received into the veins of the intestinal wall and carried thence to
the liver, in which organ they are all gathered together into a single
venous trunk which has received the name of “_vena portae_”--the
vein of the gateway. Everything that is destined to enter the liver
passes through this portal vein. In the organ itself the chyle
undergoes certain modifications, the result of which is, first, to
deprive it of its impurities and then, in addition, to effect other
changes that convert it into blood. Aselli’s glory, then, consists in
his having shown that chyle is taken up from the intestinal mucous
membrane by a set of its own vessels, and not by the veins, as taught
by Galen.
In 1651 Olaus Rudbeck of Arosen, Sweden, discovered the lymphatics of
the intestinal canal and followed their distribution into the lymph
nodes; he also established their relations with the thoracic duct and
with the venous system.
Thus, thanks to the series of brilliant discoveries made by William
Harvey, Realdus Columbus, Fabricius ab Acquapendente, Pecquet, Aselli
and a few others, the doctrine of the circulation of the blood and of
the part played by the accessory chyle and lymphatic vascular systems,
became firmly established before the end of the seventeenth century.
CHAPTER XXX
ADVANCES MADE IN INTERNAL MEDICINE AND IN THE COLLATERAL
BRANCHES OF BOTANY, PHARMACOLOGY, CHEMISTRY AND PATHOLOGICAL
ANATOMY
_General Remarks._--In the fundamental branches of medical
knowledge--anatomy and physiology--advances of a very decided character
were accomplished during the sixteenth and seventeenth centuries; and
in the preceding chapters I have endeavored to give my readers some
idea of the nature of these advances, of the men who were instrumental
in effecting them, and of the extent to which the way was made easy,
during this period, for the accomplishment of still further advances.
In carrying on the work of correcting the many errors which were found
to exist in the two departments mentioned, it was soon discovered that
the obstacles to be overcome were of a serious character, and that
the most formidable one of the group was what is universally known as
Galenism. If I now refer to this subject once more, perhaps for the
second or third time in the course of this history, it is because I
fear that my remarks with regard to the harmful influence exerted by
Galenism may not be rightly interpreted. For Galen’s personal character
I entertain, as I have already stated in the section relating to
Ancient and Mediaeval Medicine, the deepest respect, and I am filled
with great admiration for what he accomplished in advancing the science
of medicine; but at the same time I cannot overlook the fact that he
was hemmed in by insurmountable limitations. No single human being,
living at the beginning of the present era and surrounded, as Galen
was, by a herd of jealous rivals, could have successfully bid defiance
to those who considered it sacrilegious to dissect the dead body of a
fellow man; and yet, without the knowledge which may only in this way
be gained, how was it practicable for any individual, no matter how
clever he might be, to lay the foundations for a further advance in
medical knowledge? It seems to me therefore plain that Galen did all
that lay in his power to advance the science of medicine; and whatever
words of condemnation I may have employed in the text, when speaking
of the Galenists, refer solely to those physicians of later centuries
who were of such a narrow-minded type, so rigidly crystallized in the
belief that Galen’s teachings had reached the limit of all possible
knowledge in the science of medicine, that they did not hesitate to
class the efforts of men like Vesalius as acts of unpardonable impiety.
Galenism, then, refers to the very widely prevalent tendency among
physicians of the fifteenth, sixteenth and seventeenth centuries to
uphold the teachings of Galen as the _only_ trustworthy code upon
which they should depend for their guidance. In short, Galenism, at the
period named, meant for medicine a complete arrest of development.
I have now arrived at a point in the history of medicine where, owing
to the limited amount of space at my command, the difficulty of
deciding as to what subjects and what individual workers in the field
of medicine--a field now grown to very great proportions--shall receive
consideration in my sketch. Having decided from the very outset that my
best efforts shall be directed, consistently with a strict adherence
to historical truth, toward making my account readable, I now find it
absolutely necessary to jettison--if I may be permitted to use such a
nautical expression--much really valuable cargo, and to put ashore,
before continuing our voyage, many passengers of undoubted worth.
Nobody need bemoan the loss of all these valuable treasures, for the
great majority of them, I am confident, will be cared for properly by
those authors who are privileged to treat this whole subject with some
degree of thoroughness; and the reader, if he is familiar with German,
will even now find, in the excellent general treatises of Haeser, von
Gurlt, Pagel, Puschmann, Baas-Henderson and Neuburger, great stores
of the most satisfactory information concerning the thousand and one
details about which I am obliged to remain silent.
_Internal Pathology._--During the fifteenth century the
practitioners of medicine in Italy and France were still strongly
under the influence of the teachings of the Arabian medical authors.
One of the first writers in Italy to place the doctrines of internal
medicine upon a firmer footing was Antonius Benevienus, a native of
Florence (1440–1502). His treatise on some of the unusual causes of
disease, which was printed in Florence in 1506, is said to be written
in very clear language and to be based entirely upon cases which came
under his own observation. According to Haeser the first improvements
in the doctrines relating to pathological anatomy may be credited to
Benevienus, who also taught that pathological phenomena should be
studied by direct observation rather than from books.
Johannes Manardus of Ferrara (1462–1536) was a very sturdy opponent
of astrology, and, in general, did all in his power to weaken the
prevailing blind trust in the authority of the Arabian medical authors.
But the two physicians who, next to Fabricius ab Acquapendente, stand
out most conspicuously among their Italian contemporaries of the
sixteenth and seventeenth centuries, are Fracastoro and Lancisi--the
former a native of Northern and the latter of Southern Italy.
Hieronymus Fracastoro of Verona (1483–1553) ranks very high among the
physicians of the first half of the sixteenth century for his valuable
contributions to our knowledge of internal pathology. In the treatise
which he published in 1546 on contagious maladies, he states in plain
language his belief that the causes of diseases of this nature are to
be found in living germs that are endowed with the power of propagating
themselves. He divides these diseases into the following three groups:--
1, Those which infect only by contact; 2, Those which not
only infect by contact, but at the same time leave behind a
centre or focus of infection--in which category he places
tuberculosis, elephantiasis, and similar diseases; and 3, Those
which infect not only by direct contact, or through the agency
of a residuary centre or focus of infection, but also those
which are capable of spreading their infective elements over
wide areas--for instance, the pestilential fevers, certain
ophthalmias, variola, etc. (From Viktor Fossel’s version of
Fracastoro’s treatise published in Leipzig in 1910.)
Speaking of tuberculosis (called by him “phthisis”), Fracastoro says
that it is astonishing for how great a length of time the virus of this
disease retains its infective power. “It has been noted, for example,
that in quite a number of instances the clothes worn by a tuberculous
patient have communicated the disease to a healthy individual as late
as two years subsequently to the date at which they were removed from
the original tuberculous individual.” The same power of communicating
infection, he continues, may reside in such other objects as the bed,
the walls and the floor of the room in which a tuberculosis patient has
died. Under these circumstances, he adds, we are obliged to assume that
germs of this infective disease have remained attached to the different
objects mentioned.
Fracastoro was born in Verona, Italy, of parents who belonged to the
patrician class and were in easy circumstances. He studied mathematics
and philosophy at the University of Padua, and was quite prepared,
on reaching the age of twenty, to pass the examinations required of
candidates for the degree of Doctor of Medicine. Just at this time,
however, Padua was not a safe place of residence, owing to the war
that was threatened between the Emperor Maximilian the First and the
Republic of Venice. Accordingly Fracastoro took his degree at the
newly established Academy of Pordenone, in what is known to-day as the
Province of Udine (northeast of Venice); and shortly afterward, upon
the death of his father, he returned to Verona and began the practice
of medicine. As he quickly gained the confidence of the people, he
very soon found himself in a sufficiently prosperous condition to
warrant him in retaining possession of the family residence, which
was charmingly located at the foot of Monte Incaffi, midway between
the Adige River and the Lake of Garda. Here it was that Fracastoro
did a large part of his literary work, for he was a poet as well as
a physician. Pope Paul the Third appointed him to the position of
Physician-in-Ordinary to the Council of Trent, and it was by his advice
that, upon the appearance of the Plague in that city, the sittings
of the Council were thereafter held for a short season at Bologna.
Later, still other honors fell to his lot. He enjoyed the esteem of the
Emperor Charles the Fifth and of Francis the First, King of France; and
the latter’s highly cultivated sister, Margaret of Navarre, offered him
every inducement to settle at her Court, but the attractions of his own
home made it easy for him to decline all these offers. He died at his
villa on August 6, 1553, and six years later the city of Verona erected
in his honor a marble memorial tablet.
Fossel, in his biographical sketch of Fracastoro, says that the most
popular of his poetical writings was that entitled, “_Syphilis sive
morbus Gallicus_.” It was published in several successive editions,
and was translated into nearly all the languages of European countries.
I shall have occasion to refer to it again in a later chapter.
Giovanni Maria Lancisi was born at Rome on October 26, 1654. Like
Boerhaave he began his university studies under the service of the
Church, but, as time went on, his leaning toward the profession of
medicine became more and more pronounced, and he soon took up in
earnest the study of that science at the University of Sapienza,
devoting a large share of his time to dissecting and to clinical work
in the hospitals. In 1672, when he was only eighteen years old, he was
given the degree of Doctor of Medicine; and four years later, after a
competitive examination, he was appointed an assistant at the Hospital
of the Holy Ghost. In 1678 he was permitted, as a special honor, to
enrol himself as a student in the Collège de Saint-Sauveur. During
the following five years he enjoyed at this institution exceptional
facilities for studying medical literature, and was thus able to
accumulate an immense mass of useful extracts from the writings of the
best authors. In 1684 he was assigned to the duty of teaching anatomy
at the Sapienza, and for thirteen years he filled this post with great
credit to himself; Malpighi being one of those who took pleasure in
following his lectures. He had scarcely attained his thirtieth year
when he was honored by being appointed Physician-in-Chief and Privy
Councilor to Pope Innocent the Eleventh; and soon afterward he was made
a Canon of the Church of Saint Lawrence, the main purpose of which
appointment was to provide him with a suitable income. On the death
of the Pope in 1689 he resigned the latter office, in order that he
might have more leisure and freedom to pursue his professional duties.
Subsequently he became the regular medical attendant, first of Pope
Innocent the Twelfth and afterward of Pope Clement the Eleventh. He
died on January 21, 1720.
Von Haller speaks of Lancisi as “a physician who was most highly
esteemed by Pope Clement the Eleventh, who was very learned and very
philanthropic, and who loved to give aid to the afflicted and to
prevent litigation by wise counsels.” It was Lancisi also, as I have
stated on a previous page, who discovered at Rome, in the possession of
the heirs of the artist Pini who made the original drawings, the copper
plates which Eustachius had ordered nearly two hundred years earlier,
and which were to have been used by this celebrated anatomist in the
production of a most beautiful set of anatomical illustrations.[77]
The two most important original treatises published by Lancisi bear the
following titles: “_De motu cordis et aneurysmatibus_” (on the
movements of the heart and on aneurysms), Rome, 1728 (a later edition
in 1745); and “_De subitaneis mortibus Libri II_” (on sudden
deaths), Rome, 1707 (also later editions).
_Botany and Botanical Gardens._--The Egyptians, the Persians, the
inhabitants of India and China, and the ancient Greeks accumulated a
great mass of information relating to plants which might be utilized
in the treatment of different diseases. Then, in the early part of the
present era, Galen contributed not a little to our further knowledge
on this subject; but from that time forward, until the sixteenth
century, pharmacology practically remained unchanged. The beginnings of
a systematic study of all plants--in other words, modern botany--may
be traced to the establishment of botanical gardens, first in Italy
and afterward in Holland and France. According to Berendes the very
earliest attempt in relatively modern times to cultivate such a garden
was made at Salerno by Matthaeus Silvaticus. Then Master Gualterus, in
1333, was permitted by the Governing Council of Venice to make use of
a certain plot of ground for the cultivation of the plants in which he
was specially interested. So far as one may judge, however, both of
these were private undertakings. In 1545, at the request of Francesco
Buonafrede, Professor of Therapeutics at the University of Padua, the
Senate of that city laid out a garden for his uses in teaching. This
appears to be the earliest instance of the establishment of a botanical
garden in connection with a regularly organized medical school. Then,
in fairly quick succession, similar gardens were established at Pisa
(1547), Bologna (1567), Leyden, Holland (by Boerhaave in 1577), and
Heidelberg (1593). In France the University of Montpellier received
its first botanical garden in the year last named. Thus it appears
that about the middle of the sixteenth century botany began to receive
attention as a branch of knowledge which, as was then believed, it was
important for physicians to study; and from that time forward, for
more than two centuries, it formed a regular part of the curriculum in
all the leading medical schools. The two chairs of botany and anatomy
were not infrequently combined. Fallopius, for example, held the Chair
of Anatomy, Surgery and Botany in the University of Padua, and so
also did Vesling in the same university at a somewhat later date. The
first systematic works on botany were also published in the sixteenth
century. They were all written by German or Swiss authors, the most
noteworthy one of the collection being that of Conrad Gesner of Zürich
(1516–1565), who is spoken of by Haeser as “a man of noble birth, of
extraordinary industry, of extensive knowledge in every department
of natural history, and the author of a large number of treatises,
which, by reason of their intrinsic value, cannot fail to perpetuate
the memory of this distinguished scientist throughout all time.” He
had much to contend with throughout his short but eventful life. In
the first place, he was very poor--so poor that both he and his young
wife were obliged to support themselves during the early years of their
married life by teaching school. Then he studied medicine at Basel, and
afterward accepted the professorship of Greek, first at Lausanne and
then in turn at Basel and at Zürich. From the beginning to the end of
his career he was hampered by poverty and by frequent illnesses. But,
despite these obstacles and also notwithstanding the fact that he was
an indefatigable worker in matters relating to natural history, he is
reported to have played one of the most influential parts in the drama
of the Reformation. Only a man of exceptionally strong character and
of unusual ability would have found it possible to attain the success
which Gesner attained in these different undertakings and under such
unfavorable circumstances. Andreas Caesalpinus, whom I have already
mentioned as one of the earliest investigators of the question of
the circulation of the blood, also interested himself in the science
of botany. Puschmann speaks of him as the greatest botanist of the
sixteenth century. For several years he was Professor of Philosophy and
Medicine in the University of Pisa, but at a later date Pope Clement
the Eighth chose him to be his private physician and also appointed him
Professor of Medicine in the University of Sapienza at Rome. His death
occurred in the latter city in 1603.
Before dismissing all further consideration of the part played by
Italian and Spanish physicians during the sixteenth century in the
advancement of the science of medicine, I shall briefly mention a
few additional discoveries in botany and pharmacy that may serve to
render the present account more complete. In 1518 the monk Romano Pane
published the first account of the discovery of tobacco in America.
In 1560 Jean Nicot, a French diplomatist, brought back with him from
Portugal (to which country he had been sent as an ambassador) a small
supply of the seeds of the plant. To commemorate this service the
alkaloid found in the leaves of the tobacco plant was given the name of
_nicotine_. Capsicum was made known to the world by Dr. Chanca, a
companion of Christopher Columbus on the occasion of his second voyage
(1493) to America. Balsam of Copaiva was discovered by a Portuguese
monk in Brazil at some time between the years 1570 and 1600. It is
mentioned for the first time in the Amsterdam Pharmacopoeia of 1636.
Monardes described the Peruvian and Tolu balsams in 1565. Cacao was
first made known to Europeans by Fernando Cortez in 1519. About the
year 1550 coca was introduced as a drug that possesses the power of
allaying hunger and of enabling one to endure the fatigues attending
prolonged expeditions. Sarsaparilla came into use at about the same
date. Then followed jalap in 1556 and sassafras toward the end of the
century.
In Germany and in the Netherlands there were, during the sixteenth
century, very few physicians who manifested any marked degree of
learning in the science of medicine. The teachings of Paracelsus met
with a favorable reception in these parts of Europe and they continued
to hold supreme sway over the minds of men during a long period of
time. There were some physicians, however, who had received their early
professional training in Italy and France, and who for this reason
were less ready to accept unreservedly the doctrines of Paracelsus;
and, among these more independent spirits, Rembert Dodoens (Dodonaeus,
1517–1586) of Malines, near Antwerp, distinguished himself by making a
number of valuable contributions to the science of medicine. He held
the Chair of Medicine at the University of Leyden and was also the
personal physician of the Emperors Maximilian the Second and Rudolphus
the Second. He was a very accurate observer, and his writings are
particularly rich in matters relating to pathological anatomy; for
which reason not a few authorities are inclined to credit him with the
honor of being the founder of this department of medical science. Felix
Platter of Basel, Switzerland, of whose experiences as a student at the
University of Montpellier I have given a brief account on a previous
page, and who was at this time Professor of Medicine in his native
city, was also greatly interested in pathological anatomy. Haeser gives
him credit for publishing a number of valuable contributions to this
department of medical knowledge, and also for making the first attempt
at a classification of diseases.
Before I close this chapter it seems only fair that I should add a
few comments upon the careers of two physicians whose professional
attainments entitle them to some consideration. The men to whom I have
reference are Marcello Donato and Raymond Minderer.
Marcello Donato was a distinguished medical practitioner of the city of
Mantua, Northeastern Italy, who died about the year 1600. He was one of
the few who, at that early period, taught that it was very important to
study disease from nature--_i.e._, from direct observation--and
not from books. His description of the epidemic of small-pox of 1567
(published at Mantua in 1569) is worthy of commendation. His chief
work, however, is that which bears the title “_De medica historia
mirabili etc._” (Mantua, 1586.) It contains a remarkably large and
complete collection of rare and extraordinary cases belonging to every
department of medicine, and in his descriptions Donato pays particular
attention to the pathologico-anatomical aspects of each case. He
reports, for example, the instance of a Caesarian section performed on
a living woman in 1540 by Christopher Bain; the child being found dead.
Another interesting case reported by Donato is that of a child in whose
ear a cherry pit had been allowed to remain undisturbed until it began
to sprout; after which it was found easy to remove the impacted object.
In a somewhat similar case which Donato also reports, the sprouting
of the seed of Anagyris was hastened by the presence of a purulent
discharge from the ear. In both instances all attempts to extract the
foreign body had failed until the sprouting had caused the seed to
split. Finally, there is recorded the case of a young man into whose
nasal passage a leech had penetrated, while he was bathing, and had
then taken up its abode far back in the canal. Donato, by aid of direct
sunlight, “discovered the creature in that part where the nasal channel
merges into the oral cavity.” Presumably he succeeded in removing the
animal, but the text quoted by von Gurlt (Vol. II., p. 517) furnishes
no further particulars.
CHAPTER XXXI
CHEMISTRY AND EXPERIMENTAL PHARMACOLOGY
The experiments which were carried out by Antonius Musa Brassavola, in
the early part of the sixteenth century, upon animals and criminals,
for the purpose of learning the effects produced by certain drugs when
administered internally, afford one of the earliest instances of a
genuine experimental pharmacology. The account of these experiments,
which was published at Rome, in 1536, under the title “_Examen omnium
simplicium, quorum usus est in publicis officinis_,” deserves
honorable mention. An even more remarkable evidence of the research
spirit which was abroad at that period is to be found in the work done
by Fortunatus Fedelis, a native of Palermo, Sicily, and an ardent
champion of the direct method of observation as applied to therapeutics.
Van Helmont, of whose life and contributions to the science of medicine
I now propose to furnish a sketch, represents in a certain sense
Paracelsus’ successor; and, as a matter of fact, he was even more
closely associated with the development of chemistry as an independent
science than was his predecessor.
Jean Baptiste Van Helmont was born at Brussels in 1577. His parents,
who belonged to the nobility, possessed ample financial means and
were therefore able to give their son every opportunity to secure a
liberal education. While still a lad he enrolled himself among the
students of the University of Louvain, and advanced so rapidly in his
studies that, already at the early age of seventeen, he had passed
all the examinations required of applicants for the degree of Master
of Philosophy. He was not willing, however, to receive this honor
at that time, feeling that he had not acquired sufficient knowledge
to justify such acceptance; and from that date forward he turned his
attention to the study of other branches of learning. Finally, in 1599,
he accepted from the same university the degree of Doctor of Medicine,
and soon afterward left Belgium with a large party of his friends to
make an extensive tour through the Alps of Switzerland and Savoy. After
his return home in 1602 he devoted his attention chiefly to chemical
researches; but in a very short time he started off again on a journey
to Spain and France, and eventually to England, where he spent nearly a
year in the city of London, returning to Belgium in 1605. He married,
about this time, a rich heiress of Wilworde, in the neighborhood of
Brussels, and resumed with great zest his labors in chemistry and
alchemy. He was thus enabled to manufacture many remarkable remedies
with which--as he himself declared--he succeeded in curing myriads
of patients who had failed to receive any benefit whatever from the
ordinary resources of medical science. He died on December 30, 1644.
I do not feel equal to the task of expounding Van Helmont’s often very
obscure theories regarding the physical and psychological processes
that take place in the human being; regarding the distinctions which he
makes between the “_archaeus influus_”--the regulating principle
which governs all the psychical and physiological processes in the
body--and the “_archaeus insitus_”--the subsidiary power which
resides in each individual part of the body, but which at the same time
is under the control of the “_archaeus influus_”; and regarding
the doctrine that disease is the result of an “_idea morbosa_” of
the “_archaeus influus_.” August Hirsch says that in developing
these theories Van Helmont puts forward many bright ideas, which
unfortunately lead one into a wilderness of fantastic, theosophic
concepts. If sufficient time and space were at my command it might
be interesting to separate some of these bright thoughts from the
extravagances in which they are buried, and thus demonstrate the truth
of the statements made by both Hirsch and Dezeimeris to the effect
that Van Helmont, in matters relating to physiology and pathology, was
unquestionably a precise and critical observer, a sound thinker, and a
correct interpreter; but the plan of the present work will not permit
me to enter into all these details. I can only quote a few of the
teachings or sayings to which Hirsch refers:--
Digestion does not, as Galen maintains, depend upon heat, but
upon a certain ferment existing in the gastric juice.
Heat is not, as has hitherto been taught, the cause of life, but
rather one of its products.
The final cause of the sensory phenomena of life is the
_archaeus influus_, which, while it is inseparably
united with matter, nevertheless does not represent the soul
itself, but rather the organ of the soul, and is seated in the
“duumvirate” of the spleen and the stomach.
Disease, in order to acquire sufficient power to antagonize
life effectively, must unite its forces with the _archaeus
influus_.
It is claimed that Van Helmont, more than any other teacher
of medicine, was instrumental in giving the deathblow to the
practice--which prevailed in all the medical schools of that day--of
teaching the obsolescent Galenic doctrines, and that for this valuable
service alone he deserves full recognition at the hands of the medical
profession of to-day. But, as we learn from Ernest von Meyer’s history
of chemistry, Van Helmont has a much stronger claim for recognition in
the fact that he made many important contributions to iatrochemistry
and also to fundamental or pure chemistry. Taking one thing with
another, says von Meyer, we may safely assert that Van Helmont’s
useful contributions to the medical and chemical sciences by far
outweigh those which are of a fantastic or useless nature. It was he,
for example, who materially increased our knowledge of the nature of
carbonic acid. He demonstrated how it may be extracted from limestone
or from potash by the aid of acids, from burning coal, and from wine
and beer while they are undergoing fermentation. He also showed that
it is present in the stomach, in various mineral waters, and in
hollows in the earth. He gave it the name of “_gas sylvestre_.”
He would doubtless have carried his discoveries much farther along if
he had possessed the apparatus which is required for such researches.
However, despite the lack of these facilities, he was able to describe
hydrogen and marsh gas as special varieties which do not possess the
same composition as ordinary air. Finally, in his treatise entitled
“_Pharmacopolium ac dispensatorium modernum_” will be found
a goodly number of useful instructions as to the proper manner of
preparing drugs.
A complete collection of his writings was published at Amsterdam by his
son, in 1648, under the title “_Ortus medicinae vel opera et opuscula
omnia_.”
Theophrast von Hohenheim--who is known everywhere throughout the
world as “Paracelsus”--was the son of Wilhelm Bombast von Hohenheim,
a physician who belonged to one of the noble families of the Duchy
of Württemberg. He was born in 1493 at a spot called “_Das Hohe
Nest_” (the lofty nest) in the Canton of Schwyz, about one hour’s
distance from the celebrated monastery or cloister of Einsiedeln, of
which institution his father was the official physician. Switzerland,
therefore, has a right to claim Paracelsus as one of her sons. In 1502
his father transferred his home to Villach, in Carinthia (to the east
of Tyrol), and continued to live there up to the time of his death in
1534. It is not known where the son obtained his degree of Doctor of
Medicine. It is a well-established fact, however, that he received the
first part of his training as a chemist from Johann Trietheim, the
Prior of Sponheim, and his subsequent education in the laboratory of
Sigmund Fugger, the cultivated owner of wines at Schwatz in the Tyrol.
He traveled all over Europe, going from one university to another and
making the acquaintance of people who were well informed in matters
relating to natural history, chemistry and metallurgy; and during all
this time he appears to have absorbed a great deal of information
relating to almost every department of human knowledge. Finally in
1526, soon after he had returned to Switzerland, he received, through
the aid of certain influential citizens, two important official
positions in Basel,--that of City Physician and that of Professor of
Medicine and Surgery in the University. To the surprise of all, and
contrary to long-established custom, he delivered his lectures in
German and not in Latin. This action on his part called forth bitter
criticism from the university authorities, but at first it met with the
approval of the students. During the following two years, however, he
gradually became unpopular with all classes of the community, and was
finally obliged to leave Basel. Haeser attributes this unpopularity
to Paracelsus’ rough manners, to his intolerance of the opinions of
his colleagues, and to his tirades against the apothecaries for their
excessive charges. It is very difficult to determine how far jealousy
was responsible for the state of affairs which I have just described.
Cabanès, the author of an admirable biography of Paracelsus (_Revue
Scientifique_, Paris, May 19, 1894), gives his own estimate of this
remarkable man’s character in the following terms: “Poor, miserable,
and persecuted during his lifetime, he was misunderstood even after
his death, and was calumniated by history.” Paracelsus evidently
believed it to be his bounden duty to destroy the then prevailing cult
of Aristotle, Galen and Avicenna as the great teachers in medicine;
and, filled with this idea, he prophesied the growth of a new science
of medicine on the ruins of their teachings. It is stated that the
students, after one of these excited lectures, made a bonfire and
burned a number of copies of the works of these famous authors, thus
showing that Paracelsus was sufficiently eloquent to infuse some of
his own reforming spirit into the minds of his auditors. He made
a great mistake, however, when he attacked in a similarly violent
manner the shortcomings of many of his contemporaries. “The medical
profession,” he said, “has become a mere money-making business.” As a
natural result of such tirades, Paracelsus was forced to leave Basel.
He fled first to Colmar in Alsace and at a later date took refuge in
St. Gall, Switzerland; and it was while he resided in that city that
he published three books of his “_Paramirum_.” Then in 1535 he
once more resumed his wandering life, in the course of which he visited
Poland, Lithuania, Illyria, etc. On reaching Salzburg, in Austria, he
fell ill and died on September 24, 1541, at the age of forty-eight.
Paracelsus was a prolific writer. To all the treatises which he
published he gave extravagant titles. To his principal work, for
example, he gave that of “_Paramirum_”--The Surprising Marvel;
to another, that of “_Paragranum_”--Grain of Superior Quality;
and to a third, that of “_Archidoxia_,”--Transcendental Science.
He wrote treatises on syphilis, on the plague, on epidemics, on the
diseases of grave-diggers, on ore-smelters, etc. It is admitted by all
his critics that he devoted altogether too much time and thought to
alchemy, demonology, necromancy, etc. Cabanès quotes Cruveilhier as
saying that Paracelsus believed in the reality of beings of a fantastic
nature, but attached little or no importance to them. Then Cabanès
himself adds: “The thing which more than anything else absorbed his
thoughts was the irresistible desire to overthrow the Galenic idol
and substitute for it the science of experience, of observation pure
and simple.” Bordes-Pagès, another distinguished French physician,
says of this extraordinary man: “The great glory of Paracelsus is to
be found in the facts that he cast off the yoke of a former epoch,
more speculative than practical; that he summoned physicians to resume
their allegiance to experience; and that he opened a long career
for the alchemists, upon whom he urged the duty thenceforward of
making new remedies the principal object of their researches.... He
simplified and spiritualized therapeutics.” Some of Paracelsus’ own
sayings are worth preserving: “Without air all living creatures would
perish from suffocation.” “Man is the supreme animal, the one last
created.” “_Alterius non sit, qui suus esse potest_” [He who is
able to be his own master should not allow himself to be led blindly by
another]. When he was accused of being coarse-grained and of deceiving
the people, he replied: “By nature and also owing to the kind of
people with whom I associated in my youth I am not of a finely-spun
texture.... We were not nourished with figs and white bread, but with
cheese, milk and black bread-food that does not make delicate lads....
They say of me that I lead the people astray, that I am possessed of a
devil, that I am a sorcerer, and that I am a magician. Whatever truth
there may be in these charges, one thing is certain: You are all of you
unworthy to unloose the latchets of my shoes.” (From _Paragranum_,
II., 120.)
Oporinus, who acted for a long time as Paracelsus’ assistant, made the
following statements with regard to some of the methods of his former
master:--
He always kept several preparations stewing on his furnace--as,
for example, a sublimate of oil or of arsenic, a mixture
of saffron and iron, or his marvelous Opedeldoch. He never
prescribed a special diet nor any hygienic measures. As a purge
he gave a precipitate of theriaca or of mithridate, or simply
the juice of cherries or grapes, in the form of granules (about
the size of the droppings of mice), and he was careful always
to give them in uneven numbers (1, 3, or 5). He was bitterly
opposed to the polypharmacy which prevailed so widely in his day.
Cabanès says that we probably owe to Paracelsus an increased knowledge
of the virtues possessed by the different preparations of antimony,
mercury and iron, and by salines. It was he who created the distinction
between officinal and magistral preparations. To our list of
pharmaceutical preparations, he added tincture of hellebore, compound
tincture of aloes, digestive ointment, the tincture of metals (“Lilium”
of Paracelsus), the “Saffron of Mars,” etc. He was the inventor of the
precious preparation known as “_la mumie_,” a preparation which
was popularly believed to possess marvelous healing powers. Ambroise
Paré, toward the end of his career, was greatly blamed because he did
not employ this remedy, and he was finally compelled in self-defense to
write a pamphlet on the subject. (The text is reprinted in Malgaigne’s
“_Ambroise Paré_,” under the title of “_Traité de la mumie et de
la licorne_.”)
Adolphe Gubler of Paris credits Paracelsus with the distinction of
having been the first physician to give an impetus to the movement
which had for its object the application of chemistry to the perfection
of medicinal preparations. He also maintains that Paracelsus should be
looked upon as in a large degree the originator of specific remedies,
and that he is justly entitled to the distinction of having been the
first publicly to announce the “quintessences”--that is, the active
principles (vegetable alkaloids)--of drugs. According to this claim
it is understood that Paracelsus taught that each drug contained a
specially active elementary body which it was possible to extract
as a separate substance. Acting upon this belief Paracelsus did not
hesitate to give the preference to the pharmaceutical preparations
known as “tinctures”--that is, alcoholic extracts. Great credit is
also due to Paracelsus for his rejection of the doctrine that guaiac
is an efficient remedy against syphilis, and for his insistence that
mercury is the only useful agent in curing that disease. Tartar emetic
(potassium antimonyl tartrate) is one of the drugs the introduction of
which into our pharmacopoeia should be credited to Paracelsus.
One of the earliest references to genuine diphtheria is to be found in
the writings of Paracelsus, who speaks of the disease in the following
terms:--
When this disease is located in an external wound it not
infrequently spreads to the muscles of the larynx; and, _vice
versa_, when a person has the disease in his throat, and at
the same time happens to have an external wound, the malady is
likely to spread to the wound.
Paracelsus’ idea of the existence of an “_archaeus_,” a power
which presides over all physiological actions as well as over all
the operations of medicinal drugs, resembles very closely the “vital
force,” or “animism” so strongly championed by Stahl in the seventeenth
century.
From all that I have said above regarding the excitable nature of
Paracelsus it seems almost a waste of time to tell our readers that his
contributions to the science of surgery were of very slight value. He
despised the study of anatomy, claiming that a knowledge of this branch
of medical science was not essential to a proper acquaintance with the
human body. “To dissect,” he once remarked, “was a peasant’s manner of
procedure.” (Cabanès.) His surgery, as one may imagine, showed clearly
the bad effects of such beliefs.
During the latter part of the nineteenth century there developed
among the leading men of the medical profession a sentiment in favor
of honoring the memory of Paracelsus by the erection of a suitable
monument at Basel, Switzerland, the city in which he made his first
public appearance. The project met with a favorable reception and the
statue is now an accomplished fact. This is a remarkable instance of
tardy justice being rendered to the memory of a physician who, for
three hundred years, was almost universally looked upon as a vain,
half-crazy man.
The next advances of any special importance in the department of
chemistry were made in Great Britain by Robert Boyle, who was born
at Lismore, County of Cork, Ireland, on January 25, 1626. He was the
fourteenth child of the Earl of Cork. His early training was obtained
at Eton, and then afterward he spent two years at Geneva, Switzerland,
in prosecuting his scientific studies. In 1654 he entered Oxford
University and became intimately acquainted with some of the most
learned men of that day. While he was a student at the university he
became a member of what was known as “The Invisible College,” a society
which was influential in bringing about the founding of “The Royal
Society,” of which organization he was president from the year 1680 to
the time of his death in 1691.
Boyle was endowed with a noble character--modest, religious and
generous. He gained distinction as a chemist in several departments.
Applied chemistry is indebted to him for a number of important
contributions; he added to our knowledge of chemical combinations and
to the methods of analyzing them; he enriched the chemistry of gases
and also pharmacology; and he gave a clear and easily intelligible
definition of what a “chemical element” is. He laid stress upon the
doctrine that a chemical combination represents the union of two
component elements, and that this combination possesses characteristics
quite different from those possessed by either of the two component
elements. Before his day there was practically no such thing as
analytical chemistry, and it is to Boyle that we owe the establishment
of a clear conception of what the terms “chemical reaction” and
“chemical analysis” signify. The part played by atmospheric air in
combustion was made by him the subject of numerous experiments which
proved later to be of great assistance in the final solution of the
problem.
In one of his writings Boyle says in substance that if men would devote
their energies to carrying out experiments and collecting observations,
rather than to the constructing of theories without having previously
tested with thoroughness the grounds upon which they believe them to
be based, the world would be greatly the gainer. The promulgation
and insistence upon the importance of this doctrine for the growth
of the science of chemistry constitute--so those competent to judge
claim--Boyle’s greatest merit in scientific work and his most important
contribution to chemistry.
Among the chemical treatises which Boyle wrote and published the
following deserve to receive special mention: “Sceptical Chymist,”
1661; “_Tentamina quaedam physiologica_,” 1661; “_Experimenta
et considerationes de coloribus_,” 1663; and “Medical Experiments,”
1692–1698. Although Boyle was not an avowed follower of Bacon, he
carried out thoroughly the principles which the latter taught.
Raymond Minderer, a practicing physician in Augsburg, Germany
(1570–1621), deserves the credit of having added to our stock of
remedies the acetate of ammonia (_liquor ammonii acetatis_).
Diluted with an equal quantity of water it is still employed to-day as
a remedy under the name of “Spirit of Mindererus.” He was the compiler,
in 1613, of the Augsburg Pharmacopoeia.
_General Therapeutics.--Transfusion.--The Discovery of Cinchona
and Ipecacuanha._--In the department of general therapeutics, as
we learn from Berendes, several important new measures were brought
forward during the seventeenth century; and among these the following
deserve to receive brief mention in this place: the operation of
transfusing blood from a healthy individual to one who is ill; the
introduction of cinchona into the European pharmacopoeia as an
efficient remedy in the treatment of certain fevers; the similar
introduction of another South American drug--viz., ipecacuanha; and
the invention of many medico-chemical products and the improvement of
others that were already in common use.
As regards the operation of transfusion, from which great things were
expected, Sir Christopher Wren (1632–1723), the famous architect and
astronomer of London, is reported to have been the first person to
urge a trial of this procedure. On the other hand, Robert Boyle, the
chemist, actually performed the operation on animals. He followed the
method suggested by Richard Lower (1631–1691) of England, viz., by
allowing the blood to flow from the carotid artery of one animal into
the jugular vein of a second animal; while Edmund King adopted the
plan of allowing the blood to pass from the jugular vein of one animal
into the corresponding vein of a second animal. Upon a human being the
operation was probably performed for the first time (in 1666) by Denys,
Professor of Philosophy and Mathematics in Paris. Repetitions of the
operation were made, two or three years later, in London and in Rome,
but they produced no good effects and in some instances they terminated
in the death of the individual for whose benefit the operation had
been performed. In 1668 the French Parliament and the Papal Government
forbade a repetition of the operation.
In 1638--so the story runs--the wife of Count Cinchon, Viceroy of Peru,
was cured of a stubborn intermittent fever by the native physicians,
who employed, in their treatment of the malady, the bark of the tree
now universally known by the name of “Cinchona.” In 1640 Juan del
Vego, the regular medical attendant of Count Cinchon, introduced
the new remedy into Spain, but it was not until after the lapse of
about fourteen years that the drug found its way into England and
Central Europe. The price at which it could be purchased was at first
very high; it was almost literally “worth its weight in gold.” Even
as late as 1680 the bark sold in England for £8 sterling per pound.
Notwithstanding the generally recognized value of the drug in the
treatment of certain fevers there were not a few men who continued
for many years to oppose its use. Thus, Johann Kanold, a practitioner
of medicine in Breslau, Germany, is reported to have said, on his
death-bed in 1729, that he would rather die than be cured by a remedy
the action of which was so opposed to all the principles which he
considered right in therapeutics.
Ipecacuanha, another very important drug, was added to our stock of
remedial agents toward the end of the seventeenth century. It was
brought into France from Brazil, in 1672, by a French physician named
Le Gras, but its value as a remedy for the cure of dysentery did not
begin to be appreciated until after Helvetius, a semi-quack, had sold
to Louis the Fourteenth, for one thousand louis-d’or (about $4000),
the formula for the preparation which he (Helvetius) had been using
with great success during the recent epidemic of that disease, and
which moreover had effected a remarkably rapid cure in the case of
the King’s own son--the Dauphin. After the purchase had been made by
Louis the Fourteenth, in the interest of the French people in general,
it was ascertained that the only active reagent among the ingredients
of the formula was ipecac, a drug with which the Paris physicians had
long been more or less familiar. Ipecac, it will also doubtless be
remembered, constitutes the important element in what is known as the
East Indian treatment of dysentery.
Probably the earliest modern treatise on matters connected
with pharmacy is that which bears the title “_Onomasticon
Latino-Germanico-Polonicum rerum ad artem pharmaceuticam
pertinentium_.” It was published about the year 1600, and its author
was Paul Guldinus.
One of the most important iatrochemical authorities of the seventeenth
century was Johann Rudolf Glauber (1604–1668), to whom we are indebted
for the invention or improvement of a large number of medico-chemical
products. The well-known “Glauber’s salt” may be named as one of these
products, and chloride of iron as another.
CHAPTER XXXII
SOME OF THE LEADERS IN MEDICINE IN ITALY, FRANCE AND ENGLAND
DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES
_Eminent French Physicians._--Among the physicians of France who
attained a widespread and well-grounded celebrity throughout Europe
during the sixteenth century, Pierre Brissot deserves to be given
the first place. He was born in 1478 at Fontenay-le-Comte, not far
from Rochelle, and was a professor of medicine at Paris. He attained
considerable distinction, during the sixteenth century, by his advocacy
of the superiority of the Hippocratic method of bloodletting over that
introduced--or, rather, perpetuated--by the practitioners of that day
in Central Europe. The rule which was laid down by Hippocrates was
to the effect that, in venesection, the blood should be drawn from
the vein lying nearest to the part inflamed. The Greek physicians
of a later period forgot all about this rule and adopted in its
place one that was based on the doctrine that venesection practiced
in the vicinity of a focus of inflammation favors a determination
of blood to that part and therefore does only harm; and they
accordingly--especially in cases of pleuritis--abstracted blood from
the arm on the side opposite to that on which the disease was located,
or from one of the veins of the foot. This new rule was subsequently
adopted by the Arabian physicians, and it remained in full force up to
the end of the sixteenth century. A wide experience in the treatment of
the epidemic pleuritis which raged in Paris in 1514 confirmed Brissot
in the belief that the Hippocratic method is the one to be preferred;
but, despite his pleadings, the Parisian physicians refused to adopt
the method which he advocated and used their influence in securing from
the French Parliament an order forbidding him to continue employing it
in Paris. Discouraged by the treatment which he experienced in that
city, Brissot removed to Lisbon in Portugal, and soon had occasion
(in the epidemic which raged at Evora in 1516) further to satisfy
himself that the Hippocratic rule is the correct one. But here too he
encountered bitter opposition on the part of the Portuguese physicians;
his most active opponent being Dionysius, the Physician-in-Ordinary
to the King. Brissot then wrote an elaborate defense of the method
which he advocated, and this treatise was submitted to the judgment of
the Medical Faculty of the University of Salamanca. When the decision
of this learned body was given in Brissot’s favor, his opponents,
dissatisfied with the result, made still another effort to gain
their point, viz., by appealing to the Emperor Charles the Fifth.
They assured his Majesty that the Brissot Heresy, as they termed it,
was fully as dangerous to the cause of humanity as that championed
by Luther. But here again they failed. This final victory, however,
brought no satisfaction to Brissot, who died of dysentery in 1522,
just before the decision was rendered. Haeser speaks of this unusually
bitter dispute as one of the last of the violent battles which occurred
between the adherents of the Arabian physicians and the supporters of
the teachings of Hippocrates, and which terminated in “a most brilliant
victory of experience over Arabian dogmatism.”
[Illustration: FIG. 16. “THE LOVESICK MAIDEN.”
(After the painting by Jan Steen, 1626–1679.)
One of this famous Dutch artist’s objects, in painting the scene
here represented, was to satirize the practice, which was very
prevalent among certain physicians of that period, of pretending
to diagnose all sorts of maladies from the mere naked-eye
inspection of his patient’s urine.
(Courtesy of Dr. Eugen Hollander, author of _Die Medizin in
der klassischen Malerei_, Stuttgart, 1903.)]
During the first half of the sixteenth century there developed a
belief, among the more ignorant physicians, that, in many cases of
illness, important information may be derived from a simple naked-eye
inspection of the patent’s urine as exposed to view in a flask-shaped
glass vessel. In the Hippocratic writings no adequate grounds for
such a belief are discoverable, but in one of Galen’s treatises there
have been found statements which appear(?) to give some sanction to
this new idea. However this may be, it is an established fact that
uroscopy was taken up at the time named with great zeal by all the
quacks in the land and by large numbers of practitioners of medicine
who saw in this procedure an easy and safe method of bettering their
fortunes. The public at large were greatly impressed with this new and
wonderful manner of detecting disease, and for a long period--indeed,
for more than half a century--this piece of clap-trap charlatanry
continued to thrive, and to reflect only discredit upon the medical
profession. There came a time, however, when people generally began
to suspect that uroscopy was not all that the charlatans claimed it
to be, and these suspicions were voiced in the popular saying, “The
pulse is good, the urine is normal, and yet the patient dies.” The
writers who were the most active in showing up the hollowness of
the claims of the uroscopists were Scribonius of Marburg, Germany,
Peter Foreest (1522–1597) of Alkmaar, Holland, and Leonardo Botallo
of Asti, in Piedmont (born in 1530). The latter authority, it may be
recalled, owes his chief distinction to the fact that he rediscovered
what has been erroneously named in his honor the “_foramen
Botalli_”--_i.e._, the _ductus arteriosus_ in the foetus.
He also attained some distinction in another direction. He revived
the violent disputes about venesection by recommending a resort to
this therapeutic procedure in nearly all illnesses. He went so far
as to advocate four or five bloodlettings in the course of an acute
attack, in each one of which operations from three to four pounds
of blood should, as he believed, be abstracted. Indeed, he claimed
that in an extreme case it might be perfectly proper to abstract as
much as _seventeen pounds_(!). Inasmuch as Botallo’s practice
was largely confined to the strong soldiers of Northern Italy it is
easier to understand how such extravagant bloodletting did not more
often prove fatal than it did. When, soon afterward, the Paris Faculty
condemned the practice in the strongest possible terms, Botallo’s
followers characterized sarcastically the French physicians as “pigmy
bloodletters” (_petits saigneurs_).
But the efforts of Scribonius, Botallo and others to put an end to the
uroscopy scandal were--I fully believe--not the only or perhaps even
the most potent factors in bringing about the suppression of the evil.
As many of our readers will remember, the art collections of European
capitals contain admirably painted specimens of Dutch and Flemish
genre pictures representing every phase of this uroscopic fraud, and
these striking masterpieces, revealing, as they undoubtedly did to the
community at large, the ridiculous character of the claims made by the
charlatans, could scarcely have failed to give a deadly blow to the
fraud. (See Fig. 17.)
In the early part of the sixteenth century Jean Fernel of Amiens
(1497–1558) was one of the leading medical authorities of France.
After receiving his degree of Doctor of Medicine at Paris, in 1530,
he settled in that city and soon acquired considerable reputation,
not only as a practitioner but also as a lecturer. In 1545 he was
called upon to take charge, professionally, of Diane de Poitiers, the
mistress of Henry, the son of Francis the First, King of France. About
the same time he was asked to serve as First Physician to the Dauphin,
but he was not disposed to accept the latter position, as he disliked
the duties of the office and also because he feared that they would
interfere with his favorite studies. He pleaded poor health, and his
excuse was accepted as valid. That Fernel was held in very high esteem
by the royal family is evident from the events which succeeded this
refusal. In the first place, it was insisted that he should accept
the stipend (600 livres) attached to the office, as a mark of the
royal favor; and then, in 1547, when Henry was crowned king (Henry the
Second), Fernel was urged to become his First Physician; but again he
declined the honor, this time on the ground that Louis de Bourges,
who had held the position with great credit under Francis the First
(Henry’s father), was entitled to be retained in office. The King
yielded to Fernel’s generous intervention in behalf of de Bourges.
But in 1556, when the latter died, Fernel felt obliged to accept the
position which had then become vacant; and from that time forward,
until the time of his death on April 26, 1558, he accompanied the
King on all his military expeditions. As he did not possess a robust
constitution, his health suffered not a little from the frequent
exposures to hardships of all sorts to which he was subjected; and, in
addition, during this long period he saw very little of his wife to
whom he was devotedly attached.
Fernel is universally admitted by French physicians to have been one
of the most cultivated teachers and practitioners of medicine of his
day. He was a very clear writer, and would doubtless have made a number
of valuable additions to the science if he had not been carried off by
illness at a comparatively early age.
Of his published writings the following are reckoned the most
important: “_Universa medicina_,” Paris, 1567; “_De abditis
rerum causis_,” Paris, 1548, and “_Therapeutices universalis seu
medendi rationis libri VII._,” Paris, 1554. (Many editions of each
of these works were published.)
In his discussion of various questions relating to physiology Fernel
maintains that the component elements of the body are vivified by means
of heat, and he elaborates this idea very much in the same manner as
Hippocrates does that of the “_callidum innatum_.” The spiritual
life, he says, is presided over by the soul (“_anima_”). When he
comes, however, to consider the individual powers of the soul, Fernel
treats the subject exactly as does Galen. He gives expression to one
rather bright idea: “The specific functions of each of the different
organs may be inferred in large measure from the character of the
structural elements of which they are composed.”
In his scheme of pathology Fernel divides diseases into _simple_
(“_similares_”)--diseases of the tissues; _compound_
(“_organici_”)--diseases involving entire organs; and
_complicated_ (“_communes_”)--diseases in which the normal
relations between the different parts are broken up.
In the chapter which Fernel devotes to the subject of therapeutics,
there is a section relating to venesection which, according to Haeser,
is well worth reading, as it reveals the power of the writer to grasp
the leading points and to reason correctly from them.
_Two English Physicians Who Became Famous During the Sixteenth
Century._--In the early part of the sixteenth century the medical
profession of Great Britain was in a most unsatisfactory state.
Humbuggery, ignorance and superstition were at that period of time
the most prominent characteristics of the majority of physicians
upon whom the people at large had to depend for the relief or
cure of their bodily ailments, and there were very few and very
untrustworthy measures in force for the production of a better class of
practitioners. Just at this juncture there appeared on the scene a man
who was eminently well equipped to rescue England from this lamentable
state of affairs and to put her on the high road to the acquisition of
an honorable body of medical men and of a corps of apothecaries who
could be trusted to dispense pure drugs properly compounded. I refer
to Thomas Linacre, who was born at Canterbury in 1461 or 1462, was a
Fellow of All Souls College, Oxford, and a graduate of the University
of Padua, and whose biography is sketched by John Freind (1675–1728) in
such an admirably clear, concise and appreciative manner that I cannot
do better--in view of the great importance of this event in the history
of medicine in England--than to reproduce it here in considerable
fulness of detail.
Thomas Linacre was a man of a bright genius and a clear
understanding, as well as unusual knowledge in different parts
of learning: ... and, being very desirous to make further
improvements by travelling, he thought he could no where succeed
in his designs so well as by going to Italy, which began then
to be famous for reviving the ancient Greek and Roman learning.
There he was treated with extraordinary kindness by Lorenzo
de Medicis, one of the politest men in his age and a great
patron of letters; who favoured him so far in his studies as
to give him the privilege of having the same preceptors with
his own sons. Linacre knew how to make all his advantages of
so lucky an opportunity; and accordingly, by the instructions
of Demetrius Chalcondylas, a native of Greece, he acquired a
perfect knowledge of the Greek tongue; and so far improved under
his Latin master Politian, as to arrive to a greater correctness
of style than even Politian himself....
Having laid in such an uncommon stock of learning, he applied
himself to the study of natural philosophy and physick;
particularly he made it his business, and was the first
Englishman who ever did so, to be well acquainted with the
original works of Aristotle and Galen. He translated and
published several tracts of the latter....
In his own Faculty he distinguished himself so much that, soon
after his return, he was pitched upon by that wise king, Henry
the Seventh, as the fittest person to be placed about Prince
Arthur, and to take care both of his health and his education.
He was afterward made successively Physician to that king, to
his successor Henry the Eighth, and to the Princess Mary....
And indeed, as he was perfectly skilled himself in his own art,
so he always shewed a remarkable kindness for all those who
bent their studies that way; and wherever he found, in young
students, any ingenuity, learning, modesty, good manners, and a
desire to excel, he assisted them with his advice, his interest,
and his purse. And to give a still stronger proof, how much he
had the good of his own Profession and that of the Publick at
heart, he founded two _Lectures of Physick_ in Oxford, and
one at Cambridge....
But he had still further views for the advantage of our
Profession: he saw in how low a condition the practice of
Physick then was, that it was mostly engrossed by illiterate
monks and empiricks, who in an infamous manner imposed on the
Publick; the Bishop of London or the Dean of St. Paul’s for the
time being, having the chief power in approving and admitting
the practitioners in London, and the rest of the bishops in
their several dioceses. And he found that there was no way
left of redressing this grievance, but by giving encouragement
to men of reputation and learning, and placing this power of
licensing in more proper hands. Upon these motives he projected
the foundations of our College [of Physicians]; and using
his interest at Court, particularly with that great patriot
and munificent promoter of all learning, Cardinal Wolsey, he
procured Letters Patent from the King, which were confirmed
by Parliament, to establish a corporate Society of Physicians
in this city, by virtue of which authority the College, as a
corporation, now enjoys the sole privilege of admitting all
persons whatever to the practice of physick, as well as that
of supervising all prescriptions. And it is expressly declared
that no one shall be admitted to exercise physick in any of
the dioceses in England, out of London, till such time that he
be examined by the President and three of the Elects, and have
letters testimonial from them, unless he be a graduate in either
University, who, as such, by his very Degree, has a right to
practice all over England, except within seven miles of London,
without being obliged to take any license from the Bishop....
By other Acts another weighty affair is committed to the care of
the College, [viz.,] the visiting of shops and the inspection of
medicines; a thing surely of as much consequence at least to the
patient as to the prescriber....
Linacre was the first president of his new-erected college, and
held that office for the seven years he lived after.... And
perhaps no Founder ever had the good fortune to have his designs
succeed more to his wish; this society has constantly produced
one set of men after another, who have done both credit and
service to their country by their practice and their writings.
If further evidence be needed to show what was the type of mind
possessed by this remarkable English physician, I may be permitted to
quote here a single brief statement made by his friend Erasmus, the
famous Dutch scholar and theologian, in a letter addressed to John
Fisher, Chancellor of Cambridge University: “Linacre is as deep and
acute a thinker as I have ever met with.”
In England, during the seventeenth century, there appeared on the scene
only one practicing physician of such conspicuous ability and of so
marked personal traits of character as to place his name, after the
lapse of a few years from the time of his death, and by the almost
unanimous assent of his associates, high up on the roll of honor. I
refer to the famous physician Sydenham.
[Illustration: FIG. 17. THOMAS SYDENHAM.
(After the portrait in the hall of All Souls’ College, Oxford.)]
Thomas Sydenham was born at Wynford Eagle, Dorsetshire, England, in
1624. At the age of eighteen he entered Magdalen College, Oxford,
and remained there until 1644, when he enlisted in the Parliamentary
Army. After a brief military service, he resumed his studies at the
university and received his Bachelor’s degree in 1648. It was only at
a much later date (1676), however, that he was given (after he had
pursued the prescribed course of studies) the degree of Doctor of
Medicine,--and then not by Oxford, but by Cambridge. After leaving
the university he first spent a few months at the Medical School of
Montpellier, France, and then settled (1666) in London as a practicing
physician, the necessary license having been granted him by the
College of Physicians. His first medical treatise, which bore the title
“_Methodus Curandi Febres_” [Method of Treating Fevers], was
published in 1666. The third edition of this work was issued ten years
later, but with the title changed to “_Observationes Medicae_
etc.” Between 1666 and 1683 he published several other treatises,
the more important of which deal with epidemic diseases--syphilis,
small-pox, hysteria and gout.
During the later period of Sydenham’s career he attained great
celebrity as a physician; but this celebrity would have been
short-lived if it had rested on nothing more substantial than mere
cleverness and professional success. As a matter of fact he had brought
about, by his teaching and also by his example, a most important
revolution in medicine, and it was the appreciation of this fact which
led the physicians of England to bestow upon him, after his death, the
appellation of “The English Hippocrates,” and which ultimately gave him
so highly honorable a position in the history of medicine in general. A
brief review of the state of medicine in England during the seventeenth
century will enable the reader to understand the full importance of the
change which Sydenham was instrumental in bringing about.
The physicians of that period were split up into three sects: the
followers of Galen, with whom should be classed the Graeco-Arabists;
the iatrochemists; and the iatrophysicists.
The Galenists were largely intent upon the strictest interpretation of
the teachings of Hippocrates, Galen and some of the Arabian authors.
Instead of studying disease itself they devoted their time and thoughts
largely to the interpretation of the words used by these fathers in
medicine--_i.e._, to philology. Real progress in the science
of medicine was not possible along this route. Accepting without
dispute the dogma of the four humoral qualities, together with the
different temperaments which result from the predominance of any one
of them, they combated these different temperaments or constitutions
by prescribing drugs in a very great variety of combinations
(polypharmacy).
The iatrochemists, attaching small importance to simple dietetic
measures, prescribed without stint all the most active substances
belonging to the mineral kingdom and all the new remedies which the
chemists had evolved from their furnaces.
Finally, the iatrophysicists directed their efforts to the removal or
diminution of all bodily conditions that appeared to act as mechanical
hindrances to health.
Sydenham, who possessed a rare degree of common sense, cast aside
all these hypotheses, disregarded the prevailing routine methods of
treatment, and refused to accept the therapeutic novelties of the day.
“Nature is to be my guide,” he declared, and from that time forward he
studied disease at the bedside, and watched carefully, and with a mind
free from prejudice, the effects of the remedies which he employed.
Thus, pursuing the methods advocated by the great master Hippocrates,
he was able to place his medical brethren once more on the pathway
which leads to an increase in knowledge of the healing art. Practical
medicine, which had previously been falling into an almost moribund
condition, was by his efforts made again a living and growing science.
That Sydenham had a perfectly clear conception of what was needed at
that time to renew the vitality of the medical profession of England
is plainly shown by the following statement which he makes in the
dedication of one of his writings to Dr. Mapletoft:--[78]
After studying medicine for a few years at the University of
Oxford, I returned to London and entered upon the practice of
my profession. As I devoted myself with all possible zeal to
the work in hand it was not long before I realized thoroughly
that the best way of increasing one’s knowledge of medicine is
to begin applying, in actual practice, such principles as one
may already have acquired; and thus I became convinced that
the physician who earnestly studies, with his own eyes,--and
not through the medium of books,--the natural phenomena of
the different diseases, must necessarily excel in the art of
discovering what, in any given case, are the true indications as
to the remedial measures that should be employed. This was the
method in which I placed my entire faith, being fully persuaded
that if I took Nature for my guide, I should never stray far
from the right road, even if from time to time I might find
myself traversing ground that was wholly new to me.
In the brief account which I have thus far given of the part played by
Sydenham in advancing the science of medicine, I have called attention
only to the general character of the services which he rendered. It
may now be interesting to furnish here a few details that will aid
in completing the picture of this great English physician,--details
relating to his life and personal character, to his views regarding
certain diseases and the remedies which he was in the habit of
employing for their relief or cure, and to his later writings.
Throughout the greater part of his professional career Sydenham was
a frequent sufferer from gout, some of the attacks being of a severe
type and occasionally of long duration. During the winter of 1676, for
example, he was seriously ill from renal calculus, haematuria being
brought on by the slightest movements of his body. All through the year
1677 he continued to experience frequent attacks of pain, and on one
occasion he was unable to leave the house for a period of three months.
Speaking of the epidemic of the Plague in 1665, during the progress of
which he left London, Sydenham says: “When I saw that the danger was
in my immediate neighborhood I listened to the advice of my friends
and joined the crowd of those who were fleeing to the country. A
little later, when the epidemic had further increased in severity,
and before any of my neighbors had returned, I yielded to the calls
of those who had need of my services, and went back to London.” It is
worthy of remark, says Laboulbène, who fully appreciated the heroism
which prompted this last decision, that we should never have known
of Sydenham’s weakness in regard to facing his duty, if he himself
had not stated the facts. This famous epidemic, as is well known, was
accompanied by an appalling mortality.
Andrew Browne, a Scotch physician of good standing, entertained serious
objections to some of the advice given by Sydenham in the treatise
entitled “_Schedula monitoria de novae febris ingressu_,”[79]
and, in order to learn more precisely what the author’s views on the
subject really were, he decided to run down to London for a day or two.
Sydenham gave him such a cordial reception and made his stay in the
metropolis so pleasant that he remained there several months--instead
of a day or two. “And when I returned to Scotland I felt contented and
joyful as if I were carrying back with me a valuable treasure.”
As an instance of his thoughtful kindness, it is related that Sydenham
had occasion to treat a poor man who lived in his neighborhood for an
obstinate bilious colic, but his employment of narcotics did not effect
very much in the way of relief. “I felt moved by pity for this poor
man in his misery; and accordingly I loaned one of my horses to him in
order that he might take long excursions on horseback.”
Sydenham had no eagerness for professional honors, although he
appreciated highly those which came to him spontaneously. As already
stated at the beginning of this sketch, the degree of Doctor of
Medicine was not conferred upon him by Cambridge as a mere honorary
affair, but was won by him after he had passed through the regular
course of training required of all candidates for this degree. His
case, however, was peculiar in one respect: he waited until after he
had been in active practice several years before he decided to pass
through the course of training required. He was not a member of the
College of Physicians of London, and he held no official position at
Court.
The following summary may serve to convey some idea of Sydenham’s views
regarding pathology and treatment. He defines an acute disease as “a
helpful effort made by Nature to drive out of the body or system, in
every way possible, the morbific material.” As regards the latter he
makes the following remarks:--
Certain diseases are caused by particles which are disseminated
throughout the atmosphere, which possess qualities that are
antagonistic to the humors of the body, and which--when once
they gain an entrance into the system--become mingled with the
blood and thus are distributed throughout the entire organism.
Certain other diseases owe their origin to fermentations or
putrefactions of the humors, which fermentations vary in their
nature--in some cases the humors being excessive in quantity,
while in others they are bad in quality; and in either event the
body finds itself incapable of first assimilating them and then
excreting them--a state of affairs which cannot continue beyond
a certain length of time without producing further harmful
effects.
According to Sydenham the fever, in the acute diseases, assists
Nature by separating from the general (total) mass of the blood those
particles which have undergone putrefaction or have been rendered
unassimilable. Then they are driven out of the body by the route of the
sweat-glands, by diarrhoea, by eruptions upon the skin, etc. On the
other hand, in chronic diseases the morbific material is not of such a
nature as to produce fever, which is a mechanism for securing complete
purification. It is therefore deposited in one part or another of the
body where no force exists which is capable of ejecting it; or its
final transformation is not completed until after the lapse of a long
period of time.
In some of Sydenham’s writings one is occasionally surprised to find
teachings which seem to be strongly at variance with the advice which
he was so fond of giving--namely, that physicians should be careful
not to set up hypotheses which are not based upon observed facts. A
conspicuous instance of such a disregard of his own rule may be found
in his setting up of a pathological process to which he gives the name
of “inflammation of the blood.” This process, he maintains, is the
active cause of quite a large number of diseases, especially those
of an epidemic nature--such, for example, as pleurisy, pneumonia,
rheumatism, erysipelas, scarlet fever, etc. It is well-nigh impossible
for us moderns to comprehend how so practical and clear-headed a man as
Sydenham could have formulated such a purely hypothetical pathology, a
doctrine so completely lacking in anything like a solid foundation of
fact.
Sydenham excelled in the description of the clinical manifestations of
certain diseases, as, for example, small-pox, hysterical affections,
the encystment of a renal calculus, and the gout--a disease from which,
as already stated, he was a very frequent sufferer throughout a large
portion of his life. All his published works are in the Latin language,
but translations have been made into English, French, German, Flemish
and Italian. At All Souls College, Oxford, where Sydenham spent eight
years of his life, it was a fixed rule that all its members should
habitually converse and write in Latin.
Sydenham’s remarks upon liquid laudanum are worth recording:--
Of all the remedies which a kind Providence has bestowed upon
mankind for the purpose of lightening its miseries there is not
one which equals opium in its power to moderate the violence
of so many maladies and even to cure some of them.... Medicine
would be a one-arm man if it did not possess this remedy....
Laudanum is the best of all the cordials; indeed, it is the only
genuine cordial that we possess to-day. [This was written in the
middle of the seventeenth century.]
The laudanum employed by Sydenham was made according to the following
formula: Spanish wine, 400 grammes; Opium, 62 grammes; Saffron, 31
grammes; Powder of Canella and Powder of Clove, of each 4 grammes.
After much suffering and extreme weakness, Sydenham died on December
31, 1689.
Andrew Browne, the Scotch physician of whom mention has already been
made on an earlier page, makes the following comments on the closing
days of Sydenham’s career: “It is a difficult matter to believe,
and yet it is the truth: This great physician, who throughout his
life gave the clearest proof of nobility of soul, generosity and
clear-sightedness, died with the accusation hanging over his head that
he was ‘an impostor and an assassin of humanity.’” Laboulbène adds:
“After years of self-sacrifice in behalf of his fellow men Sydenham
received as his final earthly reward calumny and ignominy, and the
jealousy of many professional brethren.”
CHAPTER XXXIII
THE THREE LEADING PHYSICIANS OF GERMANY DURING THE LATTER HALF
OF THE SEVENTEENTH CENTURY: FRANZ DE LE BOË SYLVIUS, FRIEDRICH
HOFFMANN AND GEORG ERNST STAHL
The seventeenth century, says Berendes, was one of the saddest periods
in the history of Germany; but, during the greater part of this time,
the neighboring countries--Holland, France, England and Italy--still
continued to enjoy many of the blessings of the Renaissance,--such,
for example, as an uninterrupted activity of artistic efforts, of
scientific work, and of commerce;--but in Germany everything seemed to
be in a state of confusion. A bloody religious war was at this period
devastating the land, and the best powers of the people were being
wasted. Instead of increasing cultivation of manners and sentiments,
there was a steady growth of savagery. The Protestants, although they
probably were numerically superior, were split up into factions. The
Catholics, on the other hand, were united, and their power steadily
increased. In 1618 the disturbances, which previously had been
scattered in character, took on the form of what in time came to be
known as “The Thirty Years’ War,” a struggle which proved to be most
sanguinary, costing Germany a great deal in every respect. Finally,
the war was brought to an end by the signing of the Westphalian Treaty
of Peace at Lützen, in 1648. Some idea of the terribly destructive
nature of this long war may be gathered from the fact that the
population of Germany, which previously had been estimated at twenty
millions, was found to have been reduced to about six millions. Whole
towns and villages were laid in ashes, and as a consequence those
who had survived the disaster lost confidence in themselves and were
not able, at least for several years, to undertake anything in art,
literature or science; and this depressing atmosphere affected in some
degree the people of the Netherlands. Toward the end of the century,
however, there came a marked awakening among the younger generation of
physicians, and in the course of twenty or thirty years four men, only
three of whom, however, were of German birth, succeeded in attaining
a decided leadership in this department of science. The names of the
Germans are Franz de le Boë (commonly spoken of as Sylvius), Friedrich
Hoffmann and Georg Ernst Stahl. I shall now attempt to furnish, as
nearly as possible in proper chronological order, very brief sketches
of the lives of these distinguished physicians, together with an
account of the contributions which they made to the science of medicine.
_Franz de le Boë (Sylvius)._--Franz de le Boë (Sylvius) was born
at Hanau, Prussia, in 1614, of parents who belonged to the nobility
and were wealthy, and who consequently were able to give their son
every opportunity for acquiring an excellent education. Thus Franz
first received a thorough training in philosophy and the classics and
afterward visited in turn all the leading universities of Holland,
France and Germany before he finally took his degree of Doctor of
Medicine at Basel, Switzerland, in 1637. From this time forward, for a
period of twenty-three years, he devoted himself to the practice of his
profession, first in his native city and then in Leyden and Amsterdam.
In 1660 he accepted an invitation to occupy the Chair of Medicine
in the University of Leyden, and this position he held during the
remainder of his life. He died in 1672.
As a teacher Sylvius was very popular, Boerhaave alone, at a later
period, finding greater favor among the crowds of medical students and
physicians who frequented this university. Haeser and Haller both
attribute some portion of this popularity to the fact that Sylvius
combined genuine eloquence with a wonderful charm of manner and a
profound knowledge of chemistry, pharmacy and pathological anatomy.
In the practice of medicine he followed Van Helmont very closely,
but he was not willing to accept his teachings about an “_archaeus
insitus_” and an “_archaeus influus_.” The system which he
advocated was of a very simple character, and this fact undoubtedly
contributed much to his popularity among the students. His therapeutic
methods were also of a thoroughly practical nature.
Of the works which Sylvius published the following deserve to receive
special mention: “_Disputationes medicae_,” a book in which are
set forth his views regarding the fundamental principles of the science
of medicine--physiology in particular; “_De methodo medendi_,” a
treatise on therapeutics; and “_Praxeos medicae idea nova_,” a new
idea concerning the practice of medicine.
Sylvius was one of the earliest defenders of Harvey’s great discovery,
and he was also one of the first to call attention to the part played
by chemistry in elucidating some of the problems in physiology and
pathology. At the same time he was always ready to acknowledge the
importance of the part played by mechanics in respiration, in the
circulation of the blood, in the movements of the intestines, etc., in
which respects he was in entire agreement with the iatrophysicists or
iatromathematicians.[80]
Finally, there is one more respect in which Sylvius is entitled to
great credit: he paid most careful attention to the work of giving
clinical instruction. Recognizing, as I do, the importance of this
branch of medicine, I shall not hesitate to devote here a page or two
to a brief review of the manner in which it came to hold the honorable
position which it occupies to-day in all the best schemes for medical
education.
During the sixteenth century, as Puschmann assures us, an attempt was
made at Padua, Italy, to render clinical instruction an essential
part of the physician’s education, but the difficulties which were
encountered proved so much greater than was anticipated that it was
soon found necessary to abandon the plan; and then for many years no
further effort was made, either at Padua or at any of the other Italian
medical schools, to introduce clinical teaching. After the lapse of
nearly a century, Johannes Heurnius (1543–1601), Professor of Medicine
at the University of Leyden, made an effort to introduce the plan of
teaching medicine at the bedside; and a few years later (1630) two
other professors of the same university--viz., Otho Heurnius, son of
Johannes, and E. Schrevelius--formally introduced clinical instruction
at the city hospital. The plan which they adopted was the following:
The students in turn were permitted first to question the patient about
his ailment and then afterward to make whatever physical examination
appeared to be necessary; next, each one of them stated briefly what
he believed to be the nature of the malady, and also gave his views as
to the prognosis, symptoms and treatment; after which the professor
commented on these different reports, pointing out both the correct and
the incorrect features in each case. After a short trial of the plan
it became clear that it would have to be abandoned, for the students
did not like to have attention called in such a public manner to their
mistakes. Then, a few years later, Sylvius, who at that time was the
Professor of Medicine, introduced a system of clinical teaching which
is thus briefly described by his colleague, Lucas Schacht:--
When, followed by his pupils, he approached the bedside of a
patient, he assumed the air of one who is entirely ignorant
of the nature of that person’s malady, of the accompanying
symptoms, and of the treatment which was being carried out.
Then he began to ask first one and then another of the students
a great variety of questions respecting the case that was
under consideration,--questions which at first seemed to have
been propounded in a haphazard fashion, but which in reality
were so cleverly formulated as to elicit from the class all
the information needed for the making of a correct diagnosis,
while leaving on the minds of the students the impression that
they, and not the professor, had worked out the problem to a
successful result.
This system, if such it may be termed, proved extremely successful, and
the knowledge of this success spread rapidly from one end of Europe
to the other, causing students and physicians to flock to Leyden from
Russia, Poland, Hungary, Germany, Denmark, Sweden, France, Italy and
England. So long as this particular university continued to possess, as
a member of its faculty, a professor of medicine who was clever enough
to carry on clinical instruction with the same profound knowledge
of human nature as had been displayed by Sylvius, just so long did
this institution remain without a rival in this part of the field of
medical education. Then Sylvius was followed, in the work of clinical
teaching, by Boerhaave, a man admirably fitted, both by nature and by
the training which he had received, to keep the University of Leyden
in the first rank of medical schools as regards this most useful
form of discipline. After 1738, the year in which Boerhaave died,
other universities besides that of Leyden began to provide fairly
satisfactory facilities for clinical study, and among the number of
such institutions those of Utrecht, Rome, Edinburgh, Paris and Halle
deserve to be mentioned. The lack of funds and doubtless also the lack
of the right sort of teachers were the principal reasons why these
schools were not able to vie with Leyden in furnishing the facilities
needed for clinical instruction. That the fault--at least in the case
of the University of Halle--was not to be attributed to a failure
on the part of the Medical Faculty to appreciate the value of such
instruction is clearly shown by the saying attributed to Friedrich
Hoffmann, who at that period was the Professor of Medicine:--
By a mere attendance upon medical lectures no man will ever
succeed in becoming a properly equipped practitioner of that
art; it is indispensable, in addition, that he should receive
clinical instruction.
The fairly permanent establishment of this fundamental branch of
medical teaching was not effected until about the middle of the
eighteenth century, when Van Swieten, one of Boerhaave’s most
distinguished pupils, was given full authority by the Empress Maria
Theresa to furnish, at the University of Vienna, all the facilities
required for successfully carrying on such instruction. From that
time onward, to a quite recent date, Vienna has been the Mecca of all
the younger physicians who aspired to become fully equipped in the
practical branches of the science of medicine.
_Georg Ernst Stahl._--Georg Ernst Stahl was born at Anspach,
Germany, in 1660. Little is known about his early life beyond the
fact that he pursued his studies at the University of Jena, received
the degree of Doctor of Medicine from that institution in 1684, and
shortly afterward began giving private courses in medicine which proved
to be very popular and soon brought him into public notice. In 1687
he was given the position of Court Physician at Weimar. In 1694, upon
the recommendation of Friedrich Hoffmann, who was at that time the
incumbent of the regular Chair, he was appointed Associate Professor of
Medicine in the recently founded University of Halle, Prussian Saxony;
the understanding being that he was to devote his attention more
particularly to the physiological, pathological, chemical and botanical
aspects of the subject. He held this position up to the year 1716, when
he was appointed one of the attending physicians of Frederick William
the First, King of Prussia, and thereafter was obliged to reside in
Berlin, in which city he died in 1734.
Stahl was a tireless worker, and wrote a large number of treatises
(two hundred and forty-four in all) on physiological and pathological
topics--all of them in Latin. Albert Lemoine, who has written an
elaborate monograph on one of these treatises (that relating to
animism), says that, despite the obscure style in which this and most
of his other treatises are written, one may, upon careful study,
satisfy himself that Stahl is a very close reasoner and possesses a
clear mind. His most conspicuous faults, Lemoine adds, are these: he
is opinionated and vain, and objects strongly to any criticisms that
his opponents make; and yet he is careful to take up these criticisms
one by one and subject them to a close analysis. His vanity led him to
maintain that he was the only person then living who was capable of
lifting medicine out of the rut in which it was at that time rigidly
held. He manifested a sovereign contempt, not only for the men whose
opinions differed from his, but also for those who complained of the
difficulty of comprehending the Latin in which his treatises are
written. Finally, Lemoine states that Stahl is addicted to mysticism,
as is shown by the invocations of all sorts with which he begins and
ends most of his writings. Haeser adds that Stahl possessed a gloomy,
reticent and overbearing spirit, in striking contrast with the charming
sweetness of temper of his colleague Hoffmann.
Among Stahl’s numerous contributions to medical literature there
is only one in which our readers are likely to take any particular
interest; I refer to the treatise which bears the title “_Theoria
medica vera_”--the true theory upon which the science of medicine
is based. It is in this work more particularly that Stahl expounds
the doctrine of animism. As I have tried in vain to obtain a really
satisfactory conception of this doctrine, which occupied so great a
place in the thoughts of the physicians of the period between 1650 and
1750, I have decided to rest satisfied with merely reproducing here
the interpretation which William Cullen of Edinburgh, one of Stahl’s
contemporaries and also one of the greatest English physicians of
that period, gives in his celebrated “First Lines of the Practice of
Physic”:--
What is frequently spoken of as the power of nature--the “_vis
conservatrix et medicatrix naturae_”--resides entirely in
the rational soul. Stahl supposes that upon many occasions the
soul acts independently of the body, and that, without any
physical necessity arising from that state, the soul, purely
in consequence of its intelligence, perceiving the tendency of
noxious powers threatening, or of disorders any ways arising in
the system, immediately excites such motions in the body as are
suited to obviate the hurtful or pernicious consequences which
might otherwise take place.
Barthélemy St. Hilaire of Paris (1805–1895) in one of his writings
says: “I am convinced that the central idea in Stahl’s physiology was
suggested to him by the reading of Aristotle’s ‘_De anima_,’ in
which this great philosopher states that the soul nourishes the body,
and also that nutrition is one of the four ways in which the soul
manifests itself.”
Speaking of the effect of Stahl’s doctrines upon the actual practice
of medicine as a whole, Cullen says that it was of a controlling
character, leading physicians to propose the “art of curing by
expectation”; the natural result of which was that they advocated for
the most part the employment of only very inert and frivolous remedies.
On the other hand, they zealously opposed the use of some of the most
efficacious drugs, such as opium and the Peruvian bark, and resorted
to bleeding and to the administration of emetics only in exceptional
cases. Cullen adds that:--
The Stahlian system has often had a very baneful influence on
the practice of physic, as either leading physicians into, or
continuing them in, a weak and feeble practice, and at the same
time superseding or discouraging all the attempts of art....
The opposition to chemical medicines in the sixteenth and
seventeenth centuries, and the noted condemnation of antimony by
the Medical Faculty of Paris, are to be attributed chiefly to
those prejudices which the physicians of France did not entirely
get the better of for near a hundred years after. We may take
notice of the reserve it produced in Boerhaave with respect to
the use of the Peruvian bark.
Stahl, after taking up his residence in Berlin, devoted himself
energetically to the increase and spread of the knowledge of chemistry.
The thing which brought him the greatest celebrity, both in his own
lifetime and also during the years following his death, was his
propounding of the “phlogiston” theory. This theory was to the effect
that all combustible materials or substances contain (as he assumed)
an element to which he gave the name of _phlogiston_. He was not
able, however, to demonstrate the actual existence of this element;
he simply assumed that it existed. At the same time the fact should
here be stated that the terms “oxidation” and “reduction,” which came
into use during the following century, developed out of this theory of
phlogiston.
_Friedrich Hoffmann._--Friedrich Hoffmann was born at Halle,
Prussian Saxony, February 19, 1660, and received his medical education
in his native city, largely under the direction of his father, who was
himself a physician. In 1678 he attended lectures at the University
of Jena, and in the following year visited Erfurt in order to
benefit from the instruction of Caspar Cramer, who was at that time
a distinguished authority in chemistry. At the end of two years he
returned to Jena, took his degree of Doctor of Medicine, and acquired
the right to deliver public lectures. Then, during the following three
years, he visited Holland and England, and, upon his return in 1685,
settled at Minden, Westphalia, as a general practitioner of medicine.
In 1686 he was appointed District Physician of the Principality of
Minden and also Court Physician of the Prince Elector; and two years
later he accepted the position of District Physician at Halberstadt.
After the inauguration of the new university at Halle, July 12, 1694,
Hoffmann appears as one of the earliest professors chosen to serve the
institution. In 1701, when Frederick the Third, Electoral Prince of
Prussia, assumed the crown under the title of Frederick the First, King
of Prussia, he extended to Hoffmann an invitation to come to Berlin and
accept the position of Private Physician to His Majesty. Hoffmann was
not at first willing to accept the invitation, but in 1708, when the
King, who had then become seriously ill, renewed his request, Hoffmann
accepted, on condition that he might retain his professorship. In 1712
he returned to Halle and remained there until he died in 1742.
Before Hoffmann’s time very little was known concerning the nature of
carbonous (or carbonic) oxide and concerning the fatal effects which
may be produced by inhalation of this gas. It was a common belief,
for example, that the gas was given off by freshly plastered walls;
and--as an even worse error--the theological authorities showed an
inclination, in many of the fatal instances which probably were due
to inhalation of carbonous oxide, but in which no recognizable cause
of death had been discovered, to explain the event as due to the
malign interference of the Devil. In our time it is well understood
in the community that the fumes of carbonous oxide constitute the
most dangerous gas that one is liable to encounter, but in Hoffmann’s
day the people appear to have been less well informed concerning this
danger than they were in ancient times. In the treatise on this subject
which Hoffmann published in 1716,[81] several of the earliest known
instances of such poisoning are narrated, the first one being that
mentioned very briefly by Aristotle (384–322 B. C.). Then follow two
very short references to this subject in the “_De rerum natura_”
of the Roman poet Titus Lucretius Carus (95–52 B. C.). They read as
follows: (1) “The fumes of burning charcoal easily affect the brain if
thou hast not first taken a drink of water.” (Book VI., verse 803.) (1)
“If the fumes of the night lamp,[82] after it has been extinguished,
are inhaled rather deeply the effect experienced will be the same as if
one had been struck down by a blow on the head.” (Book VI., verse 792.)
The idea that the previous drinking of water is competent to prevent
the effects of poisoning by charcoal fumes is declared by Neuburger,
the translator of Hoffmann’s treatise, to be erroneous.
The earliest really satisfactory description of an instance of
non-fatal poisoning by the fumes of burning charcoal is credited by
Hoffmann to the Roman Emperor, Julian the Apostate, who reigned from
361 A. D. to 363 A. D. Before he was made Emperor, Julian was intrusted
by Constantius II., in 355 A. D., with the government of the Province
of Gaul, and in 357 he won a great battle against the Alamanni at
Strassburg; after which he took up his residence in the little city of
Lutetia, the present Paris. It was undoubtedly soon after this event
that he wrote the Greek satire which bears the title “Misopogon,” and
from which Hoffmann quotes the following account of Julian’s narrow
escape from death through the poisonous effects of carbonous oxide:--
The little city which the Celts call Lutetia is built upon a
small island in the midst of a river, and access to it from
both sides is gained by means of wooden bridges. Ordinarily the
winter climate in this region is mild, owing--as the people
of the place claim--to the proximity of the Ocean. Good wine
is produced there, and even fig-trees flourish provided care
be taken to wrap them well in wheat straw or some similar
protective material during the winter season. But my visit
happened to have been made during an exceptionally severe
winter, and as a result things which looked like slabs of
Phrygian marble, closely packed together, were constantly
floating down the river with the current, and, soon becoming
jammed, they formed a sort of natural bridge. Although most of
the houses--the one I occupied among the number--were provided
with fireplaces and chimney-flues, and might therefore readily
be heated, I was not willing that a fire should be kindled in my
bedroom. I was very little sensitive to cold, and, in addition,
I was desirous of becoming more and more hardened to its
influence.... As the severity of the weather, however, showed no
signs of letting up, I permitted the attendants to bring into
the room a few glowing coals, just enough to render the air of
the chamber less chilly. But, notwithstanding the very small
degree of heat which these few burning coals supplied, it proved
to be sufficient to draw out from the damp walls exhalations
that caused my head to feel as if it were tightly held in a
vice and also produced a sensation as if I were choking. I was
immediately removed from the room, and the physicians who were
promptly summoned administered an emetic which enabled me to
get rid of the food which I had eaten a short time before. Soon
afterward I had a refreshing sleep and was able on the following
day to resume my work as usual. [Translated from the German
version printed in Neuburger’s monograph.]
As will be seen from the reports which I have just quoted, there
existed among the Germans, early in the eighteenth century, no fixed
belief as to the real cause of death in many of these unexplained fatal
cases; and it was therefore no small public service which Hoffmann
rendered when he, in whose judgment about such matters the people at
large placed the greatest confidence, published such a clear and simple
explanation of the real cause of these deaths as that which is given in
this interesting monograph.
Hoffmann also added not a little to his fame by the invention of
a remedy which was first known as “Hoffmann’s drops,” but which
to-day appears in the United States Pharmacopoeia under the name
of “Hoffmann’s anodyne” or “_spiritus aetheris compositus_”
(sulphuric ether, 325; alcohol, 650; ethereal oil, 25).
CHAPTER XXXIV
HERMANN BOERHAAVE OF LEYDEN, HOLLAND, ONE OF THE MOST
DISTINGUISHED PHYSICIANS OF THE SEVENTEENTH CENTURY
Hermann Boerhaave, who was born at Voorhont, near Leyden, Holland, on
December 31, 1668, was the son of a poor but highly educated clergyman;
and it was owing to this circumstance that he received in early youth
a most careful training in Latin and Greek and in belles-lettres. At
the age of fourteen he entered the public school of Leyden, and made
such rapid progress in his studies--history, mathematics, the different
branches of natural philosophy, Hebrew and Chaldean languages, and
metaphysics--that he was soon able to follow regularly the lectures
given at the university. He was only fifteen at the time when his
father died, leaving him absolutely penniless; but Van Alphen, the
Burgomaster of Leyden, befriended him and furnished all the funds
needed for a continuance of his studies at the university. But young
Boerhaave, who was not willing to be entirely dependent on the aid thus
provided, contributed to his own support not a little by giving private
instruction to young students of the wealthy class. In 1690 he received
the degree of Doctor of Philosophy, the subject of his dissertation
being a refutal of the doctrines of Epicurus, Hobbes and Spinosa.
His original intention had been to prepare himself for the ministry,
but, after continuing his studies in theology for a short time, he
determined that the better course for him would be to choose the career
of physician. Accordingly he began, at the age of twenty-two, to study
the anatomical treatises of Vesalius, Fallopius and Bartholinus, and at
the same time he followed a course of instruction in dissecting, under
the guidance of the anatomist Nuck, and also occasionally attended the
lectures given by Drelincourt, who at that time was Professor of the
Theory of Medicine. In his reading of medical literature he showed a
decided preference for the writings of Hippocrates and Sydenham; and
he devoted a large portion of his time to the study of botany and
chemistry, two branches of the science of medicine in which he took a
very strong interest all through life. In 1693 he received the degree
of Doctor of Medicine from the University of Harderwyk.[83] In 1701
he was appointed Associate Professor of the Theory of Medicine in
the University of Leyden, and it was in this capacity that he began
building up that great reputation which in a very few years brought
crowds of students from all parts of the world to Leyden. As already
stated on a previous page, he owed a large part of his fame to the
admirable manner in which he conducted his clinical teaching. To show
how widely he was known throughout Europe the story is told that a
letter which had been sent to him from a mandarin living in China and
which bore the address, “To the illustrious Boerhaave, Physician in
Europe,” reached him in due course.
Soon after his first appointment at Leyden, he received other most
flattering offers, such as that of William the Third, Hereditary Prince
of the Netherlands, to accept the position of Court Physician at The
Hague, and a call from the University of Groningen (1703) to occupy
the Chair of Medicine. He declined these offers as he preferred to
remain at Leyden; but, a few years later, in 1709, he accepted the
full professorship of the Practice of Medicine in the institution
with which he was already connected. From the vantage ground of this
more responsible position he was able most successfully to teach the
students the best methods of observing, identifying and treating the
different diseases; and as a further result of this promotion in rank
his private practice grew rapidly, monarchs and princes coming from
every country in Europe to consult him about their maladies. Boerhaave
was also most popular among his fellow townsmen. It is related of
him, for example, that on one occasion, after he had been confined to
the house for about six months by an illness of a gouty nature, the
citizens of Leyden manifested their joy at his recovery by inaugurating
a general illumination of the town during the evening of the day on
which he made his first appearance on the street. He had two relapses
of the gouty affection, one in 1727 and another in 1729, and he finally
died from disease of the heart on September 23, 1738. The monument
raised in his honor by the city of Leyden bears the inscription:
“_Salutifero Boerhaavii genio sacrum_” (Sacred to the memory of
the health-giving genius of Boerhaave).
Some idea of the lucrative character of Boerhaave’s private practice
may be gained from the fact that he left to his only child, a daughter,
the sum of about four million francs. And yet he was noted for the
generous gifts which he made during his lifetime to all sorts of
scientific and benevolent objects.
Boerhaave, says Dezeimeris, exercised during his career, and also for a
long time after his death, an immense influence upon medical thought.
He is justly ranked, he adds, among the iatromathematicians, and it
is correct to say that he was largely instrumental in overthrowing
the chemical system which de le Boë (Sylvius) had developed. His own
treatise on this branch of knowledge (“Elementa Chemiae”), which was
published toward the end of his life, soon became the standard work
on this subject, and it retained its popularity for many years. “It
is to be regretted that, possessing as Boerhaave unquestionably did,
remarkable powers of observation, he should have allowed himself, in
opposition to the very principles which he advocated so strongly,
to indulge in the making of systems and hypotheses. He commenced by
advocating with enthusiasm the method of Hippocrates, and ended by
following the brilliant but not very trustworthy example of Galen.”
(Dezeimeris.)
The number of treatises which Boerhaave published is quite large,
the most important among them being the following: “_Oratio de
commendando studio Hippocratico_,” 1701; “_Institutiones medicae
in usus annuae exercitationis domesticos_,” 1708; “_Aphorismi
de cognoscendis et curandis morbis in usum doctrinae medicae_,”
1709 (English version printed in London in 1742); and “_Elementa
chemiae_,” 1732 (English translation by Peter Shaw, London, 1741).
Of the “Aphorisms,” one of the most widely known of Boerhaave’s
published treatises, I shall take the liberty of saying a few words.
This work is in reality a very concise statement of the author’s views
regarding pathology, pathological anatomy and therapeutics, and I
believe that the following paragraphs, although few in number, will
suffice to give our readers a fair idea of the general character of the
book. At the same time I must confess that I have not found it an easy
matter to understand and satisfactorily digest many of the individual
aphorisms, the text of which has been compressed into such a small
space. It therefore does seem surprising to learn from one critic that,
if one wishes to ascertain what Boerhaave’s views are with regard to
the science of medicine, one should read by preference the Commentaries
of Van Swieten, who was Boerhaave’s favorite pupil and assistant.
The following four or five aphorisms are typical specimens belonging to
the earlier sections of the book:--[84]
(7.) A disease when present in a body, must needs be the bodily
effect of a particular cause directed to that body.
(8.) Which effect being entirely removed, health is recovered.
(9.) It may be removed by correcting the illness itself in
particular, _viz._, by the applications of medicines
to the particular diseased part, or by some remedies which
operate equally upon the whole: the first we’ll call a
_particular_, the latter a _general_ cure.
(10.) The way to both is discovered either _by
observation_, or _by comparing_ one case with another,
or _by a true reasoning_ from them both.
(13.) He who doth, with the greatest exactness imaginable, weigh
every individual thing that shall happen or hath happened to
his patient and may be known from the observations of his own
or of others, and who afterward compareth all these with one
another, and puts them in an opposite view to such things as
happen in an healthy state; and lastly, from all this, with the
nicest and severest bridle upon his reasoning faculty, riseth
to the knowledge of the very first cause of the disease, and of
the remedies fit to remove them; _he_, and _only he_,
deserveth the name of _a true physician_.
Then Boerhaave proceeds to make a classification of diseases, and among
the very first groups which one finds in this classified list are the
following: “Distempers of a lax and weak fibre”; “Distempers of the
stiff and elastic fibre”; “Distempers of the less and larger vessels”;
“Distempers of weak and lax entrails”; “Distempers of the too strong
and stiff entrails”; etc.--from which it is apparent that the old
doctrine of the _strictum_ and the _laxum_, which was taught
by the Methodists in the early centuries of our era, has here been
adopted by Boerhaave in all its essential characters; and also that the
treatment which he recommends for some of these classes of maladies
does not materially differ from that advocated by this ancient school
of medicine. The following extracts, I believe, will suffice to give
the reader a fairly clear understanding of what Boerhaave means by the
expressions “distempers of the solid simple fibre,” “distempers of a
lax and weak fibre,” and “distempers of the stiff and elastic fibre,”
and will at the same time show what methods he employed for overcoming
these distempers. At the time when Boerhaave made use of the term
“fibre” (_fibra_) in the very uncertain sense in which he here
employs it, Leeuwenhoek and Malpighi were demonstrating, by aid of the
newly perfected microscope, that the so-called simple tissues were in
reality quite complex structures; and one’s first impulse, therefore,
is to express surprise that a physician of such high standing as our
author should have used the term. But we moderns must not forget that,
in those early days, it took decades for knowledge of this nature
to spread even a very short distance, as from Delft to Leyden, and
then to exert its legitimate influence upon medical thought--that
is, to be digested and afterward permanently appropriated. There can
be scarcely any doubt that, at the time (1709) when Boerhaave wrote
these aphorisms, he had already heard about the existence and the
capabilities of the recently perfected microscope, but it is not at all
likely that he had as yet digested the gains in anatomical knowledge
which had been acquired through the assistance of this instrument. The
extracts referred to above are the following:--
DISTEMPERS OF THE SOLID SIMPLE FIBRE
(21) Those parts (which, being separated from the fluid
contained in the vessels, are applied and sticking to each other
by the strength of the living body, and make the least fibre)
are the least, the simplest, earthy, and hardly changeable from
or by virtue of any cause, which are found in our living bodies.
DISTEMPERS OF A LAX AND WEAK FIBRE
(24) The weakness of the fibre is that cohesion of the minutest
parts described (21), which is so loosely linked that it may be
pulled asunder even by that degree of motion which is requisite
in healthy bodies, or not much exceeding it.
(26) The weakness produceth easily a stretching and a breaking
of the small vessels made up of those weak fibres (24), and
consequently abates of their power over the fluids therein
contained; from which distensions arise tumors, from the
stagnating or extravasated liquids putrefactions, and, farther,
all such innumerable ills as are the consequences of them both.
(28) [In distempers of a lax and weak fibre] the cure must
be obtained, 1. By aliments that abound in such matter as
is described in section 21, and which [should] be almost so
prepared beforehand as they are in a strong and healthy body;
such are milk, eggs, flesh-broths, panadoes[85] rightly prepared
of well-fermented bread; and rough wines. All which must be
given in small quantities, but often. 2. By increasing and
invigorating the motion of the solids and fluids by means of
frictions with a flesh-brush, or with flannel; by riding on
horseback, and in a coach, or by being carried in a boat; and
lastly by walking, running and other bodily exercises. 3. By a
gentle pressure or a bandage upon the vessels, and a moderate
repelling of the liquids therein contained. 4. By medicines
both acid and austere, or such as are spirituous and well
fermented, but applied with great caution and gentleness. 5. By
any means that will remove and remedy the too great pulling of
them.
[That Boerhaave belonged to the iatrophysical or iatromechanical school
appears very clearly throughout these quotations.]
DISTEMPERS OF THE STIFF AND ELASTIC FIBRE
(35) [In distempers of this group] the cure is effected, 1.
By such meat and drink as is thin and watery, without any
roughness, chiefly by the continued use of milk-whey, of
the softest herbs and salads, barley-water, thin gruel, and
unfermented liquors. 2. By avoiding of exercise, and dwelling in
a moist, coolish air, and taking long sleeps. 3. By the taking
or outwardly applying watery, lukewarm, tasteless medicines, and
such as contain the lightest and softest oils.
In the second half of the volume I find abundant evidence of
Boerhaave’s ability to treat efficiently some of the acute and chronic
maladies; and, after a perusal of the text which deals with these
affections, I have no difficulty in understanding how he came to be
looked upon as one of the leading medical practitioners of the period
during which he lived. I should be glad to reproduce here such portions
of the aphorisms as would corroborate the statement that I have just
made, but unfortunately the small amount of space that I can command
does not permit me to do this. At every step, as I advance, I am warned
against the danger of exceeding the limits permitted, and I shall,
therefore, in the present instance, have to rest satisfied with quoting
the larger part of a single paragraph in which is given an account of
the treatment employed in a case of acute pleurisy.
(890) ... If the same pleurisy be recent before the end of the
third day, yet violent from the many and strong symptoms, and
dry, in a strong, exercised, dry body, without the hopes of
the presence of (887 and 888) [a resolution or a concoction
and excretion of the cause], then let the patient immediately
be blooded largely, with a quick running stream out of a
great vessel, and a large orifice, keeping his body quiet and
leaning backwards, enforcing his breathing all the while with
coughing or panting, fomenting the side at the same time, and
gently rubbing it; which bleeding ought to be continued till the
pain seems to abate pretty considerably, unless a fainting fit
forces you to leave off sooner; at whose approach the vein must
immediately be stopped. Bleeding ought to be repeated according
as these symptoms do return upon whose account it was done the
first time; and when that skin doth not any longer appear upon
the surface of the blood, it is time to forbear more bleeding.
From the beginning ought to be used fomentations, bathings, warm
streams, liniments, plaisters, and the like; which may be of use
as they loosen, resolve, mitigate, and avert....
As only extracts of considerable length would suffice to give our
readers a satisfactory idea of the attractive manner in which Boerhaave
deals with the subject of chemistry, I prefer to omit them altogether,
and to recommend to those who are specially interested in this
branch of science, that they consult Peter Shaw’s excellent English
translation of the “_Elementa Chemiae_.”
Albert von Haller, the celebrated Swiss physiologist and historian of
medical literature, speaks of Boerhaave as “my beloved preceptor, a man
of refined taste and a speaker or lecturer so logical and charming that
one more gifted can hardly be imagined.”
CHAPTER XXXV
GENERAL REMARKS ON THE DEVELOPMENT OF SURGERY IN EUROPE DURING
THE FIFTEENTH AND SIXTEENTH CENTURIES
In the early period of the Renaissance surgery was apparently the
first of the practical branches of medicine to spring forward into
active life. Anatomy,--that is, human anatomy,--the foundation that is
absolutely necessary to the solid growth of surgery, scarcely existed
before the beginning of the sixteenth century; and it is therefore
not surprising that the records of the past reveal to us so very few
instances of men who attained any eminence as surgeons. When this
fact is taken into consideration I cannot help feeling that, in the
sketches which I drew, on earlier pages, of Theodoric of Cervia,
William of Saliceto, Lanfranchi of Milan (and later of France), Henri
de Mondeville and Guy de Chauliac, I gave to these men only a small
fraction of the credit to which they were justly entitled. Indeed,
the excellence of the work done by them and recorded in the treatises
which they published, is so great as to arouse the suspicion that they
had clandestinely acquired more knowledge of human anatomy than they
dared to admit. The life of a dissector of human bodies, it should be
remembered, was by no means safe in those days.
But the lack of a trustworthy knowledge of anatomy was not the only
hindrance to a healthy development of the art of surgery. There were
other obstacles which, up to a comparatively late period in the
sixteenth century, continued to block the advance of this art. Of
these, the principal one was perhaps the custom--not by any means
considered at that period professionally dishonorable--of keeping
secret the technique of certain operative procedures like that of
cutting for stone in the bladder or that of the radical cure of hernia.
Such knowledge was treated as private property, and was very carefully
handed down from father to son, or was sold for a large sum of money to
certain surgeons who engaged, under oath, not to reveal the details to
others. Thus we are assured by Haeser that two such eminent surgeons as
Ambroise Paré and Fabricius of Hilden were obliged to pay handsomely
for the information which they received from certain specialists
concerning their particular methods of procedure. It is from such
scraps of information which come to our knowledge casually that we
often learn the actual truth concerning the advance made at a given
period of time by a certain department of medical science. Although it
is not possible to fix the date when the custom to which I have just
referred was definitely abandoned, it may be stated as a fact that
after the seventeenth century very few instances of such ownership of
surgical secrets are discoverable in the records.
Inasmuch as at the very beginning of the Renaissance surgery was looked
upon, in the southern and central parts of Europe, as an occupation of
a somewhat menial character, the regularly organized medical schools
made very inadequate provision for the proper education and training of
those young men who were disposed to adopt a surgical career. During
the fourteenth and fifteenth centuries surgery was still tolerated at
Montpellier, but after the papal seat had been removed from Avignon
to Rome--that is, after 1479,--the pupils of that university were
forbidden to do any surgical work. In 1490, however, a course in
surgery was provided for the exclusive use of barbers. At first the
instruction was given in Latin, but, as these men did not understand
this language, the professor was soon compelled to employ a barbaric
Latin (half French and half Latin) in making his comments upon the
text of the lecture. This state of affairs lasted for more than a
century. In fact, it was not until after Paré, Franco and Wuertz had
demonstrated by their remarkable careers how honorable was this branch
of the science of medicine, that provision was made at Montpellier (in
1597) for regular instruction in surgery. But even then, for a period
of several years, it was found to be a very difficult matter to keep
the peace between the two groups of students--the medical and the
surgical; the governing authorities being finally obliged, in order
to prevent the encounters which frequently took place between the
rival bodies, to appoint four a.m. as the hour when the instruction in
surgery was to be given. Those students who were pursuing the course in
medicine looked upon the surgical pupils as intruders, as men unworthy
to associate with them, and they availed themselves of every possible
opportunity for making their connection with the university unpleasant.
In Paris, during the twelfth and thirteenth centuries the surgeons
formed themselves into corporations. Minor surgery was left entirely
in the hands of the barbers (a word which is derived from the Latin
“_barbarus_,” uncultivated) and barber-surgeons. They were
largely itinerant practitioners and army surgeons. As they traveled
from one city to another, the more enterprising ones announced their
approach by means of a sort of herald who proclaimed loudly the cures
which his chief was able to accomplish. In the course of time the
surgeons who lived in Paris formed themselves into the so-called
“College of Surgeons.” At a later date (1255) there was established
in that city by Jehan Pitard, the surgeon of Louis the Ninth (“Saint
Louis,” 1215–1270), a more perfect organization under the name of
the “College of Saint Cosmas,” which was placed under the protection
of Saints Cosmas and Damian. The members of this Brotherhood were
known as “Surgeons of the Long Robe,” to distinguish them from the
Barber-Surgeons or “Surgeons of the Short Robe”; and they were also
known as “_Maitres Chirurgiens Jurés_.” Through the influence of
Pitard this organization received from the King a set of governing
rules or constitution.
It may prove interesting to learn who Cosmas and Damian were, how they
came to be canonized, and for what reasons the organizers of the new
brotherhood preferred them to all others, as guardian saints. Cosmas
and Damian were the youngest of five brothers who belonged to a family
of some distinction in Arabia. They chose the career of peripatetic
physicians, and gave their services free to those who might have need
of them. They spent some time in the Province of Cilicia, Asia Minor,
and while in that country they met the death of martyrs, somewhere
about 287 A. D., during the persecutions of the Christians which
occurred in the reign of Diocletian. In the church pictures they are
represented as physicians, each one of whom holds in his hand either
a vessel containing a remedial preparation, or a staff around which
the emblematic serpent is twined, or (less frequently) a surgical
instrument of some kind. During the time of the Crusades there existed
an Order of Knights of Saint Cosmas and Saint Damian, who devoted
themselves specially to the care of sick pilgrims and to the freeing of
those who were held as prisoners.
In all the large cities of France there existed, during the fourteenth
and fifteenth centuries, corporations of surgeons, the great majority
of whom belonged to the class or grade of barbers. These men were not
permitted by their rules to use the knife, and, as a result, great
jealousy existed between them and the few who, having passed the
required examination, were authorized to perform cutting operations
and to assume the title of “Masters in Surgery.” In 1493, as the
result of an effort made by the barbers of Paris as a body, to gain
some knowledge of medical science, they obtained from the university
permission to purchase a corpse which had not yet been removed from the
gallows. They had, it appears, engaged a doctor of medicine to give
them instruction in anatomy, and it was upon a dissection of this body
that the teaching was to be based. In 1494 the Faculty made provision
for giving the barbers a regular course of lectures on surgery; and,
eleven years later (1505), additional privileges having in the meantime
been granted them by the university, they organized the “Corporation
of Barber Surgeons, or Surgeons of the Short Robe.” In the oath
which the members of this organization were obliged to take, it is
expressly stated, among other things, that “they will give due honor
and reverence to the Faculty, and will not administer any laxative or
alterative drug.”
From 1601 to 1731, when the _Académie de Chirurgie_ was founded,
there was an almost continuous series of squabbles between the surgeons
and the barbers, on the one hand, and the Medical Faculty of the
University, on the other. At a still earlier period, dating back even
to the fourteenth century, the quarrels were between the surgeons
(École de St. Côme) and the barbers, but, during the seventeenth
century and the early part of the eighteenth, the surgeons and the
barbers seem to have harmonized their interests and to have made common
cause against the Faculty. An edict was issued by Louis the Twelfth
in 1613 to the effect that the two corporations (the surgeons and
the barbers) should be fused into a single organization; and, even
before this, it had become customary to employ the words “surgeon” and
“barber” as synonymous terms. Finally, in the years 1644, 1645 and
1656, further agreements were entered into by the two bodies. After the
founding of the Academy of Surgery in 1731 nothing further is heard of
barber-surgeons.
In the account which I have thus far given of the agencies that were
available during the Renaissance for the perpetuation and increase of
medical knowledge, I make reference only to the established medical
schools and to the less pretentious but much more practical teaching
organizations furnished by the guilds or brotherhoods. In my remarks
I have said little or nothing about hospitals, which--potentially, at
least,--have a great deal to do with the advance of medical knowledge,
especially in the department of surgery. Unfortunately, my efforts to
procure information relating to this subject have not been rewarded
with much success and I shall therefore not be able to furnish more
than a few disconnected and very imperfect details.