4

Walnuts for Brains

Better Biologists? • A Great Start • Keeping the Momentum Up • A Change of Tune • Had Not Such Men • The Worst Blow They Ever Received • Contrary to Holy Writ • Monstrosities of Error • I Was Jolted to Discover I Was Wrong • Not Only Tolerated but Encouraged • Never, Ever, Anywhere • An Untested Novelty • It Just Kills Me • Relics and Bear’s Grease

Better Biologists?

By the time she was rushed into California’s Riverside General Hospital on the 19th of February 1995, Gloria Ramirez was already dying. Her advanced cancer had taken its toll, and she was now suffering from a combination of heart, kidney, and respiratory problems. After their initial efforts to stabilize her failed, the staff switched to emergency measures and prepared to shock her heart back into action. As they sheared off her clothing, they found a thin, oily film all over her skin.

This curious detail would have been quickly forgotten if Ramirez’s case had proceeded as normal—but it didn’t. Soon, several of those attending her began to pick up a garlicky aroma in the room. Susan Kane, the nurse closest at hand, drew some blood from Ramirez’s arm—and noticed that it smelled like ammonia. She passed the syringe to Julie Gorchinsky, who spotted tiny white-brown crystals suspended within the sample. Maureen Welch, a third team member, sniffed at it, checking for the familiarity of anti-cancer medication, but recognized nothing. Everything about the situation seemed somehow wrong.

Suddenly, Kane lost consciousness and crumpled to the ground. Gorchinsky fell too—and then stopped breathing. As the chaos kicked in around her, Welch briefly blacked out. When she came to again, her arms and legs were in violent spasm, and she was unable to control her movement. At this point the doctor in charge, Humberto Ochoa, decided he had better do something, and quick.

The three women were taken off for treatment; the ER was evacuated; patients and carers were moved out into the carpark. A couple of hardy souls were asked to stay with Ramirez in a last-gasp attempt to save her life, but it was to no avail. Less than hour after she arrived, the 31-year-old tragically passed away.

Matters outside, meanwhile, continued to be troubling. By the time it was all over, some twenty-three hospital staff had required their own medical attention. Five were kept in overnight—Gorchinsky remained in intensive care for a further two weeks. Even after her release, she never fully recovered: the unfortunate nurse went on to suffer from liver and pancreas complications, and then the bones in her legs began to die from the inside out—leaving her unable to walk without crutches.

Naturally, there arose an overwhelming demand to know what on earth had actually happened that night. What were the various smells? What was the oil on Ramirez’s skin? How had so many people been affected in such a short time in such bizarre ways? Could this happen again? If so, how might staff be better protected?

Since these events, several official bodies have had a crack at explaining what went on—but to this day, a quarter of a century later, we still have no definite conclusions. Hazmat teams could not trace any dangerous chemicals on the site. Coroners found nothing problematic in either Ramirez’s body tissues or her blood.

In the last two decades, the closest anyone has come to a workable theory is that the young woman had been self-medicating with a dubious painkiller brewed out of cleaning fluid—and that this chemical, when combined with the oxygen she was being given, had somehow reorganized itself into a form of nerve gas.¹ It should be noted, however, that the required reaction has never been observed by anybody under anything approaching real-world circumstances—and so the case, if we are being honest, remains open.

The strange and worrying tale of Gloria Ramirez is but one of many still unsolved medical mysteries, most of which can be quickly discovered with a simple online search. Alongside them, however, sit plenty of far more mundane physiological puzzles: we don’t know, for instance, why we blush. Likewise, we are uncertain about why we yawn; or why we pick our noses; or even why we have fingerprints.

And, at the deeper end of the subject, where more profound truths are thought to dwell, there is a veritable ocean yet to be charted. Perhaps the most perplexing of these harder questions is the so-called problem of consciousness—how on earth does our brain, which is an electrochemical lump of cells, give rise to the universal and undeniable sense that we really are, somehow, a person?

The point of all this—of Ramirez, of blushing, and of personhood—is a humbling one: our understanding of the human body is a long, long way from being complete. There is much that we simply do not understand about ourselves and the way we work—and often what we think we do know is called into question as new occurrences, discoveries, or test results are brought to light.

Yet why is this the case? One might have thought that, of all the sciences out there, the one most involved with looking after ourselves would also be the one we were best at. After all, aren’t we supposed to be finely honed survival machines? Shouldn’t medicine have always come top of the list for time, for thought, for effort, and for funding? Why, then, are there still so many unknowns?

Let’s put it more bluntly: shouldn’t we be rather better at biology than we are?

A Great Start

Most stories from the history of science tend to start off (for better or worse) with the Greeks, but medicine is different—for we can, without too much effort, get much further back than that. We have in our possession, for instance, an Egyptian medical document that was written in 1500 BC—and it may well be a copy of an original text another thousand years older than that.

The product of an unknown author, this intricate and remarkably scientific document is, therefore, emphatically pre-Greek: indeed, it had already been devised, copied, and used for hundreds of years before Plato’s great-great-grandparents had considered making their relationship a little less . . . well . . . Platonic. Rather gruesome at times, the pamphlet describes no fewer than forty-eight separate injuries, as well as how to treat them—and it makes fascinating reading.

Case number four in this guide—now known as the Edwin Smith Papyrus—has the charming title “Head Injury with Open, Displaced, Elevated, Skull Fracture.” The writer notes that, in this particular instance, the doctor is likely to notice the brain “shaking under his fingers” and that the sufferer “bleeds through his nostrils.” Here is the overview:

If you should examine a man for a slash wound in his head, that has penetrated to the bone, splitting his brain-case, you must palpate his wound . . . you should not bandage it. Put (him) to the ground, upon his bed under observation and support until the (critical) period of his injury passes. His treatment: it is sitting (upright). Make for him: two supports of brick until you know he has reached a turning point. Then, you have to put ointment on his head, and soften/massage the area of the back of his neck together with both his shoulders.²

Ancient human biology, then, was quite respectably advanced—especially in comparison to the likes of physics or chemistry.

And, when the Greeks did then turn up and do their thing, it got even better.

Keeping the Momentum Up

No tour of our topic, of course, could possibly bypass Hippocrates (b. 460 BC). Nicknamed the “father of medicine” (although our earlier Egyptian doctor might feel a little hard done by on that front), he helped to pioneer a holistic, evidence-based approach to healing. His system included taking the medical histories of the sufferer and their family, examining their place of work, asking about their general mood, and even working through—by hand—the newly deposited contents of their bowels. What’s more, the Hippocratic school also incorporated a clear moral dimension—physicians took an oath not to do any bodily harm and not to exploit their patients in any way. Doctoring was to be a vocation.

After Hippocrates, Aristotle took up the reins. His modus operandi, for most of his vast philosophy, was to observe the world directly and then think about whatever he saw. His eyes were more on the Earth than they were on the heavens, and this could pay dividends when it came to the dirty and messy world of sickness. Dissecting animals, for instance—as Aristotle probably did, and others following him certainly did—offered new insights as to what might be happening underneath the skin of a puzzled and poorly patient.

Then, with that hands-on groundwork laid, came Herophilus of Chalcedon (c. 335–260 BC) and Erasistratus of Ceos (c. 304–250 BC). By taking the next logical step and cutting up human beings, they made a whole range of revolutionary discoveries. Herophilus identified the eye’s cornea and retina; he distinguished between veins and arteries; he analyzed the liver; he worked out some of the functions of both male and female reproductive organs. Erasistratus built on all this, noting the one-way passage of blood through heart valves and identifying the heart as a pump.³ And we are still, by the way, half a millennium before Christendom really kicks in.

The last of the great Greek surgeons was Galen (b. AD 129). Galen’s job—which he took up for fun, and not because he needed a living—was to (try to) put gladiators back together again after they had been hacked, stabbed, impaled, or bashed to bits by a rival. This was, unpleasantly, a sure-fire way to get to know first-hand how the human body did (and didn’t) work.

Crucially, Galen kept a detailed and almost day-to-day record of his practice: he generated copious amounts of notes, published multiple booklets, drew up scores of schematic sketches, and updated older theories on plenty of bodily processes. All of this know-how was based, one way or another, on his direct personal experience. It was, as such, invaluable.

Long before the Church came into any kind of power, then, the scientific discipline of medicine was in excellent shape. It could boast millennia-old meticulous manuals, the use of patient histories and background checks, a germ of psychology, anatomical theories based on dissection—and an admired, well-paid profession which was sworn to care for, protect, and preserve human life.

Biology, we can assuredly say, was in fairly fine fettle.

But would it last?

A Change of Tune

When medicine makes it first appearance in Warfare, things immediately feel rather familiar:

In those [earliest] periods when man sees everywhere miracle and nowhere law,—when he attributes all things which he can not understand to a will like his own,—he naturally ascribes his diseases either to the wrath of a good being or to the malice of an evil being.⁴

We are being treated here, of course, to White’s usual trope—that our naively religious ancestors were horribly irrational but were, happily for us all, succeeded by the wonderfully scientific Greeks:

Five hundred years before Christ, in the bloom period of thought—the period of Aeschylus, Phidias, Pericles, Socrates, and Plato—appeared Hippocrates, one of the greatest names in history. Quietly but thoroughly he broke away from the old tradition, developed scientific thought, and laid the foundations of medical science upon experience, observation, and reason so deeply and broadly that his teaching remains to this hour among the most precious possessions of our race.⁵

So far, matters are proceeding as we might have expected from our polemicist. But then, at the precise point when he normally begins to rain down blows on Christianity for spoiling everything again, White suddenly switches to a different tune. Seemingly out of nowhere, and contrary to much of the rest of his grand composition, he begins to sing—in full voice, no less—the praises of the Church:

With the coming in of Christianity a great new chain of events was set in motion which modified [the Greek] development most profoundly. The influence of Christianity on the healing art was twofold: there was first a blessed impulse—the thought, aspiration, example, ideals, and spirit of Jesus of Nazareth. This spirit, then poured into the world, flowed down through the ages, promoting self-sacrifice for the sick and wretched. Through all those succeeding centuries, even through the rudest, hospitals and infirmaries sprang up along this blessed stream. . . . Vitalized by this stream, all medieval growths of mercy bloomed luxuriantly.⁶

Well, well, well. This is quite the turn. And yet White was genuinely onto something, for the Christian religion was indeed well suited to advancing the cause of biology.

How so?

Had Not Such Men

The Old Testament—a vast and ancient document considered holy by Jews and Christians alike—is predominantly a mix of religious instruction, historical tales, songs, and poems. Unbeknown to many, however, it also contains some pretty lengthy sections on medical advice. Take this excerpt, for instance, from the book of Leviticus:

When someone has a burn on their skin and a reddish-white or white spot appears in the raw flesh of the burn, the priest is to examine the spot, and if the hair in it has turned white, and it appears to be more than skin deep, it is a defiling disease that has broken out in the burn. The priest shall pronounce them unclean; it is a defiling skin disease. But if the priest examines it and there is no white hair in the spot and if it is not more than skin deep and has faded, then the priest is to isolate them for seven days. On the seventh day the priest is to examine that person, and if it is spreading in the skin, the priest shall pronounce them unclean; it is a defiling skin disease. If, however, the spot is unchanged and has not spread in the skin but has faded, it is a swelling from the burn, and the priest shall pronounce them clean; it is only a scar from the burn. (Lev. 13:24–28)

Leviticus is around the same age as the Edwin Smith papyrus—and this particular passage goes on to recommend that those who are declared “unclean” should shave off all their hair and wash themselves thoroughly. It seems, then, that there was some sort of early awareness within the Israelite culture of both infection and contamination long before the likes of Hippocrates had arrived on the scene.

The New Testament—which is the defining text for Christendom—also has a surprisingly medical dimension to it. Two of its major books, Luke and Acts, were written by the Apostle Luke—who was, himself, a highly methodical physician. The Apostle Paul, who wrote much of the rest of its content, also turns doctor at one point: he advises a young church leader to “stop drinking only water, and use a little wine because of your stomach and your frequent illnesses” (1 Tim. 5:23).

And, just in case those two revered saints were not exalted enough, then there was always Jesus to look to. After all, Christians worship him as God incarnate, so what he has to say about a subject is of the utmost importance. So, when he told his followers in no uncertain terms to look after the weak, the poor, the lowly, and the sick, one might expect that they would try and take his instruction rather seriously (cf. Matt. 25:31-45).⁷

All of this—ancient Egypt, the Old Testament, the Greeks, the New Testament—bodes very well indeed for the (past) future of medicine. In the fourth century after Christ, much of the world was sitting under the influence of his religion. This new religious empire had doctors among its spiritual leaders, saw looking after the unwell as a holy duty, and had inherited much good practice from its forebears. Perhaps this is why even Andrew Dickson White—who literally wrote the book on the warfare between Christendom and science—could find legitimate grounds for optimism.

And yet, what White was willing to give with one hand, he quickly took back with the other—for, he says, all this promise ended up coming to nothing:

Had not such men as Thomas Aquinas, Vincent of Beauvais, and Albert the Great been drawn or driven from the paths of science into the dark, tortuous paths of theology, leading no whither,—the world today, at the end of the nineteenth century, would have arrived at the solution of great problems and the enjoyment of great results which will only be reached at the end of the twentieth century, and even in generations more remote. Diseases like typhoid fever, influenza and pulmonary consumption, scarlet fever, diphtheria, pneumonia, and la grippe, which now carry off so many most precious lives, would have long since ceased to scourge the world.⁸

Thanks to the “tortuous paths of theology,” medicine suffered—and suffered badly. Christianity, whatever Christ might have said, had opposed it, distracted from it, and severely stunted its early growth. The killer diseases of his own era, White said, should have been killed off themselves long ago—and the fact that they hadn’t been was the fault of the Church.

This is a radical claim indeed—but he felt he had the evidence to support it.

The Worst Blow They Ever Received

The first exhibit that White presents is this: Christianity unilaterally banned, under all conceivable circumstances, the internal examination of the dead.

While he admits that this was not a unique position—some preceding cultures had also prohibited the practice—Christendom, he says, took the matter to a whole new level altogether:

To these arguments [from earlier worldviews] against dissection was now added another—one which may well fill us with amazement. It is the remark of the foremost of recent English philosophical historians, that of all organizations in human history the Church of Rome has caused the greatest spilling of innocent blood. . . . Strange is it, then, to note that one of the main objections developed in the Middle Ages against anatomical studies was the maxim that “the Church abhors the shedding of blood.”⁹

This is polemical writing at its best. White points out what he considers to be an appalling hypocrisy: Catholicism had spilled more blood than any other philosophy had, but had banned dissection on the basis of its bloodiness. Not only was this hypocritical in the extreme, but it was also devastating for medicine:

On this ground, in 1248, the Council of Le Mans forbade surgery to monks. Many other councils did the same, and at the end of the thirteenth century came the most serious blow of all; for then it was that Pope Boniface VIII, without any of that foresight of consequences which might well have been expected in an infallible teacher, issued a decretal forbidding a practice which had come into use during the Crusades, namely, the separation of the flesh from the bones of the dead . . . it soon came to be considered as extending to all dissection, and thereby surgery and medicine were crippled for more than two centuries; it was the worst blow they ever received, for it impressed upon the mind of the Church the belief that all dissection is sacrilege. . . . So deeply was this idea rooted in the mind of the universal Church that for over a thousand years surgery was considered dishonourable.¹⁰

White does admit that dissection began to take place in Europe from the thirteenth century onward, but is careful to point out that it only happened in universities “which had become somewhat emancipated from ecclesiastical control.” Over time, he says, these less dogmatic institutions grew in confidence, and the landscape gradually changed for the better. By the time we get to the sixteenth century, then, medicine had developed a small but visible chance of recovery:

Finally came a far greater champion of scientific truth, Andreas Vesalius, founder of the modern science of anatomy. The battle waged by this man is one of the glories of our race. From the outset Vesalius proved himself a master. In the search for real knowledge he risked the most terrible dangers, and especially the charge of sacrilege, founded upon the teachings of the Church for ages.¹¹

This hero of White’s, Vesalius (1514–1564), quite literally turned dissection into an art form. He oversaw the production of the most wonderfully detailed woodcuts, each portraying the discoveries he had made when opening up his subjects’ bodies. It was a huge leap forward for human anatomy, and even now his diagrams still populate many textbooks.

His great service to science cost him dearly, however—for, according to White, despite many years of “braving the fires of the Inquisition,” Vesalius was eventually brought down. The Church—one way or the other—managed to end his unholy work permanently:

Vesalius was charged with dissecting a living man, and, either from direct persecution, as the great majority of authors assert, or from indirect influences, as the recent apologists for Philip II admit, he became a wanderer: on a pilgrimage to the Holy Land, apparently undertaken to atone for his sin, he was shipwrecked, and in the prime of his life and strength he was lost to the world.¹²

Thus it was that the organization which “abhors the shedding of blood” deliberately brought about century after century of unnecessary deaths. What else may have been learned from Vesalius, and others before and after him, if only the Church had behaved differently? How many patients might have been saved?

Still, its ban on dissection and its persecution of anatomists were not the only failings of the Church, White says. In another shocking move, its irrational dogma gave rise to something very nearly as bad as pointless death.

Namely, pointless pain.

Contrary to Holy Writ

In Physicians, Plagues and Progress, Oxford historian of science Allan Chapman (whom we met in the last chapter) manages to cover pretty much the entire history of medicine—from ancient Egyptian operations to the Ebola epidemic of 2015. During nearly all of this vast timespan, despite all the changes and development, he says, medical professionals have come face to face with one terrifying constant:

Whether the surgeon treated the wounded in Pharaoh’s army, as in the Edwin Smith Papyrus of c. 1500 BC, whether he were Galen with his gladiators, John of Ardene with his medieval knights, John Hunter or Sir Astley Cooper at Guy’s and St Thomas’s Hospitals in 1830, they all had one thing in common: the necessary infliction of appalling suffering upon their patients.¹³

There had been numerous attempts, of course, to limit this “appalling suffering” over the years—not least by using copious amounts of alcohol. In the end, however, a consensus developed. The best thing to do, it was decided, was to forget the idea of preventing pain, and to focus on something else instead: speed.

A lightning-quick cut, followed by a lightning-quick clean (in some cases) and lightning-quick stitching or cauterizing became the new goal for the best of the best. As techniques improved, some surgeons in the early nineteenth century could take off a limb and sort out the ensuing mess in less than a minute.

One of the biggest names in the business was Scotsman Robert Liston (1794–1847)—a man so celebrated that he was still earning praise from the British Medical Journal in 1908, more than half a century after his death:

He was the foremost operator in London, his powerful “shoulder of mutton fist” and his wonderful skill with the knife enabling him to deal successfully with cases which other surgeons preferred to leave alone. It is told of him that, when he amputated, the gleam of his knife was followed so instantaneously by the sound of the saw as to make the two actions appear almost simultaneous.¹⁴

Still, as fast as some of these operations might well have been, they were hardly a pleasant experience. Screams, convulsions, and patients thrashing around wildly were everyday occurrences in the life of a surgeon.

But then, right in the middle of Liston’s heyday, a new technology emerged in America which promised a previously unimaginable scenario—surgery without any pain. An innovator as well as an outstanding practitioner, Liston was one of the first to make use of this almost magical ether in 1846. Despite his own reference to the substance as a “Yankee Dodge,” all went successfully. The game had changed—forever.

James Young Simpson (1811–1870) of Edinburgh, another talented surgeon, was fascinated. After finding that ether was somewhat unpredictable in its effects, he sought out an alternative of his own. Arriving at the very new chloroform, he found it worked well enough on himself and his friends for him to start using it in his day job: obstetrics. Wonderfully, women would now be able to have some sort of pain relief during childbirth; a curse as old as history itself was finally being lifted—by the strong and dependable arms of empirical science.

And yet, as White has already warned us, whenever progress is on offer, theology will find a way to stand against it. The glorious triumph of anesthetic, Warfare recounts, was no exception:

From pulpit after pulpit Simpson’s use of chloroform was denounced as impious and contrary to Holy Writ; texts were cited abundantly, the ordinary declaration being that to use chloroform was “to avoid one part of the primeval curse on woman.”

Simpson had seen this coming—for, incredibly, even some of his own pregnant patients had warned him off. He wrote that some had told him “an immunity from pain during [childbirth] was contrary to religion and the express commands of Scripture.”¹⁵

Thinking this through, Simpson decided to push back—and, in 1847, he published his Answer to the Religious Objections Advanced Against the Employment of Anaesthetic Agents in Midwifery and Surgery. In it, the Scotsman came up with an ingenious riposte for his opponents:

I allude to . . . the first surgical operation ever performed on man, which is contained in Genesis ii. 21:—“And the Lord God caused a deep sleep to fall upon Adam; and he slept; and he took one of his ribs, and closed up the flesh instead thereof.” In this remarkable verse the whole process of a surgical operation is briefly detailed. But the passage is principally striking, as affording evidence of our Creator himself using means to save poor human nature from the unnecessary endurance of physical pain.¹⁶

Clever stuff.

Until now, the reader may note, we have not heard anything on the subject from a certain John William Draper. This is, admittedly, partially due to the fact that Conflict is significantly shorter than its cousin, and therefore covers less material—but the Church’s sheer callousness when it came to pain relief was so galling that Draper also decided to make room for it:

When the great American discovery of anæsthetics was applied in obstetrical cases, it was discouraged, not so much for physiological reasons, as under the pretense that it was an impious attempt to escape from the curse denounced against all women in Genesis iii. 16.¹⁷

And, while on medical matters, Draper dropped in another pious pearler:

When the Mohammedan discovery of inoculation was brought from Constantinople in 1721, by Lady Mary Wortley Montagu, it was so strenuously resisted by the clergy, that nothing short of its adoption by the royal family of England brought it into use.¹⁸

This additional point had not escaped White, either:

English theologians were most loudly represented by the Rev. Edward Massey, who in 1772 preached and published a sermon entitled The Dangerous and Sinful Practice of Inoculation. In this he declared that Job’s distemper was probably confluent smallpox; that he had been inoculated doubtless by the devil; that diseases are sent by Providence for the punishment of sin; and that the proposed attempt to prevent them is “a diabolical operation.” . . . This struggle went on for thirty years.¹⁹

So, the Church had banned dissection and autopsies, opposed anesthetic, even for women in labor, and then thrown the Bible at inoculation and vaccination. So much for building on early promise. So much for looking after the sick.

And Draper and White were not done yet.

Monstrosities of Error

The various frictions mentioned thus far, Conflict and Warfare were both keen to point out, were merely symptoms of an underlying illness. The real issue was not opening cadavers, or administering pain relief, or preventing disease; it was, instead, the fundamental opposition of Christianity to the concept of medicine as a whole.

Here, for instance, is Draper’s take: “It had always been the policy of the Church to discourage the physician and his art; he interfered too much with the gifts and profits of the shrines.”²⁰ And so “for the prevention of diseases, prayers were put up in the churches, but no sanitary measures were resorted to. From cities reeking with putrefying filth it was thought that the plague might be stayed by the prayers of the priests.”²¹ White agrees: “ . . . we find cropping out every where the feeling that, since supernatural means are so abundant, there is something irreligious in seeking cure by natural means: ever and anon we have appeals to Scripture.”²²

The grand result of all this supernatural irrationality, they allege, was a descent into farce. Draper—rather humorously, it must be said—explains that demand for holy relics got so big that the Church was forced to increase its supply:

There were several abbeys that possessed our Savior’s crown of thorns. Eleven had the lance that had pierced his side. If any person was adventurous enough to suggest that these could not all be authentic, he would have been denounced as an atheist. During the holy wars the Templar-Knights had driven a profitable commerce by bringing from Jerusalem to the Crusading armies bottles of the milk of the Blessed Virgin . . . none of these impostures surpassed in audacity that offered by a monastery in Jerusalem, which presented to the beholder one of the fingers of the Holy Ghost!²³

He then comments that, having finally seen scientific sense: “modern society has silently rendered its verdict on these scandalous objects.”²⁴

Warfare has a fair old go too, making sport of yet more religious silliness:

Closely connected with these methods of thought was the doctrine of signatures. It was reasoned that the Almighty must have set his sign upon the various means of curing disease which he has provided: hence it was held that bloodroot, on account of its red juice, is good for the blood . . . eyebright, being marked with a spot like an eye, cures diseases of the eyes . . . bugloss, resembling a snake’s head, cures snakebite . . . bear’s grease, being taken from an animal thickly covered with hair, is recommended to persons fearing baldness.²⁵

In other words, had a medieval monk wanted to mend a maddening migraine, he would have foraged for a divinely designed object in nature which physically resembled the problem. James Hannam, historian and author, takes up the story:

No inspired guesswork is required. The [walnut] has a hard outer shell which, when cracked open, reveals a soft craggy interior divided into hemispheres. The similarity between the edible part of a walnut and the brain must have struck herbalists as undeniable. This signature was nature’s way, or God’s way for a Christian healer, of showing man which plant to use to treat a head complaint.²⁶

This feels like quite the backward step from the careful detail of the Edwin Smith Papyrus. Here we are, three thousand years on from that medical masterpiece, and the Church has given people walnuts for brains instead.

This rather depressing collapse has caused many a lament. Walter Clyde Curry (1887–1967), poet and historical writer, famously said that medieval medicine was chock-full of “monstrosities of error.”²⁷ His contemporary in the field, heavyweight thinker Charles Singer (1876–1960), was equally damning: “Surveying the mass of folly and credulity . . . it may be asked, is there any rational element here? The answer, of course, is very little.”²⁸

And so—despite its wonderful early start with the Egyptians, the Old Testament, the Hippocratic Oath, patient histories, Aristotle’s evidence-based approach, Greek dissection, and the bright hope of Jesus’s command to care for the sick—late medieval biology, under Christianity, seems to offer “very little.”

Perhaps, without Christendom’s centuries-long stranglehold on science, things would have been different. Perhaps we would now know why we pick our noses, or why we yawn, or even what consciousness is. Perhaps, in fact, the strange events surrounding Gloria Ramirez might never have happened in the first place—for, without the constant interference of dogma, we might already have achieved that oh-so-precious goal: a cure for cancer.

The case against the Church here seems overwhelming. We must remember, however, that it also seemed overwhelming as regards the flat Earth—yet that particular house turned out to be made of straw. What will happen, then, if we start huffing and puffing strongly enough at the Christianity-messed-up-medicine dwelling?

Will it fall down, too?

I Was Jolted to Discover I Was Wrong

Well, if straw does eventually emerge as the dominant material once more, we would have to conclude it had been put there by some rather reputable builders—for Draper and White enjoy the backing of quite a few famous names. Here, for example, is an excerpt from the highly esteemed British Library’s entry on Vesalius: “For 1000 years after Galan’s [sic] death almost no original anatomical inquiries were performed, mainly because the Church was against the dissection of human bodies.”²⁹

Conflict and Warfare’s chorus line is also repeated in the 2009 edited volume Surgery: Basic Science and Clinical Evidence, which was “heartily recommended” by none other than the Journal of the American Medical Association:

By the end of the Middle Ages [AD 1500 onward], it had become apparent to physicians that further progress in the knowledge of medicine, specifically surgery, could not be attained unless scientific studies of human anatomy were made. By that time, the church’s ban on human vivisection was showing signs of weakness.³⁰

The British Broadcasting Corporation is also with Draper and White. On a revision page aimed at the quarter of a million high school students who take the history GCSE each year, it wrote: “Causes of medical stagnation in the Middle Ages included the forbidding by the Church of dissection, and its encouragement of prayer (and superstition).”³¹

Even the US Senate has toed the line. Senator Arlen Specter, during a 2005 debate about stem cell research, warned those present to learn the lessons of the past—for they must make sure, he urged, that Christian dogma did not hold medicine back as it had before: “Pope Boniface VII [sic] banned the practice of cadaver dissection in the 1200s. This stopped the practice for over 300 years and greatly slowed the accumulation of education regarding human anatomy.”³²

This is a weighty crowd. Could the British Library, the American Medical Association, the BBC, and the Senate really all be wrong?

Surely not.

And yet, in a 2009 article written by the journalist Christopher Howse for the Telegraph, there is a hint that they just might be:

I thought I was fairly immune to popular myths and vulgar errors about science and religion. Hardly anyone believed in a flat Earth in the Middle Ages, I knew. . . . So I was jolted to discover I was wrong in supposing that the medieval Church forbade human dissection.³³

Hmm. Can we get to the bottom of this?

Not Only Tolerated but Encouraged

Let’s cut to the chase: the Church did not ban dissection. Likewise, it did not ban autopsies, or anesthetic, or inoculation. We can go further: Christendom did not even oppose these things, either. Instead, Christians were often at the forefront of both their development and their use. All of which means that the story, as Draper and White and many exalted others tell it, is not far from being completely backward.

Let’s tell it again, then—but this time, we shall do it the right way around.

Firstly, the common notion that the Greeks and Romans were dissecting here, there, and everywhere is simply false. Other than the aforementioned Herophilus and Erasistratus, the somewhat surprising fact is that no one in Greece or Rome carried out medical dissection, either before them or after them. This is why the classicist and expert in ancient medicine Heinrich von Staden decided to ask, in what would become a groundbreaking paper: “What had rendered the practice impossible for so long [beforehand]? What rendered it impossible again for more than 15 centuries after Herophilus and Erasistratus?”³⁴

Digging through key documents covering many centuries and many cultures, von Staden concluded that it was simply the position of nearly everyone nearly all the time across the ancient world that dead bodies were not to be messed with. This view was a constant, regardless of religion, language, mythology, and level of scientific sophistication. Even societies in which the dead were embalmed treated those who actually did the deed as highly circumspect and, in one way or another, “unclean.”

In the light of von Staden’s study, White’s earlier analysis can be flipped on its head. For, when dissection eventually did resurface in the twelfth and thirteenth centuries—which it did, and as a learning tool, no less—it happened under the auspices of Catholicism, in its universities and schools, where it was given both its legitimacy and its sponsorship by the leaders of the Church.

Indeed, should we permit ourselves the same level of polemic license as White did, we could put it this way: it was the ancients (Greeks included) who placed a ban on dissection, and the Church that legalized it. We could say that it was Christendom that finally freed medicine from this irrational dogma. Katharine Park, the Harvard professor who brought our last chapter to a close, shows just how wrong Draper and White really were: “Most medieval church authorities not only tolerated but encouraged the opening and dismemberment of human corpses.”³⁵

So, what were the two of them up to? How did they end up asserting the very opposite of the truth?

Never, Ever, Anywhere

Well, we should perhaps begin with one of White’s chief pieces of evidence. His thirteenth-century edict that supposedly did all the damage—"the Church abhors the shedding of blood”—turns out, upon further investigation, to be a rather problematic one.

As far as anyone can tell, it is first found not in the 1200s, but in the 1700s. French surgeon François Quesnay (1692–1774) had read the work of an earlier historian, Étienne Pasquier (1529–1615), and had decided to borrow some of it for his own writings. He translated one of Pasquier’s own phrases about the Church and blood into Latin, placed the result between quotation marks, and stuck it into his text. One can only suppose that others saw this and assumed that this entirely new expression actually had much earlier origins—and, just like that, it seems a myth was born.³⁶

White, for what it is worth, does not quote Quesnay as his source—instead, he references other historians sitting in the gap between him and the Frenchman. Perhaps the slogan was so succinct, so believable, and so useful that it ended up spreading far and wide fairly quickly, despite its lack of genuine historicity—we cannot be sure. What we do know is that in the 1960s, historian C. H. Talbot tried to chase it down, and found that all roads ended with Quesnay. He labeled it “a literary ghost” and, having searched the medieval literature accordingly, confirmed that “no earlier source for this sentence can be found.”³⁷

Then, in 1978, classicist Darrell Amundsen set out on a similar quest. After wading through every relevant Church document from the Middle Ages and failing to find the phrase anywhere, he commented that:

It is frequently claimed that the Church forbade the practice of surgery to all clerics on the ground that Ecclesia abhorret a sanguine, that is, “The Church abhors the shedding of blood.” This maxim is sometimes attributed to canon 18 of Lateran IV although usually to the Council of Tours, which took no action on the question of the practice of surgery.³⁸

White’s second piece of evidence is also misleading. He claims that Pope Boniface’s decretal about not boiling flesh from the bones of dead crusaders “soon came to be considered as extending to all dissection,” but that is a gross exaggeration. Yes, a small number of folk misunderstood it, took his instruction too far, and backed off somewhat—yet they were in the tiny minority. The vast majority carried on with their practices, unperturbed. Andrew Cunningham, in his study The Anatomist Anatomis’d, sums up the situation rather bluntly:

As a life-long evangelical atheist I certainly hold no brief for the Catholic Church. Nevertheless the fact is that the Catholic Church has never been opposed to the practice of anatomy, whether for post-mortem, demonstration, teaching or research purposes. Never, ever, anywhere.³⁹

Park agrees: “I know of no case in which an anatomist was ever prosecuted for dissecting a human cadaver and no case in which the church ever rejected a request for a dispensation to dissect.”⁴⁰ And, while she is on the topic, Park takes White to task on another of his assertions: “There is no convincing evidence that Vesalius ran afoul of church authorities two hundred years later.”⁴¹

It is now Cunningham’s turn to agree with Park:

Although White claims that Vesalius was attacked using “weapons theologic” . . . he presents no evidence or referencing for such claims. It would be difficult to do so, since they are figments of White’s imagination. It must be remembered that this is a work of propaganda, and the truth rarely bothers propagandists.⁴²

White, then, has misled people on dissection, on Church history, and on the life and fate of Vesalius. So believable was his account that he has duped some of the most eminent authorities of our own time, who continue to propagate his exaggerations and untruths. The late and masterly historian of science Colin Russell (1928–2013) provides a fascinating insight into the lasting effect of Warfare’s folly:

I had a research student who looked at this as part of a bigger task and, to cut a long story short, he found that all the stories to this effect, which are in all the modern textbooks on the history of medicine, are actually almost baseless; but not quite, because he traced them down in a sort of family tree to just one source, and that one source was A.D. White.⁴³

Once again, then, we have a clear-cut example of a world largely fooled. The British Library was sucked in. The American Medical Association was tricked. The BBC were hoodwinked.

And Senator Arlen Specter—rather fittingly, perhaps—had referenced a literary ghost.

An Untested Novelty

As it happens, Draper and White did not just get dissection horribly wrong, but anesthetic and inoculation too. While it is true that Simpson the obstetrician had felt the need to defend his use of chloroform against religious zealots—even going so far as to write a pre-emptive booklet on the topic—the big showdown he had anticipated never actually materialized.

White, in Warfare, had us believe that Simpson was preached against all over the place, and that his life-improving actions had been denounced, universally, as ungodly—but this is just not true. In actual fact, the vast majority of those who did oppose pain relief during childbirth were not priests at all—they were doctors.

According to many of the professionals at the time, pain was a necessary part of labor—for without it, they argued, both mother and baby might come to serious harm. These physicians feared that a sleeping woman would not be able to push at the right moments, and that the result could be disastrous for her and her child. After Simpson was able to demonstrate that such worries were wholly unfounded, however, their complaints quietly melted away. And that was that.⁴⁴

It is a similar story with inoculation. Draper wrote that it had been “strenuously resisted by the clergy”—but it hadn’t. There certainly was strenuous resistance, but it was not from the clergy. Boston, for example, had been hit by smallpox in the 1720s, and had faced a decision on whether or not to gamble on the new technique. Here is what happened:

Boston ministers, guided by [Reverend] Cotton Mather, for the most part stood in favor of extending the experiment in inoculation. . . . Most physicians, on the other hand, led by Dr. William Douglass, the only practitioner in town with a medical degree, opposed inoculation as an untested novelty, attacked the clergymen who fostered it, and called upon the town selectmen to halt the experiment.⁴⁵

In this landmark New England case, then, we find that Draper’s broad assessment is both upside-down and inside-out. Historian Maxine Van de Wetering has called his bluff: it was the medicos pleading for caution, and the preachers championing the “untested novelty.”

The debate, by the way, became rather intense: at the height of the argument, Mather actually had a bomb thrown into his house. Fortunately, it failed to go off—but a note was subsequently found attached to it which read “you dog, dam you! I’l inoculate you with this; with a pox to you.”⁴⁶

Ultimately, the statistics came down on the side of Mather, and inoculation won out. Did some individual firebrands denounce it in some sermons in some churches either side of the Atlantic? Yes. Did the Church, as a unified body, oppose it? Did “Christendom”? No. Instead, some of its most influential members, Mather included, were the ones who gave it life.

It Just Kills Me

The big medical picture of Conflict and Warfare—complete with carefully painted details of dissection, anesthetic, and inoculation—is suddenly not looking all that great. It is a very poor representation of reality; it is an unreliable guide. When Draper wrote that “It had always been the policy of the Church to discourage the physician and his art” he could hardly have been more wrong—and historians have been demonstrating as much for decades.

Nearly a century and a half later, though, the Draper–White portrait is still being faithfully reproduced by those supposedly in the know. Here, for instance, is a paper in the peer-reviewed medical journal Anatomy & Cell Biology, published as recently as September 2015:

The flickering light of human dissection was completely snuffed out with the burning of Alexandria in 389 AD. Following widespread introduction of Christianity in Europe during the Middle Ages, the development of rational thought and investigation was paralysed by the church authorities. . . . During this period, human dissection was considered to be blasphemous and so was prohibited. For hundreds of years, the European world valued the sanctity of the church more than scientific quest. . . . One of the significant proscriptions that Pope Alexander III enunciated at the Council of Tours in 1163 was . . . named as “Ecclesia abhorret a sanguine” meaning “The church abhors blood.”⁴⁷

Almost every statement in the passage above is wrong—and yet the article has over a hundred footnotes in total, and there are plenty even in the short section we have quoted. Many of these cite other peer-reviewed journals, including the enormously prestigious Journal of the American Medical Association. Draper and White, it would seem, are everywhere. It is little wonder, then, that Park seems almost ready to give up:

Every time I read something in The New York Times that Leonardo da Vinci had to hide the fact that he was doing dissection, and every time I listen to a tour guide in Italy tell these stories, it just kills me. I don’t know how to get rid of this myth.⁴⁸

Relics and Bear’s Grease

Perhaps, however, we should not entirely dismiss Conflict and Warfare and their despair at the dreadful state of medieval medicine. After all, if we do a little checking, we can quickly find that the doctrine of signatures was a real thing. The same can be said of the sin theory of disease, and of blood-letting, and purges, and potions, and incantations, and pious visits to various shrines.

We must be careful, then, not to throw out some babies with their conflict thesis bathwater. After all, when a historian as distinguished as Charles Singer can survey pretty much the entire field of medicine in the Middle Ages and conclude that it “lacked any rational element,”⁴⁹ we have to take him seriously—don’t we?

Well yes, we do—but that does not mean that we cannot also question such received wisdom. And, in the years since Singer hung up his typewriter, plenty have done so. What they have found has led to what could probably be called a mini-revolution in the discipline: for it seems that the Dark Ages were not all that dark after all: “it becomes clear that medieval intellectuals were not only rational; they were hyperrational—to them, logic was . . . the single most important tool for the investigation of the natural world.”⁵⁰ So says one of the new breed of medievalists, Richard Raiswell. Yet this is hardly the image we were left with by Draper, and White, and Singer, and Specter, and the British Library, and all those others. Were the Dark Ages really so badly named? Could the folk who lived back then—committed as they were to the healing powers of questionable relics and bear’s grease—truly be called hyperrational with a straight face?

Let’s find out.