into pure grief.^[19]

This combination of passions or transitions from one passion into the other was also considered by some medical students from Edinburgh, as we shall see. Combining passions suggested a way of psychological analysis and psychological treatment. Hume's enthusiasm for natural philosophy drove him far so as to compare the passions with optical phenomena:

Are not these as plain proofs, that the passions of fear and hope are mixtures of grief and joy, as in optics it is a proof, that a colour'd ray of the sun passing thro' a prism, is a composition of two others, when as you diminish or increase the quantity of either, you find it prevail proportionally more or less in the composition? I am sure neither natural or moral philosophy admits of stronger proofs.^[20]

For the enlightened students, educated by ratio et experientia, this metaphor must have been delightful. It is also interesting to notice that ideas of uncertainty in fear are preeminently present in theories of acting. We shall pay brief attention to the concept of fear as it was used in the theater. An actor had to play his part in such a way that his facial expressions and his gestures could be recognized by a large audience. In effect, there were prescriptions for the interpretation of the passions.

A semblance of fear should be expressed by a shrinking of the body; the actor should stand erect, with his arms along his body and his fists closed. His legs should be slightly apart; his eyes should be flickering with a restless glance. He should pace up and down the stage, twisting his fingers, but at the same time keep his shoulders hugged and he should express the uncertainty in his face.^[21] These instructions were

[18] Ibid., 181.

[19] Ibid., 218.

[20] Ibid., 219.

[21] J. Jelgershuis, Theoretische lessen over de gesticulatie en mimiek (Amsterdam: Meyer/Warnars, 1827), 150.

Pl. 6. "Expressions of Fear by Actors," in J. Jelgerhuis, Theoretische lessen over gesticulatie en mimiek (Amsterdam, 1827).

partly inspired by the French painter Charles le Brun (1619-1690), who wrote a manual on the way of illustrating the passions.^[22] This booklet influenced several Dutch painters including Gerard de Lairesse (1641-1711), who praised le Bruns's work.^[23] But the actors were also indebted to Petrus Camper (1722-1789) and Georges Louis Leclerc de Buffon (1708-1788), who paid attention to the physiognomy of the passions from a medical and a biological point of view. Buffon described with great care the changes of the facial expression in various stages of fear, observing the eyes, the eyebrows, the lips, and the opening of the mouth.^[24] Petrus Camper tried to explain these changes anatomically, paying tribute to the innervation of the facial muscles and urging his students to notice the changes in the body in general, when they were

[22] Over de afbeelding der Hartstogten of Middelen, om dezelve volkomen te leeren afteekenen, translated into Dutch by F. Kaarsgieter (Amsterdam, 1703), from the original French version by Charles le Brun, Conférence sur l'expression générale et particulière (Paris, 1698).

[23] Jelgershuis, Theoretische lessen, 130.

[24] Buffon's Histoire naturelle was published between 1749 and 1789. Part of this impressive work is on the natural history of man. In this study, he described the expressions of passions. Histoire naturelle, vol. 20 (Paris, 1799), 177, 183).

Pl. 7. "Expressions of Fear by Actors," in J. Jelgerhuis, Theoretische lessen over gesticulatie en mimiek (Amsterdam, 1827).

describing frightened persons.^[25] These facial expressions were also observed by the physicians, who mentioned these signs in their description of the frightened patient. But physicians used a medical interpretation; they were more interested in the physiological explanation of the pale color, the trembling lips, and the shaking knees, than in a lively portrayal of the patients' physionomy. We find these representations in particular in some student dissertations.

FEAR AND ANXIETY IN MEDICAL DISEASE

The main diseases of the time which held anxiety as an underlying symptom were hypochondria and hysteria. The diagnosis of such a disease

[25] P. Camper, "Over de wijze, om de onderscheidene hartstogten op onze wezens te verbeelden" (On the way to depict different passions on our appearances). This lecture was presented to the pupils of the Academy of Art in Amsterdam in 1774. Published by A. G. Camper in Redevoeringen van wijlen Petrus Camper (Utrecht, 1792).

was of great importance for a medical practitioner. The treatment would be lengthy and the patient would need serious attention. If he succeeded in curing the patient, he was considered a successful doctor and he could afford himself a praxis aurea, earning much money from usually well-to-do patients. Hypochondria thus became an especially fashionable disease. As the Swiss structuralist critic and historian of medicine Jean Starobinski has pointed out, it was closely related to melancholy, the classic disease described by Hippocrates, as a neuropsychiatric syndrome with depression, hallucinations, mania, and convulsive crises.^[26] The theory of the origin of this disease was humoral: a corruption of the black bile would mix with the blood and act as a poison. Afterward, authors differentiated the signs and symptoms of the disease in various clinical pictures. Galen described three types of melancholy, one located in the whole body, one located in the brain, and finally a third type, hypochondriacum flatulentumque morbum , a disease in the upper abdomen with flatulence, belching, abdominal pain, and fear.^[27]

This last form of melancholy became a separate entity, known as hypochondria, described in medical treatises from the seventeenth century onward as a common disease. Among others, Robert Burton (1577-1640), who published his Anatomy of Melancholy in 1621, maintained that the boundaries between melancholy and hypochondria stayed rather vague and held that one was simply a form of the other. The physician accepted patients with an isolated delusion as long as they were socially acknowledged as hypochondriacs. He would treat them with much care, provided they were not too excited or aggressive, only involved in their own world, without causing nuisance to their environment. In the event a patient became agitated by a delirium or a dominating "idée fixe," insanity was suggested, and the patient was sent to an asylum for care. Boerhaave took this idle fixe as the most serious symptom of melancholy, combined with the agitated delirium without fever.^[28] Hypochondria in the eighteenth century was a disease with a great variety of symptoms

[26] Jean Starobinski, "Geschichte der Melancholiebehandlung yon den Anfäangen bis 1900," Acta Psychosomatica (Basel) 4 (1960): 15.

[27] E. Fischer-Homberger, Hypochondrie, Melancholie bis Neurose: Krankheiten und Zustandsbilder (Bern, Stuttgart, Vienna: Verlag Huber, 1970), 15. The author refers to Galen, De locis affectis, liber 3, cap. 10.

[28] H. Boerhaave, Aphorisms, 1089. The Aphorismi de Cognoscendis et Curandis morbis in usum doctrinae domesticae were first published in Leiden in 1709. They were translated into English by J. de la Coste in 1715 as Boerhaave's Aphorisms concerning the Knowledge and Cure of Diseases.

of which fear was only one of the complaints. It mainly affected men of all ages, and women after their childbearing period.^[29] The patients were afraid of death, afraid of diseases, afraid of being poisoned. Sometimes they were possessed by delusions, such as the impression of a number of frogs hidden in their abdomen or that they were changing into glass figures.^[30] This glass delusion is a remarkable phenomenon in the history of psychiatry. It was widespread from the beginning of the seventeenth century up to 1850, when the diagnosis disappeared into a new and different system of nosology.^[31] Patients suffering a glass or pottery delusion had one thing in common: an obsessive fear they might break into pieces. They did everything to protect themselves; they were even afraid of being pushed or touched.

The first description of such a delusion can be traced back to the second century. It was described by Rufus of Ephesus. The patient fancied himself to be a "keramon," a large piece of pottery.^[32] In another case a Florentine nobleman fancied himself to be an oil vessel, and there are various other cases of the pottery delusion to be found in history.^[33] In the book On the condition and disposition of the human body, which was published in 1561, the Dutch physician Lieven Lemnius (1505-1568) gave a very exact description of a patient who believed his buttocks to be made of glass.^[34] He was afraid to sit down, he thought his buttocks would break and the glass would be scattered all over the floor. This case history was repeated in various textbooks all over Europe. Because of

[29] At the Edinburgh Infirmary thirteen cases of hypochondria, of which nine were men and four women, were registered between 1770 and 1800. G. Risse, Hospital Life in Enlightenment Scotland: Care and Teaching at the Royal Infirmary of Edinburgh, Cambridge History of Medicine, ed. Charles Webster and Charles Rosenberg (Cambridge: Cambridge University Press, 1986), 153.

[30] F. F. Blok, Caspar Barlaeus: From the correspondence of a melancholic (Assen and Amsterdam: Van Gorcum, 1976), 110. This book deals with the depression of the eminent scholar Caspar Barlaeus (1584-1648), how he informed his friends of the glass delusion and other signs of his disease, and how his friends reacted to his melancholy. It also gives information on the medical treatment of depressions at the time.

[31] A. J. Lameijn, "Wie is van glas? Notities over de geschiedenis van een waan" ("Who is made of glass? Notes on the history of a delusion"), in Een Psychiatrisch Verleden, ed. J. M. W. Binnenveld et al. (Baarn: AMBO, 1982) 26-93. A. J. Lameijn is a Dutch psychiatrist who made a profound study on the glass delusion.

[32] Lameijn, "Wie is van glas?" 28. See also Hellmut Flashar, Melancholic und Melancholiker in den medizinischen Theorieen der Antike (Berlin: de Gruyter, 1966) and Starobinski, "Geschichte der Melancholiebehandlung."

[33] See works cited in n. 32. The case was mentioned by the artist Benvenuto Cellini (1500-1571) in his autobiography, first published in 1728. La Vita was translated into English in 1771 for the first time.

[34] L. Lemnius, De habitu et constitutione corporis (Antwerp, 1561), fol. 141v.

the rather grotesque phenomena of the disease, these delusions became a favorite subject for literature and poetic expression. For instance, Constantijn Huygens, the seminal Dutch poet of the early seventeenth century, wrote a poem as early as 1622 on the glass delusion of a hypochondriac.

Here's one fears everything that moves in his vicinity
What's wrong? Well every where he's touched is made
                    of glass, you see
The chairs will be the death of him, he trembles at the bed,
Fearful the one will break his bum, the other smash his head
Now it's a kiss appeals him, now a flicked finger shocks
Just as a ship that's gone off course sails, fearful
                    of the rocks.^[35]

The gloomy aspect of these delusions was the loss of the identity of the patient. Moreover, it could mean an impulse for disorderliness, superstition, or even religious sectarianism.

So even in hypochondria or in the twilight zone of melancholy these delusions were observed with suspicion by the enlightened rationalists, since they disturbed the wordly order of state. Henry More warned in his Enthusiasmus Triumphatus (1656) of these perfidious dangers:

For I shall easily further demonstrate that the very nature of Melancholy is such, that it may more fairly and plausibly tempt a man into such conceits of inspiration and supernatural light from God, then it can possibly do into those more extravagant conceits of being Glasse, Butter, a Bird, a Beast, or any such thing.^[36]

In contrast, these delusions were mostly accepted as a part of a fashionable, if somewhat seraphic, disease: "the English Malady, the spleen or the Vapours," in Dr. Cheyne's memorable phrase, as hypochondria was known in England and France.^[37] The patients were not incarcerated so

[35] Blok, Caspar Barlaeus, 115. Constantijn Huygens (1596-1687) was a well-known poet and secretary to the Stadholder Frederik Hendrik. The poem was probably composed for Barlaeus.

[36] Henry More, Enthusiasmus Triumphatus (London, 1662; reprint, Los Angeles: William Andrews Clark Memorial Library, University of California, 1966, as Publication no. 118 of the Augustan Reprint Society), 10. See also H. J. Schings, Melancholie und Aufklärung (Stuttgart: Metzler Verlag, 1977), for the tensions between delusions and authorities.

[37] Richard Blackmore, A treatise of the Spleen and Vapours (London, 1726), 161-162. See also Ilza Veith, "On Hysterical and Hypochondriacal Afflictions," Bulletin of the History of Medicine 30 (1956): 233-251. There were a vast number of medical treatises written on hypochondria; for a survey of eighteenth-century treatises on this disease see Fischer-Homberger, Hypochondrie, 35-44, also her bibliography.

long as their disease did not develop into the cerebral condition of melancholy, which was considered to be a state of insanity.

The hypochondriac might also be vexed by the nightly apparition of an incubus.^[38] This is a little monster which sits upon the belly of the patient. The poor victim feels a heavy pressure on his stomach, he lies frightened and paralyzed with wide-open eyes looking at his nasty visitor without being able to move or to scream. Sometimes the monster does not sit on his victim, but is experienced as lying under his body. In that case, it is called succubus, a typical nightmare for a male patient, since either the victim or his physician ascribed a sexual origin for the apparition. The students define the succubus as a consequence of onanism,^[39] which was coming under the attention of the physicians at the time. When young women complained about suffering from a nightmare in the shape of an incubus, it was usually considered to be a symptom of suppressed sexual desire. Sometimes the victims are caught by seizures, which dispel after some time. This nightmare has a long history. The incubus was already known to St. Augustin^[40] and has been associated with demonic powers. When the belief in demons was on the wane, the incubus continued to harass anxious patients. It was used as a theme in art, the good and the bad nightmare, as painted for instance by the Swiss artist Henry Fuseli in 1781.^[41]

The presence of an incubus could also be a symptom of hysteria, a condition considered to be the female counterpart of the exclusively male hypochondria. This disease had its seat in the womb. Thomas Sydenham (1624-1689) wrote a famous book on the disease, in which he described the womb as "the seat of a thousand evils," suggesting that Hippocrates had already mentioned this fact. Hysteria caused headache, anxiety, convulsions, and several disturbances in sensation. The greatest

[38] The incubus became a popular theme for medical theses under the influence of the mechanistic explanation of human physiology. In Leiden the first thesis on this subject was defended by a Polish student, Christiaan Maevius, in 1692. In 1734 a Dutch student, Matthaeus Huisinga, presented his Dissertatio Medica Inauguralis sistens Incubi causas praecipuas, followed by the Swedish student Tiberius Zacharias Kiellmann in 1739 on the same subject.

[39] See on this problem Th. Tarczylo, Sexe et liberté au siècle des lurainères (Paris: Presses de la Renaissance, 1983).

[40] Augustinus, De Civitate Dei, liber XV, cap. xxiii. Virgil describes the incubus in the Aeneid, 12.908-912 non lingua valet, non corpore notae sufficient vires; nec vox aut verba sequuntur (the tongue is powerless, the familiar strength fails the body, nor do words or utterance follow—tr. Mackail).

[41] A. M. Hammacher, Phantoms of the Imagination (New York: Harry N. Abrams, 1981), 41-46.

Pl. 8. German cartoon in the manner of Rowlandson, "The Pressure of an Incubus" (ca. 1800).

danger of hysteria was its location; "suffocation of the womb" might affect pregnancy in its early stage and cause serious harm to the embryo. Thomas Sydenham called hysteria and hypochondria the same disease; the hysterical man, however, was only fully accepted in the nineteenth century, when Jean Marie Charcot analyzed hysteria as a neurological disease and traced the signs in both sexes.^[42] The frightening symptoms of the disease were usually the changes in body sensations, sometimes followed by convulsions. Gerard van Swieten (1700-1772), professor in Vienna and a true pupil of Boerhaave, ascribed the onset of the disease to emotional breakdown:

Healthy women, who have been made angry or frightened become anxious, their blood gets upset in the vessels and their heartbeats accelerate. Shortly afterwards, they experience something in their abdomen turning and moving, rising on the left side. As soon as this sensation hits the mid-

[42] On hysteria, see Ilza Veith, Hysteria: The History of a Disease (Chicago: University of Chicago Press, 1965), especially chapters 7 and 8; idem, "On Hysterical and Hypochondriacal afflictions." Also E. Fischer-Homberger, Krankheit Frau und andere Arbeiten zur Medizingeschichte der Frau (Bern, Stuttgart, Vienna: Hans Huber Verlag, 1979).

Pl. 9. A. W. M. C. Ver Huell (1822-1897), "Nightmare Showing Incubi," in A. Ver Huell, Zijn er zoo? (Arnhem: P. Gouda Quint, 1852).

Pl. 10. Henry Fuseli, "Three Frightened Girls" (ca. 1780-1782).

riff, they get a feeling as if they are being strangled. Then they experience a heavy globe in their throat, usually they fall into convulsions.^[43]

During the eighteenth century the cause of hysteria became firmly rooted in the nervous system. The brain itself was considered to have a high degree of irritability. In addition, patients were believed to have weak cardiovascular and muscular systems: patients fainted easily, even by such light shock as the appearance of a mouse! More serious cases would be accompanied by hysterical paralysis or a disturbed imagination with frightening delusions of devils, making obscene gesticulations. These patients were considered to be possessed by a demon, especially when they had additional symptoms such as a hoarse voice, uttering blasphemy, a tortured face, and a loss of sensibility in certain parts of the body. In these instances the church would be consulted for an exorcism. The more enlightened doctors, however, described these patients as severe cases of hysteria and not victims of the Devil. Anton de Haen (1704-1776), a professor in Vienna and a Dutch pupil of Herman Boerhaave, treated several hysterical patients without the interference of an exorcist with good results.^[44] In his book On Miracles de Haen described his rather drastic therapy on severe cases of presumed demoniacal possession. The patient was put under a cold shower each time she started to curse God and the Empress of Austria or other authorities. Certainly these women suffered, but without necessary documentation we lack a full appreciation of eighteenth-century hysteria. More specifically, there seems to have been no instance of a female George Cheyne or John Hill. That is, the expounders of the condition were, like Cheyne and Hill, males, and except for a few comments about hysteria by women (I do not mean in fiction but in didactic-explanatory statements) the medical literature of hysteria is a male record composed exclusively by males. While this archive defines and describes the condition, its degree of sympathy is often lacking, sometimes for no other reason than that the physician could not penetrate its dynamcis. In fact, the cases of

[43] Gerard van Swieten, Commentaria in Hermanni Boerhaave Aphorismos de Cognoscendis et Curandis Morbis (Hildburghausen, 1754), 3:416. Ad S 1075 of Boerhaave's Aphorisms . See n. 28.

[44] See Dieter Cichon, Antonius de Haens Werk "De Magia " (1775), Münstersche Beitrage zur Geschichte und Theorie der Medizin no. 5, ed. K. E. Rothschuh. R. Toellner, and Chr. Probst (Münster, 1971). The medicalization of hysteria was very important, since in Austria witchcraft and incantations still were practiced and consequently witches could be burned at the stake! See also A. De Haen, De Miraculis Liber (Frankfurt and Leipzig, 1776), 194 for his description of a woman, who was supposed to have been possessed by the devil for eighteen years.

the "hysterical passions," as they were called already in 1667 by Willis^[45] and others, give us more insight into the phenomenology of hysteria than into the psychology of the suffering women. Furthermore, several of these cases should rightly be considered as the more serious disease, psychosis, a true form of insanity.

Besides the diseases hypochondria and hysteria, or the combined diagnosis, there were various other reasons why patients were continually frightened. As has already been said, we shall not discuss the psychotic fears of the insane patient in this study. Our main interest remains focused on the daily life of men and women who were frightened for some reason and complained about these fears to their family, their friends, or their physician. Such anxieties have been described by scholars in learned treatises and by novelists in literature, but also in a long line of anecdotes, which are repeated again and again from the classical authors like Galen and Pliny onwards. What kinds of fears are mentioned? Besides the fear of the changed bodily sensations in hysteria and hypochondria like the glass delusion, the patients were scared of ghosts, monsters, bed-curtains, mice, earthquakes, explosions, burglars, contagious diseases, and even masks. Both Boerhaave and Tissot believed that masks may be very disconcerting. Tissot referred to Boerhaave in his warnings:

Mr. Boerhaave discussed various cases of epilepsy in his work, following a sudden fright. Two of these cases were caused by masks. If we compare these with my cases we may say that this type of amusement is not without danger.

Indeed, Boerhaave warned against Twelfth Night parties for children and also against "making faces or grimaces." Even the reflecion of a distorted face in a mirror could frighten a sensible person and provoke convulsions.^[46] A false face could frighten not only pregnant women and children but even men. We shall return to this point later on.

[45] Thomas Willis accepted already a neurogenic cause of hysteria in 1667. See Veith, Hysteria, 133, 134. See also Robert Frank, chapter 4 above.

[46] S. A. Tissot, Traité des nerfs et leurs maladies (Lausanne, 1778). I consulted part IV from the Œ uvres complètes (Lausanne, 1790). Tissot describes on p. 392 a case of a child frightened by masked children on the street during a party. The child suffered from diarrhea for some weeks. Tissot refers to Boerhaave on p. 406. See Jacobus van Eems, Hermanni Boerhaave Praelectiones Academicae de Morbis Nervorum (Leiden, 1761), 2:801. Boerhaave repeated in his lectures the danger of frightening spectacles and the "homo larvatus," the masked man. See also John Locke, Some Thoughts concerning Education (1693) on scaring children with stories on ghosts and monsters. This work was already translated into Dutch in 1697. A French edition was prepared by P. Coste, which was reprinted many times, the fifth edition in Amsterdam in 1743.

PI. 11. A. W. M. C. Ver Huell (1822-1897), "Fear of the Bed-Curtains," in A. Ver Huell, Zijn er zoo? (Arnhem: P. Gouda Quint, 1852).

But fear and anxiety were most striking in serious affections of the body. It is true, most eighteenth-century studies of anxiety discuss five points of fear accompanying diseases: cardiac origin, an intoxication of the respiratory system, an obstruction of the abdominal tract, different types of fever, and agonia, the struggle with death. Anxiety itself was considered to be of physical origin, while fear was primarily a matter of the mind. Great medical thinkers on disease—Morgagni, Hoffmann, Boerhaave, Van Swieten, Gaub—treated all five of these points in their medical manuals with great attention. Yet we must remember that various symptoms in hypochondria may have had their origin in physical causes, which were yet to be perceived and understood: such as abdominal cancer or obstruction of the pathways of the bile by pathological changes in the tissue of the liver (cirrhosis). A defect of the cardiac valves was often diagnosed as hysteria, as were brain tumors and other neurological diseases. Before introducing some independent theories let us first pay attention to changes in the medical schools, where psychological phenomena were incorporated in the teaching program.

PIETISM, MECHANISM, AND THE SENSORIAL POWERS OF THE BRAIN

At mid-century there were three important medical schools in continental Europe whose leaders held competing medical philosophies: the schools of Georg Ernst Stahl (1659—1734) and Friedrich Hoffmann (1660-1742), both in Halle, Germany, and a third school of Herman Boerhaave (1668-1738) in Leiden. In the schools of Hoffmann and Boerhaave, medicine was practiced on the basis of a mechanical model of the human body. Stahl's system, however, has been labeled animistic or vitalistic. In Stahl's concept the soul is the leading power of the organic structure and is directly involved in any behavior of the body.^[47] The impact of these schools upon existing medical education fostered order and structure in the teaching program and generated a rational basis for medicine. In the other European countries there was little impact for a complex number of reasons, much too complicated to be

[47] On the animistic and vitalistic doctrines of Stahl see L. J. Rather, "G. E. Stahl's Psychological Physiology," Bulletin of the History of Medicine 35 (1961: 37-49 and Lester S. King, The Philosophy of Medicine: The Early Eighteenth Century (Cambridge, Mass., and London: Harvard University Press, 1978), 143-151. See also G. S. Rousseau's important study of Enlightenment vitalism and Bakhtin in The Crisis of Modernism: Bergson and the Vitalist Tradition, ed. Frederick Burwick and Paul Douglas (Cambridge: Cambridge University Press, 1991).

treated at any length here. In France, mechanism as a leading principle was hardly accepted.

In Germany and Leiden the concepts of the mechanistic schools interacted quite peacefully with the animism of Stahl, especially on physiological grounds such as the circulation of the blood, and the idea of sanitas (health) as an equal, moderate, and continuous perfusion of the humors through the parts of the body. But there was a difference in therapy: Stahl paid more attention to uncommon drugs, which he used in a sophisticated therapy of the presumed cacochymia in the body. Cacochymia was a supposed putrefaction of the body fluids, and an important part of Stahl's concept of disease. The main part of the recommended drugs were herbal, mentioned in the Wurtemberg Pharmacopoeia (1741).^[48] Stahl also accepted more uncommon drugs as lapis manati and cornu cervi. Lapis manati is a part of an otic bone of Manatus Australis (sea cow) and was used in treating spasmodic diseases. Cornu cervi (Harts horn), discussed by Stahl in 1690, was a popular antispasmodic remedy in the chemiatric schools. Hoffmann prescribed alterantia to change the temper of the blood and the organs.^[49] These medicines were based on the corpuscular theories of Robert Boyle's chemistry, related to the Cartesian concept of the crucial ether as a spiritual fluid through the nerves. Boerhaave wanted to act upon the "spissity" (thickness) of the body fluids and to control the density and the laxity of the fibers. His drugs were mainly Galenic and he attached much value to diet and exercise, especially in cases involving the sufferings and passions of frightened patients.^[50]

The extraordinary convergence of Pietism in Halle and a concept of the persona (the soul inextricably linked with man's individual being) created a new school of medicine which the Germans called "Pastoralmedizin," pastoral medicine.^[51] In this concept medicine was the servant

[48] See Joachim Petrus Gaetke's dissertation on the general therapy of hypochondriasis, De Vena Portae Porta Malorum Hypochondriaco-splenetico-suffocativo-hysterico-colico-haemorrhoidariorum (Halle, 1698), 52-55 (on the portal vein as the gateway to the evils of hypochondria, of smothering of the spleen and the womb, and of hemorrhoids in the colon).

[49] On Hoffmann's therapy, see K. E. Rotschuh, Konzepte der Medizin in Vergangenheit und Gegenwart (Stuttgart: Hippokrates Verlag, 1978), 247-249.

[50] On Boerhaave's therapy, see B. P. M. Schulte, Hermanni Boerhaave Praelectiones de Morbis Nervorum 1730-1735, Analecta Boerhaaviana, 2, (Leiden: E. J. Brill, 1959).

[51] Wolfram Kaiser and Arina Volker, "Michael Alberti (1682-1757)," Wissenschaftliche Beiträge der Martin-Luther-Universit t (Halle-Wittenberg) 4 (1982): 9-11. See also Rothschuh, Konzepte, 67-70. Michael Alberti was the author of the Specimen Medicinae Theologicae (1726).

of faith and godliness. The conscientia medica, medical conscience, should always be aware of the agreement of a medical theory with theology. Students of pastoral medicine were to learn how to preserve the tranquilliras animi —the mental balance of the patient—a medical approach highly appreciated by evangelists and preachers. Stahl taught that there must be a direct interaction between mind and body and dictated his ideas to his students in the form of deontology: a list of duties including "musts" and "must nots." After digesting this material, students were required to dispute or defend it in dissertation.^[52] There are a large number of propemtica (introductions) by Stahl which accompany these student works. In these speeches Stahl emphasizes medical ethics; he discusses the role of the physician in medical practice and his responsibility to his patients. For instance, in 1706 when Henricus König presented a thesis De curatione aequivoca (On a well-balanced therapy), Stahl gave his propemticon De temeritate, timiditate, modestia et moderatione medici (On drastic and reticent, on modest and restrained medical behavior) as an example of variability in an administration of therapy by the physician. Various propemtica such as De Dissensu Medicorum (1703) (On the disagreeing doctors), De Visitatione Aegrorum (1703) (On the visit of patients), De Testimoniis Medici (1706) (On medical reports), De Constantia Medica (1707) (On medical steadfastness), De Auctoritate et Veritate Medica (1705) (On medical authority and integrity) deal with ethics. Hoffmann went even further and expressed the need for morality in some letters to young doctors. One such letter is on physical pietas, which he describes as a spiritual combination of mental and physical health. Thus mental health is only possible as the individual's complete union with, and devotion to, the source of life: God.^[53] As such, it may restore physical health in a patient. Stahl stressed this point too in every discussion of the animi pathemata : frightened patients might be bled to restore the temperies of the blood, but Stahl warned his students that if they wanted to treat

[52] A collection of medical dissertations presented to the Halle Faculty is present in the university library a Leiden, dating from 1696-1714. They have been bound in four volumes under the title G. E. Stahl ii... Dissertationes Medicae, turn epistolares turn academicae in unum voluraen congestae (Halle, 1707 ff. ). This collection also contains dissertations defended under the supervision of Hoffmann, A. O. Goelicke (1671-1744) at Magdenburg, Johann Gottfried Berger (1659-1756) at Wittenberg, and Michael Alberti (1682-1757), just mentioned. The volumes of the collection were more or less haphazardly gathered; there is no introduction and the pages are not indicated, except for the first volume.

[53] "Epistola gratularia ad Virum Magnificum, Excellentissimum atque Experientissimum Dn. Bernhardum Barnstorffium," Halle, 1 October 1696, in Stahl, Dissertationes, vol. 3. A congratulatory letter was reserved for important inaugurations "more majorum." In this case, it was Bernard Barnstorff, who was Dean of the Rostock University.

patients psychologically, they should be in tune with themselves and tread lightly,^[54] rather resorting to doctrina moralis.^[55] Needless to say, students were not permitted to vent their personal opinions in these dissertations, but their experience allowed some conjecture to avoid explanations of diseases by natural or materialistic causes alone.

The state of medical affairs differed profoundly in Leiden. There, students were free to speculate in their writing, albeit more or less in agreement with the current school philosophy. Calvinism and the hierarchical, mechanistic concept of the body guided by an immortal soul were compatible views on man. In Leiden the concept of medicine remained theoretical and scientific; unlike the students in the Halle school, they paid less attention to moral or spiritual issues, to the physician's duties, or to the noble task (officium nobile ) of the physician.

At least in part, the difference in medical thinking was due to the introduction of the concepts irritability and sensibility.^[56] The growing importance of the nervous system in physiology focused the attention of scholars on these phenomena. The human body summoned a new view. It became an organism with a mind, which was believed to be responsive to outside influences apart from the pathways of mechanical connections. The mind/body relation became crucial in a different way, as well; more attention was suddenly paid to psychology, education, physiognomy, and medical anthropology. In Leiden, Hieronymus Gaub took the chair after Boerhaave's death in 1738. Gaub's concept of the human body was mechanistic in Boerhaave's sense, but he was also deeply involved in the mind/body discussions then taking place within and without the university, and, especially, in the pathemata of the mind,^[57] which

[54] J. J. Reich, "De Passionibus Animi Corpus Humanum Varie Aherantibus" (Diss. Halle, 1695), in Stahl, Dissertationes 1:97. Temperies, "inter se mutua proportia," is meant by Stahl as a chemical balance in the blood; homeostasis in present medicine.

[55] Geyer-Kordesch, "Cultural Habits of Illness" (n. 10 above), 178-204. She considers Pietism an affair of the sentiments. The faithful "feel" themselves pietists. They "feel" God within their heart. (In Calvinism, God is outside, he is the Arbiter, a dialogue is possible.)

[56] Richard Toellner, "Albrecht yon Hailer: Ueber die Einheit im Denken des letzten Universalgelehrten," Sudhoffs Archiv 10 (1972): 17l-182. Albrecht von Hailer published in 1750 his famous study on these properties of the parts of the body, especially of the muscles. Since tissue could react to a stimulus, even when it was no longer in contact with the body, irritability and sensibility had a rather autonomous quality.

[57] L. J. Rather, Mind and Body in Eighteenth-Century Medicine (London: Wellcome Historical Medical Library, 1965). This is an excellent study on Gaub's addresses De Regimine Mentis, quod Medicorum est —a great help for any scholar who wants to be informed on the complex material of the mind/body problem in medicine at the time.

became his preeminent study. He inspired Robert Whytt (1714-1766), the Scots Professor of Medicine in Edinburgh, who used Gaub's textbook for teaching purposes.^[58] So there became a close teaching connection between Leiden and the Edinburgh school, founded in 1727 on Boerhaave's model, where the interest in psychological phenomena was growing. We may naturally expect to find concepts derived from both schools in Leiden publications, especially in the students' dissertations.

The growing interest in the sensorial powers of the brain was also responsible for a shift in the concept of disease accompanied by fear such as hypochondria and hysteria, and was especially apparent in the work of Robert Whytt, who declared these diseases to be neurogenic,^[59] by which he meant originating in the nervous system. Another important consequence was the popularization of the mind/body subject. S. A. Tissot's (1728-1797) influential book Traité des nerfs et leurs maladies (Lausanne, 1778) became especially popular, not least because he gave an extensive survey of case histories on the animi pathemata, which were cited by professors of medicine all over Europe. The medical schools at Paris and Montpellier, where mechanistic doctrines never took root, explained virtually all emotional disturbances as "crises nerveuses" and looked for chemical changes in the blood and for indigestion.^[60] Furthermore, the concept of sympathy gained ground again, especially in Montpellier. This "action on a distance," or external aspects of nerve endings acting in a type of vibrational or materialistic sympathy, was entirely condemned by the mechanists, but later in the eighteenth century it captured the interest of all the European physicians. Tissot paid great attention to the action on a distance upon several parts of the body by the distribution of the peripheral nerve. By this distant influence the brain had the sympathy of the stomach (consensus ), and the concept became very important in physiology and psychology, not only in

[58] R. K. French, Robert Whytt, the Soul, and Medicine, Publications of the Wellcome Institute of the History of Medicine, n.s., vol. 17 (London, 1969), 151. The textbook is H. D. Gaub, Institutiones Pathologiae Medicinalis (Leiden, 1758), which was quite popular. It was translated into English in 1778 by C. Erskine and published by C. Elliot and T. Cadell in London and Edinburgh.

[59] French, Robert Whytt, 31-45. See also Fischer-Homberger, Hypochondrie, 32.

[60] Jean Astruc (1684-1766) lectured in 1759 at the Collège Royal. In this lecture, he discussed the causes of hypochondria and hysteria, especially the primary cause of tension of the nerves. See the MS at the Municipal Archives in Middelburg, corr. David Henri Gallandat (1732-1782). On Gallandat, see G. A. Lindeboom, Dutch Medical Biography: A Biographical Dictionary of Dutch Physicians and Surgeons 1475-1975 (Amsterdam, 1984).

France,^[61] where Tissot's influence was considerable, but also in Scotland among Whytt's students.

The consequences for psychotherapy were not obvious. Galenic drugs were still dominant, and as we have seen, Gaub prescribed Peruvian bark and musk for attacks of hysteria or fearfulness.^[62] Gaub had a special preparation for his tranquilizing medicine: he combined valerian root with Peruvian bark in a single pill. For hysterical patients his formula was an odorous drink composed of musk, Peruvian bark, and several other herbs. All these herbal and chemical formulas were fine, but they only worked to subdue the hypochondriac's fear. Amelioration required psychological treatment, a subject about which even the young medical students then had suggestions.

PORRIDGE AND RUSSIAN TEA

The following views of the concept "fear" were presented by medical students in their dissertations. Principally, there were three different conceptions: anxiety (anxietas ) fear (metus ), and fright (terror ) The students wrote their treatises in obedience to the philosophical doctrines of the school, but they were encouraged to voice their own opinions; in fact they betray their training ground in a most amusing series of manners. The German students, for instance, were systematic in their discussion of the signs of fear in a patient. They often quote the case histories described by J. N. Pechlin (1644-1692), professor at the University of Kiel in Germany,^[63] preferring the tale of the intimidated professor who was so frightened of his students that he would empty his bladder and rectum in a special pot just before he entered the lecture hall. In another

[61] Heini Walther Bucher, Tissot und sein Traité des nerfs: Ein Beitrag zur Medizingeschichte der schweizerischen Aufklärung, Zürcher medizingeschichtliche Abhandlungen, ed. E. H. Ackerknecht, Neue Reihe, 1 (Zurich, 1958), 44-54. For Whytt's relation to the consensus, see the lectured notes of his Edinburgh pupils.

[62] See Hamers-van Duynen, Gaubius (n. 1 above), 186.

[63] J. N. Pechlin, Observationum Physico-Medicarum Libri tres quibua accessit Ephemeris Vulneris Thoracici et in earn Commentarius (Observations in physics and medicine in three books, and a comment on the description of a wound in the chest) (Hamburg, 1691), liber III—obs. XVII: "A Metu alvi flexus" (Loss of Faeces, caused by Fear); mentioned by J. J. Monjé, a student from Tübingen who took his degree in Leiden in 1785: Spec. Medica Inauguralis de animi pathematibus eorum effectibus nec non salutari eorundem in morbis efficacia (Dissertation on the affliction of the soul and their effects, with (sometimes) salutary efficacy in diseases). See also Abraham Heemskerk, Dissertatio ethico-medica inauguralis De Animae Pathemature Efficacia in corpus Humanum (Medical-ethical dissertation on the efficacy of the affliction of the soul upon the human body) (Leiden, 1754). Pechlin is often cited by Gaub in his De Regiraine Mentis etc.

tale, a preacher lost his urine, when he stood in the pulpit preaching about the miracles by Christi A Leiden student tells a similar story, this time about a lady who lost her urine each time she went to Holy Communion. Most of the case histories relating to fear involve rather grotesque details verging on the scatological, and they were repeated in medical textbooks and popular handbooks all over Europe during the late eighteenth century.^[64]

Among these dissertations the one written by William Clark, an Englishman, stands out.^[65] Clark was a devout Christian who eventually settled down as a general practitioner in rural Wiltshire. In his attempt to reconcile observations in medicine with the Christian faith, his dissertation remains more in the tradition of moral theology than a medical argument. Clark first treats the free will of man, which should, he believes, control the emotions. God gave emotions to man as guardians against evil and danger, and should be compared, by analogy, with physical pain as a bodyguard, which alerts the mind in case the body is threatened. But, Clark contends, the physician's duty extends beyond consideration of the patient's temper. Clark's teacher, Boerhaave, had discussed the observations of Sanctorius (1562-1636) in his lecture on imperceptible perspiration.^[66] Sanctorius described this imperceptible natural perspiration under different circumstances. He observed that people who were depressed and scared gained weight; they were "heavier" than when they were happy and relaxed. Boerhaave, said Clark, advised his students to restore the perspiration in case of depressed and frightened patients by administering drugs to open the pores, but Clark disagreed. In his opinion, excitement, caused either by fear or anger, should be tempered, not medicated. To be an Englishman meant to be moderate, and moderation was a way to prevent monumental changes in the quality of the body fluids. The best prevention against

[64] For instance, Wilhelm Gesenius, Medicinisch-moralische Pathematologie oder Versuch über die Leidenschaften und ihren Einfluss auf die Geschäfte des körperlichen Lebens (Erfurt, 1786). The most popular medical book at the time remained S. A. Tissot's Traié des nerfs et leurs maladies (Lausanne, 1790); see n. 46.

[65] Wiliam Clark (1698-1780) studied medicine under Boerhaave and took his medical degree in Leiden in 1727, writing a dissertation on the influences of the emotions upon the human body (Dissertatio Medica Inauguralis De Viribus Animi Pathematum in corpus humanum ).

[66] Sanctorius published in 1614 his Ars de Statica Medicina aphorismorum sectionibus septan comprehensa (Treatise on static medicine contained in seven sections of aphorisms) in Venice. He became one of the founders of the Italian iatromechanical school. The Leiden edition of Medicina Statica was published in 1728. Clark refers to Boerhaave's lectures after hearing Boerhaave speak on the insensible perspiration in case of emotions.

these ominous changes (which might provoke water retention) was daily consumption of a rich, English porridge, and a flask of Rhine-wine at night. Thereby Clark drew attention to the relaxing effect of food and drink in a tense patient.

Clark also bore great admiration for the well-known doctor George Cheyne, whose treatise entitled An Essay on Health and Long Life was published in 1726.^[67] The last paragraph of Clark's dissertation is a long and reverent quotation from a chapter by Dr. Cheyne on the affectus animi.^[68] Clark's theory of fear may be medical and derived from Boerhaave's lectures, but his main concept lies more in the tradition of moral theology than in moral treatment. His ideology is more involved in faith than in medicine. He accepts Boerhaave's explanation of the physiological phenomenon of fear according to the experiments of Sanctorius, but he objects as follows:

What is said in Sanctorius' theory on the effect of expected joy and hope, could more justly be applied to the hope and faith of the Christian believers.^[69]

It is the charitas divina that gives these laws to the animi pathemata. Man should listen first to God (Paul,Rom. 2:15): one knows best in his heart. Clark considers disease to be a punishment of God, also a fear. He is aware of physiology and his medicines are meant to calm down an upset stomach, but he resists interfering in the pattern of anxiety by introducing psychological factors or attempting to analyze the patient's fear.

Clark's dissertation on fear differed considerably from one presented in 1738 by another student of Boerhaave, Otto Barckhuysen, a Russian student in Leiden about whom virtually nothing biographical is known.^[70] Barckhuysen discussed his idea of terror as a sudden, unexpected confrontation with a danger, which resembles our notion of fright or alarm. But he was not inclined to call upon the metaphysical, and was interested neither in the seat of the soul nor in the interaction between body and soul and its relation to God. Barckhuysen also rejected Leibniz's theory

[67] In London, 1726, by Strahan, and in Bath by John Leake.

[68] He refers to G. Cheyne, Tractatus de Sanitate Tuenda, cap. de animi affectis, sec. 22. See on Dr. Cheyne: G. S. Rousseau, "Medicine and Millenarianism: 'Immortal Dr. Cheyne," in Hermeticisra in the Renaissance: Studies in Honor of Dame Frances Yates, ed. Allen Debus and Ingrid Merkel (Cranbury, N.J.: Associated University Press, 1987), 192-230.

[69] Clark, Dissertatio, 25.

[70] Otto Barckhuysen, Diss. med. inaug, sistens considerationem Terroris Pathologico-Therapeuticam (Medical dissertation for the doctor's degree, on the pathology and therapy of terror) (Leiden, 1738).

Pl. 12. Cartoon by T. Rowlandson, "Delirium with Fever" (1792).

of a preestablished harmony, which means that he rejected the notion of a perfect dock-like arrangement between body and soul.^[71]

Barckhuysen argued that physicians should be direct and practical, should observe the psychological reactions of their patients, and should try to understand the principles of these reactions. Neither philosophers nor moralists should interfere with the treatment of the fearful patient. Barckhuysen provides the example of a merchant who hears the news of a shipwrecking of one of his best ships loaded with merchandise, which partly belonged to some merchant colleagues under his charge. He reasons that the best way to break the catastrophic news to this poor man is to inform him gradually —this pace is crucial. If the merchant were to be confronted with the full reality at once, he may become morbidly terrified, which can lead in turn to apoplexia or even to sudden death. By contrast, when he is intentionally kept in suspense, merely

[71] At the time a dispute raged between Stahl and Leibniz on the agreement. See L. J. Rather and J. B. Frerichs, "The Leibniz-Stahl Controversy—I, Leibniz' Opening Objections to the Theoria Medica Vera, " Clio Medica 3 (1968): 21-40; "II, Stahi's Survey of the Principal Points of Doubt," Clio Medica 5 (1979): 53-67· Leibniz compares the action of the body and that of the soul as the maintenance of a perfect synchronization of two independent clocks.

supposing the ship is missing but having no further news, he naturally becomes a victim of anxiety, which may cause loss of body temperature and perspiration, as described above, accompanied by palpitation of the heart, paleness, and shivering. Slowly induced anxiety is preferable to shock, says Barckhuysen, since the body can then build up a kind of physical resistance to the full impact of the catastrophe. In the meantime the doctors can take care of his comfort. As an ameliorative he suggests some hot Russian tea, carefully prepared from several mixed herbs! Barckhuysen is very proud of his Russian compatriots. Generally speaking, he says, the Russians are not easily frightened; they harden their bodies and minds by swimming in an air hole in the ice, even during the severest cold of wintertime.

Clark and Barckhuysen, both true followers of Boerhaave's doctrines, did not try to analyze the psychological factors involved in the process of fear. They did not define guilt or hallucination, nor did they refine the differences between anxiety and oppression. Mainly, they interpreted all ailments of the psyche as a breakdown of mental processes which allowed for depression and the symptoms of fear and anxiety to surface in response to stress. Moreover, anxiety and fear were used as synonyms for the same state of mind, albeit that most students attributed a corporeal quality to anxiety and a spiritual quality to fear. The difference m the treatises that have anxiety as a subject and those that deal with one or more emotions (animi pathemata ) lies in the choice of the diseases put forward in the dissertations. For example, anxiety and pain are closely intermingled in the diseases discussed by those students who took anxietas as a subject of their studies. Five corporeal examples of anxiety are prominent in these studies: anxiety caused by (1) heart failure, by (2) pulmonary obstruction, by (3) abdominal oppression, by (4) serious affects of the nervous system, and by (5) surgical intervention.^[72]

By discussing these five examples of anxiety, the students could test their knowledge of clinical medicine, culminating in a long description of agonia, the struggle with death.^[73] Moreover, they could demonstrate

[72] See Francis Gallis, Disputatio Medica lnauguralis de Anxietate (Harderwijk, 1739): he followed Boerhaave's institutions, but his therapy is based on Stahl's doctrines. Dirk Schouten, Disputatio Medica Inauguralis de Anxietate (Leiden, 1742): Boerhaavian physiology, Hoffmann's therapy. Isaac Voyer, Dissertatio Medica Inauguralis de Anxietate (Leiden, 1769): following Hieronymus David Gaub, Institutiones Pathologiae medicinalis (Leiden, 1758), S 683.

[73] Prosper Alpinus, De Praesagienda Vita et Morte Aegrotantium Libri Septem, ed. H. Boerhaave, emendationes Hier. Day. Gaubius (Leiden: Ex. off. Isaaci Severini, 1733; editio princeps, Frankfurt, 1601). Boerhaave considered this work of the highest importance for the daily praxis of medicine. Prosper Alpinus was a famous physician who became director of the botanical garden at the University of Padua in 1593.

that they had followed Boerhaave's clinical teaching in the Caecilia hospital as well as his instruction in physiology. With the help of his pupil H. D. Gaub, Boerhaave edited The prediction of life and death of the diseased (1733) by the famous Italian physician Prosper Alpinus (1533-1617). The definition of anxiety in this context is: the sad and obstructed perception of the mind or the sensation that our life is fading away.^[74] For instance, this feeling of terror is dominant in being choked, in having a perforated stomach, or in the terrible anxiety in rabies. The more subtle feelings of anxiety as experienced in hypochondria or hysteria were of relatively minor concern to these students, whose interest was peaked by more serious diseases. They were most eager to explain these dreadful sensations in terms of iatromechanics. The affliction of the mind was considered to be only a consequence of the disease itself; it was a consensus (sympathy) between the brain and the affected organs. This thinking is evident in the medical explanation of the incubus;^[75] such a monster does not really exist. It is a product of imagination, caused by oppression of the abdominal area, due to overeating and drinking too much wine. It is a consequence of Newton's laws of gravity, which teach us that the weight of a body presses against another body with a certain force. Thus, the stomach presses against the diaphragm and the diaphragm presses against the heart. By this pressure the circulation to the head becomes obstructed, and the ventricles of the brain become overfilled, the pressure disturbs the animal spirits, and the monster appears in a certain shape to the patient, such as his imagination would allow.

These strict mechanical explanations are also applied to the serious conditions of heart failure, gas poisoning with sulphureous vapors in volcanic eruptions, and the frightening experience of the amputation of a leg. Medical students paid little mind to the workings of the imagination; we must look instead for studies on the affectus animi, or on the

[74] "Anxietas est ergo illa tristis, molestaque Mentis perceptio, vel sensus quo putamus vitam destituram esse." See also Schouten, De Anxietate, and Gallis, De Anxietate, who claim that it is "quasi certamen cum morte" (any anxiety is like a struggle with death). The word agonia (Greek) was used in ancient medicine, similar to angor in the double meaning of combat and anxiety. See Prosper Alpinus, De Praesagienda Vita, lib. III, cap. IV.

[75] See Huisinga, Dissertatio... sistens Incubi causas praecipuas (n. 38 above). He gives a mechanical explanation. The backward position of the head gives an intracranial obstruction of the ventricles, there is no more secretion of the animal spirits, so the body cannot move. The apparition of the incubus is not a matter of metaphysics but a product of imagination.

perturbationes animi —in other words: on the effects of the emotions upon the mind.

MUSIC AND NO-RESTRAINT

In 1735 we find the very first testimony in the Leiden school of a changing interest in the animi pathemata. James Goddard, a student from Jamaica, defends under Boerhaave his dissertation De animi Perturbationibus (On the disturbances of the mind),^[76] in which the beginnings of psychology are discernible. Goddard, already recognized for his work on Descartes, Hobbes, and Locke,^[77] was impressed by the series of lectures on diseases of the nervous system presented by Boerhaave between 1730 and 1735. In these lectures Boerhaave gave several explanations of the transmission of emotional disturbances to the different parts of the body. Goddard grew interested in this theme and expanded it, describing several symptoms of body change as a consequence of hidden fear: the voice of the patient changes, it is softer, the stomach suffers from spasm, the pulse becomes smaller and accelerates. He also notes changes in facial expression, the paleness, the restless glance. Goddard provides an amusing picture of anthropological and environmental differences between people with regard to their emotional reactions: Catalans are restrained and do not show their emotions, the French on the contrary are more exuberant. People from the mountains and people living in the plains react differently, as Hippocrates taught. Goddard then deals with inherited traits. An aggressive father will beget a hot-tempered lad, and a funk (stercoraeus) will beget a funk! He believes that passions have a contagious affect: "like laughing faces get moist when crying people come in," or "like a disease strikes as lightning, a sudden emotion can spread easily." According to Goddard, women are

[76] James Goddard was born in 1714 in St. Ann, Jamaica. In 1732 he attended Jesus College, Oxford; in 1733 he matriculated in Leiden. Boerhaave took personal care of this dissertation. R. W. Innes Smith, English-speaking Students at the University of Leiden (Edinburgh and London, 1932).

[77] John Locke's Some Thoughts concerning Education (1693) was translated into Dutch in 1698 by Barent Bos in Rotterdam under the title Verhandeling over de opvoeding der kinderen. Another Dutch edition was published in 1753 in Amsterdam by K. van Tongerlo and F. Houttuyn. Locke's theories on education were discussed in lectures, probably by Gaub. Thomas Hobbes was following Descartes, but his mechanism and materialism were condemned by the authorities of the church as well as by university professors. Goddard rejects Hobbes's theories from De Homine (1657) on the innata praenotio (inborn knowledge).

much more susceptible to fear than men, especially when they eat too many sweets.

He also proposes various therapeutic measures against fear. The majority of these prescriptions were already well known and frequently mentioned by the teachers of the schools in Europe. We can find them in all books on hypochondria, such as George Cheyne's English Malady (1733),^[78] q which was most popular during the eighteenth century. Physical exercise, fresh air, moderation in the use of alcohol, and a light diet without herbs or fat food. Especially for fear and sadness Goddard recommends the soothing affects of music and traveling, preferably sea voyages, or occupational therapy. We can recognize those advices as being already familiar in the chapters on hygiene in the ancient textbooks. So far as music therapy was concerned, Goddard referred to the Tusculan Disputations of Cicero^[79] and mentioned Pythagoras's therapy with the violin and songs. Music therapy became popular again in the eighteenth century, especially in those systems of medicine which had a mechanical background: Goddard calls it a medicamentum amabile and he points out the use of musical therapy in tarantism, a disease caused by the bite of the tarantula, a spider that was common in harvest time, especially in Italy. He does not discuss the physiology of the cure. Goddard's psychotherapy is partly suggestive; when the physician prescribes remedies, he should emphasize the beneficial effects to be expected from their use. Hope and optimism, bolstered by proper medical guidance, should keep fear at distance. The author does not suggest tranquilizing the patient's mind. Emotions, even fear or grief, are necessary for a healthy life. Life should not be a stagnant pool; the passionless doctrines of any form of Stoicism are unhealthy for the patient.

[78] George Cheyne, The English Malady: or, A Treatise of nervous diseases of all kinds, as spleen, vapours, lowness of spicity, hypochondriacal and hysterical distempers, etc. (London and Dublin, 1733). On Cheyne, see Rousseau, "Medicine and Millenarianism' (n. 68 above). A popular work called Hypochondriasis, a practical treatise on the nature and cure of that disorder, commonly called the hype and the hypo was written in 1766 by John Hill. It was reprinted in 1969 with notes and apparatus by G. S. Rousseau.

[79] Goddard refers to Tusculan Disputations, liber IV, cap. II. In this chapter Cicero points at the importance of the music of the harp as soothing the emotions. See also H. J. Möller, Geschichte und Gegenwart musiktherapeutischerKonzeptionen (Stuttgart: J. Fink Verlag, 1971), 18. Also W. Kümmel, Musik und Medizin: Ihre Wechselbeziehungen in Theorie und Praxis von 800-1800 (Freiburg and Munich, 1977) as a general survey. Also E. Ash-worth Underwood, "Apollo and Terpsichore: Music and the Healing Art," Bulletin of the History of Medicine 21 (1947): 639-673. The general idea in the eighteenth century was that music stimulated the vital spirits by the composition of the sound waves, which penetrated into the brain.

Stoicism, as other authors in this book have noticed in its national contexts, was a dominant philosophy in Leiden during the sixteenth and seventeenth centuries. The ancient authors like Seneca, Plautus, Tacitus, and Terence were studied, and the virtues of steadfastness, modesty, and prudence were elements of the neo-Stoic moral philosophy.^[80] This morality suggested a strong mind, not sensitive to emotions, and a capacity for self-restraint. Goddard is against this hiding, this repression, of emotions. He opts for a no-restraint therapy: let the patient scream it out !

Goddard most likely attended some lectures given by H. D. Gaub, who had been teaching at the university since 1734. In 1747 Gaub presented his well-known address as the vice-chancellor of the university: De regimine mentis, quod medicorum est (The management of the mind, as it concerns physicians). It was here that Gaub discussed the interrelationship of mind and body in healthy and mentally confused persons. He made a distinction between minor disburbances of the mind and diseases of the mind, and he pointed out the importance of corporeal defects in mental disturbances. He tried to convince his audience that once these corporeal defects were treated, the mind would be cured as well. At the end of his address, Gaub pleaded that physicians should actively engage in a search for new drugs capable of affecting the mind. Understandably, his lecture created a stir in the Leiden community. Among the audience was Julien Offraye de La Mettrie, whose volume L'homme machine appeared that same year. This publication, which included case histories from Gaub's address, was condemned by the intellectual world as being irreligious and materialistic.^[81] Gaub received similar charges and was reprimanded for his remarks on the search for mind-altering drugs and for inspiring La Mettrie. To put the matter right, Gaub gave a second address in 1763 on the same subject. In this speech he publicly and emphatically denied any involvement with "the little Frenchman's... mechanical man."^[82] He pointed out the patient's responsibility for his own emotional disturbances, the harmful effects of emotions upon the body, and the sometimes salutary effects of anger and terror upon a patient. He avoided questions about drugs, warned physicians

[80] See Gerhard Oestreich, "Justus Lipsius als Universalgelehrter zwischen Renaissance und Barock," in Leiden University in the Seventeenth Century: An Exchange of Learning, ed. Th. H. Lunsingh Scheurleer and G. H. M. Posthumus Meyes (Leiden: Briil, 1975) 180-20l.

[81] Rather, Mind and Body (n. 57 above), 13.

[82] Ibid., 115-122. Also quoted by Rather.

of their limitations, and pleaded for a commitment by physicians to treat the "Whole Man."

The scholarly style of both lectures confirms that the Leiden professor had deeply and thoroughly studied the issues. Gaub's influence is quite obvious when we review the following dissertations by two students whose work also inspired the doctrines of the Edinburgh school to emerge. The first treatise was written by Thomas Cogan, who graduated in 1767.^[83] The second work was presented in 1777 by twenty-five-year-old Thomas Pemberton.^[84] Both students had widely read the books of the contemporary medical schools: Gaub's pathology, Boerhaave's lectures, Haller's physiology, van Swieten's commentaries, Whytt's essays, and Friedrich Hoffmann's medical counsels. Pemberton had also attended a lecture series given by William Cullen. The results of their efforts were tripled. First, both students had a better grasp on the concept of fear, and no longer confused that sensation with others. Second, they understood the theory of inspiring fear in patients as a means to cure them, referring to remarkable case histories of past and contemporary character. Finally, they were alert to the most current and successful psychological achievements.

SHOCK THERAPY AND ANALYSIS OF FEAR: THE ORIGINS OF MODERN TECHNIQUES

Thomas Cogan (1736-1816) defended his dissertation De Animi Pathematum vi et modo agendi in inducendis vel curandis morbis (On the

[83] Thomas Cogan (1736-1818) was 31 years old when he took his degree in Leiden. He started his career as a minister of the Anglican Church in England, but he became a Unitarian and had to leave his parish in 1762. He went to the Hague, where he served as a minister. When he intended to marry a banker's daughter, he was refused by her father, unless he trained for the medical profession. He got his medical degree at Leiden in 1765 and presented his dissertation in 1767. He defended his thesis under Gaub, saying that he had collected his material from different authors and different schools, but that he thanked his teachers (probably also B. S. Albinus) for their support. It is clear from this study that he wanted to be well informed on the physiology of the mental processes and that he was avoiding explanations in the field of moral theology. In his later work he tried to combine the medical and the moral insights into the problem. His essay Philosophical Treatise on the Passions was printed in 1800; in 1802 a second edition followed. Later, he turned fully to moral theology, See Dictionary of National Biography (London: Smith and Elder, 1887), vol. 11.

[84] Thomas Pemberton was born in 1750. He took his medical degree in Edinburgh and went to Leiden. His father, Eduard, was a friend of Boerhaave. See Innes Smith, English-speaking Students.

power of the emotions and their action in causing or curing disease) in 1767. His study is in complete agreement with Gaub's concepts on the disturbances of the mental processes by the pathemata, which he describes as perturbations of the mind by the classical emotions: hope, joy, love, shame, anger, fright, fear, and sadness.^[85] Cogan discusses each affect in a physiological and a psychological context. He also offers suggestions on how to induce some of these emotions in patients. Terror (fright) cannot be medically cured or provoked. But the effect of terror can be produced by inducing a state of shock.^[86] Such induced shock has been successful in curing symptoms of depression. It is possible to cure a fever by inflicting terror; even a mute may talk after a shock! A paralyzed patient may suddenly walk, and girls may suddenly start to menstruate. But shock treatment is not indicated for the already frightened patient. Imposed terror will further paralyze a fearful patient: he becomes pale and cold, with trembling lips, his hair rises, and he loses control over his bladder and bowels. His heartbeat accelerates, his pulse becomes rapid and uneven, and he feels pressure (anxietas ) on his chest.^[87] Fear, Cogan states, is the gateway to serious diseases: it agitates the irritability of the nervous system, the capillaries contract, and patients who are living in a continuous state of anxiety may suffer physically. According to mechanical principles, if the contracted capillaries were not supplying the delicate parts of the body with sufficient quantities of blood, irregular cell growth or tumors could result. Cogan cites Van Swieten's remarks on breast cancer in women who live under stress.^[88] Fear has other negatives in connection with disease. Frightened people are likely to contract contagious diseases earlier than those who are strong-minded (fortitudo animae ), as was described by Diemerbroeck's study on an epidemic of the bubonic plague.^[89] Cogan offers

[85] Spes. gaudium, amor, pudor, ira, terror, metus, moeror—this is the classical series from Galen onward. A systematic description with a classification of the passions was published by Christian Heinrich de Marees, De Animi Perturbationum in corpus potentia (Göt-tingen, 1775).

[86] Thomas Cogan, De Animi Pathematum vi et modo agendi in inducendis vel curandis morbis (Leiden, 1767), 28.

[87] Ibid., 30.

[88] G. van Swieten, Commentaria in Hermanni Boerhaave Aphorismos de cognoscendis et curandis morbis (Commentaries on Herman Boerhaave's Aphorisms on diagnosing and curing diseases) (Hildburghausen, 1754), 1:495. Van Swieten notes the danger of long-lasting depressions (affectus animi tristes et biliosi ). These can provoke tumors or change chronic illness into cancer. The case of the breast tumor was described ibid. 1:127.

[89] IJsbrand van Diemerbroeck (1609-1674) studied an epidemic of the bubonic plague at Nijmegen in 1636-1637, which he published in 1644 in Arnhem. The book was reprinted several times. The idea of fear as a provoking factor for infectious diseases was already known to the ancients.

a mechanical explanation to describe how fear-based skin eruptions complicate disease: fear causes the skin vessels to contract, limiting the expulsion of contagious material through perspiration, which aggravates skin eruptions. Since eighteenth-century doctors saw many patients with smallpox, Diemerbroeck's observations at the time of a bubonic plague epidemic received new interest and a new underlying theory was considered.

In his psychological analysis of the anima pathemata Cogan discusses combinations of the emotions. He describes the effects of proneness to anger (iracundia ), which produces a grim visage, sleepless nights, and bad appetite, especially in combination with hatred and jealousy.^[90] While loneliness produces fear and sadness, a combination of fright, sadness, and anger may drive a person to suicide.^[91] Cogan also rejects humoral theories to explain the effects of the emotions upon the body and maintains that all responses are dependent on the system of nervous irritability and sensibility; the patient responds to diverse stimuli with diverse reactions.^[92] Here then was a model of psychology that depended exclusively on prescribed notions of mind and body viewed in relation.

But why has the highest Arbiter Rerum (God) created the emotions in such a way that they always produce the same phenomena in the human body? Why does anger act so differently from sadness and hope so differently from fear? Cogan also introduces the human element in differing human responses, but he considers the infliction of emotions not only a matter of physics but a consequence of the construction of the society as well.^[93] The living-together of people influences the mind. The body reacts on the conflicts in society by the passway of the mind. We

[90] Cogan, De Animi Pathematum vi, 35.

[91] Ibid. The idea of composed passions of the mind in different combinations is present in Descartes's and Hume's theories. Descartes analyzes the emotions in passiones primitivae with the opposite passion, for instance amor-odium, laetitia-tristitia, spes-metus. He refines the emotions further: hope gives safety, fear gives despair, indignation gives wrath. Cogan analyzes more as a physician! But he is an admirer of Descartes, judging by his motto: "Nihii affirmo, nihilque ab ullo credi velim, nisi quod ipsi evidens et invicta ratio persuadebit" ("I affirm nothing, and I would have no one believe anything unless convinced by clear and irrefutable reasoning") (Principia philosophiae [Amsterdam, 1644], pars 4, art. 207).

[92] Cogan, De Animi Pathematum vi, 36. He relies on Robert Whytt, Physiological Essays, … II. Observations on the sensibility and irritability of the parts of men (Edinburgh, 1755), 2-3.

[93] Cogan, De Animi Pathematum vi, 38-39.

can notice these changes in the trembling, frightened people who must appear in court, even when they are not guilty. But, Cogan asserts, the human body adjusts itself to the burden of the emotions imposed by society on the mind. It is the physicians' task to take better notice of the mental state of their patients, to find the right way to stimulate the emotion that favors the healing of the disease.^[94]

Thomas Pemberton's psychological analysis of metus is quite interesting. He states that fantasy, the product of disordered imagination, causes disease, whereas the expectation of an approaching calamity generates fear. He cites David Hume's remark on a man in prison who had just received a death warrant.^[95] Pemberton speaks of terror (fright), the sudden confrontation with an unexpected danger. There is also pavor, the children's fright, as described by John Locke—a consequence of a faulty education by maids and nurses who tell the children stories about ghosts and monsters. Timor is the kind of walled-in fear of which the patient is unaware. Pemberton pays particular attention to this form of fear, the tired and sick patient with lower-back pain, weak and slow pulse, and frequent urination. He describes cold and perspiring hands and feet, deep sighs, pale faces, visual disturbances, and inertia as signs of suppressed anxiety.^[96] One recognizes in this description the quintessential neurasthenia, described in 1880 by George Miller Beard, as the new disease of American civilization,^[97] just as hypochondria had been the disease of English civilization par excellence in Europe during the seventeenth and eighteenth centuries. Pemberton also discusses the fear of earthquakes, of volcanic eruptions, of confrontation with masked men, of burglars, of ghosts, of bed-curtains, of mice, of women, of loneliness, of poison, and of contagious diseases. And he also mentions the use of inflicting terror (fright) as a means of therapy.

Aside from the cases described by Pemberton, various textbooks offer grotesque studies using terror in the form of therapy. For instance, the

[94] Ibid. Various students use this point of opposite passions in their dissertations. They refer to Sanctorius, Ars de Statiea Medicina, the chapter on the emotions (sec. 7, aphorism 12). "Ira et spes auserunt timorem, et laetitia moestitiam" (Wrath and hope may chase fear, and joy sadness). For instance, Wilhelmus Ouwens, a Dutch student who got his doctor's degree in Leiden in 1737 on the subject De Horrore (On Shivering), 44, and Pemberton, De Metu, 59.

[95] Pemberton, De Metu, 17, citing David Hume, Of the Passions (n. 17 above), 190.

[96] Pemberton, De Metu, 35.

[97] George Miller Beard (1839-1883) published in 1880 A practical treatise on nervous exhaustion (neurasthenia); its symptoms, nature, sequences, treatment. The concept "neurasthenia" was first published in the Boston Medical and Surgical Journal 3 (29 April 1869): 217-220.

Pl. 13. Cartoon by T. Rowlandson, "Delusion of Persecution" (1792).

well-known case of Herman Boerhaave's action in the orphanage of Haarlem is recorded. In this orphanage a girl fell into convulsions caused by a sudden fright. Gradually the other children developed fear symptoms and one after the other fell to the floor. Boerhaave called all the children into the common room of the orphanage. He had pots prepared with glowing coals. On these pots he put small iron hooks of different configurations. Then he said to the children: "I do not know of any medicine to cure you. But each child be it a boy or a girl, that falls into a convulsion, will be burned with a little hook in his arm." The children were terrified with this prospect and nobody fell down again. Indeed, when one can detach the mind from an idea and replace it by another feeling or by terror, convulsions can be cured.^[98]

Pemberton also mentions a case described by Tissot:

[98] Pemberton, De Metu, 54. This case history was quoted by many authors. It was first described by Boerhaave's nephew Abraham Kaau Boerhaave in his study Impetum faciens dictum Hippocrati per corpus consentiens philologice et physiologice illustratum (The so-oiled Hippocratic arousal, experienced in the body, explained by its philology and physiology) (Leiden, 1745), 355-406. See G. A. Lindeboom, "Boerhaave in het weeshuis," Nederlands Tijdschrift voor Geneeskunde 102, no. 1 (1958): 24.

A Swiss officer refused to be bled since he always fainted at the sight of blood. The commander solved the problem by giving the order: attention! accompanied by a role of the drums. This distraction allowed the officer to be bled without problems.^[99]

Two further examples which Pemberton describes come from Schenck von Grafenberg and may be considered "classic" studies of recovery with induced shock:

A depressed girl refused to obey the physician's orders. The doctor asked her father's permission for a drastic therapy. The doctor went out, undressed, rushed back naked into the room and jumped into the girl's bed. The startled girl jumped from her bed and her depression ended.^[100]

An unmarried woman was frightened by a mouse and became subject to a permanent fear of mice. The doctor forced her to put a dead mouse in her lap and again shock acted as a cure.^[101]

The lap was, of course, the crucial geographic spot. If the girl could keep it there—as she apparently did, although for what length of time is unknown and unrecounted—close to the uterus, for so long the acknowledged seat of female hysteria, then her dread of mice would be allayed. According to Pemberton, who found the story credible, it was successful. In both cases, the action of the physician held overtones of sexual aggression, which were salutary for the patients. The girl who refused to get up from her bed was probably a virgin. The woman who feared mice was generally fearful and timid. Shock was induced and both were able to reduce their anxieties. In another example of induced terror, Pemberton mentioned a lecture, given by William Cullen on whooping cough in children. Cullen discussed terror as a therapeutic agent, and he mentioned some habits used in folk medicine but not well documented. Children who were suffering long-lasting coughs were

[99] Mentioned by S. A. Tissot. See n. 46 above. I found the passage in the German edition Säimtliche zur Arztneykunst gehörige Schriften … übersetzt nach den neuesten Verbesserungen (Leipzig, 1761), 4:338.

[100] Pemberton, De Metu, 55. He cited Joannes Schenck yon Grafenberg (1530-1598), a famous physician from Freiburg. His book, which contains many case histories, was later edited by his son and reprinted many times. See ParathsÎwn sive observationum medicarum rarum, novarum, admirabilium, et monstrosarum volumen (Volume of rare, new, remarkable, and strange medical observations) (Frankfurt, 1609), 154: "singulari solertia medici a melancholia asserta" (A case of melancholy, cured by the extraordinary ingenuity of a physician). This book by Schenck was kept as a handbook for medical students in the university library at Leiden, having been acquired in 1618. The call number is 637A1.

[101] Pemberton, De Metu, 44.

locked into a working mill.^[102] The crepitaculum molare (the sound of the grinding millstone) would so frighten them that they would overcome their coughing reflex. According to Pemberton, Cullen was not supporting this drastic treatment, he just offered it as a neutral example of the therapeutic effect of terror. Cullen mentioned the mill in his textbook when he discussed the therapy of whooping cough, but he promoted the use of herbal medicines.

Cogan as well as Pemberton had discarded considerably the earlier mechanistic explanations of the interaction between mind and body in cases of anxiety. Both discuss the nervous system as the seat of the disturbances, and they accept the vascular changes only as secondary symptoms. They notice the variation of sensibility of the brain for the stimuli of fear, and, after careful analysis, they record a difference in anxiety-proneness. Pemberton acknowledges that anxiety may underlie other emotional symptoms, such as a general state of depression. But they both use the classic shock agent again, to expel a passion with the opposite emotion. Still, their observations witness a sharp analysis of emotions, and they come very near to modern trends in psychology and even more contemporary ones in psychiatry.^[103]

DISCUSSION AND CONCLUSION

Eighteenth-century man, as we have witnessed again and again in this book, was living in a changing world. At the beginning of the age, immaterial forces such as witchcraft and possession by demons, cosmic influences, and hidden sympathies were still evident everywhere, in spite of the growing confidence in reason and experience. But the allegory of the world was fading, fear no longer had a valid alibi. The world picture became mechanized and secularized as well. Newton's empty space had replaced the concentric nine spheres, the harmony of the world around the earth was losing its mysteries and its charm. In this world, eighteenth-century man tried to be "absolute," that is, free from the chains of mystery and fantasy, obedient to reason and understanding. In this world there was no place for human feelings, which should be

[102] Ibid., 55. William Cullen, First lines of the Practice of Physic (Edinburgh, 1784), vol. 3, S 1423. He mentions "terror" but not the mill.

[103] For instance, the modern concept of state and trait anxiety. See Charles D. Spiel-berger, "Anxiety as an Emotional State," chap. 2 of Anxiety: Current Trends in Theory and Research (New York, Academic Press, 1972), 1:23-49.

straightened and dissimulated, or, later in the century, overacted by the heroes and heroines of Romanticism.

Perhaps we cannot call the eighteenth century an age of anxiety with total impunity, but anxiety and fear were extant everywhere just as they are in our time. Then, however, the objects of fear were different and anxiety was not so hidden in complicated psychological jargon as it is today. Furthermore, the anxiety of the patients during their too often incurable illness made a deep impression upon their family and their family doctor. To watch a patient struggling for breath, writhing in pain, bleeding to death, or having one epileptic fit after another is frightening. Incapability of the physician to give relief to the patient and his family is a disgrace for the medical profession. It is small wonder the medical schools paid more tribute to the actual diseases than to the nonfatal symptoms. Most disease was "atrocious,"^[104] painful, stinging, lingering, and if the physician was impotent to save the patient from agony and death, he should at least know the underlying pathophysiology of the process. So doctors were most eager to find remedies to give the patient free breath, to relieve the spasms, to stop bleeding, and to avoid epileptic fits and convulsions. In this last category especially, the passions of the mind were taken into consideration.

In eighteenth-century case histories and other medical literature, a remarkable number of patients are mentioned who suffer from convulsions, epileptic fits, or grimaces. In the first half of the century, these pathological phenomena are most often ascribed to fear or to a sudden fright, especially with children. Grimaces and distorted faces must have been observed everywhere, in the streets, in the taverns, in the schools. Why did Boerhaave and Tissot attach so much value to these faces, mentioning them together with false faces and masks? Why was the homo larvatus (masked man) such a danger? According to Jean-Jacques Rousseau, there was a great distance between "être" and "paraître," between the inner feelings of man and the social mask he was obliged to wear.^[105] Wearing such a social mask entails a precarious and delicate balance for a sensitive nature. But a civilized man had to wear his mask to fit into

[104] Atrocis rarissimique morbi historia conscripta ab Hermanno Boerhaave (Leiden. 1728); Atrocis, nec descripti prius, morbi historia secundum medicae artis leges conscripta ab Hermanno Boerhaave (Leiden, 1724). Two case histories of serious diseases, accompanied by pain and anxiety.

[105] Lameijn, "Wie is van glas?" 50. J. -J. Rousseau, Du Naturel de Jean Jacques et ses habitudes: Deuxième Dialogue, in Œuvres complètes (1784), 3:156 ff. In this chapter, Rousseau discussed paintings of well-known men like David Hume. Did the artist portray the man as he really was, or as he wanted to present him to the Paris public?

the new order of optimism and rationalism and to show a firm belief in the order of nature, with its laws and certainties.^[106]

By contrast, man was confronted with his own political and social impotence to change the world in which he lived into a more righteous world of a different order. Eighteenth-century sensitive man dreamed of a utopia, even a satirical utopia in which the order of his time was criticized.^[107] He was used to his social mask, wearing it invariably—but he should not be confronted with a man wearing a black mask or a false face. Such a man had neutralized the social order, he did not belong to civilization, he was an outlaw, a symbol of disorder and irrationality. The false face could be an omen for a complete destruction of the reality of the people that confronted the mask-wearing figure. There was no longer security and certainty. And certainty was wanted most by the enlightened intellectuals. It was a high topic in medicine.^[108]

Diseases in which anxiety caused by an underlying psychological problem was involved became popular in eighteenth-century medicine; they even dominated the daily practice of physicians, as we have seen. No doubt hypochondria and hysteria were the refuge of many uncertain people, who were hiding their problems behind the fig leaves of these diseases. They were ultimately diseases of civilization, as John Hill intuitively warned his readers in his brief but revealing analysis of this cultural phenomenon and as students at almost all universities, both in Europe and on the Continent, wrote in their dissertations: a soft life, high living, late nights, too much studying by the light of a lamp, too much tea or coffee, too much air pollution—these were in their opinion the causes of hypochondria and hysteria.^[109]

In spite of the iatromechanical explanation of anxiety and terror and the other passions of the mind, there is no great tendency to analyze fears of patients or to study the psychological differences in their relations before 1740. This was partly due to the authority of the dominant religion, which did not allow physicians to intrude into the psychic problems of the patient, especially when guilt feelings and remorse were

[106] Foucault, Histoire de la folie (n. 3 above), 392-393. He speaks of "monde illusoir ou s'annonce l'antiphysis."

[107] Lameijn, "Wie is van glas?" 51.

[108] On "certitudo" in medicine, see Erna Lesky, "Cabanis und die Gewissheit des Heilkunde," Gesnerus 2 (1954): 152-182; Pierre Jean George Cabanis (1757-1808), Du degré de la certitude la médecine (Paris, 1798); Petrus Camper's address De certo medicinae (Amsterdam, 1758), translated into Dutch and published in Bijdragen tot de Geschiedenis der Geneeskund 19 (1939): 87-103.

[109] John Hill, Hypochondriasis, a practical treatise (London, 1766), 20-21.

involved. Medicalization of psychic problems was not encouraged by the church, which compounded already varying interpretations of the way physicians should deal with patients vexed by fear. In Halle, all efforts were combined to train the students in perfect bedside manners and duties of a physician, but they were instructed to refrain from any attempt to analyze the fear. We may assume that this was also the case in Catholic universities.

Fear as a passion of the mind was more open for discussion in the Calvinist universities of northern Europe, provided the medical professors avoided materialistic interpretation of the mind and did not endanger the doctrine of free will. But the more tolerant attitude of the Calvinists was not enough to allow medical insights into psychic problems to develop. The mechanistic concept of the function of the human body provided a closed and rigid system by which virtually all reactions of the human body to emotions could be explained. The function of the nervous system was of lesser importance; in cases of easily frightened people it was "facile mobile," easy to manipulate.^[110] Nerves provoked only the less-startling circulatory changes, which produced the symptoms of fear: paleness, palpitations of the heart, trembling lips, and shaking knees. In contrast, changes in the human body, caused by failure of the circulation of the blood and other mechanistic causes, such as the incubus, could produce a disturbed imagination, resulting in fear or anxiety.

These mechanistic explanations take an important place in medical textbooks throughout the century. No paradigmatic change took place after the introduction of irritability and sensibility into physiology, in spite of the fact that the central nervous system gained more importance. But Haller's First Lines of Physiology^[111] were carefully studied by William Cullen, and became an important part of the doctrines of the Edinburgh school. Cullen's concept of disease, in which debility of the brain and its connections were discussed, opened a field of interest in psychic phenomena.

In medical psychology, differing only in a few remarks from that science which is simply called psychology, the actions of the soul or mind are investigated. A more elegant subject, and more worthy of attention, can not be imagined, than the thinking principle in man.

[110] This term was popular with the Leiden students; for instance, William Clark and the students who discussed anxiety used it in their dissertations.

[111] The English edition was completed after the Göttingen edition of 1764, annotated by H. A. Warisberg (1739-1808). See First Lines of Physiology by the celebrated Baron Albertus Haller, M.D. etc., translated from the correct Latin edition printed under the inspection of William Cullen M.D. (Edinburgh, 1786; reprint, New York and London, 1966, as vol. 32 of Sources of Sciences).

So read a passage in the First Lines of Physiology which was most welcome to the students.^[112] Moreover, as we have seen, the Leiden school of H. D. Gaub was open to all new achievements in the field of psychosomatic medicine. When Gaub was appointed professor of chemistry in the medical faculty in 1734, he was cooperating closely with Boerhaave in preparing the edition of Prosper Alpinus's work on the prediction of life and death in illness.^[113] Boerhaave presented his lectures on nervous diseases between 1730 and 1735. As we know from L. J. Rather's work, the mind/body relation was more in the picture of the medical teaching from that time on. So James Goddard, the first student in Leiden who tried to discuss the psychology of the passions of the mind, found that the ears of the professors of the medical faculty were open. In the attempts made by Gaub and his students to pay more attention to the psychology of fear, many case histories were reproduced from ancient medicine on. These studies, often characterized as "grotesques," were brought forward as examples of diseases resulting from a sudden fright or the use of terror as a therapeutic agent.

In this respect we must recall Cogan's study of the treatment of psychic diseases, as well as William Cullen's report on folk medicine in England, where a child with whooping cough was locked into a mill. In Yorkshire, it was long the practice of mothers to cure whooping cough by putting their children through the hoppers of a mill.^[114] Inducing fright in a patient may overcome a reflex, as Pemberton demonstrated in his review of Boerhaave's treatment of a case of mass hysteria in the Haarlem orphanage. But the probabilities of using an electric shock to cure a patient who was haunted by an "idée fixe," or a delusion, did not come into practice before 1800, when Giovanni Aldini (1762-1834) published his experiments with electric shocks administered to mentally ill patients."^[115]

Millstones and rotating instruments as a treatment for agitated patients became popular again at the end of the century. Erasmus Darwin (1731-1802) suggested rotation for a patient suffering from fever, "so as to whirl him round with his head most distant from the center of mo-

[112] First Lines 2:38.

[113] See n. 73 above.

[114] Samuel X. Radbill, "Whooping Cough in Fact and Fancy," Bulletin of the History of Medicine 13 (1943): 33-52.

[115] Giovanni Aldini, Essay théorique et expérimental sur le galvanisme (Paris: Fournier, 1804).

tion, as if he lay across a millstone."^[116] Darwin considered any form of severe emotional disturbance, even madness, to be accompanied by fever. He suggested diminishing the "sensorial power" by spinning the fever out of the body.^[117] Since millstones were not available to the average practicing physician, a rotating bed or chair might be used. Darwin's rotation idea was elaborated and actually applied in practice by Joseph Cox (1762-1822). It became a regular treatment for mentally disturbed patients owing to the work of the Belgian psychiatrist Joseph Guislain (1797-1860), who designed several rotating chairs for his patients.^[118] Just the appearance of these frightening instruments aroused fear among those who were to undergo this treatment.

The mill as therapeutic instrument may be understood as a straw in the wind announcing a new period in the history of mankind—not merely the beginnings of the Industrial Revolution, which would bring new instruments for medical treatment and diagnosis, but the force of the new psychology. Moreover, there were few, frightening, and almost demonic powers, if one can call them by this name, such as the steam engine, electricity, the new chemical formulas of materials yet unknown. Fear of new technology would arise as engineering marched ahead and would continue as one of the great menaces of our time. In this respect, Pemberton's reference to Cullen's lecture on the use of a mill to cure a child's whooping cough strikes us as a prophecy. Time will tell how prophetic it really was.

[116] Erasmus Darwin, Zoonomia; or The laws of Organic Life (London, 1794-1796), 2:608.

[117] Ibid. 578.

[118] Joseph Cox used a rotating chair: Practical Observations on Insanity ... (London, 1804-1814). I did not consult this work. Joseph Guislain pays full tribute to Darwin for the idea of rotation: see Traité sur l'aliénation mentale et sur les hospices des aliénés (Amsterdam, 1826), 1:374, discussed by Flynn in chap. 5 above.