Bullitt History of Medicine Society

11

Bullitt History of Medicine Society

February 13, 2002

Watson A. Bowes Jr., M.D.

What Can We Learn from Sir Thomas Browne?

As a freshman medical student I read Harvey Cushing's biography of Sir William Osler and learned that the second book purchased by Osler was an 1862 edition of Religio Medici (The Religion of a Doctor) by Sir Thomas Browne. This same volume was with Osler throughout his life and rested on his coffin along with a single sheath of lilies at his funeral. (Cushing II, p 686). This initiated my interest in Sir Thomas Browne, whom I vaguely recalled as the author of one or two examples of 17th century prose in my English Literature textbook in college.

Osler was introduced to Sir Thomas Browne by the Rev. William Arthur Johnson, an Anglican clergyman, who was the founder and Warden of Trinity College School, a prep school for Trinity University in Toronto. Osler enrolled at Trinity College at age 16 intending to study for the clergy, following in his father's footsteps. While at Trinity he was captivated by Johnson's avocation as a naturalist and his encouragement of the students in observations and experiments with nature. Johnson and his wife often entertained the students at the parsonage where Johnson would frequently read aloud passages of Religio Medici. While in his second year at Trinity College School at age 17, Osler purchased his second book, the 1862 edition of Religio Medici at W. C. Chitwell's bookstore in Toronto. Slide: Religio Medici, 1862 edition. Cushing wrote that only the Bible did Osler know more nearly by heart than Religio Medic. (Cushing I, p 51) Inspired by Johnson's interest as a naturalist and his love of Sir Thomas Browne's prose and philosophy, Osler changed his career goal and, after leaving Trinity College, enrolled in the medical school at McGill University.

Twenty-nine years later, in an address to medical students and faculty at McGill, Osler recalled the important influence of Religio Medici in his life:

”…no book has had so enduring an influence on my life. I was introduced to it by my first teacher, the Rev. W. A. Johnson, Warden and Founder of the Trinity College School, and I can recall the delight with which I first read its quaint and charming pages. It was one of the strong influences which turned my thoughts towards medicine as a profession, and my most treasured copy - the second book I ever bought - has been a constant companion for thirty-one years..."

Browne's Education

Sir Thomas Browne, the third of four children, was born in 1605 in London. His father, a cloth merchant, died when Thomas was 8 years old, and his mother soon remarried. The record is mixed about whether Thomas's stepfather misappropriated the children's inheritance, but there is no question that Browne was provided the best of education and maintained a good relationship with his stepfather. From age 11 to 17, Browne attended Winchester School, one of the finest in the England at the time. At age 18 he matriculated at Broadgates Hall, Oxford, which during his time became Pembroke College. A measure of Browne's academic achievement was that he was selected to give the student oration at the inauguration ceremony for the new college. (Finch, p 42-53)

Although Browne achieved an impressive classic education at Winchester and Oxford, the latter was no place to obtain training in Medicine. William Harvey's description of the circulation of the blood (De Motu Cordis) published in 1628 was not mentioned in the Oxford medical curriculum 20 years later and students learned the texts Hippocrates and Galen. Dr. Thomas Sydenham (1624-1689), one of the leading physicians of the time, said, "One had as good send a man to Oxford to learn shoemaking as practicing physic." (Severn) Consequently, after a year of brief apprenticeship with one or more practitioners in or near Oxford and a trip to Ireland with his stepfather, Browne went to Europe to continue his medical education. He was there from 1630 to 1633 spending approximately one year each at the University of Montpellier in the south of France, the University of Padua in Italy, and the University of Leiden in Holland. (Hughes) These were the acknowledged centers of excellence in medical education. Montpellier was in its waning years of importance. Also medical education there was affected by the common belief that dissection of the human body was sinful. At Monpellier only one autopsy was performed each year. The University of Padua, where William Harvey obtained his medical degree in 1602, was the most celebrated medical school at that time. Leiden was ascending in reputation when Browne matriculated and obtained an MD on December 21, 1633 after defending his thesis, the title and subject of which have not survived. The medical education at Leiden placed a much greater emphasis on clinical teaching than at other medical schools in Europe. (Sugarman)

When Browne was pursuing his medical studies abroad, Europe was in the midst of the Thirty-Years War and bubonic plague. Ten years before Browne arrived in Montpellier, the city, which was largely Huguenot (Protestant) was laid waste by the army of Louis XIII and Cardinal Richelieu. In 1629, the year before Browne’s presence there, the plague infected the population and 2000 deaths occurred. Scarcely a year before Browne went to Padua a third of the population of the region had died of the bubonic plague.

His education at Winchester, Oxford, and the several European universities had served him well. He had read widely and was fluent in Greek, Latin, English, French, Italian, and Dutch and could read Hebrew, German and Spanish as well. He was a keen observer, interested in any almost any subject that crossed his intellect and was deeply concerned about the most vexing philosophical and theological issues of his day. Perhaps the most surprising thing about his life is how little some of the most “important” events seemed to be of concern to him: the civil war in England, the thirty years war in Europe, and the plague in Europe and England. These events were seldom mentioned at any length in his published work or his correspondence

Upon returning from his medical studies in Europe, Browne was obliged to practice under the supervision of a well-established doctor before being licensed to practice medicine. Where this preceptorship occurred is not entirely certain, and the name of Browne’s preceptor is unknown. There is nothing in Browne’s own writing that identifies where he was during these years. A number of accounts of Browne’s life assumed that he was living and practicing near Halifax in Yorkshire; but one of the most conscientious Browne scholars, Frank Livingstone Huntley (University of Michigan) summarized the evidence as pointing to Browne’s have been somewhere Oxfordshire (Huntley pp. 90-98). Whatever the case, the importance of these four years is that it was during this time that Browne, before the age of 30, wrote Religio Medici, the book that was to earn him a secure place in literary if not in medical history.

Lesson: If you believe that the events of your life will be of any interest to posterity, and you are concerned about the record being accurate, write the facts down in some form while you still have the wit and energy to do so.

Browne’s medical practice and family

In 1637 at age 32, having completed his apprenticeship, or his residency as it might be regarded today, Browne received the Oxford degree of MD and became a licensed physician. The same year, upon the urging of friends from his Oxford days, he moved to Norwich, where he resided and practice until his death in 1862 at age 77. In 1641, at age 36, Browne married 20-year-old Dorothy Mileham. Browne’s good friend and earliest biography, the Rev. John Whitefoot, commenting upon the match said:

“Mrs. Browne was ‘a lady of such symmetrical proportion to her worthy husband, both in the graces of her body and mind, that they seemed to come together by a kind of natural magnetism.’” (Gosse p. 24)

Browne's decision to marry is often viewed in the light of his comments in Religio Medici about marriage:

"I was never yet once, and commend their resolutions who never marry twice, not that I disallow of second marriage;… I could be content that we might procreate like trees, without conjunction, or that there were any way to perpetuate the world without this triviall and vulgar way of coition; It is the foolishest act a wise man commits in all his life, nor is there any thing that will more deject his coold imagination, when hee shall consider what an odde and unworthy piece of folly hee hath committed…." (II, 9)

Nothing is known of Browne' s courtship of Dorothy Mileham or whether she was aware of what Browne had written about marriage in Religio Medici. If she was aware of it, she must have found it humorous that he so willingly joined with her in "this triviall and vulgar way of coition" to produce 12 children.

Lesson: Love trumps the best intentions. Or as Pascal wrote: "The heart has its reasons of which the reason knows nothing…" (Pensées #477)

Of the Browne's twelve children, including twins who died in infancy, only four, a son and three daughters, survived their mother and father. It is clear, from the correspondence of Thomas and Dorothy Browne to each other and to their children as well as from recollections of family friends, that theirs was a loving and devoted family characterized by deep mutual respect. Dorothy Browne must also have been a patient and devoted wife, having indulged her husband in his huge collection of books and specimens that were stored throughout their home in Norwich. Through his correspondence and other documents, we know that Browne was a successful, busy, and humble practitioner, a respected authority in the community and a generous philanthropist to church and educational and civic institutions.

Brown was an omnivorous reader, and his library contained most of the important medical tests of his time including De Motu Cordis, which was published in 1628. It is clear that he was conscientious about his own life-long professional education. Characteristic of the state of knowledge about disease and therapeutics in the 17 century, the treatments Browne prescribed were intended primarily for the relief of symptoms rather than to cure disease,. In a very interesting letter of consultation, written entirely in Latin, Browne offered advice to another physician about a patient with a perplexing condition of edema, leg ulcers and a rash. Browne called the condition “scorbutic miasma” and recommended treatment that included 41 medications, all of which were in the official pharmacopoeia of his day, but none of which would be used to day to treat any condition or even be recognized by medical students in their course in Pharmacology. Browne’s extensive correspondence with his son, Edward, also a physician, shows that Browne was familiar with a wide range of geriatric, pediatric, obstetric, and gynecologic conditions. Among his interests were disorders of the mind. In an in-depth analysis of Browne’s writings, Dr. Jerome Schneck, a psychiatrist in New York, found that Browne's insight about psychiatric illness was considerably ahead of his time. As some evidence of his esteem as a physician, Browne was elected a Fellow of the Royal College of Physicians in 1664.

In 1671, at age 66 Browne was knighted by King Charles the II. The record shows that the King had intended to bestow the honor on the Mayor of the city, who declined, and Browne was proposed as a substitute. (Patrides. Above Atlas p 21). Although Samuel Johnson believed that the honor was given to Browne for his literary celebrity, it is more likely that it was for his loyalty to the crown during the civil war. Browne was one of 432 prominent citizens of Norwich who in 1643 refused to subscribe to a fund to assist Parliament, led by Cromwell, in its war against King Charles I.

One of the more controversial aspects of Sir Thomas Browne's life and character involve his participation as an expert witness in the trial of Amy Duny and Rose Cullender, two women accused of bewitching children. On March 10, 1664, the women were found guilty and hanged. Browne’s role in this sad event has been variously characterized as, on the one hand, an example of his narrow-minded acceptance of erroneous religious superstitions, and on the other hand, entirely in keeping with the prevailing attitudes about witchcraft in his time. Of interest, this event in Browne’s life was not mentioned in the short biography of his life by Samuel Johnson, written some 70 years after Browne's death, suggesting that Johnson assumed that this matter did not reflect either for good or ill on Browne's character.

There is considerable disagreement among scholars about the nature and influence of Browne’s testimony. The only extant description of the events (in William Cobbett's State Trials) states that Browne testified not only on the subject of bewitchment but also that he was clearly of the opinion that the women were bewitched.(Bennett, pp. 11-17) Browne’s belief in witchcraft and witches was stated in Religio Medici:

“For mine owne part, I have ever beleeved, and do now know, that there are Witches: they that doubt of these, do not onely deny them, but Spirits; and are obliquely and upon consequence a sort not of Infidels, but Atheists” (I, 30)

Belief in witchcraft was common in the17th century as evidence well respected scientists who shared this belief: Robert Boyle, Francis Bacon, and William Harvey among others. It is true that in the latter years of Browne’s life, opinion about existence of witchcraft was beginning to change. Nevertheless, between 1660 and 1718 there were thirteen books published asserting the existence of witches, and a review of the Transactions of the Royal Society up through 1678 found no repudiation of belief in witchcraft. (Bennett, p 11). It was not until well into the next century that belief in witchcraft no longer prevailed. But even then, 100 years after Browne lived, John Wesley maintained to the end of his life that to give up witchcraft was to give up the Bible. (Knott)