Essays of Michel de Montaigne — Volume 13

by Michel de Montaigne

["Describing it by the epithets of an animal trailing with its slime over the herbage, without blood or bones, and carrying its house upon its back, meaning simply a snail."—Coste]

It was a good rule in their art, and that accompanies all other vain, fantastic, and supernatural arts, that the patient's belief should prepossess them with good hope and assurance of their effects and operation: a rule they hold to that degree, as to maintain that the most inexpert and ignorant physician is more proper for a patient who has confidence in him, than the most learned and experienced whom he is not so acquainted with. Nay, even the very choice of most of their drugs is in some sort mysterious and divine; the left foot of a tortoise, the urine of a lizard, the dung of an elephant, the liver of a mole, blood drawn from under the right wing of a white pigeon; and for us who have the stone (so scornfully they use us in our miseries) the excrement of rats beaten to powder, and such like trash and fooleries which rather carry a face of magical enchantment than of any solid science. I omit the odd number of their pills, the destination of certain days and feasts of the year, the superstition of gathering their simples at certain hours, and that so austere and very wise countenance and carriage which Pliny himself so much derides. But they have, as I said, failed in that they have not added to this fine beginning the making their meetings and consultations more religious and secret, where no profane person should have admission, no more than in the secret ceremonies of AEsculapius; for by the reason of this it falls out that their irresolution, the weakness of their arguments, divinations and foundations, the sharpness of their disputes, full of hatred, jealousy, and self-consideration, coming to be discovered by every one, a man must be marvellously blind not to see that he runs a very great hazard in their hands. Who ever saw one physician approve of another's prescription, without taking something away, or adding something to it? by which they sufficiently betray their tricks, and make it manifest to us that they therein more consider their own reputation, and consequently their profit, than their patient's interest. He was a much wiser man of their tribe, who of old gave it as a rule, that only one physician should undertake a sick person; for if he do nothing to purpose, one single man's default can bring no great scandal upon the art of medicine; and, on the contrary, the glory will be great if he happen to have success; whereas, when there are many, they at every turn bring a disrepute upon their calling, forasmuch as they oftener do hurt than good. They ought to be satisfied with the perpetual disagreement which is found in the opinions of the principal masters and ancient authors of this science, which is only known to men well read, without discovering to the vulgar the controversies and various judgments which they still nourish and continue amongst themselves.

Will you have one example of the ancient controversy in physic? Herophilus lodges the original cause of all diseases in the humours; Erasistratus, in the blood of the arteries; Asclepiades, in the invisible atoms of the pores; Alcmaeon, in the exuberance or defect of our bodily strength; Diocles, in the inequality of the elements of which the body is composed, and in the quality of the air we breathe; Strato, in the abundance, crudity, and corruption of the nourishment we take; and Hippocrates lodges it in the spirits. There is a certain friend of theirs,—[Celsus, Preface to the First Book.]—whom they know better than I, who declares upon this subject, "that the most important science in practice amongst us, as that which is intrusted with our health and conservation, is, by ill luck, the most uncertain, the most perplexed, and agitated with the greatest mutations." There is no great danger in our mistaking the height of the sun, or the fraction of some astronomical supputation; but here, where our whole being is concerned, 'tis not wisdom to abandon ourselves to the mercy of the agitation of so many contrary winds.

Before the Peloponnesian war there was no great talk of this science. Hippocrates brought it into repute; whatever he established, Chrysippus overthrew; after that, Erasistratus, Aristotle's grandson, overthrew what Chrysippus had written; after these, the Empirics started up, who took a quite contrary way to the ancients in the management of this art; when the credit of these began a little to decay, Herophilus set another sort of practice on foot, which Asclepiades in turn stood up against, and overthrew; then, in their turn, the opinions first of Themiso, and then of Musa, and after that those of Vectius Valens, a physician famous through the intelligence he had with Messalina, came in vogue; the empire of physic in Nero's time was established in Thessalus, who abolished and condemned all that had been held till his time; this man's doctrine was refuted by Crinas of Marseilles, who first brought all medicinal operations under the Ephemerides and motions of the stars, and reduced eating, sleeping, and drinking to hours that were most pleasing to Mercury and the moon; his authority was soon after supplanted by Charinus, a physician of the same city of Marseilles, a man who not only controverted all the ancient methods of physic, but moreover the usage of hot baths, that had been generally and for so many ages in common use; he made men bathe in cold water, even in winter, and plunged his sick patients in the natural waters of streams. No Roman till Pliny's time had ever vouchsafed to practise physic; that office was only performed by Greeks and foreigners, as 'tis now amongst us French, by those who sputter Latin; for, as a very great physician says, we do not easily accept the medicine we understand, no more than we do the drugs we ourselves gather. If the nations whence we fetch our guaiacum, sarsaparilla, and China wood, have physicians, how great a value must we imagine, by the same recommendation of strangeness, rarity, and dear purchase, do they set upon our cabbage and parsley? for who would dare to contemn things so far fetched, and sought out at the hazard of so long and dangerous a voyage?

Since these ancient mutations in physic, there have been infinite others down to our own times, and, for the most part, mutations entire and universal, as those, for example, produced by Paracelsus, Fioravanti, and Argentier; for they, as I am told, not only alter one recipe, but the whole contexture and rules of the body of physic, accusing all others of ignorance and imposition who have practised before them. At this rate, in what a condition the poor patient must be, I leave you to judge.

If we were even assured that, when they make a mistake, that mistake of theirs would do us no harm, though it did us no good, it were a reasonable bargain to venture the making ourselves better without any danger of being made worse. AEsop tells a story, that one who had bought a Morisco slave, believing that his black complexion had arrived by accident and the ill usage of his former master, caused him to enter with great care into a course of baths and potions: it happened that the Moor was nothing amended in his tawny complexion, but he wholly lost his former health. How often do we see physicians impute the death of their patients to one another? I remember that some years ago there was an epidemical disease, very dangerous and for the most part mortal, that raged in the towns about us: the storm being over which had swept away an infinite number of men, one of the most famous physicians of all the country, presently after published a book upon that subject, wherein, upon better thoughts, he confesses that the letting blood in that disease was the principal cause of so many mishaps. Moreover, their authors hold that there is no physic that has not something hurtful in it. And if even those of the best operation in some measure offend us, what must those do that are totally misapplied? For my own part, though there were nothing else in the case, I am of opinion, that to those who loathe the taste of physic, it must needs be a dangerous and prejudicial endeavour to force it down at so incommodious a time, and with so much aversion, and believe that it marvellously distempers a sick person at a time when he has so much need of repose. And more over, if we but consider the occasions upon which they usually ground the cause of our diseases, they are so light and nice, that I thence conclude a very little error in the dispensation of their drugs may do a great deal of mischief. Now, if the mistake of a physician be so dangerous, we are in but a scurvy condition; for it is almost impossible but he must often fall into those mistakes: he had need of too many parts, considerations, and circumstances, rightly to level his design: he must know the sick person's complexion, his temperament, his humours, inclinations, actions, nay, his very thoughts and imaginations; he must be assured of the external circumstances, of the nature of the place, the quality of the air and season, the situation of the planets, and their influences: he must know in the disease, the causes, prognostics, affections, and critical days; in the drugs, the weight, the power of working, the country, figure, age, and dispensation, and he must know how rightly to proportion and mix them together, to beget a just and perfect symmetry; wherein if there be the least error, if amongst so many springs there be but any one out of order, 'tis enough to destroy us. God knows with how great difficulty most of these things are to be understood: for (for example) how shall the physician find out the true sign of the disease, every disease being capable of an infinite number of indications? How many doubts and controversies have they amongst themselves upon the interpretation of urines? otherwise, whence should the continual debates we see amongst them about the knowledge of the disease proceed? how could we excuse the error they so oft fall into, of taking fox for marten? In the diseases I have had, though there were ever so little difficulty in the case, I never found three of one opinion: which I instance, because I love to introduce examples wherein I am myself concerned.

A gentleman at Paris was lately cut for the stone by order of the physicians, in whose bladder, being accordingly so cut, there was found no more stone than in the palm of his hand; and in the same place a bishop, who was my particular friend, having been earnestly pressed by the majority of the physicians whom he consulted, to suffer himself to be cut, to which also, upon their word, I used my interest to persuade him, when he was dead and opened, it appeared that he had no malady but in the kidneys. They are least excusable for any error in this disease, by reason that it is in some sort palpable; and 'tis thence that I conclude surgery to be much more certain, by reason that it sees and feels what it does, and so goes less upon conjecture; whereas the physicians have no 'speculum matricis', by which to examine our brains, lungs, and liver.

Even the very promises of physic are incredible in themselves; for, having to provide against divers and contrary accidents that often afflict us at one and the same time, and that have almost a necessary relation, as the heat of the liver and the coldness of the stomach, they will needs persuade us, that of their ingredients one will heat the stomach and the other will cool the liver: one has its commission to go directly to the kidneys, nay, even to the bladder, without scattering its operations by the way, and is to retain its power and virtue through all those turns and meanders, even to the place to the service of which it is designed, by its own occult property this will dry-the brain; that will moisten the lungs. Of all this bundle of things having mixed up a potion, is it not a kind of madness to imagine or to hope that these differing virtues should separate themselves from one another in this mixture and confusion, to perform so many various errands? I should very much fear that they would either lose or change their tickets, and disturb one another's quarters. And who can imagine but that, in this liquid confusion, these faculties must corrupt, confound, and spoil one another? And is not the danger still more when the making up of this medicine is entrusted to the skill and fidelity of still another, to whose mercy we again abandon our lives?

As we have doublet and breeches-makers, distinct trades, to clothe us, and are so much the better fitted, seeing that each of them meddles only with his own business, and has less to trouble his head with than the tailor who undertakes all; and as in matter of diet, great persons, for their better convenience, and to the end they may be better served, have cooks for the different offices, this for soups and potages, that for roasting, instead of which if one cook should undertake the whole service, he could not so well perform it; so also as to the cure of our maladies. The Egyptians had reason to reject this general trade of physician, and to divide the profession: to each disease, to each part of the body, its particular workman; for that part was more properly and with less confusion cared for, seeing the person looked to nothing else. Ours are not aware that he who provides for all, provides for nothing; and that the entire government of this microcosm is more than they are able to undertake. Whilst they were afraid of stopping a dysentery, lest they should put the patient into a fever, they killed me a friend, —[Estienne de la Boetie.]—who was worth more than the whole of them. They counterpoise their own divinations with the present evils; and because they will not cure the brain to the prejudice of the stomach, they injure both with their dissentient and tumultuary drugs.

As to the variety and weakness of the rationale of this art, they are more manifest in it than in any other art; aperitive medicines are proper for a man subject to the stone, by reason that opening and dilating the passages they help forward the slimy matter whereof gravel and stone are engendered, and convey that downward which begins to harden and gather in the reins; aperitive things are dangerous for a man subject to the stone, by reason that, opening and dilating the passages, they help forward the matter proper to create the gravel toward the reins, which by their own propension being apt to seize it, 'tis not to be imagined but that a great deal of what has been conveyed thither must remain behind; moreover, if the medicine happen to meet with anything too large to be carried through all the narrow passages it must pass to be expelled, that obstruction, whatever it is, being stirred by these aperitive things and thrown into those narrow passages, coming to stop them, will occasion a certain and most painful death. They have the like uniformity in the counsels they give us for the regimen of life: it is good to make water often; for we experimentally see that, in letting it lie long in the bladder, we give it time to settle the sediment, which will concrete into a stone; it is good not to make water often, for the heavy excrements it carries along with it will not be voided without violence, as we see by experience that a torrent that runs with force washes the ground it rolls over much cleaner than the course of a slow and tardy stream; so, it is good to have often to do with women, for that opens the passages and helps to evacuate gravel; it is also very ill to have often to do with women, because it heats, tires, and weakens the reins. It is good to bathe frequently in hot water, forasmuch as that relaxes and mollifies the places where the gravel and stone lie; it is also ill by reason that this application of external heat helps the reins to bake, harden, and petrify the matter so disposed. For those who are taking baths it is most healthful. To eat little at night, to the end that the waters they are to drink the next morning may have a better operation upon an empty stomach; on the other hand, it is better to eat little at dinner, that it hinder not the operation of the waters, while it is not yet perfect, and not to oppress the stomach so soon after the other labour, but leave the office of digestion to the night, which will much better perform it than the day, when the body and soul are in perpetual moving and action. Thus do they juggle and trifle in all their discourses at our expense; and they could not give me one proposition against which I should not know how to raise a contrary of equal force. Let them, then, no longer exclaim against those who in this trouble of sickness suffer themselves to be gently guided by their own appetite and the advice of nature, and commit themselves to the common fortune.