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"That sublimest juyce in our body": bloodletting and ideas of the individual in early modern England.

Blood always speaks beyond itself. A meeting point between the material and the vital, it is a substance suffused with meaning more than physiological. For the ancient writers of Leviticus, life itself was in the blood, and the elaborate blood rituals they described both marked the hierarchies of social relationship and separated the space of the sacred from the profane. For medieval pilgrims to holy shrines in northern Europe, bloody hosts, Eucharist wafers miraculously marked by the blood of salvation, signaled the continuous intervention of the divine into the historical world. Even today, in a world less immediately given to granting meaning to bodily fluids, blood--and our handling of it--continues to exert its symbolic power: as Catharine Waldby and Robert Mitchell have recently shown, the enormous upsurge in blood donation after 9/11 conveyed not only a widespread wish to offer aid in a crisis but also complex ideas about citizenship and national identity. (1)

In early modern England, too, blood's referential range extended beyond the medical: for about twenty years during the Commonwealth and early Restoration, an intense but short-lived debate arose about phlebotomy, the ancient and venerable art of incising veins to let blood from particular parts of the body. Phlebotomy had been a normative practice of Galenic medicine since the earliest centuries of the Common Era. Although over the centuries questions had at rimes arisen about the details of its use--about when precisely to let blood, about how much blood to let, and, especially, about which specific veins were appropriate to cut for which specific conditions (2)--on the whole, the controversies about phlebotomy never questioned the efficacy of the treatment itself. (3) For a short time in the seventeenth century, however, with Galenic physiology under pressure from new anatomical and physiological discoveries, and with the dominance of Galenic medical practice threatened by competing medical practitioners, the efficacy of phlebotomy itself was called into question. Phlebotomists were suddenly recast by their critics as nothing more than "bronchotomists," literally, cutthroats; phlebotomy itself was compared to butchery, an effort akin to amputating an arm just to remove a splinter. (4) One writer claimed that phlebotomy was invented by the devil himself, intended to suck the lifeblood from God-fearing Englishmen. (5) The virulence of such attacks against a practice so ingrained in the daily life of the populace inevitably elicited equally impassioned defense: phlebotomy's supporters ridiculed those who derided the technique as pompous know-nothings, ignorant of the rudiments of physic, thinking to make a revolution in learning merely by dressing up old ideas in new and obscure terms. (6)

Even by the standards of the seventeenth century, a period not known for civilized restraint in printed debate, the energy of the back-and-forth assaults is impressive. In part, and perhaps most fundamentally, these arguments concern the legitimacy of the technique itself and of the Galenic tradition in which it thrived; they debate specifically whether or not phlebotomy, if practiced correctly, works as Galenists claimed as an effective prophylactic against and as cure for a host of particular conditions. But other issues were involved as well.

Raw commercial competition, for example, gave an edge to the insults. By the middle of the seventeenth century, the urban centers of England saw increasing competition among different kinds of medical practitioners. Most of the men who wrote against phlebotomy were chemical physicians, followers of Joan Baptista van Helmont, the early seventeenth-century visionary and medical reformer. Unlicensed by the College of Physicians, these chemical physicians were unable legally to practice medicine in London and its environs. (7) By warning of the dangers inherent to the traditional reliance on phlebotomy, these physicians were challenging the legitimacy of current legal strictures about who got to practice medicine in the most populated and well-to-do areas of England. (8) They advertised themselves as properly English and avowedly Christian healers: eschewing what they scorned as the pagan heritage of Galenic medicine, they advocated what they instead framed as a medicine grounded in Christian charity: safe, chemically-derived pharmacology instead of the cruel assault of the bloody lancet. If the book-buying public could be convinced that the frightful techniques of Galenic medicine were not only unnecessary, but also un-English and unchristian, then perhaps there would be more room for these chemical physicians to sell their services with greater success.

Beyond these immediately commercial concerns, there was in the attack against phlebotomy a more theoretical question of what kind of learning should be deemed most appropriate for medical men to possess. Phlebotomy's advocates were, by and large, university trained physicians, which means both that they were Galenists (since that is the medicine the universities predominantly taught) and that they were educated in medicine as a mode of natural philosophy: they studied authoritative texts along with their accumulated commentaries; they learnt techniques of logic and analysis; they sought to understand and explain the physiological condition of man in the wider context of nature, or phusis--hence their role as physicians. Phlebotomy's detractors, on the other hand, typically derided the education offered at university, and their commitment to chemical medicine was more empirically based. They tended to value practical, experiential knowledge and close observation of events more than reasoned explication of texts and events understood in relation to comprehensive systems of nature. (9) That type of abstract knowledge they deemed pretty much useless when it came to actually doing anything in the world. Thus one writer taunted, "How much do the intricacies of scholarship matter" to a

Sick Man that lies groaning on his bed ... haling for breath as for life? What is this man's Learning to him if he cannot ease him and give him Relief?. If after all [the] learned Argumentation, and Eloquence of the Galenist, some trivial Chymist that hath learnt something by blowing the coals for his Master, shall cure him, without any long preamble, be serious, and tell me ... whether this man ... be not to be encouraged to be had in some estimation in any well-goverened Land? (Galeno-pale, 16)

In this sense, the attack on phlebotomy was part of the general ferment in the late seventeenth century about what constitutes knowledge itself, and about how knowledge was best to be acquired. The medical reformers understood themselves as Bacon's heirs, looking to erase the "tyranny" of the old learning and working to further "the publick good." (10) As Noah Biggs said, "the whole mode, method, and body of physick as it is now prescribed and practiced ... groans for a reformation" (18). To the defenders of phlebotomy, their opponents were mere "Bacon-faced" quacks, sloppy in their logic, rejecting ideas they simply did not understand (Stubbe, 172). (11)

The attack on phlebotomy was thus never only about how to handle blood in the course of medical practice. But as much as it concerned who got to practice medicine and what kind of knowledge was necessary for its success, I want to suggest that the language of the objections, the specific troping of the arguments against phlebotomy and against the Galenic tradition that fostered its use, indicates something more--namely, not just a rejection of traditional medical theory and practice, but a fundamental reconception of how individuals exist in relation to the test of the world. Grounded in the assumptions of the Galenic tradition, the early modern practice of phlebotomy understood human existence in the seamless context of a larger surround; individuals were inextricably embedded in an environment from which they could not be isolated either conceptually or medically. Phlebotomy's detractors, on the other hand, envisioned an almost entirely different individual, a patient not defined idiosyncratically by particular context but rather existing in conceptual self-enclosure, inhabiting an "outside" environment from which he or she must vigilantly be protected, especially from what gets framed as "foreign" invasion. Even as it concerns seemingly narrow questions about a particular medical practice, then, the debate about phlebotomy engages also competing understandings of the individual that co-existed, at least for a moment, at the cusp of the modern world.

In this first part of what follows, I try to establish the individual implicated by traditional Galenic medicine. Though it is now close to a commonplace that Galenism understood the individual in the Latinate meaning of that term--as undivided, in this case, from environment--I want to focus particularly on the means of monitoring and regulating that ail-inclusive system, namely on dietetic medicine, and particularly on the manipulation of the six non-naturals that helped to maintain a homeostatic balance both within the individual and between the individual and the environment of which he or she was a part. (12) Dietetic medicine furthermore provides the appropriate context in which to understand phlebotomy because phlebotomy was one of the standard techniques typically called upon to maintain or restore such balance. This section thus tries to sketch the individual implied in a pattern of medical practice.

The second section turns from Galenic practice to Helmontian prose. Considering the attacks against phlebotomy, I focus particularly on the formulation of arguments, on the language that points toward the kind of conceptual categories that undergird a wide range of the chemical physicians' positions. Because my interest is to educe an underlying assumption that structures explicit arguments, my concern in this section will be less on the local circumstances of each text's production than on particular rhetorical formulations that recur among them. The chemical physicians whose texts I cull were never explicitly concerned with the contours of personhood as such; the debate they engaged in was carried out on a different plane entirely, having to do, as I have indicated, with medical theory and practice, with commercial interest and institutional prestige. But the terms of their arguments, drawn from the reformist discourse of the mid-century and from Helmontian medicine, suggest that other issues were involved, and it is to these that I will attend. From their opposition to Galenism most generally, to their theorization of disease and their advocacy of chemically-based cures, to their understanding of the blood itself, strict and heavily value-laden binary pairs structure their articulation of key concepts. Taken together, I will suggest, the patterns of their prose contribute to the rise of a sense of the individual that long outlasted the intensity of this local debate.

Like law and theology, the other two of the three traditional branches of higher learning, physic as it was traditionally taught in the universities was designed to affect an individual's behavior through advice offered by a professional. (13) For law and theology, this meant offering advice about how best to live in concert with legal strictures and with God's will; for medicine, it meant providing advice about how to live in accordance with the norms of nature. Living in accordance with nature promoted health and long life; living contrary to nature likely lead to illness and death. A good part of the job of a university-trained physician was thus concerned with preventive medicine: aside from the curative aspect of being able to identify the causes of disease and provide appropriate remedies, the physician was to advise people in the details of how to conduct their lives in balance with nature. Galenic medicine was thus "dietetic" in the specific meaning of that word: "dietetic" comes from the Greek word diaita, meaning "way of living" or "mode of life."

In order to offer informed advice on diet, physicians paid particular attention to an individual's inborn temperament--defined by which of the four humors predominated in him--and orchestrated a life-regimen that was specifically geared to tune that individual's temperament with the manifold conditions of her life and environment; these would include things such as his geographical location, his job, his age, and his stage of life. The mechanisms for making these adjustments were the six non-naturals, those aspects of life that could cause variation in a person's bodily constitution, but were, unlike the bodily temperament given in birth, under an individual's control. (14) The six non-naturals--air, food/drink, exercise/rest, sleep/ waking, evacuation/repletion, and the passions of the soul--were essential aspects of life, and, to some extent at least, manipulable. Just as misdirection in the non-naturals could cause superfluities or deficiencies--disharmonies in the bodily economy--that could create dangers to one's health, so proper regulation of the non-naturals could, again at least theoretically, either avert disharmony altogether or restore it if lost. Careful management of the non-naturals could thus maintain or restore health and prolong life. As the sixteenth-century physician Thomas Cogan put it in The Haven of Health, "by the temperance of [the non-naturals] the bodie being in health so continueth: by the distemperance of them sicknesse is induced and the bodie dissolved." (15)

Given a somatic system of individualized temperaments regulated by such idiosyncratic variables as ambient air and daily diet, professional medical advice in the early modern period was (optimally at least) highly personalized. (16) Different temperament types existed about which generalizations could be made--the sanguine constitution, for example, or the phlegmatic--but to be optimally effective, regimen had to tailor an individual's peculiar temperament type to his or her particular condition of living. John Archer, for example, in his 1673 medical manual, Every Man His Own Doctor, advised readers looking to devise their own regimen to regulate their food intake in accordance with their constantly shifting life situation. Thus a phlegmatic person was instructed to eat differently from a sanguine person, but differently, too, in different seasons and at different life stages, and also differently depending on where he or she lived or what he or she did for a living. A good part of Archer's text is thus comprised of detailed descriptions of the qualitative characteristics of "the Nature, Temper and Virtue of most food now used in this Kingdom" so that everyone could "easily see and know by comparing it with his constitution what is friendly and healthful to him and what is inimical." (17) Archer's expressed hope was that if everyone could learn to recognize his own inborn temperament (and Archer included instructions for how to figure this out) then everyone would be able to tailor their own lifestyle--direct their own diet--through a careful regulation of the non-naturals, and thus, as his ride promised, be "His Own Doctor."

Dietetic medicine had to be so carefully individualized because the person assumed by its practice was conceived to be literally constituted by the environment of which the person was a part. The same elements and qualifies (earth, water, air, fire and hot, cold, dry, moist) that comprised the entirety of the material universe comprised, too, the physical human body. The elements and qualities of the environment were expressed in the body as the four humors, and it was the balance of these, in relation to one's particular environment, that made up a person's temperament and day-to-day medical condition. Manipulation of the non-naturals could modify that balance for better or ill, but it was impossible to conceive of the individual living in a dietetic regimen outside of the material context that comprised her.

A convenient example for considering the inextricability of the body with its surround is provided by the nature of blood production. In Galenic physiology, blood was generated in stages through the body's digestive process. Essentially, blood was aliment, digested and refined. Comprised of all four humors, blood, in both its quantity and its quality, was determined to a large degree by what one ate. In turn, the quality of food was determined by the condition of its own generation. Thus an animal's aliment and environment helped to determine that animal's constitutional quality as food (in the form of milk or meat), and that, in turn, helped to determine the bodily condition of the individual who ingested that food. As Cogan explains in The Haven of Health, "the goodnesse of the pasture helpeth much to the goodnesse of the milke: for ill pastures make ill milke, and good pastures make good milke: for such as the food is such is the bloud and such as the bloud is, such is the milke." (18) As Cogan here makes clear, the medium of commerce between aliment and the body is the blood. The cow (in this case) eats grass, which, digested, becomes blood, which, refined, becomes milk, which, once again digested and refined, becomes blood in the body of man. When Sir Thomas Browne quipped, "we are what we all abhorre ... Cannibals," he was, as was his wont, not just joking but telling a truth: as he explained, "all those creatures we behold, are but the hearbs of the field, digested into flesh in them, or remotely carnified in our selves.... All this masse of flesh which we behold ... this frame wee looke upon, hath been upon our trenchers." (19) Dr. Browne's joke--that we have eaten ourselves into existence--was thus, as he would say, "no mere trope of rhetorick" but in some sense quite literally true: an animal's aliment helped to determine the humoral mix of that animal's blood, which nourished that animal's flesh; ingested by a man, that flesh helped to determine the humoral mix of his blood, thus his flesh, thus his overall temperament. What one ate, and how much, had everything to do with the quality and texture of one's blood, which, in turn, had everything to do with what (or who, temperamentally speaking) one was. To a great extent, environment produced the person.

Optimally, one generated through the stages of digestion just enough blood of just the right quality for one's temperament, and, again optimally, the blood moved through the body in just the right directions and amounts (in order to flow freely and smoothly, blood had to be of optimal consistency and temperature). But, like food intake, the system of blood production and flow needed vigilant monitoring to ensure proper function. Phlebotomy was the means to manipulate the course and amount of blood in the body. In some sense residing at the opposite dietetic pole of food intake, phlebotomy was an evacuative technique (along with purging, blistering, and the giving of clysters) that constituted a normative part of dietetic regimen. By following carefully-wrought instructions on where, when, and how much to bleed, a physician could regulate the amount of blood in one's body and direct its proper flow. Aside from its use in curing specific ills, regular, prophylactic use of phlebotomy both ensured a healthful balance of humors within the individual and calibrated a person's life in relation to the environment in which he or she lived.

The proponents of phlebotomy in the late seventeenth-century were fully attuned to this understanding of the purpose of the technique. Chief among them was Henry Stubbe, a staunch Galenist and member of the College of Physicians, who, in the late 1660s and early 1670s wrote a series of attacks on the Royal Society, particularly against the claims of Joseph Glanvill and Thomas Spratt that the new science would prove useful and progressive to England and to humanity at large. (20) In 1671, he published An Epistolary Discourse Concerning Phlebotomy, which he structured as a point-by-point refutation of the chemical physician George Thomson's attacks on phlebotomy and Galenism generally, published just a few years before. An Epistolary Discourse is thus much concerned with discrediting Thomson, a man who "hath either out-lived his Learning, or never was endued with any," along with the Helmontian doctrines he espoused (Stubbe, 1). But amid the mud-slinging, Stubbe vigorously defends the legitimacy of phlebotomy as an effective and until-then well-regarded technique. However unnatural or counter-productive the practice may seem to modern sensibilities, for Stubbe bloodletting was a wholly natural procedure; in fact, it worked in imitation of nature itself. As he explained, "Nature doth seem to direct us thereunto by her own excessive evacuations in that kind" (25). Nature constantly calibrates on its own, working to keep a person in somatic balance. Nature accomplishes this balancing act in a variety of ways, among them spontaneous natural bloodlettings, as in menstruation or bleeding from the nose or from hemorrhoids, which were generally considered to be healthful. Thus,

If it be true, that Nature doth oftentimes alleviate even in the beginning, and in the end cure Diseases by spontaneous evacuations of Blood, at the Nose, and Uterus, by vomiting and stool, then a Physician, whose business it is to imitate Nature in her beneficial operations, is sufficiently authorized and impowered to practice due Phlebotomy, by the best of precedents. (Stubbe, 134)

Bloodletting aided nature in its own efforts; it simply worked more forcefully and thus more beneficially when the situation was more acute. Nicolas Culpeper, citing Galenic aphorisms in his own treatise on bloodletting, noted the same confluence of natural and surgical means: "They need no blood-letting," he said, "that have any natural evacuation." (21) In 1617, Lady Anne Clifford attributed her daughter's recovery from an ague to her profuse nose bleed. (22) The important thing was to accomplish the evacuation; the technique--whether by nature's own efforts or by surgical intervention--did not matter much. (23)

The rules for phlebotomy were detailed and numerous, but they all bespoke the interrelation between the individual and the environment. It was bad to let blood when the ambient temperature was too hot or cold; people with hotter temperaments needed the procedure more regularly because they tended to generate more blood; those with cooler complexions didn't need it so much. Age, sex, and diet mattered, but so too did time of year: spring, which tended to produce excess blood, was a favored time to let blood. The time of month was important, too: the amount of blood in the body typically fluctuated in concert with phases of the moon, so it was considered best to let blood when the moon was full because the body was typically fullest of blood at that time.

Stubbe urged this wide-ranging evaluation in his defense of using phlebotomy as a treatment, for example, for the pest. A physician must pay particular regard to "the season and course of the year, the countrey, the sex, the age, the temperament, and the individual constitutions of persons, [along with] many other circumstances" (76; see also 36, 82, 135, 162.) Because blood was the primary medium for the body's interlacement with the environment, knowing how properly to handle the blood depended on knowing pretty much everything about both the person and the environment in which he or she lived.

Although Stubbe repeatedly stressed that he was advocating a modernized form of phlebotomy, based on ancient authority but informed by Arabic and even chemical advances, his sense of the usefulness of phlebotomy as a key feature of dietetic medicine would not have differed in any substantial way from the one voiced by Simon Harward at the turn of the seventeenth century (38). Through phlebotomy, Harward had said,

the fulnesse of the body doth come to a inediocrity, griefes which come by extension are pacified, the spirits are refreshed and naturall heate evented, the liras being as it were eased of a great burthen, are made more quick and ready to execute every office, nature is inabled to concoct what is requisite, and to expel the unprofitable, flowing humours are either drawne back or turned aside, from the place where they annoy, or else are they dispatched and utterly avoided, narrow and obstructed passages are opened; and finally very present help is brought thereby to many dangerous infirmities. (24)

Phlebotomy is praised here for being refreshing, enlivening, invigorating. Despite its known perils, its ability to induce weakness and even death if not practiced properly, phlebotomy was understood by Stubbe and by the Galenic tradition he espoused as life-promoting because it formed part of a system that assumed human life to exist in tempered balance with everything else in the world. Bloodletting enlivened because by removing unhealthful excess, for example, or relieving dangerous heat, the practice realigned the body with the healthful norms of nature. For the proponents of phlebotomy in the early modern period, bloodletting functioned within a homeostatic system of which the patient was but a part.

Phlebotomy as a means to maintain or restore homeostatic balance accords also with the general Galenic understanding of disease, and it is here that we can start to see the conceptual divide separating the practice's proponents from its detractors. For the learned physicians in the Galenic tradition, disease was a physiological condition, a variation from an ideal norm, rather than an identifiable, external or independently-existent entity. Disease was understood to be a result of excess, obstruction, putrefaction--some dysfunction in the proper condition or movement of bodily fluids. (25) Theoretically at least, every instance of disease was considered to be unique because every individual was uniquely constituted by his or her unique temperament. It is this infinite diversity of specific temperaments that explains why Archer offers instruction for individuals to tailor their diet to their own idiosyncratic needs. This also explains why the proponents of phlebotomy stressed that there is no one regimen or course of treatment appropriate for everyone. Diseases might differ in England and China, but that is because every disease instance is peculiar to every individual as he or she is defined by his or her own peculiar and differing context. (26) Because such difference is universal, Stubbe is at pains to point out that phlebotomy is universally practiced: "what can seem more rational than ... that which so many Ages have recommended unto us, and in the use whereof, not only Greece and Rome, but all Nations universally, as well as Civil, are agreed on?" (26; see also 140-41, 193-97). It is counted as a point in his favor that phlebotomy was used in ancient times, and now, in foreign countries and in England.

The chemical physicians, on the other hand, conceived of disease in a fundamentally different way. Following the teachings of van Helmont, they thought of disease as an entity, a something that at least in part had existence separate from the patient herself. (27) As van Helmont's English translator put it, disease has "an essential thingliness" that identifies it and gives it its specific characteristics. (28) This so-called ontological model of disease came to dominate eighteenth-century British medicine, especially under the influence of Thomas Sydenham's efforts to classify diseases based on his clinical, bedside observation of symptoms (after, that is, the emergence of nosology). For the chemical physicians of the seventeenth century, however, the model was less clinically based, being more closely tied to van Helmont's idea that disease results from an assault by an external entity on an individual's life force. (29) Alleviating disease therefore meant not rebalancing the humors, but calming an agitated life force--a force van Helmont explicitly personified, calling it the Archeus. (30) A physician's goal was therefore to remove--or, better, to find a way to urge the Archeus itself to remove--the external something that was creating a disturbance in the economy of the body.

Given this disease model, the key concepts that structure the Galenic understanding of individuals--balance, harmony, and well-temperedness--simply make no sense. The goal of a physician tending someone sick is not to recalibrate the humors; rather, it is to rid that person of a foreign body, an "unwelcome guest." The terms that structure the concepts here are thus outside the conceptual scope of Galenic thinking; they are instead strictly oppositional. What is internal to the person is under attack from something outside, something foreign, something threateningly alien. (31) As the disease model is different, so, too, is the understanding of the person suffering from disease: not unbalanced, obstructed, or overheated (for example) and so diseased, but rather vulnerable, attacked, penetrated, and host to an aggressive outsider, a disease. The person understood as existing in homeostatic balance, the Galenic individual undivided from environment, here gives way to the person understood as separate and in need of protection from all that is outside: rendered schematically, this model more nearly resembles the modern individual, independent and ideally self-enclosed.

The two chemical physicians whose texts I most frequently rely on here to demonstrate the point are Noah Biggs and George Thomson. Though otherwise an obscure figure, Biggs was the first of the group to attack Galenism, publishing in 1651 a polemic addressed to Parliament urging it to reform the medical establishment. (32) Thomson, surely the most outspoken and vituperative of the English Helmontians, had already published a treatise on the plague when he wrote the first of what became a series of virulent critiques of Galenic medicine and its proponents. The first of these was Galeno-Pale (1665), a treatise that sought to advocate Helmontianism mostly by arguing the "abuses and disrepute" of Galenism and modern Galenists. (33) Despite his antagonistic stance, however, Thomson did have some medical repute: Galeno-Pale was dedicated to the Archbishop of Canterbury, who had supported the Helmontians' ultimately unsuccessful effort to establish a College of Chemical Physicians, and Thomson came to the notice of William Harvey for his successful work on splenectomies (although he complained that his priority in this regard was not sufficiently recognized). (34)

Although we can easily disparage Thomson's writings for their always tetchy tone, it is at least in part because Thomson--and Biggs, too--wrote as polemicists, and wrote so often in such stark and emphatic terms, that their prose is useful for analysis. Their attacks against phlebotomy and against Galenism generally are based on a series of binary pairs that define a definitive boundary between a self-enclosed inside and everything else, now marked as outside. This pattern appears most simply in their derision of Galenic medicine as a whole: the problem is not merely that Galenic medicine is ineffective or even dangerous (though it certainly is that, too), but that Galenic medicine is "foreign," deriving from a source "outside" the true Christian tradition, in which chemical medicine finds its home. This idea of a true and self-sufficient inside against a false and dangerous outside structures manifold aspects of their thinking, not only about the Galenic medicine they reject, but also about the chemical medicine they embrace--about the nature of the disease situations they treat, the preparation of remedies they recommend, and, most significantly, about blood and its relation to well-being. Taken together, these pairs function to create an individual starkly different from the one treated by Galenic medicine: ideally isolated from his environment, this individual is not tempered to, but separated from the surround.

The arguments of phlebotomy's detractors against its Galenic proponents are multiple, ranging from the physiological (the four humors are "an absurdity") (Galeno-pale, 44), to the therapeutic (dietetic medicine is "a tyrannous cheat") (35) to the ethical (the Galenic physician "aims at the Purse of his Patient, rather then the Recovery of his Health") (Galeno-pale, 23). (36) But in framing their opposition to Galenism overall, these writers offer as paradigmatic the irrefutable fact that Galen was a heathen; devotion to Galen gets construed as a willful rejection of all things Christian.

Noah Biggs, for example, couches his plea to Parliament in largely Christian and salvific terms. Drawing on the rhetoric not only of Baconian advancement of learning but also of puritan zeal, Biggs frames his efforts as an act of "deliverance." He praises Parliament for their reformation in "divine things, in religion, in worship," but, borrowing an argument from Milton's Areopagitica, he urges Parliament not "to pitch [their] tents here," but rather to continue their work in order to attain "the utmost prospect of Reformation" (Biggs, a4r). Just as Milton had urged Parliament in 1644 to retract the newly established licensing laws by asking its members to recognize that the inventors of licensing were those they would be "loath to own" (for Milton this meant mostly the Catholic inventors of the Index), so Biggs announces to the "great and grave ... Assembly ... sitting in Parliament" that

The common allow'd Physick, which is at this present day prescribed and practiced in this Nation, the Inventors of it, some of them, were such whom ye will be loth to own, and of whom one day and perhaps not long, we shall be perfectly ashamed. As though our souls and head were not our own; as though there were no Smith in England, but we must thus foot it over to the rimes of Trajan, and City of Pergamus [Galen's birthplace]; to the Romances and Directories of such uncircumcised Philistines, is such Barbarism and Rudeness to the lofty Genius of this Nation.... (a4v)

True knowledge of nature, the foundation of the medical arts, is not contained in the "spurious productions, and Colossian Library of Galen," Biggs argues, for God would never "turn it over to him"; it is thus a "terrible thing truly, to prefer Aristotle ... and condemn the truth of God," to "lap up the prodigious vomits of Aristotle, Galen and other illiterate Ethnicks" (blv; D2r; see also 20) True knowledge of nature can be revealed only by God and only to those who "apply [themselves] to the declarations of [God] Himself in his works of the Creation" and are led "by the hand to receive Truth from himself and give it out to others" (b2r). Natural philosophy and the medicine derived from it are--or should be--exclusively Christian endeavors properly befitting a reformed Christian nation.

This opposition between heathen and Christian is something of a refrain for Biggs, typifying all that is wrong about traditional medicine. It even explains the very stagnancy of the art, its fundamental inability to alleviate suffering and cure disease. Not per se because the medicine is bad (though it is that, too) but because it is pagan-based: "The Art of Physick hath stood a long time at a stay, as is a shame to think; without any progresse made; because we had rather stand to, and bring honour to, and deck and polish the Inventions of foreigners, Greeks, Barbarians and Ethnicks. " People therefore wrongly believe that "our ancestours resting places [are] like Hercules pillars, inscrib'd with a Ne plus ultra; as if they had attin'd to the Meridian of all knowledge" (22-23).

To some extent, these are the standard complaints of Baconian reformers, typically bemoaning the state of learning as stultified under an oppressive obedience to ancient authority. But the troping here accentuates the obstacle to progress as devotion not just to the ancient, but to the foreign, to "ethnicks" and aliens. The true physician, Thomson writes, is one who "having a Commission from the Angel Raphael, is endued with the gift of Healing" (Galeno-pale, Air). Healing is still a medical endeavor, but it comes alone from the Christian God. The prime exemplar of the true Christian healer, says Thomson, is van Helmont himself, who was "without all question, ordained in these last times by especial providence of God, for the comfort of and relief of distressed Man" (Galeno-pale, 4).

This tendency to distinguish true from false medicine along the axis of native Christian culture versus a foreign, "ethnick" and pagan one finds an analogue in these texts' troping of disease, particularly in their idea of the Archeus as the innate, native life-force responding to the onslaught of what gets framed as a foreign invasion. The Helmontian Archeus, it must be recognized, is not the same thing as the Christian soul: not separable from the body, it does not enter the body from the outside, and it doesn't exist beyond death. Instead, it personifies the vitality of the body, the specific form, function, and purpose of organic matter. (37) But this vitality, the body's vital spirit, is not created from the body's concoction of respired air, as it is for the Galenists; vitality does not result from an interface with the environment. Rather, it is innate to the body itself, the "primum Mobile, moving sine Motore alieno"--the first mover, moving without alien motion (Aimatiasis, 9). The Archeus is thus paradigmatic of the truly native, the essence of the self-enclosed individual.

As the personified life-force, the Archeus is conceived as a benevolent but "most exquisitely sensitive" ruler of the physiological oeconomy, working to protect the body from the hostile forces of the environment; it is a "sentinel which continually watches for the preservation of this citadel." (Aimatiasis, 51, 40). The Archeus is thus primarily responsible for disease response: it is stung into reaction by something external to it. When Thomson, for example, critiques the habit of some physicians to give a prognosis at the time of crisis in a disease (the time when the disease is presumably at its worst), he calls upon this idea of the native Archeus working to eject an alien invader. "Be advised," he warns his readers,

not to surfer him that waits for a crisis, and cannot give thee in a short time a sufficient Testimony of an effectual Cure, to proceed any further; for be assured that a good Physician never looks after a Crisis, (Standing still as a meer spectatour while Nature is oftentimes worsted upon unequal terms by its enemy) but with all expedition unroostest that unwelcome Guest, that bath taken up its lodging in the vital Spirits, wherein the longer it lurks, the more difficult it is to eject ... and so at length confounds the Oeconomy of the whole Body.... (Galeno-pale, 23)

Thomson here figures the disease situation as a household drama, with actors personified as combatants in a struggle to rule the workings of the body. The "external" cause of disease is an invader, an "unwelcome guest" that assaults the "native" ruler of the body. As the passage continues, the native/alien dichotomy gets positioned along a Christian/heathen divide: "wherefore an Honest and Prudent Chymist ... falls forthwith upon the extirpation of any malady, whereas the Galenist labours to circumcise and lop off here and there [only] the Branches or Symptoms" (Galeno-pale, 23).

Galenists, who do not understand the true nature of the combat, act not only without effect ("mere spectatour[s]" to a "lurk[ing]" "enemy"), but also without Christian intent: blind to the truth of the matter, they merely "circumcise ... the Symptoms," mistaking the external and material for the true spiritual heart of medicine.

As disease is figured as a response to a foreign invasion, so remedies, in order to be effective, must rely on what is native to ward off the alien assault. The native, though, is a capacious category, encompassing not only the physiological workings of the body itself (and particularly the workings of the Archeus to expel the unwelcome guest), but also what qualifies as proper material for creating cures. Thus, what gets extracted from the plant-based remedies these writers often recommend is understood to be what is specifically native to the plants themselves. Drawing on commonplace Helmontian tenets, Biggs, for example, urges the belief that God created cures for all diseases in "simples," the essence of plants that can be distilled only through pyrotechny, or "the art of working by tire." The chemical process engendered by tire "emancipates" what Biggs calls the "domestick" essence of plants from "the gabardine of corporeality." Like the active agent in the body's oeconomy, the effective ingredient of a plant is what is intrinsically native--what is "domestic"--to that plant. The domestic essence of plants is sufficient, Biggs says, for "the cure of all diseases" (Biggs, 49, 114, 33).

If native simples are God-given essences whose virtue, when learned, will cure all disease, Biggs furthermore makes it clear that only native plants will do. God, he says, will not have us use "Barbarian Drugs from the Indian shore":

Such is the Trade, habit and iterate Custome and Practises of our Indian drug-merchants and Physick-mongers; such is the zealous and ignorant affectation, stupidity and perverse covetous nature of some; the hammer ofwhose desires, beats on the anvil of compleating and filling up the measure of the vices and miseries of their native Countrey, by the importation of foreign and heathenish drugs. (Biggs, 59)

Here the privileging of the native in the body and in approved pharmacology finds its logical extension in the promotion of nativist commerce: drugs must be native; to search elsewhere for them is to "nose the high and sagacious Genius of the English Nation, and to lay them open to the scorn and derision of other Nations." (60). Medicine is thus a nationalist enterprise as well as a Christian one. "Home-bred diseases have their remedies likewise at home," Biggs implores; there is simply no need for "the Apes and Peacocks of Forreigners" (63). (38)

This same dichotomy between native and foreign even structures the critique of evacuative therapies as a whole. Phlebotomy was perhaps the central evacuative technique--and it was certainly the one the chemical physicians objected to most strongly--but it was not the only one. Purges, emetics, and laxatives were also routinely used to rid the body of excessive or corrupted humors. For the chemical physicians, however, evacuation was deemed both ineffective and dangerous because it failed to rid the body of the dangerous foreigner in its midst. Biggs, for example, does not deny that laxatives work, that ingested medicines (what to him are "poisons") induce prolific evacuation. His objection rather is against the claim that what get evacuated are corrupted or excessive humors. It is rather "meer putrefaction ... meer rotten consum'd melted matter [generated] through the poison of the laxatives" themselves that emerge from evacuations. Rather than aiding the ailing, such laxatives in fact debilitate the host, allowing the "enemy" to "exercise this cruell raging and ravening within, in the flesh and bloud" (66). The "rotten stinking melted stuffe" that emerges from an ingested laxative is nothing usefully disposed of but is rather the detritus of the laxative itself, the unpleasant result of a needlessly invited invasion.

Perhaps not surprisingly, clysters--laxatives from the other end--get troped the same way. For Biggs, clysters were something "to be abhorred as a cruel and beastly remedy." Every clyster, he says, is "naturally an enemy to the Intestines." "Turds," on the other hand, are the "naturall and domestick content of the gutts" which do not "prick or gnaw ... until it cornes to the fleshy parts of the intestiuum rectum." Thus, he concludes, "every clyster seeing it is an exotick guest and alien to the guts, it cannot choose but be troublesome and ingratefull to them" (106, 107) Biggs uses the same language to describe clysters and laxatives as he uses to describe the Galenic medicine that endorses them: all are alien, exotic--natural and "domestick" neither to the body nor the nation. (39)

Thomson, too, thinks of remedies in terms of the native/alien dichotomy. He tells a story, frequently told in these texts, of van Helmont himself, who was "brought almost to the gates of Death" by Galenic treatments of "enormous purgation." Van Helmont might have been cured "very suddenly," says Thomson, had the physicians attended to "that true peccant matter, which is the principal occasional cause of Diseases ... which stole in through the pores of the Skin and there settled in the innate Archeus" (Galeno-pale, 58). The Galenists failed and nearly caused van Helmont's death because they didn't understand that the "innate" Archeus was under attack by something "peccant" stealing in from outside.

Perhaps nothing more expresses the underlying idea that the individual and the medicine meant to treat him, are, rightly conceived, native (against foreign), Christian (against heathen), and English (against alien) than the attack against phlebotomy itself, that "pernicious technique," that "bloody cruelty." The objection resides fundamentally in these writers' understanding of the blood. (40) For them, blood is not a mixture of humors, as Galenists contend; it is rather a "pure homogeneous juice," self-same and unlike anything else. Chemical writers typically claire that evidence of different substances that settle out in evacuated blood--which according to Galenists is evidence of the different humors--is actually an effect of the exposure of blood to the air, not intrinsic to the blood, but a corruption that occurs in the porringer, or bloodletting bowl. Though generated in the process of digestion (as it was, too, for the Galenists), blood is primarily the work of the Archeus, who makes it the "proper habitation of the vital spirit, the immediate instrument of the Soul" (Aimatiasis, 2). It is therefore "the most pure sincere, and sublimest juyce in our Body," the "pure Sweet Homogeneous, Balsamick, Vital Juice," the "most highly exalted Liquour of Life" (Galeno-pale, 52; Aimatiasis, 2, 3). Blood, in other words, is the vehicle of life itself, the material epitome of what is innate to the living body. This in essence is what Scripture means when it says, as Biggs quoted it, "life lurkes in the bloud." According to Holy Writ, he says, "the soul ... rides in the chariot of the bloud" (Biggs, 151, 139).

The fact that blood is described as the vehicle not for an interchange with the environment but rather for the pure vital soul makes its necessary intercourse with the "outside" seem particularly dangerous. Thus, though the "goodness and pravity" of the blood can fluctuate due to "internal conditions," such as exorbitant passions, blood is especially sensitive to outside influence--to the ambient air, for example.

The chemical writers, it must be noted, do not reject the idea of the non-naturals (of which air is one); Thomson, for example, was very much attuned to the effects of lifestyle on the texture and state of the blood, and he considered Hippocrates, from whom the system of the non-naturals ultimately descends, to be "that good old candid physician." But the environment is generally considered treacherous, as something one needs protections from, rather than something one strives to achieve attunement to. "Hostile atoms" from the air, for example, can pollute the blood; "venomous fumes" when inhaled can "infect" the blood. Fevers are produced by "atoms Hostile to the Texture of our bloud, which rushing in through the more patulous passages of the Body, or stealing in through the less visible pores, do frequently alter, and contaminate this Aetherial Liquor" (Aimatiasis, 49, 13). Assaults such as these from the "outside" put the Archeus into "a violent passion," an "extream displacency ... at the presence of so tedious, vexatious, virulent and mortiferous a sociate" (Aimatiasis, 23; 21). Breathing the ambient air is necessary, of course, but replete with danger: "we receive injury from this subtil ambient," Thomson warns. The Archeus, ruler of the enclosed individual, must ever guard against the "mortal enemy" that lurks outside (Aimatiasis, 13, 63).

Given their understanding of the blood, the chemical physicians saw phlebotomy as the epitome of all that was wrong with Galenism. If blood is the bodily seat of life itself--the only position, they maintain, supported by Scripture--then phlebotomy is fundamentally unchristian, not only because it is cruel, but because it denies the truth of Scripture's explicit dictates about it: The "bloody course [of phlebotomy] ought to be voted cruel and unchristian, the life or Soul being seated in the Blood: God having created the Medicines of the Earth, not Bleeding, cutting holes in the Skin, Blisterings, and such like butchering Tortures, to cure miserable man." (41) Furthermore, if blood is coterminous with life, then one cannot have too much blood because it is illogical to claim that one has too much life. The idea of letting blood to reduce plethora--its most common function--is not only useless, it is absurd: "never has any man too much of that most vital Balsom called Sanguis, the encrease or diminishment of which shortens or prolongs our days" (Aimatiasis, 52). Thus, one can not deplete blood without also depleting life: as Biggs asserts, "Seeing according to Holy writ, the life lurkes in the bloud, therefore a plentiful profusion of bloud, cannot but be a considerable prejudice to life" (151). These writers are ready to admit that phlebotomy does work in one very restricted sense: it induces exhaustion. But this is not an exhaustion that relieves suffering or promotes health. Phlebotomy does nothing to attack the unwelcome guest; rather it illogically attacks the very essence of life itself, bringing on an exhaustion that likely betokens death (Biggs, 167).

For Thomson, phlebotomy threatens far more than physical health; it is "no small cause" of immorality and even of rampant religious sectarianism. Frequent "sangumissions," he explains, exhaust the Archeus, which in turn allows a multitude of "calamities of Body and Mind [to be] hatched up." The mind, he continues, then becomes "possessed with Melancholy, black, discontented thoughts, uncapable to receive truth, becomes forward, peevish, careless of virtuous Action, desperately bent to follow for diverstisement, a voluptuous sensual life, or to contrive Innovations, Heresies, Schisms, and factious Rebellions, and what not." (42) Thomson even sees "this Blood-sucking course" as a threat to the vitality of the nation iself:

Away then with this detestable lavish Phlebotomy, that hath destroyed more then Tobacco or the Sword together, may it be banished [from] the Court, City, and countrey, nor ever be depended upon hereafter in this Island, or any of His Majesties territories, for the cure of any difficult Disease; but let it be confined and inflicted as a feral Plague upon all those that delight in Blood, and hate our Gracious Sovereign, and all his loyal Subjects. (Galeno-pale, 55)

Phlebotomy here finally cornes to represent a vampiric savagery, a dangerous foreign import, an inhuman threat meant to suck the lifeblood from a native, civilized, Christian nation.

As the anti-phlebotomy tracts worked to create a picture of a new, chemically-based medicine, they helped also to create and characterize a new patient that that medicine treats: Christian and English, living in but in need of protection from an often hostile environment. The native and domestic aspects of that individual--in physiological health and disease as much as in the medicines and remedies that are meant to treat him--are to be protected and policed from foreign invasion. If the body has permeable borders, that permeability is now problematic: the true patient, like the true medicine meant to treat him, is now in the best of health when separated off from all that is outside.

By the end of the seventeenth century, the chemical medicine of the English Helmontians had pretty much dropped from the scene. Various explanations have been offered for its decline, among them the idea that patients were accustomed to the need for strong and potentially dangerous therapies, like phlebotomy, in order to counter the strong and dangerous ailments from which they suffered. (43) Moreover, the Helmontian reliance on quasi-mystical notions like the Archeus did not correspond to the more public, rationally-based medicine of the early eighteenth century. After the short period of intense attack, phlebotomy, too, continued in full force as an important part of medical practice, not undergoing significant challenge again--as a technique--until the nineteenth century. (44) But some aspects of the work of these chemical physicians did survive: the idea that disease can be understood ontologically, for example, and the general idea that human physiology can be chemically conceived. What also survived--and in fact flourished in eighteenth century--was their understanding of the individual as ideally insulated from the dangers of foreign agents and environments, an individual not constituted by the confluence between body and environment, but threatened by what can be definitively said to be outside him. Explicitly, what these writers wanted was medical reform; they wanted to eradicate what they felt was a dangerous and unnecessary medical technique. In that effort they pretty much thoroughly failed; what they did accomplish, however, what they helped in some small way to consolidate, was self-bounded modern man.

Fordham University

NOTES

(1) On blood in the priestly rituals of Leviticus, see William K. Gilders, Blood Ritual in the Hebrew Bible: Meaning and Power (Johns Hopkins U. Press, 2004); on the many meanings of Christ's blood at such pilgrimage sites, see Caroline Walker Bynum, Wonderful Blood (Philadelphia: U. of Pennsylvania Press, 2007); on the growing economy in human tissue, including blood, see Catherine Waldby and Robert Mitchell, Tissue Eeonomies: Blood, Organs, and Cell Lines in Late Capitalism (Duke U. Press, 2006). The best treatment of the multiple and competing meanings of blood in early modern discourse remains Gail Kern Paster's The Body Embarrassed: Drama and the Disciplines of Shame in Early Modern England (Cornell U. Press, 1993), chap. 4.

(2) Phlebotomy had been practiced since Hippocratic times but did not become central to medical practice until Galen. For a full history of phlebotomy in the West, see Peter H. Niebyl, "Venesection and the Concept of the Foreign Body: A Historical Study in the Therapeutic Consequences of Humoral and Traumatic Concepts of Disease" (PhD dissertation, Yale University, 1969). For Galen's writings about the importance of and rules for bloodletting, see Peter Brain, Galen on Bloodletting: A Study of the Origin, Development and Validity of his Opinions (Cambridge U. Press, 1986); on the specific controversy in which the anatomist Vesalius was involved, concerning whether it was best to bleed directly from the afflicted side of the body or to propel the blood away from that side, see John B. deC. M. Saunders and Charles Donald O'Malley, eds. Andreas Vesalius Bruxellensis: The Bloodletting Letter of 1539 (New York: Henry Schuman, 1947).

(3) Erasistratus, for example, against whose ideas Galen wrote, did not deny that phlebotomy worked; he just thought that its dangers outweighed its advantages and that the same somatic effects could be achieved more safely, for example, by starvation. See Niebyl, "Venesection," 69.

(4) George Thomson, Galeno-pale: or, a Chymical Trial of the Galenists (London, 1665), Avi r. Subsequent references to Galeno-pale appear parenthetically.

(5) George Thomson, Aimatiasis, or, The True Way of Preserving the Bloud in Its Integrity and Recifying It (London, 1670), 55. Subsequent citations of Aimatiasis appear parenthetically.

(6) Henry Stubbe, An Epistolary Discourse concerning Phlebotomy (n.p., 1671), 3, 28, 41, 63. Subsequent citations of this text appear parenthetically.

(7) The College of Physicians, it should be noted, was not entirely opposed to chemical medicine. It included some chemical remedies in its Pharmacopoeia and in 1648 established a chemical laboratory with William Johnson as its chemist. But these were considered insufficient steps by more thorough-going Helmontians, who considered those they called "Galeno-Chymists" to be men "as monstrous and Anomalous as a Centaur Or Syren" (Galeno-pale, 19).

(8) The population of London increased dramatically over the course of the seventeenth century. Given that only physicians licensed by the College of Physicians could practice in London legally, and given the limited number of these, there were simply not enough legal practitioners to go around. Furthermore, licensed physicians tended to care for the upper echelons of society; the thriving "middle classes" were not served by them. This situation created an opportunity for robust competition among--strictly speaking, illegal--practitioners, including apothecaries and chemical physicians. On the commercial ground of the larger controversy between the Galenists and the chemical physicians, see E M. Rattansi, "The Helmontian-Galenist Controversy in Restoration England," Ambix 12 (1964): 1-23.

(9) On the relations between debates within seventeenth-century medicine and the emerging emphasis in the new philosophy on experience and matters of fact, see Harold Cook, "The New Philosophy and Medicine in Seventeenth-Century England," in Reappraisals of the Scientific Revolution (Cambridge U. Press, 1990), 397-436. See also Allen G. Debus, "Chemists, Physicians, and Changing Perspectives on the Scientific Revolution," Isis 89 (1998): 66-81.

(10) Noah Biggs, Mataeotechnia medicince praxews: The Vanity of the Craft of Physick (London, 1651), a2r. Subsequent references to Biggs appear parenthetically.

(11) Although in reality the divide was not as stark as the opponents claimed (several of the Helmontians had university degrees and Galenism never discounted the value of experience), the debate did get explicitly framed in terms of the relative value of "words" versus "works." The chemical physician George Thomson, for example, nonetheless defined an "accomplished physician" as one who learns primarily from "Pyrotechnical Trials, set upon with our own hands, often iterated, discreetly managed" rather than one who attends to "the gay outside of various Languages, Sophistical Disputations, [and] Histories of Antiquity" (Misochymias Elenchos: or, A Check Given to the Insolent Garrulity of Mr. Henry Stubbe [London, 1671]) 2. Stubbe, for his part, repeatedly accused Thomson of not being able to formulate a coherent syllogism (see, e.g., 28, 41).

(12) On the Galenic understanding of the embeddedness of human beings in the environment, see, for example, Timothy J. Reiss, Mirages of the Selfe: Patterns of Personhood in Ancient and Early Modern Europe (Stanford U. Press, 2003), chap. 8.

(13) Cook, "New Philosophy," 407. This paragraph's characterization of physic as it was taught in the English universities is drawn from Cook's article. The structure and content of university curricula changed gradually over the course of the early modern period, but medicine, theology, and law retained their status as the higher disciplines. For a socio-cultural analysis of changes in the curricula, see Peter Burke, A Social History of Knowledge, from Gutenberg to Diderot (Malden, MA: Polity Press, 2000), chap. 5.

(14) For details about the non-naturals and early modern dietetics more generally, see Heikki Mikkeli, Hygiene in the Early Modern Medical Tradition (Helsinki: Academia Scientiarum Fennica, 1999). An early modern formulation of dietetic regimen may be found in Eleazar Dunk, The Copy of a Letter written by E. D. Doctour of Physick to a Gentleman (London, 1606).

(15) Thomas Cogan, The Haven of Health (London, 1612), A4r.

(16) Highly individualized treatment based on humoral constitution and particular lifestyle was the theoretical ideal indicated by Galenic medicine. This does not mean, however, that medical practice actually accomplished such individuation. Even many medical texts identified diseases by aggregation of symptoms and advised treatments without specific regard to individual patient temperament and lifestyle. See Andrew Wear, Knowledge and Practice in English Medicine, 1550-1680 (Cambridge U. Press, 2000), 116-19.

(17) John Archer, Every Man His Own Doctor (London, 1673), Cr.

(18) Cogan, Haven, 176.

(19) Thomas Browne, Religio Medici, in Sir Thomas Browne: The Major Works, ed. C. A. Patrides (London: Penguin, 1977), 107.

(20) On Stubbe's critiques of the Royal Society, see Harold Whitmore Jones, "Mid-Seventeenth Century Science: Some Polemics," Osiris 9 (1950): 254-74; on Stubbe more generally and especially in regard to his republicanism, see James R. Jacob, Henry Stubbe, Radical Protestantism and the Early Enlightenment (Cambridge U. Press, 1983).

(21) Nicolas Culpeper, Two Treatises, the First of Bloodletting ... the Second of Cupping and Scarifying (London, 1663), 45.

(22) The Diary of the Lady Anne Clifford, cited in Wear, 408.

(23) Overall, phlebotomy worked to achieve any one of four goals: to reduce a plethora or excess of blood, to vent a boiling or inflammation of the humors (as was typical in fevers) or (particularly in pre- or non-Harveian versions) to force the humors to move from one part of the body to another if they had taken a wrong course (either because they had settled in some improper place or because they were violently surging toward an inappropriate part of the body). For a useful summary of phlebotomy's standard uses, see Simon Harward, Harward's Phlebotomy (London, 1601), 5-6. Given the Galenic ideal of somatic balance, plethora especially was considered dangerous, responsible for conditions as diverse as cancer and sterility; plethora was also perilous because excess humors could easily putrefy and then generate corrupting and noxious vapors. Fears of plethora continued long after Harvey's discovery of the circulation dampened concerns about the directional flow of the blood.

(24) Harward, Phlebotomy, A3r.

(25) Niebyl, "Venesection," 135.

(26) This not to say that generalizations were not possible. Precisely because of the material interconnectedness of bodies and environment, topography, geography, air, and climate were all aspects of what constituted temperament. It was therefore possible to identify national constitutions at least in broad terms and to make general evaluations of national differences. On this idea of "geohumoralism" and especially its exploitation in the drama of Shakespeare and other early modern English writers, see Mary Floyd-Wilson, English Ethnicity and Race in Early Modern Drama (Cambridge U. Press, 2003).

(27) Van Helmont's works were translated into English in Oriatrike: Oor, Physick Refined, trans. J[ohn] C[handler] (London, 1662), although his ideas, and some of his manuscripts circulated earlier. On van Helmont, see Walter Pagel, Joan Baptista van Helmont: Reformer of Science and Medicine (Cambridge U. Press, 1982), and A1len Debus, The Chemical Philosophy: Paracelsian Science and Medicine in the Sixteenth and Seventeenth Centuries (1977; rpt. Mineola: Dover, 2002), 295-345. On the transmission of Helmontian ideas in England, see Antonio Clericuzio, "From van Helmont to Boyle. A Study of the Transmission of Hehnontian Chemical Medical Theories in Seventeenth-Century England," The British Journal for the History of Science 26 (1993): 303-34. On Helmontian medicine, especially in England, see Wear, Knowledge and Practice, chaps. 8 and 9. On van Helmont's disease concept, see Walter Pagel, "Van Helmont's Concept of Disease--To Be or Not to Be? The Influence of Paracelsus," Bulletin of the History of Medicine 46 (1972): 419-454, and Pagel, Van Helmont, chap. 5.

(28) Van Helmont, Oriatrike, trans. Chandler, 484; quoted in Wear, Knowledge and Practice, 370.

(29) More specifically, disease was caused both by an external agent and by an internal response. In addition to Neibyl, "Venesection" and Pagel "Van Helmont's Concept," see, too, Peter Niebyl, "The Helmontian Thorn," Bulletin of the History of Medicine 45 (1971): 570-95.

(30) On van Helmont's concept of the Archeus and how it fits into his understanding of biology generally, see Pagel, Van Helmont, chap. 4.

(31) This ontologically-based model of disease was not new to the early modern period; its roots were ancient in origin, as were those of the Galenic model. What is new in this period is the troping, the way the disease model gets expressed.

(32) On Biggs, see A. G. Debus, "Paracelsian Medicine: Noah Biggs and the Problem of Medical Reform" in A. G. Debus, ed., Medicine in Seventeenth-Century England (U. of California Press, 1984), 33-48, and, more briefly, Clericuzio, "From van Helmont to Boyle."

(33) After Stubbe wrote a response in An Epistolary Discourse, George Thomson countered with several others, including Misochymias Elenchos: or, A Check Given to the Insolent Garrulity of Henry Stubbe (London, 1671), and A Letter Sent to Mr. H. Stubbe (London, 1672). Thomson wrote against others, too: Aimatiasis was directed against Thomas Willis's influential work on fevers, and particularly against Willis's advocacy of bloodletting as a remedy for them.

(34) On Thomson's work on splenectomies, see Charles Webster, "The Helmontian George Thomson and William Harvey: The Revival and Application of Splenectomy to Physiological Research," Medical History 15 (1971): 154-67.

(35) George Starkey, Helmont's Vindication: or, A Short and Sure Way to a Long life (London, 1657), b4 ivr.

(36) The charge that Galenists adhered to their brand of medicine mostly for the money was a frequent refrain. Starkey, 88, for example, accused Galenists of performing their work "with ease and idleness, and accompanied with riches, credit, esteem, and honour, their work is not attended with any pains, until they come to practice, and then that only consists in visits, which pains is the key to their wealth."

(37) Pagel, "Van Helmont's Concept," 422.

(38) Support of native-based cures was not new in the writings of the chemical physicians; even in the sixteenth century writers advocated native cures for native diseases, as, for example, did Timothie Bright in A Treatise: Wherein Is Declared the Sufficiencie of English Medicines, for Cure of All Diseases (London, 1580). The point here, though, is that the emphasis on nationalist medicine coheres with a more fully played out sense of the native--not only in herbal, plant-based remedies, but in disease models, therapeutic techniques and (I want to claim) in the idea of human being as a whole.

(39) This same trope even structures Biggs's treatment of the art of pyrotechny itself. Bad distillation methods yield a "strange, foreign nature and quality" of things rather than the true and "natural" essence of plants (118).

(40) Galeno-pale, 3; Starkey, Helmont's Vindication, b4 ivr.

(41) Thomson, Aimatiasis, 8. The Galenists counter to this argument was somewhat tricky since they, too, sought to abide by Scripture. Stubbe, for example, recognized the Scriptural assertion that "life is in the blood." He argued, though, that one cannot at all points read the Bible literally if one wants to catch its true intent. See Epistolary Discourse, 17.

(42) It is perhaps not surprising that Thomson considers chemical medicine, which purifies rather than depletes the blood, to hold promise for both individual and national health: the widespread adoption of chemical remedies, he foresees, would help "that exorbitancie in Religion and evil Manners" to be "sooner ... rectified" (Misochymias Elenchos, 43-44).

(43) See Wear, Knowledge and Practice, 406.

(44) By the eighteenth century, phlebotomy was once again considered, in the words of one advocate, "one of the most useful, effectual, and general Remedies in the whole Art of Physick, when rightly and judiciously made use of." R. Butler, An Essay Concerning Blood-letting (London, 1734), 32. For a discussion of the decline of bloodletting in the nineteenth century and a short-lived revival of the practice in the twentieth, see Guenter Risse, "The Renaissance of Bloodletting: A Chapter in Modern Therapeutics," Journal of the History of Medicine and Allied Sciences 34 (1979): 3-39.
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