Why Was "Custom a Second Nature" in Early Modern Medicine?

"Custom is a second nature" is a saying that circulated long before the early modern period and in many different cultural settings. But the maxim had special salience, reference, and force in dietetic medicine from the late medieval period through the eighteenth century. What did that saying mean in the early modern medical setting? What presumptions about the body, about habitual ways of life, and about the authority of medical knowledge were inscribed within it? And what was the historical career of the saying as views of the body, its transactions with the environment, and the hereditary process changed through the nineteenth and twentieth centuries?

[Antoine Augustin Parmentier (1737-1813): military pharmacist, humanist and scholar]

From "Frison" pharmacy of his district, Sainte Croix square in Montdidier, where he learned the trade of a pharmacist when he was 15 years old, to the General Inspectorate of the health service of Army responsability he helds from the 1st Germinal, Year IV until his death, Antoine Augustin Parmentier was both an humanist and anerudite scholar even if often, posterity and legend reduce his image only to that of"the inventor" of the most common Solanaceae. His work, more than 189 publications, and his innovative ideas, made advancing scientific knowledge including food chemistry and nutritional health but also in various other areas: blood analysis, preparation of drugs...Better known as "Fighter of the only war that has a biological and moral justification: the war against hunger" as Jose Castro President of the FAO in 1954 recalls, less is known about the excep- tional longevity, 56 years, and riches of his military pharmacist career during which he participated in 17 campaigns and he was captured 5 times. Apothecary "sub-help" of the army of Hanover in 1757, he became apothecary "gagnant maitrise" in 1766 and transiently apothecary Major at the "Hotel des Invalides", then Royal Censor, chief pharmacist of Geneva Army, and Board Member Health to the Minister of War in 1788 and then again from 1792 to 1813. In 1796, he was charged with five other inspectors of the reorganization of the health service. Outstanding organizer, he simplifies and deeply streamlines, especially in the pharmaceutical field, evidenced by its pharmaceutical form for the use of military hospitals of the French Republic in 1793. He left his mark for a long time in the military health Service. Member of the general council of civilians hospices of Paris, he is responsible for organizing the central hospital pharmacy, which led him to publish in 1811 the pharmaceutical code for the use of civilian hospitals, relief at home and infirmaries of prison. Benefactor of mankind, but also recognized scholar, the Academy of Sciences made him one of its members in 1795. Parmentier was in 1803, the first president of the Society of Pharmacy of Paris who became the National Academy in October 1979. He died on December 17, 1813 leaving a considerable body of work.

Food, growth and time: Elsie Widdowson's and Robert McCance's research into prenatal and early postnatal growth

Cambridge scientists Robert McCance and Elsie Widdowson are best known for their work on the British food tables and wartime food rations, but it is their research on prenatal and early postnatal growth that is today seen as a foundation of the fields studying the impact of environment upon prenatal development and, consequently, adult disease. In this essay I situate McCance's and Widdowson's 1940s human and 1950s experimental studies in the context of pre-war concerns with fetal growth and development, especially within biochemistry, physiology and agriculture; and the Second World War and post-war focus on the effects of undernutrition during pregnancy upon the fetus. I relate Widdowson's and McCance's research on the long-term effects of early undernutrition to the concern with recovery from early trauma so pertinent in post-war Europe and with sensitive (critical) periods, a concept of high importance across different fields. Finally I discuss how, following a hiatus in which fetal physiology engaged with different questions and stressed fetal autonomy, interest in the impact of environment upon prenatal growth and development revived towards the end of the twentieth century. The new field of "developmental origins of health and disease", I suggest, has provided a context in which Widdowson's and McCance's work has regained importance.

[Dietary prescriptions for the elites of the kingdom of Navarre in the 16th century: the cases of Juan Rena and Juan de Alarcón]

The aim of this article is to present and analyse four dietary prescriptions from the 16th century prepared for Juan Rena, a cleric of Venetian origin, and his servant Juan de Alarcón, which are kept at the Archivo General de Navarra. These documents demonstrate the interest of the patients and physicians in dietetics, understood as a group of health and hygienic measures based on the Galenic res naturales and res non naturales. These four prescriptions are closely related to the ad personam or consilia health regimens, which represent a genre of medical literature whose significance in Renaissance Spain has received little attention. The cases studied reveal the high esteem in which the elites held the possession of therapeutic resources adapted to their individual needs, which were compiled and copied for personal use.

[25 Years in nutrition and food research in the Iberoamerican knowledge area]

INTRODUCTION

Research is usually considered a reliable indicator of the degree of development. Research in a problematic area such as food and nutrition for a given region, should have an impact on scientific production in agreement with the importance of the problem, the research capacity and the available resources for generating such a research.

OBJECTIVE

To identify some indicators of Iberoamerican research in nutrition and food.

METHOD

Retrospective study of Iberoamerican scientific production in nutrition and food in the last 25 years. The data were obtained from the bibliographic database Science Citation Index Expanded, Journal Citation Reports Science Edition Database 2011, both included in the Web of Knowledge (Thomson Reuters), and the database of the World Bank.

RESULTS

49,808 papers were registered, the 3.20% of the Health Sciences collection in SCI. The evolution was fitted to an exponential model, N&D (R² 0.962) and FS&T (R² 0.995). The average production in N&D per average population was higher in Spain with 0.659 papers/million. The highest rates of productivity and profitability were found in Guatemala with 12.963 papers/1000 researchers and 1.486 papers/million $ respectively. The average production in FS&T of the different countries per average population was higher in Cuba with 21.624 papers/million. The productivity index was higher in Uruguay with 25.999 papers/thousand researchers. The profitability index was higher in Guatemala with 0.271 papers/million $.

CONCLUSION

There is exponential growth in the two categories studied N&D and FS&T. Productivity and profitability was higher in countries with low R&D (Research & Development) budget.

Sciences of appetite in the Enlightenment, 1750-1800

Advice about diet has been an important part of Western medicine from its inception. Although based partly on the presumed qualities and effects of foodstuffs, such advice rested chiefly on the constitution and circumstances of individual patients, including their unique appetites and eating habits. In the eighteenth century the nature of appetite itself came to be a subject of growing interest in the sciences, especially in medicine, natural history, and physiology. Within these sciences attention to the eating proclivities of individuals began to be displaced by interest in uniform processes of ingestion and digestion. In turn dietary advice came increasingly to rely on general standards of health and the digestibility of foodstuffs. Central to the promotion of uniform standards was the increasing credence given to experimental procedures that claimed to offer new certainties about the digestive process. As experimental science took hold, appetite, long regarded as a perplexing blend of psychic and somatic elements, assumed subordinate status as an object of inquiry to phenomena thought readily susceptible to laboratory manipulation. These eighteenth-century developments stand at the origin of the modern nutritional science that denigrates individual appetites in favor of universal rules of 'healthy eating.'

Balancing acts: Picturing perspiration in the long eighteenth century

This essay examines the historical fortunes of an image that throughout the seventeenth and eighteenth centuries became a landmark of the medical doctrine and practice of static medicine advanced by the physician Santorio Santorio (1561-1636). The image depicted a man sitting on a large Roman steelyard, which allowed the weighing of bodily discharges and gave guidance on the intake of food. Well into the eighteenth century, the image of the weight-watching man accompanied Santorio's work on the art of static medicine and, most likely, contributed to its success. It appeared in a variety of medical works and navigated across competing medical theories and different medical genres, while remaining largely unscathed. This essay explores the success and the historical agency of this image. Focusing on the history of its copies and variants, it investigates how the image came to symbolize the attempt to transform dietetics into an experimental practice, and accordingly preserve its pivotal significance in the medical world.

Evolution and trends of the dietetics profession in the United States of America and in Argentina: north and south united by similar challenges

Since the early stages the profession of dietetics has been characterized as a multifaceted discipline and influenced by scientific and social changes. Today, health and nutrition-related diseases are becoming more global--as is the dietetics profession. The aim of this article is to review the history, education, work and challenges for dietetic practitioners in North and South America, specifically in the United States and in the Argentinean Republic. It was in Argentina where the first Latin American dietetics school was established. Both countries have since shaped the profession creating standards for education and practice in response to advances in the biopsychosocial sciences and economic and environmental changes. Reviewing both the past and current diversities in both Americas contributes to a better understanding of professional strengths and weaknesses, and can prepare dietetics specialists to meet today's needs. Regardless of local disparities, it is interesting that current and future challenges for the dietetics profession are similar between the two countries, such as growing rates of obesity, limited access to and choice of healthy diets among various income groups, busy lifestyles and decline of family meals. These common issues and the availability of Internet tools offer a unique opportunity for partnership and research that can lead to successful creative nutrition interventions and programs. In turn, such joint initiatives will confirm the essential role for the profession--not only in the western hemisphere--but also globally.

Cookery, diet and district nursing in late nineteenth-century London

While health education in late nineteenth-century Britain could be beneficial for every household, it was particularly so where district nurses understood family circumstances and adapted knowledge to individual needs. During this period sick room cookery training and lectures on hygiene and dietetics became standard for nurses--especially following the reforms of Matron Eva Lückes at the London Hospital. Because understanding about health was not widespread in society, due to the living conditions and poverty of so many patients, and because doctors had few opportunities to convey such knowledge, the active support of nurses in the community proved to be essential for translating professional knowledge into words commonly understood. By demonstrating cooking and other health-related skills in the homes of the poor, nurses played an important part in improving the nation's health.

Catastrophe and the response by nurses - 100 years ago in the BJN

We may complain of the infl uenza crises in the UK today, but is does not compare with the severe crisis reported in the BJN (January 1909). It is interesting to note the response of the community and nurses:

[Quantity, quality, harmony and adaption: the guiding principles of a society without hunger in Josué de Castro]

This article analyzes the links between the biological and social spheres established by Josué de Castro in his studies of alimentation. First it looks at how the author introduced modem dietary principles at the same time that hunger and malnutrition were unveiled in parts of Brazil, aiming at the configuration of a national alimentation policy. Second, at it examines how he expanded the debate, giving visibility to the dynamics of states and the political direction of a world that was being dismantled in which hunger and alimentation were an intrinsic part of the spatial distribution of power. In the postwar scenario the dietary principles of quantity, quality, harmony and adequacy were transposed as the guiding principles for a society without hunger at the global scale.

Diet and dietetics in al-Andalus

Al-Andalus society (711–1492) based its idea of health on the wisdom of Classical Greece, the Hippocratic–Galenic theories, as well as the Persian and Hindu cultures. The twelfth century in al-Andalus is considered to be the most prolific period for works of a scientific and technical nature. At the time, the main treatises on dietetics were written and this science reached its widest expression with such leading figures as Ibn Wāfīd, Avenzoar, Averroes and Maimonides, whose works revealed the first scientific knowledge on the nutritional processes of the human body. Diet was regarded as being essential for health and the prevention of disease. Dietary guidelines were written for different age groups, different body types and different seasons of the year. The amount of food to be ingested, the number of meals recommended and the order in which the food should be consumed were all issues that were discussed. A variety of foods were thought to have medicinal properties, some of which are known today. The diet in al-Andalus was varied and very probably made a substantial contribution to the origin of the present-day Mediterranean diet, rich in olive oil, wholemeal cereals, fruit and vegetables, fish, lamb, poultry, nuts and spices. We also find that many of the terms in current use in diet and agriculture are a living testimony to the Arabic influence, as are many of the dishes of our varied Mediterranean gastronomy.

The rise and fall of dietetics and of nutrition science, 4000 BCE–2000 CE

Objective

To outline the history of dietetics since its beginnings in recorded history, and of nutrition science in its first phase beginning in the mid-nineteenth century and then its second phase in the second half of the twentieth century.

Method

Three narrative overviews: of dietetics from its beginnings until after the end of the mediaeval and then Renaissance periods in Europe; of nutrition science in its first phase from its beginnings in the mid-nineteenth century until the middle of the twentieth century, with reasons for its rise; and of nutrition science in its second phase in the second half of the twentieth century, with reasons for its decline.

Conclusions

In its third phase in the twenty-first century, the new nutrition science should regain much of the vision and scope of its preceding disciplines.

History of the calorie in nutrition

The calorie was not a unit of heat in the original metric system. Some histories state that a defined Calorie (modern kcal) originated with Favre and Silbermann in 1852 or Mayer in 1848. However, Nicholas Clément introduced Calories in lectures on heat engines that were given in Paris between 1819 and 1824. The Calorie was already defined in Bescherelle's 1845 Dictionnaire National. In 1863, the word entered the English language through translation of Ganot's popular French physics text, which defined a Calorie as the heat needed to raise the temperature of 1 kg of water from 0 to 1 degrees C. Berthelot distinguished between g- and kg-calories by 1879, and Raymond used the kcal in a discussion of human energy needs in an 1894 medical physiology text. The capitalized Calorie as used to indicate 1 kcal on U.S. food labels derives from Atwater's 1887 article on food energy in Century magazine and Farmers' Bulletin 23 in 1894. Formal recognition began in 1896 when the g-calorie was defined as a secondary unit of energy in the cm-g-s measurement system. The thermal calorie was not fully defined until the 20th century, by which time the nutritional Calorie was embedded in U.S. popular culture and nutritional policy.

Diet, dietetics and flora of the Holy Bible

The study of history of medical science from non-medical sources needs no apology. At first the discussion of what was thought in the past rather than what is known now appears to be of merely antiquarian value. The knowledge of Diet, Dietetics, medicinal plants dates back to the remote antiquity of mankind. The Hebrews can be proud of having preserved in the Old Testament many old medical practices and traditions, which throw light on ancient medicine. The Bible is genuinely documented book representing the wisdom, medical knowledge and the culture, of a nomadic race. This article contains information of some medicinal plants, which are useful for treating different kinds of ailments and some with nutritious qualities.

I dressed your wounds, God healed you--a wounded person's psychology according to Ambroise Parè

Ambroise Parè (1510-1590) was actively involved in wound treatment, studying wounds from various points of view. Many of his published works provide cutting-edge insights regarding nutrition, pain, and debridement, as well as psychological counsel for wounded persons--advanced thoughts, considering the times. Parè believed the energy of the human body and mind played an active role in wound healing. Parè's stature, as far as wound care is concerned, is a result of his judgment and wisdom in applying knowledge of human principles to medical practice. Detailing and celebrating events in his life relevant to the practice of wound care underscore the skills and compassion vital to healing regardless of the century. The article title is drawn from the engraving on his tombstone.

[Principle stages of scientific activity of the clinics for dietary nutrition affiliated to the Institute of Nutrition within 1930-2005 years]

The article gives a brief account of activities of clinics for dietary nutrition affiliated to the Institute of Nutrition within 1930-2005 years.

Dietetic practice: the past, present and future

The history of dietetics can be traced as far back as the writings of Homer, Plato and Hippocrates in ancient Greece. Although diet and nutrition continued to be judged important for health, dietetics did not progress much till the 19th century with the advances in chemistry. Early research focused focuses on vitamin deficiency diseases while later workers proposed daily requirements for protein, fat and carbohydrates. Dietetics as a profession was given a boost during the Second World War when its importance was recognized by the military. Today, professional dietetic associations can be found on every continent, and registered dietitians are involved in health promotion and treatment, and work alongside physicians. The growing need for dietetics professionals is driven by a growing public interest in nutrition and the potential of functional foods to prevent a variety of diet-related conditions.

Leadership: reflections over the past 100 years

Leadership, viewed by the American Dietetic Association as the ability to inspire and guide others toward building and achieving a shared vision, is a much written-about topic. Research on leadership has addressed the topic using many different approaches, from a very simplistic definition of traits to a more complex process involving interactions, emotions, and learning. Thousands of books and papers have been published on the topic of leadership. This review paper will provide examples of the varying foci of the writings on this topic and includes references for instruments used to measure leadership traits and behaviors. Research is needed to determine effective strategies for preparing dietitians to be effective leaders and assume leadership positions. Identifying ways to help dietitians better reflect on their leadership experiences to enhance their learning and leadership might be one strategy to explore.

[Between cooking pot and sick-bed. Dietetics in Germany, 1890-1980]

The article analyses the development of the "dietary assistant" as a profession in Germany. It describes the major steps of its evolution and argues that this evolution mainly depended on two factors. First on the development of nutritional science and dietetics, when the physicians experienced the importance of well-prepared dishes and meals, but realised, that they did not have the practical skills to prepare suitable meals for people with metabolic disturbances. Second the evolution relied on the ambitions of young women, since the beginning of the 20th century, to achieve a qualified job. The German development is compared with that in other countries and the question is raised as to why German dietary assistants, unlike elsewhere, did not achieve the status of an academic discipline.

[Ancient dietetics - lifestyle and medicine]

The wide reaching meaning of eating and drinking is already recognized in antiquity. The declared aim of antique dietetics is the upbringing to a healthy lifestyle. Fundamental considerations of dietetic, theoretically organized ideas can be traced back to the Presocratics, who, for the first time in cultural history, let themselves be guided by direct observations from nature. Working from the meaning of dietetics as pure nutritional teaching, one can see in the Corpus Hippocraticum a significant, systematic attempt to put forth dietetics as a concept of lifestyle. Here a central aspect is that of equilibrium, as it is expressed in the rule of the four humours. Dietetics continually become a connecting link between Natural Philosophy and Anthropology and a lifestyle orientated to nature. Finally, Galen introduces a further systematization of the already existing and the increasingly modified. Nutrition and health are brought into association and the theoretical presupposed practically overturned. In late Antiquity dietetical outlooks continue to be discussed, which were transferred to the Middle Ages and still show practical relevance.

[A German pioneer in Turkish dietetics: Elisabeth Wolff]

In Turkey, the foundation of modern dietetic started only in 1935 at the IInd Clinic for Internal Medicine at the Medicine Faculty of Istanbul University on behalf of the clinic's director Sen. Prof. Dr. Erich Frank, a well-known expert on diabetes, and his dietician Elisabeth Wolff, both having refuged from the 1933's Gemany. Wolff, one of the early leading and example representatives of the dietetic arising new in the world and Europa at that time, presented and taught the new treatment in Turkey where she worked for 32 years. Frank cooperated intensively with her to establish a modern diabetes treatment with uptodate methods in Turkey on the dietary treatment of internal diseases.

[The most important sources of the Graeco-Arabic medicine]

The author gives a comprehensive guide to Hungarian scholars, who attempt to search the history of Graeco-Arabic medicine and dietetics, respectively. This guide contains a short introduction into the different types of sources, lists the main authors, editions and texts available in Hungary indicating the libraries where the sources are to be found. The author organizes his material according the the main authors of the subject. Helped by this useful "database" researchers might be able to avoid difficulties of the first steps on this still, actually, largely unexplored field of the history of medicine .

[Longlived examples. Function and formal principles of historical exempla of old age in the early-modern dietetic literature]

Since antiquity, the exemplum can be proven in numerous types of texts, as it fulfills a notable didactic and rhetorical function: On the one hand it serves to a deductive illustration of common doctrines; on the other it is until the Enlightenment the scientific basis of cognition: in the view of medieval artistotelists, of who FRANCIS BACON was (in a special sense) one of the last champions, the exemplum takes on an inductive function: the sensual perception of the exampla generates the understanding of the universal, as the exemplum always refers to the exemplar, to the original form. Regarding the eminent deductive/inductive significance of the exempla, it is not surprising that they are an essential factor in dietetic literature. Whereas such exemples were very rare in the general literature on health care written by physicians and in specific papers of old-age assistance, they formed an integral part of texts composed for a large public by medical laymen such as (Ps.-) ROGER BACON, MARSILIO FICINO, ALVISE CORNARO or FRANCIS BACON. In these studies, the issue of a natural limit of human life was discussed intensively. In this context the "historical" sources were of high importance, even if, from a todays point of view, their use was completely non-historical. Often their crude instrumentalization and new interpretations can only be understood in the scholarly context of the time: E.g. in debates of specialists with outsiders or when serving as argument for physiological theories and therapeutical regimes. Not until late Renaissance, the historical exemple was replaced by the individual experience. It is striking that most of all historical exemples found in dietetic papers were positive. This humanistic and Christian ideal concept of old age, which completely contradicts the medical reality, had obviously a stronger fascination on the authors of early modern times than the inductive function of negative exempla (which are very important for a rational reasoning). Besides the scientific exemple, it is the idealizing one which, in the dietetic texts, gradually assumes the moral function of not discouraging the often aged readers, but of encouraging them to a constructive way of living.

Trusting George Cheyne: scientific expertise, common sense, and moral authority in early eighteenth-century dietetic medicine

Whenever physicians give directions to patients there is always a question of their authority to do so: what is it that they know, and who is it that they are, that gives them this authority? The problem is fully general, but it takes especially interesting forms in early modern dietetics, where patients were reckoned to possess much pertinent and reliable knowledge, and where medical dietetics occupied terrain already densely occupied by moral prudence. This article addresses these issues in relation to the writings and practice of George Cheyne (1671-1743), iatromechanist, dietary writer, and fashionable physician. Special attention is given to the relation between Cheyne's scientific expertise and the texture of the advice he gave to two patients, the printer and novelist Samuel Richardson and Selina, countess of Huntingdon.