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M. Aleman and J. Locke, two frustrated physicians, Vesalius, VI, 2, 83-89, 2000In 1666, while still at Oxford and assisting amedical colleague, David Thomas, a crucialevent took place, his encounter with Lord AshleyCooper, later Earl of Shaftesbury, one of theoutstanding statesmen of the age. An immediatesympathy between the two men became evidentand Lord Ashley invited Locke to move into hishousehold to become the family physician andmedical advisor.Locke was involved in the negotiations forthe marriage of Ashley's son and later deliveredhis grandson, but the relationship between thetwo men became increasingly close and resultedin a major collaboration in political writings andin practical affairs such as Locke's designing aconstitution for the Carolinas, for which LordShaftesbury was Lord Proprietor, and Lockehimself invested in several of these colonialventures including the slave trade.He was a late starter in his political andphilosophical writings and they were mostlyproduced between 1671 and 1689, butthroughouthis life he continued to write on medical subjects,mostly in his commonplace books, largely to befound in the Bodleian Library at Oxford. Hecollaborated with the great empirical physician,Thomas Sydenham (9), and in writings with RobertBoyle and other members of the RoyalSociety on human blood and other topics (10). Inthese works it is often impossible to determinewhen Locke was the transcriber and when theprincipal author and investigator.The work that he prized above all others,written and revised over many years, are hisEssays Concerning Human Understanding DeIntellectuwhlch deal with psychology, education,political science, and many related topics. It wasthe first book published under his own name, thetwo previous ones having been anonymous,and while the first edition appeared in 1689, theauthor continued to make major revisions inseveral later editions, the last one posthumous.It is clear that in his early Oxford period,starting in 1652, Locke was anxious to obtain amedical degree. Although he did get his MB, theOxford authorities denied him the MD degree.The reasons were clearly religious. Locke wasLow Church; Oxford was the centre of HighChurch sentiments. For similar reasons he wasexpelled from Oxford in 1684 by royal command.The most vivid reports by Locke and hismedical colleagues deal with the illness anddeath of Lord Shaftesbury, his patron and mostimportant patient.Ashley Cooper, later Lord Shaftesbury, wasorphaned young and lived in various householdsof relatives, all in the south of England. It is fairto assume that as a child he was in frequentcontact with sheep and sheepdogs, an importantfactor in his later medical history. He had abrilliant political career, with many ups and downs,reaching the pinnacle as Lord Chancellor andhaving to flee for his life in 1683 after a longincarceration in the Tower. Until close to theend, Locke's career was intimately bound to thatof his patron, although for several years beforethe latter's death, he was travelling in Franceand Holland, largely to avoid political reprisals.As early as the age of 16, Shaftesbury beganto suffer from severe bouts of colic, mostly in theleft upper quadrant, often with fever andsometimes with jaundice. These episodes baffledhis physicians who attempted to blame them onvarious accidents, including the overturning of hiscarriage in Breda, Holland. Note the similaritywith the history of Frai Garcia Guerra.In 1668 he developed a large painful mass inthe right upper quadrant and Locke, afterconsulting Sydenham and several other medicalauthorities in England and France, recommendedthat the mass be drained, a very riskyprocedure at the time. While Locke definitelysupervised the surgery, it seems likely that theoperation itself was carried out by a barber-87
M. Aleman and J. Locke, two frustrated physicians,, VI, 2, 83-89, 2000Aleman and Locke were very different men :both geniuses, one an erratic man, the other ahighly moral, serious, extremely organizedthinker. But they shared a lifelong interest inmedicine, frustrated by the religious prejudicesof their day. They each shared the affection andpatronage of an important public figure, whohappened to have suffered from the samedisease. We are fortunate in having the vividand lucid account of the two writers, whichallows us to reconstruct with considerablecertainty the case histories of the illness whichthe two eminent patients shared.Referencessurgeon, who a couple of years later repeatedthe procedure. A silver cannula was insertedand it drained successfully for 15 years, extrudingfluid and «skins», which Dr Osier first explainedas being typical of hydatid disease, caused byEchinococcus (ref. 9).Shaftesbruy had many political enemies whoattacked him viciously, mocking his life-savingdevice. Dryden, in particular, savaged him in«Absalom and Achitophel». After years of confinementin the Tower he was tried for treason,was acquitted, and fled to Holland. He acquiredDutch citizenship to avoid extradition, had anattack of «abdominal gout», and died after abrief, acute illness, presumably when his drainbecame occluded. Locke was not there at thetime and had not been with Shaftesbury forseveral years.This philosopher had a few other importantpatients including Lady Northumberland (ref.10)with tic douloureux, but increasingly his effortscentered on political philosophy where hecontinued to revise his magnum opus, The Essay.In his later years he was the house guest of LadyDamaris Masham and her family, and he diedthere in 1704.1. M. Aleman, Guzman de Alfarache, p.132. M. Aleman, Ortografia, Folio54, VI E. Cros, MateoAleman p.133. M.A. «Sucesos»4. V. Andrade, «Ensayo», p.595. V. Andrade, «Ensayo» p.686. J. Locke, «Essay»7. Osier, «Alabama Student" p.70, quoting H.R.Fox-Rourne8. J.R. Milton, in «Locke's Philosophy", Ed. G.A.J.Roberts, p.359. Osier, «Alabama Student»10. K. Dewhurst, «John Locke», p.93-111Notes1. Almaden : A mine, in Arabic, the emperor CharlesV (King Charles I of Spain), in serious financialstraits because of numerous military expeditions,gave the Fuggers this mining concession inexchange for their banking support. Condemnedfelons were provided for the deadly labor. Bleiberg,Nuevos Datos Biograficos.2. In one of his petitions, M.A. assumed the surnameof Ayala, presumably to suggest aristocratic origins.3. «Alfarache» possibly derived from the Arabic«Faraq» : happiness, freedom from care, or from«Alfarax»; a small horse from the light cavalry.4. Loosely, «From illusion - ordeception - no practicalwisdom can be gleaned"5. P. Garcia, «Transhumancia»6. Marquez «Canto» and personal communication7. Consulted in the John Carter Brown Lib. Providence,R.I. Reissued in two modern editions.88
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