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c h a p t e r t w e lv e Medical Consultations 12.1 Between Theory and Practice, Carnival and Lent Throughout this work we have seen that anatomical research was closely interwoven with medical practice: anatomists were routinely engaged with pathology and therapy in so many ways that often these areas of medicine cannot be disentangled. In this chapter we turn to medical practice from the perspective of an underestimated and understudied literary genre, medical consultations. A consultation is a letter usually written by renowned physicians in response to a request from patients, their relatives, or their attending physicians, known as a letter of referral. Patients tended to belong to urban elites, such as nobles or ecclesiastics. Consultations date back to thirteenth-century Bologna and probably originated from legal examples; they often involved a form of compensation and were more common in Italy. Compensation may not have always come in monetary form: the apostolic protonotary at Castrocaro, for example, promised to remember Morgagni at the holy altar. Unlike case histories, consultations often lacked information on the entire course of the disease and the outcome of the therapy; at times, however, consultations were not isolated documents but formed a series illustrating the course of the disease, while the outcome was later added to the manuscript with a brief annotation or a cross. Whereas case histories may be retrospectively colored by the outcome of the therapy, consultations were written while the outcome was not yet known and therefore retain a tentative nature. Most features remained constant over time, although variations occur depending on when and where they were composed and the personal style of the physician. Consultations followed obvious constraints: notably, they were written in absentia and responded to cases that had been at least partly conceptualized by the attending physician or the patient; therefore, they can legitimately be seen as a form of commentary or reflections on a text rather than nature. Despite such constraints, they provide valuable evidence and rare insights into the way of thinking of a physician and practical medicine, if not downright bedside practice.¹ 332 Anatomy, Pathology, and Therapy There are additional reasons why consultations are such important historical documents . Some historians have drawn a sharp and anachronistic distinction between anatomical research and medical practice in the seventeenth century: the former would be tied to the emergence of modern science, the latter would be a remnant of a bygone era. Bruno Basile, for example, argued that the nature of medical consultations , especially their being at a distance rather than based on a physical inspection of the patient, forced authors to rely on ancient methods. Basile then shifted his attack on medical practice as a whole, arguing that the Medici archiater Francesco Redi was an experimentalist and a Galilean as a naturalist, but he was pre-Galilean or even Aristotelian as a physician. More recently, others have dismissed in the same vein Malpighi’s remedies as resembling the potions of Macbeth’s witches.² It is easy to see how such thoughts may have originated, given that the seventeenth-century pharmacopœia on which Redi, Malpighi, and their colleagues relied included the use of human urine, ground human skull (used against mental disorders), spirit of human blood, viper’s meat, crab eyes, pulverized red coral, broths with frogs and tails of river crabs, hartshorn jelly, and the application of warm animal viscera. As Jack Pressman has powerfully reminded us in the case of lobotomy in recent times, however, the notion of therapeutic success has to be seen in a historically sensitive fashion.³ Despite all this, it is profoundly misleading to separate consultations and medical practice more broadly from anatomical investigations. Historians who dismiss Malpighi ’s or Redi’s medical practice implicitly compare it with modern remedies rather than those available at the time. It is implausible to see in Redi and Malpighi cases of “intellectual schizophrenia”—as implied by Basile—but when we notice similar forms of reasoning and remedies used in the eighteenth century by Giuseppe del Papa, Albertini, Morgagni, and many others, one realizes that it would be necessary to issue a similar charge against at least a long medical century. Many of the preparations recommended by Malpighi could still be found in the official pharmacopœia of 1770, such as the Antidotarium of the Bologna College of Physicians.⁴ Thus, medical practice, including medical consultations, is a powerful antidote against a double anachronism that makes the very same protagonists of seventeenth-century...


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