Chapter 1
Between Medicine and Rhetoric
Stephen Pender
To physician, idĂ©ologue, and reformer Pierre-Jean-Georges Cabanis, writing in 1788, medicine was the âbasis of the only good rational philosophy.â1 Medicine, Cabanis argues, comprehends the âorganic statesâ (Ă©tats organiques) and âphysical sensibilitiesâ (sensibilitĂ©s physiques) essential to intellection and emotion, action and reaction. That the intellect and the passions hold sway over the body is âan incontestable general factâ (un fait gĂ©Ă©ral incontestable); so too do physical processes condition moral operations.2 Cabanisâ âphysiological monism,â his assertion that âthe moral is only the physical considered under certain more particular points of view,â is central to his and othersâ efforts to establish a secure, material foundation for moral philosophy in the late eighteenth and early nineteenth centuries.3 To Cabanis, moral philosophy cannot rest solely or comfortably on its theological substrata; instead, it should be investigated under the lissom rubric âphysiology,â envisioned as a âscience of manâ encompassing ethics, politics, and healing. Thus armed, physicians might form a ânew priesthood,â its liturgy medical, moral, and social reform.4
If medicine was to be the âbasisâ of a new, rational philosophy, its theory and practice required substantial renovation. In Du degrĂ© de certitude de la mĂ©dicine (1798), Cabanis moors this reformation to the recovery of Hellenistic medical thought. Consonant with late eighteenth-century neoclassicism, Cabanis insists that medicineâs ancient legacy offered its inheritors a substantial repertoire of theories and practices as well as âall the means necessary to lead to their attainment.â Attempting to rescue medicine from âan uncharted seaâ (une mer inconnue) of uncertainty, combing ancient texts for resources that might assist his project, Cabanis proposes precise, detailed clinical observation as the engine of reform in contemporary nosology, medical epistemology, and therapeutics.5 âThe true knowledge of our art,â Cabanis argues in Du degrĂ©, âis constituted of a more or less correct assemblage of sensations derived from clinical observations.â6 âSensationsâ are the physicianâs perceived or recalled impressions, âtraces dans les organes de la pensĂ©e,â raw material assembled for judgement.7 For Cabanis, the solution to medical uncertainty hinges on the putative relationship between careful clinical observation, its extension by analogy (what ancient physicians called âtransition to the similarâ), and induction.8 Cabanis sifts these sensations with tools drawn from the history of rhetoric:
Noting with care all the circumstances capable of seducing, agitating, or convincing in discourse, in images, or in the form of reasoning, the ancient rhetors [les anciens rhĂ©teurs] were soon convinced that these beauties, or rather the means by which they are produced, are far from being as numerous as at first sight they would seem to be; and that by uniting under the same title all those that resemble each other, they are all reducible to a very limited number of heads, or of common results.⊠The preceding remarks are equally applicable to those objects which the study of diseases presents to our minds. Each new case is at first believed to present new facts â but these, however, are only new combinations or shades of the same circumstances.
While physicians must continue to pursue the particular âspiritâ [gĂ©nie] of an illness and inquire into the effects of specific remedies, by focussing on âcommon resultsâ and by drawing on the methods of ancient rhetors, this âmĂ©thode symptomatiqueâ simplifies the observation, history, and treatment of disease.9 Cabanisâ enthusiasm for this symptomatic method is tempered by his recognition that diseases âare various, and susceptible of infinite complication,â that medical semiotics âor the art of recognising different states of the animal economy, by their characteristic signs, is without doubt the most difficult, as well as the most important branch of medicine.â Faced with misprision, in practice physicians must content themselves with âcertitudes practiques,â practical certainties, which are nevertheless sufficient to ensure âconservation et ⊠bien-ĂȘtre.â10
Nor does Cabanisâ engagement with its history exhaust his attention to rhetoric; elsewhere, investigating the relationships between medicine, âbelles-lettres et arts,â he concluded that âthe cultivation of letters and of fine arts can be moored to the more severe work of the art of healing.â As Ludmilla Jordanova observes in relation to Cabanisâ Coup dâĆuil sur les rĂ©volutions et la rĂ©forme de la mĂ©dicine (1804), it âshould not be thought that literature and art were peripheral to medicine â quite the contrary, they constituted its very core, provided its languages, and were its basic tools of thought.â While Cabanis nowhere suggests that physicians declaim in grand style, even his attentiveness to Hippocrates was in part stylistic.11 Cabanisâ recourse to les anciens rhĂ©teurs also sharpens the focus on individual skill; he urges discretion and sagacity, recommending the study of art for refining the physicianâs tact.12 As we shall see, these strictures draw on residual notions of what might be called âmedical prudence.â
Cabanisâ turn to rhetoric as a model for thinking through contingency and probability in medical experience exemplifies the form of loose, eclectic reasoning â seeking out common forms from variable, particular data; reasoning about causes from the probable evidence of effects; and turning to the trivium for assistance in doing so â that has characterised medical thought since early modernity.13 Gravely susceptible to error, medical reasoning relies on signs and examples, both gleaned from experience and both the subject of rhetorical inquiry; like rhetoric, medicine reaches plausible conclusions from probable premises.14 As Nancy Struever has argued, from the fourteenth century, particularly in the work of Pietro dâAbano, rhetorical figures were used to explain medical theory, and both rhetoric and medicine are pragmatic and interventionist: one devoted to the body, the other to the body politic. Struever has investigated this ârhetorical-medical mind set,â the intrication of therapy and cure, in dâAbano, Petrarch, Descartes, and others; and she has proposed a dual history of rhetoric and medicine in order to account for these habits of thought.15 Indeed, rhetoric is a âmethod for dealing with ⊠domain[s] apparently beyond methodâ â ethics, politics, and medicine.16 In order to find viable means for inflecting normative medical theory with particulars and experience, ancient and early modern physicians settled on rhetorical and ethical tools â analogy, exemplarity, prudence. They enlisted a ârhetorised logic,â or that aspect of rhetoric in the Aristotelian tradition that involved interpreting signs, essaying probability, and establishing proofs;17 in Francis Baconâs resonant phrase, the subject of rhetoric is âImaginative or Insinuative Reason.â18 And since both rhetors and physicians must intervene, they must embrace certitudes practiques.
An examination of the antecedents of Cabanisâ âsymptomaticâ method emphasises, if it does not solve, one of the central problems for the human sciences: how might general rules (about judgement, practice, intervention) be formed from the knowledge of particular cases? How might we attain âpractical certaintyâ in any inquiry devoted to the thinking, feeling human subject? How might a habit of thought, immured in one discipline, dwell productively in another? Early modern medicine is a fecund testing-ground for this inquiry; as Carlo Ginzburg notes in what is now a famous essay, the âfuture epistemological essence of the humane sciences was already being formulated in ⊠discussions on the âuncertaintyâ of medicine.â19
I focus on this moment in a very complex work â part of Cabanisâ broad and controversial programme of medical reformation based on âspeculative physiologyâ20 â in order to isolate a constellation of ideas that has ancient roots and early modern branches, perhaps even contemporary foliation. In Du degrĂ©, Cabanis conjures the history of rhetoric as an entrepĂŽt from which physicians might draw methods and models for reasoning about symptoms, for negotiating the relationship between the general (conceptions of illness) and the particular (individual cases). For physicians struggling with the variable, conflicting medical theories and a frangible, uncertain practice, rhetoric offers methods for reducing phenomena to their common forms, for placing these forms within emergent systems, and for practical intervention devoted to agitation, comfort, or cure.
Here, I explore some of the less obvious affinities between rhetoric and medicine â not solely to better understand Cabanisâ ruminations, but to suggest that rhetoric is a significant, and sorely neglected, aspect of medical thought from antiquity through to the early modern period. Both rhetoric and medicine are concerned with embodiment and with the passions, of course; since all accounts of perception and emotion must be âenmattered,â as Aristotle insists, rarely was either treated in isolation from medical thought. This association between medicine and rhetoric is quite clear in both Cicero and Quintilian, for example, who enlist medicine in their inquiries into the passions.21 However, my purpose here is to suggest that rhetoric and medicine share forms of inference and reasoning as well as areas of inquiry and, in passing, to argue that these intersections should have more purchase in intellectual history.22 While early modern physicians for the most part reject persuasion, the affinities between medical thought and ârhetoricised logicâ are clear; sound conjecture ...