Medicine and Molière’s ‘Imaginary Patient’

It has been said millions of times “hopefully the end of our path through life will come to us suddenly, almost by surprise, not giving time for the pain to harass and martyr us”. And if it could be, giving us a brief moment for a warm farewell. Jean-Baptiste Poquelin (1622-1673), better known as Moliere, whose birth marks four centuries in this year of (dis)grace, was one of those lucky ones. On February 17, 1673, during the fourth performance of Le Malade imaginaire (The imaginary patient), which had been released a week earlier, had a seizure. Transported to his home, he passed away three or four hours later. In the play he represented –cruel paradox– the role of Argán, the imaginary patient, that is, an incurable hypochondriac.

What Molière intended with ‘The imaginary patient’ was to make fun of an increasingly obsolete medicine that had not yet had its Isaac Newton

Like so many other literary works that survive the passage of time, that are installed in the cultural memory of humanity, there are many readings, interpretations, that can be given to the imaginary patient. We see reality, don’t forget, with the eyes of our feelings, interests, desires, fears, likes or phobias. Some will focus their attention on the often-told story of the (apparently) impossible loves of Angélica, daughter of Argán. Others in the cunning tricks of her stepmother Belina. And there will be no shortage of those who rejoice and admire the shameless common sense of Tonina, the maid, accustomed to navigating between very different waters, those that cross those they serve.

The case of Miguel Servetus

However, the historian of science in me enjoys finding in classic works of literature and theater references or allusions to characters or episodes from my discipline. And in the imaginary patient there are. One of them is the mention of “The blood circulation”, a very topical medical issue at the time of Molière and that had previously given rise to some tragedies. One was suffered by the Aragonese Miguel Servet (1511-1553), who is credited with the discovery of the existence of a “minor circulation” of blood through the lungs; so that, contrary to what Galen maintained, the blood could not pass from the right ventricle of the heart to the left, but had to do it in another way.

Now –and this reflects what medicine was also at that time–, for Servetus, blood went beyond “the purely material”: he believed that it was the seat of the soul, breathed into human beings by God. And he spread this mixture of theology and science in a book published in 1553, Christianismi restitutio (The Restoration of Christianity), which brought him problems with both the Catholic and Protestant Churches. He escaped the Inquisition, but to fall into the hands of the no more sympathetic Calvin, who had him burned alive by his heretical ideasalong with five bundles containing the recently printed sheets of the 500 copies of his book, of which only three copies were saved, or are known.

An anatomical disquisition

Perhaps Molière was thinking of the English physician William Harvey (1578-1657), who was the most distinguished in the study of blood circulation. In 1628, Harvey published one of those books that remain in history: Exercitatio anatomica de motu cordis et sanguinis in animalibus (An anatomical disquisition relative to the movement of the heart and blood in animals). In it, and through a series of dissections and experiments, he described the heart as a muscle that contracts and dilates, explaining the circulation of blood as the result of the impulse received by the dilation of the arteries when the heart contracts. However, despite Harvey having taken a step forward of great importance in the knowledge of human physiologynot everyone accepted his ideas, like one of the characters in the imaginary patientTomás Diarreus, aspiring doctor.

In Spain, in the years immediately after the appearance of Of motu cordis, only four physicians agreed with him, while the rest of the Hispanic medical profession opposed. It was a time when the old theory of the four organic flows (humours) was still very present: blood, phlegm, black bile (melancholy) and yellow bile. Depending on whether one or the other dominated, people would be sanguine, choleric, phlegmatic or melancholic. The imbalance of humors (dyscrasia) was the cause of disease and healing was achieved by reducing the dominant principle through bloodletting and purging, the negative if not deadly effects of which were suffered by patients for two millennia.

What Molière wanted in this work was to make fun of those doctors, of an increasingly obsolete medicine. Today it is much easier to make fun of such falsehoods, entrenched assumptions in a tradition that turned a deaf ear to the supreme judge that is the evidence; but neither should we impose our current criteria, the result of long and painful efforts, in which errors coexisted with successes, nor forget that the science of the human body had not yet had its Isaac Newton; in fact, it was easier to begin to understand the heavens than our body.

transfusion experiments

Medicine advanced, but often in the dark. A good example of this is the experiment carried out on November 23, 1667 by two English doctors, Richard Lower and Edmund King (the latter, physician to King Charles II): the transfusion of blood from a sheep to a man! Surprisingly, this one survived. However, in 1668 a patient of the French pioneer in transfusionsJean Denis, who taught medicine in Montpellier, died after a transfusion, and this fact put an end to these experiments in humans until 1900, when the discovery of antibodies and antigens made such a practice safer and led to, in 1905, George Washington Crile performed the first direct blood transfusion, although the practice did not become widespread until World War I.

still remain numerous diseases that affect our body and mind that current medicine does not know how to combat, but even so, how lucky we are to live in a time like the current one!