ARCHIBALD PITCAIRNE By L. JOLLEY, M.A. Librarian of the Royal College of Physicians of Edinburgh Archibald PlTCAIRNE occupies an ambiguous position in the history of medicine. Edinburgh and Leyden hold him in honour as one of the founders of their medical traditions. The rest of the world remembers him, if they remember him at all, merely as one of the more extreme exponents of the iatro-mechanical doctrines. Many of the histories 1 of medicine omit his name. Haeser devotes more space to him than any other historian but for Hseser Pitcairne is merely an outmoded and irrational theorist with a taste for useless and disgusting remedies. It is hard to see how such a man could have won an international reputation and have been remembered with pride and affection by succeeding generations. 3^952 is the tercentenary of Pitcairne's birth and an appropriate occasion to re-examine his achievements and try to reconcile the conflicting impressions of the man. The outline of Pitcairne's life is generally familiar. Born on Christmas day 1652, the son of a prominent Edinburgh merchant, he first planned to enter the church but like his great contemporary and rival, Sir Robert Sibbald, he was repelled by the barrenness and violence of late seventeenth century presbyterianism. After con- sidering the law he decided on medicine. He graduated M.D. at Rheims in 1680 and returned to Edinburgh to practice. He rapidly became one of the leading Edinburgh physicians and when the Royal College of Physicians received its Royal Charter on St Andrew's Day 1681 he was elected a Founder Fellow and became its second secretary. In 1692 the University of Leyden invited him to become Professor of Medicine. His stay there was brief and within twelve months he had returned to Edinburgh. The causes of his return are not altogether clear but pressure from the relatives of his second wife, Elizabeth Stevenson, certainly played a part. The rest of his life was marked by no external incidents of note and he died in 1713- Despite the fact that he spent the greater part of his life remote from the medical centres of the day Pitcairne was never isolated. He remained in con- stant touch with the great continental physicians and indeed an un- " friendly critic said of him that from the depths of Scotland he 2 attempted to reign over the whole of medicine." It was from his published works that Pitcairne drew the European reputation he enjoyed in his own day and an examination of these works must come first in an effort to see him again as his contem- A Sydney Watson Smith Lecture delivered in the hall of the Royal College of Physicians of Edinburgh, 18th December 1952. 40 L. JOLLEY poraries saw him. It must be admitted that these works contain no> distinctive original contribution to knowledge. It is true that Pitcairne, by a process of arithmetical calculations rather similar to those employed by Harvey himself, arrived at the conclusion that the circulation of the blood was completed by its passage through the minutest vessels of the body.3 His deduction of the existence of the capillaries had, however, been anticipated by Malpighi and Leeuwenhcek who worked on the sounder basis of microscopic observation. There is no reason to doubt the originality of Pitcairne's work but it cannot entitle him to even a modest place amongst those who are remembered because they made some essential addition to the understanding of the working of the human body. This is an admission which must be made but it remains true that Pitcairne clearly contributed something to the study of medicine which his contemporaries valued. His first printed work, A Solution of the Problem Concerning Inventions (1688), is a discussion of those passages in Hippocrates which were cited by Harvey's enemies to show that the circulation of the blood was no new discovery. In the seventeenth century a physician had still to be a master of Greek and Latin learning and Pitcairne, one of the most distinguished of Scots Latin poets, was not deficient in this. But the work is more than a display of classical knowledge. It is primarily a discussion of the principles of evidence and a plea for reason and demonstration against authority. Pitcairne constantly turns to the mathematicians for help in showing how conclusions should be drawn because the mathematicians have established a certain method of reasoning. The combination of well-knit argument and wide knowledge of the early medical writers proved irresistible, and by this little work Pitcairne finally disposed of the obscurantists who when no longer able to deny the circulation of the blood, maintained that the ancients knew all about it. The Solution of the Problem of Inventions first drew attention to Pitcairne. The Oration Proving the Profession of Physic Free from the Tyranny of anty Sect of Philosophers (1692), established his repu- tation with his contemporaries and the study of it still provides the best explanation of that reputation. It was delivered as the inaugural lecture in the chair of medicine at Leyden and won from the University authorities the unusual recognition of a doubling of the professor's stipend. In some histories of medicine the Oration is referred to as a manifesto of the iatro-mechanical school, but this it is not. Although the title suggests a theme completely remote from any modern interest, what Pitcairne is discussing is a subject of perennial importance? what are the problems the physician should attack and how should he go about them ? Pitcairne sets out to explain why medicine in 1692 has not made the advances which it could have been expected to make. The practical improvements which should have sprung from the great discovery of the circulation have not appeared. In the course of the century all the other sciences have made great advances, ARCHIBALD PITCAIRNE 41 " but After so great improvements in Botany and Anatomy and the appearance of a new Face of Things in so many other Arts we still find the old Standard of Physic prevail everywhere." There are two reasons for this. Physicians have asked the wrong questions and have not understood the scientific evaluation of evidence. A physician must confine himself to what will have practical consequences in curing diseases. Medicine has been entangled with metaphysics and the art " of physic is over-burdened with conjectures. Such Enquiries after Physical Causes as are generally proposed by the Philosophers are entirely useless and unnecessary to Physicians. For these are points which the Heads and Patrons of Sects have wrkngled about from the beginning of the World to our days and all to no purpose." A "Physical " " Cause which the philosophers seek after is that unknown something " in things from which they derive all its properties. The business of a physician is "to weigh and consider the Powers of Medicine and Diseases as far as they are discoverable by their Operations and to reduce them to Laws," not to seek after Physical Causes. He must " compare the observations that have been made by others, and continue to be made everywhere, upon Diseases and their Remedies, and without Regard to Opinions, which are nothing in Comparison to the certain Convictions of our Senses, to collect from what usually happens, what will, and what we are to do in that case." The physician must limit his objectives. He must also distinguish carefully between what he knows and what he conjectures. "It is unfair to assert anything for Truth either in the Theory or Practice of Physic which stands in such a degree of uncertainty as no man would willingly have the security of his Property to stand." The methods of the mathematicians and astronomers must be the methods of the " " physician. These do not trouble about a Romantick Hypothesis concerning the structure of the world but depend upon observations and deduce their laws from them. Astronomers are not worried by " " " Frivolous Disputes" whether or not Substantial Forms or " " Subtile Matter exist, but helped by a few Postulata work out the motions of the stars. Physicians must imitate them. They are not to assume things as certain which are doubtful. They are not to revive the old meaningless terms of the ancients in a new form but to cultivate " physic not under the disguise of such fictions but upon the trials of experience." Iatro-mechanical theories do peep through in many parts of the Oration but they are not its main theme and do not account for its reception. What Pitcairne presented to his audience was the prospect of a new and more rational approach to medicine which would be certain to produce startling results. The advances of the mechanical and mathe- matical sciences had already begun to transform the environment in which men lived. If medicine were only to discard the impertinent discussion of useless speculations and adopt the methods of the mathe- matical sciences then it in its turn would make a great leap forward. 42 L. JOLLEY It is easy to understand the enthusiasm of Pitcairne's audience. To them as to the writer of the introduction to the English translation of " his works He was one of the first who leaving the old conjectural Method of Physical Writers struck into a new and more solid way of Reasoning grounded upon observations and upon Mathematical " Principles," and who took it as his task to lay more certain and infallible Fundamentals of the most comprehensive Art the Mind of Man is capable of attaining." Medicine is the slowest and most disappointing of the sciences and certainty and infallibility still elude it.