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Journal of the History of Medicine and Allied Sciences 58.2 (2003) 230-231



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Ian Maclean. Logic, Signs and Nature in the Renaissance: The Case of Learned Medicine. New York, New York, Cambridge University Press, 2002. xvi, 413 pp., illus. $70.00.

What did it mean to think like a doctor in Renaissance Europe? This is the question Ian Maclean sets out to answer in his fascinating and meticulously researched new study. The answer, he argues, is to be found not simply in the content of medical thought but in its underlying structure, a structure based on the trivium and quadrivium of the undergraduate arts course. Prior to studying Galen, Hippocrates and Avicenna, an aspiring doctor had thoroughly imbibed Aristotelian logic and natural philosophy. The ways of assessing evidence and arriving at logical conclusions as well as categories for organizing knowledge learned in the arts course were taken up in the medical school curriculum, shaping the way learned doctors viewed their patients, their work and their world.

Like medicine, the higher faculties of law and theology were grounded in the trivium and quadrivium. However, Maclean shows that the lessons of the arts course were taken up in medical school curricula and by medical writers in unique ways. In particular, although learned physicians liked to claim for their field the same rigor and certainty that characterized Aristotelian logic, in reality categories, definitions, logical processes and notions of causality were adopted in looser and less rigorous ways by medical authors and teachers. Maclean describes this process of appropriation and adaptation most fully in the case of the doctrine of signs. “Signs” had a particular meaning and place in syllogistic logic. As he read his Aristotle in the arts course, a student would learn that smoke was a sign of fire. But when he began studying the branch of medicine known as semiotic or semiology, he would soon discover that for a doctor, no sign was this clear and certain. Instead, the signs a physician used to make a diagnosis—such as pain or pallor—were always inherently ambiguous to a greater or lesser degree. One sign could be an indication of two or more diseases or could mean different things depending on the stage of the disease in which it manifested itself. While a philosopher could say with certainty, “if smoke, then fire,” a physician never could say with the same degree of certainty, “if the patient has a pain in the right side, then he has pleurisy.” Instead, in order to arrive at a diagnosis, the physician typically had to rely on syndromes, or groups, of signs. In the case of pleurisy, there was a syndrome of four signs: coughing, fever, difficulty breathing, and pain on the right side. But because each of these four signs taken individually was uncertain (any one of them could [End Page 230] be a sign of numerous diseases), the combined argument, “if coughing, fever, difficulty breathing and pain in the right side, then pleurisy,” was still less rigorous and certain logically than the statement, “if smoke, then fire.” While the doctrine of signs learned in the arts course had to be adapted to meet the exigencies of medical practice, it did provide an indispensable way of organizing and making sense out of the seemingly infinite variety of signs a physician might encounter in his day-to-day work.

Although physicians used the logical processes and categories of the arts course in a looser, less rigorous way than they initially had been taught, they nonetheless emphasized in their writing and to their students that medicine was based firmly on Aristotelian logic and physics. This claim allowed learned physicians to distinguish themselves from unlearned empirics. It also gave them grounds to assert that medicine was a “science” and that physicians, like lawyers and theologians, were practitioners of a liberal art.

Maclean’s erudite and finely textured account of learned medicine is bracketed by two larger historical categories, the Renaissance and the Scientific Revolution. Both of these...

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