Notes on the medical properties of food during the 18th century (J. Worth Estes) [article review]

These notes are taken while reading the article written by J. Worth Estes in the Journal of the History of Medicine and Allied Sciences. The comments are mine, reflecting my own views and my thoughts during my PhD researches and wanderings…

Reference : “The Medical Properties of Food in the Eighteenth Century”, J. WORTH ESTES, Journal of the History of Medicine and Allied Sciences, APRIL 1996, Vol. 51, No. 2, pp. 127-154, Oxford University Press, http://www.jstor.com/stable/24624109

“There is no sharp borderline between food and drug” (p.127) underlines J. Worth Estes, quoting Henry S. Sigerist (A History of Medicine, 1951).

This phrase points out the “nutritional roles” and the functionalities of food in a therapeutic way (“healing roles” he says). This utilitarianism is very ancient, and Galen or Dioscorides saw plants and food as same products used to heal the body (or the mind). The article written by J. Worth Estes also emphasizes on the influence of the work in the ancient Hippocratic corpus : “food’s role in supplying the body’s ordinary, predictable, needs”. Quoting the Hippocratic corpus, he notes that dietetic and nutritional practices are linked to medical and pharmacological therapies. In fact, they all repair the body, filling in the “continual loss“, the imbalances of the body in its different parts, the “damaged” parts..

In this article, J. Worth Estes focuses on the “clinical application of foodstuffs, or food groups, to the prevention or cure of specific symptoms or diseases as interpreted within the framework of eighteenth-century notions of pathogenesis“. He also discusses the way foodstuffs and their therapeutic values were “accommodated” to fit the changes in the varying notions of “pathology”, which were profoundly transformed between the end of the 16th century to the end of the historical period one calls “Enlightenment“.

The great pathological paradigm of the centuries before the Enlightenment was : humoralism. It was taking its roots in the Aristotelian natural philosophy which the Medieval and the Renaissance world of scholars rediscovered. Food would manifest its necessity and utility through different elements such as fire, water, earth and air, and through different qualities : “hot, cold, moist and dry” (p.128).

Worth Estes reminds us of galenism, a humoral theory of balances and imbalances of the body humors, that dominated Western medical vision. Contemporary historians can still find reminiscences of this theory lingering in the uses of : “blood, phlegm, black bile and yellow bile” (p.128) which were deeply rooted in the medical practices and the physiological comprehension of our bodies.

Through the years, dietetics and nutritional approaches were inspired by these ancient theories, often re-adjusted and accommodated, meaning “adapted to” new usages, new plants, new encounters and new diseases. Worth Estes says : “Cucumbers, for instance, were effective in such illnesses because they are cool and moist.” One can say, those systems made medical practices focusing on symbolism/sympathy or antagonism, rather than magical views or biological concepts.

Worth Estes explains that medical treatments were based on “regimen“, and drugs were used to “neutralize the symptoms” (p.130). Drugs had some barbarous names (in my opinion) such as “emetics, cathartics, diuretics, narcotics, refrigerants, and blisters” (p.131). Another type of therapeutic mode was based on “solidism” (p.131), to help stimulate the “tone of the heart and arteries“.

In this article, I found that “vegetables were served when available, but that was seldom in the harsh Scottish climate” (p.134) and meat or alcohol were preferred (as it was viewed as “tonic, diuretic, and antiseptic” (p.134). I think this quote made me realize that environment and climate were important data that I had to consider in my PhD thesis.

New therapeutic values, created for food products, were categorized as such : “Acid, alkaline, salty, acrid and aromatic, spirituous, viscous and glutinous, oily and aqueous”. They were the new qualities/values that allowed practitioners to categorize food in a new way. Those values were not plainly medical properties but were describing physiological functions in foods. As we know today, one should eat each food category in equal parts and with moderation but during the 18^th century, Worth Estes says the new regimen based on these new food categories could be detrimental to children, for example, as it could deprive them of rich nutritional intakes (p.138).

Worth Estes asks : ” The question of how foods acquired the properties that physicians imputed to them had concerned botanists, and farmers, as well as physicians, for some centuries, although most recognized that water, fertilizers, and salts were necessary to achieve optimum plant growth. The problem was, which factors were most critical?” (p.139)

I found this question particularly interesting for my own PhD thesis research which I am leading towards horticulture, gardens, plants acclimatization, etc.

Also very interesting is the part concerning “clinical practice in the kitchen” (p.142). I am exploring food and cookbooks, however the common practices and “day-by-day menus” are much more exciting than scholar treatises. I am looking for archives which could provide me the prescriptions of doctors for their patients’ diet. Quantities and measures (“Quantity, quality and order” p.143) are really something I haven’t studied enough but these were based on a very rational way of cooking.

“Similar volumes took up the same theme by listing specific therapeutic (as opposed to nutritive) effects of foods, usually introduced by comments on the pathophysiology of disease, especially as related to animal versus vegetable foods, as well as current chemical concepts, and kinds of food to be avoided” (p.143)

Food was not categorized anymore (apparently) via the scala naturae, in a certain hierarchy from earthy grounds to celestial spheres, but was organized according to its specific values. In so doing, physicians viewed meat as food for bodily strength and vegetable food for “intellectual exercises” (p.143)

Another interesting thought from this article is: “A few other divines regarded diet and nutrition as the entire basis of a healthy life, but most, including Mather, taught that piety, religion, and the fear of sin were even more dependable aids to longevity.” (p.145). I can’t help thinking that both moral values and quality of food and diet were closely linked to provide longevity.

Some physicians were writing against animal food “major part of the aliment ought nevertheless to consist of vegetable substances.” (p.145) (from William Buchan, Domestic Medicine, from the 1798 Edinburgh edition). The value (economical, social, even political) of vegetables never ceased to change during many centuries. Plants were valued as remedies, spices were luxurious products, but some other vegetables such as root-vegetables were seen as merely good for veterinary purposes : food for animals. Nevertheless, some roots were valued in Aztec traditions or in Western remedies against infertility.

“A small number of health guides targeted special audiences. Among them were books aimed at women for use during pregnancy and just afterward. One, by Nicholas Culpeper, the self-proclaimed astrological physician of the seventeenth century, was still in print a century later and included a chapter on diet in which the author advised: “Let [the pregnant woman’s diet] be easy of concoction [digestion]; let her eat Quinces to strengthen the Child . . . Let her abstain from sharp Meats, very bitter, or salt, and things that can provoke Terms, as Garlick, Onions, Olives, Mustard, Fennel, Pepper, and all Spices.” (p.146)

The author of the article makes a clear difference between medical practice and medical theories. He says that the patients, men or women, could have less interests in “medical theorizing” than in actual cookbooks recipes. He explains “there is no evidence that they consciously chose among medical theories when choosing a menu.” (p.147)

In the same fashion, Worth Estes declares that there was no special evidence of physicians prescribing food rather than “conventional” drugs. My opinion is that they were too intricately linked to assume that one was preferred to the other. The difference, for me, lies in the food categories : meat versus plants / vegetables and also : cooked food versus raw food.

The author reminds us of one aspect about the usage of such remedies (in both categories meat/plants) : their effectiveness. The effectiveness was mostly claimed if only the remedy had worked and healed a patient once. There was no other systematic and verified study made (no “double-blind negatively-controlled clinical trials on which we rely today to prove the efficacy of putative remedies“, p.149), as chemists or doctors do nowadays.

The different important phases which helped in changing the concepts of pathology were :

– Antoine Lavoisier’s “vital air” which he re-named oxygen (p.132) (and the body burning food to produce carbon dioxide)

– “New light on the medical roles of acids and alkalis, relevant (…) on the physiology of digestion” with scientific progress by Albrecht von Haller or Hermann Boerhaave (p.135)

– Modern chemistry, and categories of foodstuffs, etc.

The appendix A at the end of the article is very useful. I have noted that Endive is cooling, weak and cathartic, that onions are stomachic, diuretic, diaphoretic, expectorant, that manna is cathartic, expectorant and carminative, etc. The appendix B gives us an insight of therapeutic practices with the definitions of some of the most common therapeutic properties. The Appendix C helps us understand the medical descriptions of foods with examples and sources.

To read the full article, see Jstor website : Reference : “The Medical Properties of Food in the Eighteenth Century”, J. WORTH ESTES, Journal of the History of Medicine and Allied Sciences, APRIL 1996, Vol. 51, No. 2, pp. 127-154, Oxford University Press, http://www.jstor.com/stable/24624109

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