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Singapore Med J 2003 Vol 44(1) : 005-007 In Stamps

Medicine in Stamps Paracelsus (1493-1541): The Man Who Dared S Y Tan, MD, JD and M E Yeow, BM, BCh* Professor of Medicine Adjunct Professor of Law, University of Hawaii

* Dr Yeow is a medical graduate from Oxford, and an incoming internal medicine resident.

he first two thousand years of medical France, Paracelsus interrupted his studies to join history began with in 460 B.C., the army where he gained additional surgical and and ended with the Renaissance in the medical experience. Tth 16 century. Hippocrates and laid the ethical The Fiasco: The itinerant Paracelsus foundations for the profession, discarded curse as treated the sick wherever he went, but he also causation of disease, and proffered the rudiments managed to serve in various armies and work in the of physiology and therapeutics. But much of what mines. In , for example, he participated in was taught – and perpetuated – was erroneous, and the Peasant’s Revolt, where he sided with the it was not until the Renaissance, that European peasants. When the revolt was suppressed in 1527, period of revolutionary social, cultural, and Paracelsus was forced to move to . He intellectual ferment, that science-based medicine was then summoned to Basel by two well-placed began to take root. public figures, , a philosopher, and To bridge the transition from two millennia of Johannes Frobenius, a humanist printer. Frobenius doctrinaire medicine to a more open and questioning was about to have his foot amputated, and new world is to expose and repudiate Paracelsus was able to save the man deficiencies of ancient medical wisdom. from surgery, for which he was rewarded At the dawn of the 16th century, a with the appointment as Town Physician. heretic with the unlikely name of He had assumed this came with a Bombastus Paracelsus took on this professorship at the University, and perilous role. His single-minded therefore began lecturing to medical courage and brash confidence shook students and the public on his novel free the shackles of medicine’s rich concepts of medicine and his quarrels but oft-misguided Greek heritage, and with Galen. thereby earned him a place as one of At the time, the teachings of Galen medicine’s greatest heroes. still held sway and although postmortem The Early Years: Paracelsus was born Phillipus dissections were allowed, the results were doctored Aureolus Theophrastus Bombastus von Hohenheim to fit in with the anatomy that Galen taught. in 1493 in Einseideln, a small town near Zurich, Imagine the shock and controversy when Paracelsus Switzerland. He was the son of a physician, but was handed out the following flyer advertising his lectures: a weak child afflicted with rickets. His childhood “...we will deliver it (medicine) from the gross was an unhappy one. His mother, in a fit of errors. Not by following the teachings of the depression, committed suicide by jumping off ancients, but by our own observations of nature... a bridge. At age 14, Paracelsus left home and We all know too well that most doctors today make wandered from university to university to study grave errors... because they anxiously cling to the under famous teachers. In 1513, he came to , words of Hippocrates, Galen, , and others... Italy, where the Renaissance was in full swing. I explain publicly for two hours every day with When war broke out between Germany and great assiduity and for the greatest benefit of my 006 : 2003 Vol 44(1) Singapore Med J

audience books on practical and theoretical Treatment of syphilis was an example of his medicine... I have not copied out these books from approach. Columbus introduced the disease to Hippocrates or Galen, as others have done, but I Europe upon his return from the New World, and have created them by ceaseless efforts, based on my physicians employed guaiac preparations from trees own experience, which is the most authoritative found in the in the belief that “Indian” teacher of all. And if I prove anything, it will not wood would treat an “Indian” disease. Paracelsus be by quoting the authorities, but by experiments rejected this treatment, and instead recommended and reasoning... I do not believe in the teachings the use of small doses of mercury. In fact, mercury of complexions and humours of the ancients, remained the chosen anti-syphilitic treatment who erroneously use them to explain all diseases... until the 1940s, when clinical trials disproved its Basel 5 June 1527.” effectiveness, and the world ushered in the era of History records Paracelsus as having thrown antibiotics. medical texts by Galen and Avicenna into a bonfire, An early pioneer in the field of mental illness, and denounced them and their followers as Paracelsus refuted the notion that mental “misbegotten crew of approved asses.” His blunt disturbances were linked to demon possession. words offended the citizens of Basel, and his He recognised that mental illnesses can be forthrightness bred hostility among his peers at the hereditary, and that some patients were predisposed. University. Finally in 1528, after less than a year, He also understood the nature of psychosomatic he fled Basel following an apparent dispute over a disease. For such illnesses, Paracelsus said, defamation lawsuit. “Therefore you should apply treatment not as in His Contributions to Medicine: Underlying all ordinary disease, but you should treat the spirit. of Paracelsus’ teaching was a firm belief that For it is the spirit that here lies sick.” knowledge was the result of one’s observation of Among other important contributions was his nature and one’s experience in life. If something recognition that the inhalation of silicon dust can was unclear, then one had to devise an experiment cause silicosis. This observation probably was to prove or disprove a hypothesis. He believed that the result of his earlier experience working in “Medicine can only be learned from what which the the mines. Paracelsus also recognised the geographic eyes can see and the fingers touch... Practice should variations of certain diseases, and correctly not be based on speculative theory; theory should associated cretinism with endemic goiter. And he be derived from practice.” made one of the first attempts at artificial ventilation For 1500 years, medicine had been grounded by inserting bellows into the patient’s nostrils to inflate on Galen’s humoral theory, which held that the four his lungs. Unfortunately, the bellows were apparently fundamental bodily “humours” – phlegm, blood, occluded with cinders, and his resuscitation yellow bile, and black bile, corresponded to the four failed. However, his technique led to later refinement human types – phlegmatic, sanguine, choleric, and by John Hunter, the inventor of artificial mechanical melancholic. Any imbalance in the four “humours” ventilation. resulted in disease. Treatment to restore this balance Paracelsus himself wrote little during his consisted mainly of herbal concoctions called lifetime, but his adherents preserved much of his galenicals. Paracelsus, on the other hand, was teachings. He recognised that medicine was a special steeped in (“It is not the task of alchemists calling and “the art of medicine is rooted in the to make gold, but to prepare ”) and heart. If your heart is false, you will also be a false believed that the body was more like a chemical physician; if your heart is just, you will also be a laboratory. He roundly rejected Galen’s humoral true physician.” The unmarried Paracelsus is also theory, and attributed illness to chemical imbalances credited with saying, “Four things you should from within, to external causative agents such avoid are strong flavoured wines, rich food, anger as epidemics, or to heredity. He advocated replacing and women.” galenicals with metallic chemicals such as lead, A Man Before His Time? The irreverent antimony, and mercury that had hitherto been used clinician of the Renaissance began one of his writings in random doses with toxic effects. Paracelsus used with the statement, “I am different, let this not these substances in a more refined state, and in upset you.” He seemed to care little of how others smaller, more specific dose, with the caution that, viewed him, although he managed to respond in a “In all things there is a , and there is nothing 1537 article entitled, “Seven arguments, answering without a poison. It depends only upon the dose to several of the detractions of his envious critics.” whether a poison is poison or not...” Among other things, he explained his discoveries, Singapore Med J 2003 Vol 44(1) : 007

his prescriptions, and his odd manner and scornful among others, were the men who had the courage mien (“It is not the way in my country for men to to challenge established concepts and attitudes. achieve anything by spinning cocoons”). It is said that the human species rejects a new idea Paracelsus would probably have been better just as it rejects a foreign protein. Men of vision accepted had he been less theatrical and dogmatic. and courage through the ages have rarely found He firmly believed what he taught, and the acceptance among their contemporaries. Instead truth was not to be compromised. His almost they often faced rejection and vilification. In the megalomaniac character is reflected in his name, world of medicine, Paracelsus ranks as one of its Bombastus, the likely originator of the word foremost pariahs. Vacillating between episodes of “bombastic.” His other name, “Paracelsus” literally brilliance and drunkenness, he remained his entire means beyond, or superior to, Celsus, who was a life an unwanted wanderer without a home. On great medical writer in first century Rome. September 24, 1541, he died a pauper, from cirrhosis Arrogance, coupled with a volatile temper and of the liver and nephritis. Buried in a small chapel penchant for not mincing his words resulted in in Salzburg, Paracelsus had managed to survive all Paracelsus outstaying his welcome at most of of 48 years. the places he travelled to. To this day, history is uncertain whether to judge him instrumental REFERENCES in heralding the age of modern medicine, or whether Materials for this essay were excerpted or adapted he was just a lot of noise. As recently as the from the following sources: The Story of Medicine 400th anniversary of his death, the Royal College of by Victor Robinson, 1931; Paracelsus: Selected Medicine remained critical of the man: “It cannot Writings, by Jolande Jacobi, 1951; Sourcebook of be said that the abusive rantings of Paracelsus Medical History by Logan Clendening, 1942; contributed to the general progress of science and A by Lois Magner, 1992; medicine... For he was a rude, circuitous obscutantist, Feder G, Paradigm lost: A celebration of Paracelsus not a harbinger of light, knowledge and progress.” on his Quincentenary, Lancet 1993; 341:1396-7; But if courage is the first of all virtues, then De Vries A, Paracelsus: Sixteenth-century Physician- Paracelsus was the premier virtuous Renaissance Scientist-Philosopher, NY State J Med 1977; 77:790-8; man. The 15th and 16th centuries were still firmly Davies JE et al, Paracelsus and Mechanical rooted in the teachings of Hippocrates, Galen, Ventilation, Resuscitation 2000; 47:3-5; Bernoulli R, Avicenna and the other giants of medicine. A wind Paracelsus – Physician, Reformer, Philosopher, of change was coming, the Renaissance, and Scientist, Experientia 1994; 50:334-8; Davies A, Paracelsus, along with thought leaders of his day – Paracelsus: A Quincentennial Assessment, J R Columbus, , and Leonardo Da Vinci Soc Med 1993; 86:653-6.