Classical Sources
In a sense, medical tenets derived from Hippocrates, Galen, and Ibn Sina belonged to university curricula and were supposed to inform a student and enable him to become a doctor. Establishing what is known about the reputation of classical authority in the Scientific Revolution helps us delineate what interpretative method Santorio used in understanding and explaining the corpuscular nature of the world, human bodies included. Before Andreas Vesalius’s De corporis humani fabrica (1543), descriptions and qualities prevailed in medical education.
The use of ancient sources had been common practice for medical education. For instance, one of the first medical textbooks to be circulated widely through printing, Fasciculus medicinae, collected physicians’ sources for classroom use as a compendium.
Specific qualities were important to delineate for Santorio, too; thus, perspiratio insensibilis would vary based on seasons, age, diseases, diet, and non-naturals (Ars de statica medicina I, VII). Designing one’s diet while considering later advantages, or damage, was a concept derived from Epicurus himself.
Santorio was instrumental in modernizing medicine. He acknowledged so in the Preface: no one in medicine had achieved a precise quantification of perspiration and its variations (III, LXXI; III, LXXVI; IV, XXIX; in Santorio's words,“Novum atque inauditum est in medicina posse quempiam ad exactam perspirationis insensibilis ponderationem pervenire: nec quispiam Philosophorum, nec Medicorum unquam hanc medicae facultatis particulam aggredi ausus est”). Therefore, if Santorio opened the path to quantitative medicine, his consistent use of written ancient sources is fundamental in his definition of a new medical practice.
In fact, educational issues were also a matter of concern for Santorio, as well as for the Medical School of Padua at that time, especially in the case of nutrition and digestion. Historical retrospections are not only an important part in Santorio’s medical training, but also an inspiration to using his collection of medical records in the light of important classical and Hellenistic texts, which were appreciated in the 1600s for their embodiment of early corpuscular theory. The second aphorism in the first book claims that a doctor ignoring what benefits a person, which means ignoring perspiratio insensibilis, is deceiving his patients (Aphorism I, II; compare to Lucretius III, 474-75 “Et quoniam mentem sanari corpus ut aegrum/ cernimus et flecti medicina posse videmus.” Lucretius VI, 1178-79 “. . . defessa iacebant/ corpora. mussabat tacito medicina timore”). Epicurean inspirations resonate in the foundation of Santorio’s medical method:
. . . we do not choose every pleasure. Instead, we pass up many pleasures when we will gain more of what we need from doing so. And we consider many pains to be better than pleasures, if we experience a greater pleasure for a long time from having endured those pains. So every pleasure is a good thing because its nature is favorable to us, yet not every pleasure is to be chosen — just as every pain is a bad thing, yet not every pain is always to be shunned.
It is proper to make all these decisions through measuring things side by side and looking at both the advantages and disadvantages, for sometimes we treat a good thing as bad and a bad thing as good (Epicurus, Letter to Menoikos).
Emotions could alter one’s bodily functions, too, still along the lines of the principle of contraria contrariis curantur (VII, XII: “passio enim animi non medicinis, sed alia passione contraria superatur”). The Salerno school is quoted directly only once, regarding wine drinking (III, LXXVIII). Aphorisms and discussions became part of those medical certainties which relied on observation, quality, and a physics of fluids explained through the theory of humors. While it is often assumed that Santorio started an innovative medical method and practice along the line of the seventeenth-century Scientific Revolution in Italy, classical texts remained an authoritative presence in the shaping of his early modern medical education, as well as in his teaching practice at Padua University. Therefore, if Santorio opened the path to quantitative medicine, his consistent use of written ancient sources is fundamental in his definition of a new medical practice. Quantities, in fact, are a frequent presence in Santorio’s aphorisms (I, VI; I, LVI; I, LVIII; I, LIX; I, LXXII; III, I; III, IV; III, V; III, VIII; III, IX; III, X; III, XXXV; III, LXVIII; III, LXIX).
A Roman doctor, Celsus, had also devoted attention to diet, fasting, and selection of foods because a Greek doctor, Asclepiades, had so established (De medicina III, 4 “Asclepiades ubi aegrum triduo per omnia fatigarat, quartum diem cibum destinabat;” on foods that limit nausea and stimulate appetite, see Celsus III, 6, 11). Pliny also described Asclepiades’s practices; in an encyclopaedic manner, the Latin writer gave a list of five basic tenets for good health: fasting, wine, massage, walking, and traveling for mental distractions (Pliny, Naturalis Historia XXVI, 13: “quinque res maxume communium auxiliorum professus, abstinentiam cibi, alias vini, fricationem corporis, ambulationem, gestationes, quae cum unusquisque semet ipsum sibi praestare posse intellegeret, faventibus cunctis, ut essent vera quae facillima erant, universum prope humanum genus circumegit in se non alio modo quam si caelo demissus advenisset”). This list found immense favor and would stick around in physicians’ practice for long time, because it was easy and pleasing at the same time (Physician Sassonia also commented on Asclepiades’s mild, pleasant remedies in De phoenigmis (p. 5): “Asclepiadem . . . qui primus veterem medicinam immutauit, & cruciatus omnes detrahere voluit, ac blandimenta varia, lectos inquam pensiles, balnea, frigidae potum, atque alia id genus ad aegrotantium demulcendos animos excogitauit”).
Definition of quantities is a recurring line for Santorio’s observation, including the lack of nutrition during fasting (IV, XX), sexual activity (III, LXXIX; III, LXXXII), differences in perspiratio insensibilis caused by sexual intercourse (VI, II), but also sleep (IV, I; IV, II; IV, XII; IV, XXVIII; IV, IV; IV, LIV), restless sleep (IV, V), the difference between sleep and wake (IV, XVIII; IV, XIX), a ratio in sleep (IV, VII) and a ratio in wake (IV, LVI), and naps (IV, XXXI; IV, XXXVII). Observations in patients’ diet allow for generalization: one can maintain health by maintaining a regular weight (I, LXIX), since a range of healthy weight does, indeed, exist (“quod vero detur minus, et maius salubre pondus,” III, XXXIII). (For the concept of metabolism, see Harris, D. F. “The Date of the Introduction of the Term Metabolic.” Nature 98: 389-90 (1917))
Classical books justified a certain criticism towards doctors’ practices, namely the lack of discipline and regulation in terms of nutrition, which Santorio worked extensively to solve, finding inspiration in Pliny the Elder’s Naturalis Historia (Book 29; Pliny’s bias and records on Asclepiades, Bianchini V-VI, VIII, IX, passage from Cato’s condemnation of medicine, XII, XIV-XV, rhetoric). Santorio’s medical criticism is targeted against those practitioners who take care of purgation, without considering perspiratio insensibilis (I, LXI; in the case of royal patients, III, LXXV), or those who do not recommend isolation during plagues (I, CXXXVIII). Santorio stepped into this educational asset by reinforcing criteria for legitimacy and avowal. Since textual approval allowed theories to gain credibility and be passed along as an authoritative text, Santorio’s reference to Galenic principles allowed to re-introduce Epicurean and Lucretian theories of matter. As a matter of fact, aphorisms in his Ars de statica medicina are instrumental in framing Santorio’s theory of perspiratio insensibilis. Medical knowledge determines the best time for eating, based on a recurrent, regular weight verification. Even though it is easy enough to check that with instruments, such as scales, Santorio points out that only Apollo, a god associated with medicine and divination, would know that without scales (“Tunc erit cibandi tempus, quando corpus reducetur ad illud pondus, salubre tamen, quo fruebatur Paulo antequam hesterno die ingessisset cibum: istud solus Apollo sine trutina sciet,” III, LXXVII). Digestion is fundamental for good health, since there exists a correspondence (“sympathia”) between stomach and brain (IV, XL: “Nulla causa saepius somnum interturbat, quam ciborum corruptela: id efficit quae est inter stomachum et cerebrum sympathia”).
Introducing new perspectives and, consequently, new medical practices related to digestion and metabolism was not an easy task for Santorio. Scientific perspectives allowed him a clearest access to measurements, thus encouraging distinct attitudes towards weight, absorption, bodily waste, and perspiratio insensibilis by comparing theories of Celsus and Asclepiades and their interpretation, as found, for instance, in Prospero Alpini’s De medicina methodica (Book II, particularly cap. 2 and 6). Celsus also concentrated on dietetics, pharmaceutics, and digestion (“concoctio”) in his Prooemium (Prooemium 9, 20-21) Santorio also discussed Celsus’s statements critically, once disagreeing with the scarce, or excessive use of the six non-naturals (aphorism III, XLII). Celsus himself resorted to an aphoristic statement in order to describe Asclepiades’s method (“Asclepiades officium esse medici dicit, ut tuto, ut celeriter, ut iucunde curet. Id votum est, sed fere periculosa esse nimia et festinatio et voluptas solet,” III, 4). It was, again, a merit of Asclepiades to concentrate on digestion for healing (Celsus III, 4: “Asclepiades medicamenta sustulit; alvum non totiens sed fere tamen in omni morbo eius uti professus est”).
Another scientist, also a Padua resident, was exploring the scientific method in those years: Galileo Galilei. Galileo and Santorio sent letters to each other; Galileo also knew about Santorio’s work from correspondents: Gualdo described Santorio as a new lecturer at Padua University and Sagredo discussed the thermoscope (Gualdo wrote from Padua on November 11, 1611 (“il medico Santorio, che stava in Venetia,” in Opere di Galileo, Volume XI, 230-31). In Sagredo’s words in a letter from Venice on June 30, 1612, “Il S.r Mula… mi riferì haver veduto uno stromento dal S.r Santorio, col quale se misurava il fredo et il caldo col compasso, et finalmente mi communicò questo essere una gran bozza di vetro con un colo lungo, onde subito me sono dato a fabricarne de molto esquisiti et belli” (Opere di Galileo, Volume XI, 349-51). For further discussion on the thermoscope and intellectual priority, the instrument deriving from Santorio’s or Galileo’s idea, see Bigotti 31-33).
The importance of quantifying medical descriptions emerges from Santorio’s letter accompanying his newly published book to Galileo Galilei:
L’opera è ridotta in afforismi, i quali nascono da due principii certissimi. Il primo è la diffinition della medicina, proposta da Hippocrate nel libro De flatibus, dove dice: Medicina est additio et ablatio; additio eorum quae deficiunt, et ablatio eorum quae excedunt. Il secondo principio di quest’arte è l’esperienza, la quale è prova del resto. Che quest’arte, da me inventata, veramente sii importantissima, è cosa chiara, perchè può distintamente mesurar l’insensibile transpiratione, che, alterata o impedita, secondo l’opinion d’Hippocrate et Galeno, è origine quasi de tutti i mali . . . lei sola, come dice il nostro quarto afforismo della prima settione, è maggiore de tutti gli escrementi sensibili insieme del nostro corpo (letter from Venice, February 9, 1615; Opere di Galileo, Volume XII, 140-42).
Once interpreting data, i.e. numbers attached to specific qualities, through a medical lens, there emerged importance of units and comparisons between a healthy and sickly condition, and phases of them. In particular, changes between recorded weights mattered in Santorio’s reflection (I, LXXIII; I, LXXXI; II, XXIII; II, XLI; II, LII; III, XXXVII). Santorio started an innovative medical method and practice along the line of the seventeenth-century Scientific Revolution in Italy; at the same time, classical texts were an authoritative presence in the shaping of early modern medical education. Thus, Santorio’s medical education built on classical and Hellenistic texts and historical retrospections such as Alpini’s cultural mediation, in addition to empirical case studies that embodied an early corpuscular theory.
Roman writer Lucretius had described nature as matter, where void is absent; even incorporeal-looking things, such as steam and light, are made of corpuscles that exist both individually and as conglomerates (De rerum natura II, 150-56 “vapor . . . lumenque serenum . . . non per inane meat vacuum . . . nec singillatim corpuscula quaeque vaporis/ sed complexa meant inter se conque globata;” Lucretius IV 199-201 “Praeterea si quae penitus corpuscula rerum/ ex altoque foras mittuntur, solis uti lux/ ac vapor, haec puncto cernuntur lapsa diei;” Lucretius VI, 1063-64 “interutrasque igitur ferri natura locata/ aeris ubi accepit quaedam corpuscula, tum fit”). As a matter of fact, perspiratio insensibilis looks like steam in a body, based on some of Santorio’s descriptions. When comparing measurings, Santorio considers perspiratio insensibilis and all other excretions (I, IV), day-to-day differences in weight (I, XVI), effects of a less efficient perspiratio insensibilis (I, LX); the combined effect of perspiratio insensibilis and humors (I, LXV); changes in perspiratio insensibilis after eating pork or mushrooms (III, XXIV) or watermelons (III, XXV), as well as density differences between liquid and solid foods (III, LXIV).
