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‘Old age is not an academic subject’ – thus the Italian legal philosopher and political scientist Norberto Bobbio, then eighty-five, began a brutally honest portrayal of his own experience of ageing. In this 1994 essay he speaks out vehemently against the rhetorical glorification of life’s final phase that has been common among scholars, especially under the influence of Cicero.1 There is no doubt that the personal experience of ageing on which Bobbio insists cannot be replaced by scholarly discourse. Nevertheless, universities have devoted a wide range of research and teaching to the topic, and their contribution to the discourse of ageing is such that modern society can no longer be imagined without it. Early Western universities also treated the subject of ageing. The study of Aristotle and Galen was of especial importance. What it indicates, paradigmatically, is
1. an almost exclusively theoretical approach based on the scholarly reading, discussion and organization of accumulated knowledge. In contrast, practical observation (experientia) possessed almost no independent heuristic significance, generally serving instead to confirm theory. Theories were developed 2. predominantly through the reception and adaptation of a canon of venerable writings endowed with the highest authority. Finally, the naturalist and philosopher Aristotle also represents 3. the starting point for the interdisciplinary academic study of old age, as he was an authority not only for medieval philosophy and theology, but also for the emerging university discipline of medicine.
The modern university, it is true, is still fundamentally characterized by the primacy of theory, the fruitful incorporation of available knowledge in teaching and research, and interdisciplinarity. Medicine, however, as an empirical life science, has distanced itself from these basic principles; instead, practical relevance, innovation in knowledge and skills, and progressive specialization are at a
Old Age and Disease in Early Modern Medicine
premium. These differences between early and modern universities are in themselves banal, but they must be recognized and seen as the reason for a central premise of this study: the foreign character of bygone scientific culture. These are essential but difficult presuppositions for the investigation of conceptions of old age in early modern medicine. Modern interests and questions, for example about progress and discoveries, or about the perspective of the patient or client (justly emphasized from today’s standpoint by Norberto Bobbio), are subordinate to these considerations. Ultimately, they can only be taken up secondarily – after an understanding has been reached of the basic theoretical principles that were so decisive for the worldview and self-expression of early modern Europe.
1. Methodological Considerations
These preliminary considerations also determine the methodological approach of the following study. Concepts of old age in early modern medicine can only be soundly comprehended by reconstructing a representative range of the concomitant processes of developing, portraying, and communicating theoretical knowledge. This requires of historians of medicine, and of readers as well, an arduous process of adaptation: whilst we are accustomed to the search for the novel and the spectacular as an intellectual norm of our time, now we must appreciate the repetition and variation of centuries-old traditional knowledge as science. The impartial and comprehensive analysis (to the extent such is possible) of extant text corpora might be much less spectacular than, say, the identification and verification of modern science’s theoretical foundations in a narrow selection of sources; still, such ideas’ representativeness for their time remains unclear, and out of context the sources can only be evaluated partially and in extracts. In contrast, the comprehensiveness aimed at in the study of a given body of texts yields quantitative evidence (e.g., how often certain hypotheses are made in comparison to others), and this affords above all a valid portrayal of ‘mainstream’ medical concepts of old age. The power of a study grounded in this way goes far beyond the desultory evaluation of works by certain more-orless famous contemporaries. In fact, it takes the next step, fitting the apparent peculiarities of these putatively ‘forward-looking’ individuals into the historical context under consideration. Ultimately, the object of a representative portrayal of medical conceptions also includes recognizing and singling out actual deviations from the norm; they arouse our interest, of course, on account of their progressiveness or curiosity, but they remain grounded in their historical context and can be characterized accordingly. In its search for broadly diffused medical views of old age, the present study thus considers a much larger range of written sources from the sphere of early modern medicine than ever before. In order to give the source-base a certain
unity, it has been limited for the most part to so-called normative specialist literature written by physicians. Other sources, considerably more fruitful from the point of view of social history, will have to be disregarded. Letters, tax lists or hospital records could complement traditional medical conceptions of old age with the essential counterparts of subjective experience and objective practical relevance, but they would go beyond the scope of this book. Thus, only a certain point of view surfaces in this study, that presented by the highly-stylized specialist literature of the medical profession. The formative influence that these theoretical conceptions had on the everyday life of the time, however, should not be underestimated. The decision to focus on the specialist literature of learned medicine brings its institutional context equally to the fore: the university, with its above-mentioned structures of treating and communicating knowledge. The university, however, will only become the setting for the presentation of knowledge in the second half of the period under consideration. Nevertheless, even before this time nearly all the authors treated here underwent a formative medical education. Our study must therefore pay particular attention to the typical academic structures of organizing knowledge that were mentioned at the outset: on the one hand the reception of traditional knowledge, medical and otherwise, about old age, on the other interdisciplinary integration with other areas of expertise. In this way it will be possible at the same time to do justice to the polyhistoric ideal of the period. Considerations on the quantitave foundation of concepts of old age and their place in the broader context of learned medicine have also determined the temporal span of this study: it is essentially identical with the period of the early modern university (from ca. 1300) until the French Revolution. Texts from before the era of printing will only play a marginal role, as only a few of them discretely treated the topic of old age and also made a noteworthy impact. The subsequent three centuries, despite dramatic conceptual and heuristic changes, are marked by a continuous intellectual tradition. Their intellectual foundation was the reception of antiquity, their common medium the lingua franca of learned Europe, Latin. Both come to an end around 1800, thus providing a terminus to the period of study. Limiting the study to a shorter span of time, and therefore to one historically much simpler to define, would be easy to justify; the quantitative distribution of the sources (see below), however, makes it unwise. Speaking against such a foreshortening is also the goal of the method we have adopted: to provide an overview of the medical discourse of old age, and to reconstruct the currents of reception for proto-geriatric medicine in the early modern period.
Old Age and Disease in Early Modern Medicine
2. Guiding Questions
A caveat has already been given against anachronistic hypotheses that on their face appear incongruent with the intellectual tradition of early modern specialist literature. Nevertheless, it would be inappropriate to approach early modern science in a theoretical vacuum. Indeed, our methodological considerations give rise to a number of interesting questions dealing with: 1. the sources analysed; 2. the concepts discussed, as well as their traditions, discontinuities, and development within the period under consideration; 3. underlying tendencies of the medical discourse of old age. 1. A whole range of formal questions relates to the sources under analysis and their place in the context of contemporary specialist literature. Here the questions tend to be of a philological nature: Who wrote about the topic of old age, when and why? What kind of form and content characterize the kinds of texts2 that deal specifically with this topic? Are there any related genres? For what audience were they (presumably) intended? Does the age or social status of the author, patron, or audience play a decisive role? How is the production of specialist literature distributed across the period of study? 2. Regarding content, the conceptions discussed must be investigated across the whole range of texts. What anatomical, physiological and pathological models of old age and ageing are discussed, and what ideas are developed for prevention and treatment? Does specialist medical literature also assimilate information on numerical, psychological and social ageing in its description of biological decline? What relationship do various concepts of old age bear to one another, to scientific theories about growth, involution and death, as well as to conceptions of illness? What is the meaning of contemporary innovations in medicine and science? What influence do older medical and non-medical sources exert over concepts of old age; what is the extent and the nature of their reception? What are the possibilities and limits of the interdisciplinary discussion of these concepts? 3. Finally, distinctive features of the medical discourse of old age can be sought after with regard to the theory of professions. Are there any indications of an early modern ‘proto-geriatrics’ or ‘gerontology’ (in the sense of a science of longevity), or of a ‘medicalization of old age’?3 Does the final period of life first become construed as a separate age on account of the normative power of medicine, and, conversely, are there any signs of a gradual deconstruction of this artefact? What moral judgment does the medical discourse of old age embody in comparison to social views of old age, and are the differences rooted in the nature of the medical profession?
These are only the most important questions arising from a source-based, reception-historical study of medical concepts of old age. Their investigation is the object of the individual chapters of this study. The most important findings will be presented in the Conclusion.
3. Selection of Sources
As explained in the section on methodological considerations, the range of sources is confined to normative texts of learned European medicine between 1500 and 1800. Within these limits, all available writings on old age were treated as objects of inquiry. Their investigation was facilitated with the help of bibliographical aids such as printed library and university catalogues4, several specialized bibliographies5 and electronic resources (OPACs). Admittedly, this research method brings with it the risk of systematic error in the geographical distribution of identified sources, since northern and central German libraries, as well as the Biblithèque nationale de France, have catalogued their old dissertation holdings more comprehensively than other repositories have.6 The search for sources yielded two main groups, namely (1) about 130 medical university texts (predominantly from the period between 1620 and 1800) and (2) about thirty proto-geriatric texts written without any direct connection to universities and pertaining predominantly to the dietetic tradition of Galenic gerocomies. In addition, a selection of (3) general medical writings and handbooks and (4) writings on longevity were considered, chosen on the basis of the range and relevance of their treatment of the topic of old age. The same criterion applies to theological, legal, philosophical and philological works, which were generally selected and investigated in relation to specific questions (see the following section).
4. Plan of the Study
A study that, for reasons of method, takes about three hundred years into its purview cannot be arranged solely according to thematic (e.g., medical) and conceptual criteria. And yet a chronological division into general historical ages (organized, e.g., by centuries or by political or cultural-historical events) would obscure the relevant changes that take place in the subject matter and in the history of science. Looking to the texts themselves, a chronological break appears in the early seventeenth century (1620-30). This period witnesses both the waning of a first wave of dietetic writings (the true gerocomies) and the beginning of proto-geriatric university texts. Thus the material can coherently be divided into two main sections with minimal chronological overlap: one devoted predominantly to gerocomies (Chapter 2), the other to university texts (Chapter 3). Both genres are investigated according to the traditional medical specialties
Old Age and Disease in Early Modern Medicine
5. The State of Research
of physiology, special pathology, dietetics and therapy; many of the texts themselves were arranged along these lines. General medical works are consulted for comparison in both chapters in order to determine the degree of specification found in proto-geriatric writings; medical texts on longevity are also discussed. Differentiating proto-geriatric texts from those on longevity is complicated by an overlap in subject matter that can at times be considerable; it is therefore necessary to undertake a combined analysis of formal and subject-specific characteristics as well as of differences in the way old age is evaluated. The central role played by the reception of ancient sources in early modern texts necessitates prefacing the two main sections with a third that assembles the relevant testimony from Greco-Roman, Islamic and medieval Latin medicine, (natural) philosophy, natural history and literature (Chapter 1). These three main sections provide a comprehensive overview of early modern proto-geriatrics as an academic culture of learning. They are complemented by a case study (Chapter 4) that, in light of additional texts some of which are in part unrelated to the field, investigates the source material for special peculiarities.7 Here the spotlight is on gender and a nearly forgotten sub-group of the elderly: old women.
Old age has long been the object of historical research, although different waves of scholarly interest can be observed in various fields of specialty. Of the numerous studies in the history of medicine, as well as those of a more general historical or philological nature, only the most important can be mentioned here. Research pertaining more strictly to the history of medicine began dealing with past medical concepts of old age relatively early8, parallel with the beginnings of modern geriatrics in the 1940s. The best scholarly study of old age and ageing is still that published in 1958 by the renowned historian of science Mirko D. Grmek, which takes a diachronic, systematic, and concept-oriented approach.9 Paul Lüth’s monograph on the history of geriatrics (1965) is the most extensive and still the most recent comprehensive account of medical perceptions of old age in the context of the general history of medicine and intellectual history. After Lüth, studies in the history of medicine focus only on specific time periods or particular topics.10 In summary, it can thus be said that research on old age in this field, despite achieving a relatively high standard early on, has to a large extent become antiquated both methodologically and factually (although specialized studies are an exception). Shortcomings are especially clear for the early modern period. The opposite is the case in various fields of general history, where the topic of old age was discovered rather late. One of the impulses was Simone de Beauvoir’s
voluminous 1970 study denouncing (for the first time) the repression of old age in modern society; it is a work of popular science written from an ethnological and historical perspective. In historical social research, a field developed by Philippe Ariès and Jacques Gélis, childhood and old age have been topics since 1960.11 Since then the number of studies on old age has continually increased, especially in the fields of historical discourse analysis and people’s history, and it is now nearly impossible to survey. Such studies occasionally address medical aspects of old age, although naturally without giving them closer consideration. Meanwhile cultural history (Kulturgeschichte) and the history of mentalities have produced numerous surveys.12 More comprehensive research in social history tends to focus on the nineteenth and twentieth centuries and only pays cursory attention to earlier ages;13 it was in this context, for example, that HansJoachim von Kondratowitz was one of the first to formulate the important thesis of the ‘medicalization of old age’ (1989). Research in early modern social history, in contrast, still generally takes the form of micro-studies on account of the kinds of sources it uses. This is also the case for the few studies touching on medical topics.14 The findings of historical demography are relevant for the subject as well.15 Finally, since the present essay is concerned with textual and reception history, certain studies from the realm of classical philology are also of importance.16 Regardless of its particular method, the following essay can thus clearly find support in available research for what pertains to the historical framework, the main features of medical concepts of old age, and the selection and interpretation of the most important proto-geriatric texts. Beyond these rudiments, however, the history of early modern geriatric medicine is a vast expanse of unknown texts and authors still requiring discovery, description and analysis.
6. Introduction to the Subject
In their scant instruction in the history of medicine, medical students learn that geriatrics was born in the early twentieth century and thus that it constitutes one of the more recent specialties in their future profession. This is fully correct in view of the naming17 of geriatrics and of its late professionalization; only in the 1940s did the discipline begin to develop with the founding of its own professional associations and journals and finally with its recognition as an area of specialty, including the denomination of its practitioners as geriatricians. Nevertheless, it will not be anachronistic to speak of ‘proto-geriatric’ literature of the early modern period, as the following essay repeatedly does. Specialist medical literature of this kind, namely monographic accounts of physiological, pathological, therapeutic, preventative and diagnostic issues regarding the elderly, did not begin with the largely still familiar works of Max Bürger, Marjory Warren,
Old Age and Disease in Early Modern Medicine
Ignaz Nascher or Jean Martin Charcot. On the contrary, it was already developing (under the rubrics just named) at the end of the fifteenth century, and certain aspects had formed a central element of medical literature for two thousand years before that. Despite its astonishing range and sophistication, this older specialist literature is barely known today even by experts in the field, not least because before the nineteenth century it was written almost exclusively in Latin – once the language of medicine but now little understood. The rediscovery of this literature is desirable for many reasons: medical historians would gain numerous new tesserae for filling in the mosaic of earlier medicine; the modern geriatrician, as well as the medical layman, could use the mirror of history to study current questions and problematic issues in the field, many of which are timeless; older approaches could then be compared to modern ones, thus spawning ideas for the future. This is especially the case for ethical questions, which abound in geriatrics. In addition to these professional issues, the general portrayal and valuation of old age are also of great interest. A few preliminary remarks on the early modern situation remain to be made. It may be assumed as known that the populations of early modern European societies were marked by an age distribution that differs drastically from that of today. From the sixteenth to the eighteenth centuries, a newborn had a nearly constant average life expectancy of only about thirty years. Yet this statistic hides the fact that individuals of that time could also grow old, especially if they lived beyond ten years of age, before which at least one-third of all children died. After that point, average life expectancy rose to nearly fifty years, which meant that quite a few people reached an age that even by today’s standards would be deemed old. Regional and temporal differences aside, less than 10 per cent of people lived beyond sixty18, and eighty- to ninety-year-olds were a downright rarity. The result of these circumstances, on the one hand, was that both the general population and physicians had a different notion (from us) of when old age began: despite different traditions and the lack of benchmarks for a social definition of old age (such as a fixed retirement age), fifty was the age most often named19; seventy rather than eighty was realistically considered the upper limit of life expectancy. Thus the early modern physician saw old people in today’s sense relatively seldom, and even in the eighteenth century he still had only little occasion to acquaint himself with their particular anatomy through the dissection of cadavers. On the other hand, the greater physical demands on large sections of the population, as well as deficient nutritional and living conditions, led to the earlier deterioration of certain organs (e.g., joints, teeth) and the accumulation of certain (e.g., rheumatic) ailments. In contrast, other illnesses that today are common in old age, such as malignant tumours and dementia, were for purely demographic reasons encountered much more rarely.20
Another peculiarity, finally, concerns the gender neutrality of old age. In line with the customs of the time, in which the male sex was considered the human norm, the texts almost exclusively use the term senex (old man). As an early modern substantive, senex is, of course, technically masculine, and it will thus be rendered as such in what follows, but in light of the context it must be regarded as pertaining to both sexes. Female terms (anilitas, anus, vetula) were only used for topics specific to women.21 A parallel to this terminological indifference can also be found, by the way, in the early modern assessment of elderly sex-life, although women are ascribed full asexuality even earlier than men. The fiction of gender neutrality is abandoned, however, when the alleged lustfulness of the elderly is discussed from a moral point of view, or their marriageability from a forensic one.22 This example arrestingly shows just how highly stylized early modern specialist literature was. This fiction, however, is ruptured time and again by reality, which otherwise remains hidden behind equally conventional counter-arguments. The selective use of such arguments highlights their instrumentalization; in addition, they provide important indirect evidence of the individual authors’ views. Ample variations of this phenomenon will appear in the following essay.
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