_Age of Renovation (continued).--Student-life During the Fifteenth and
Sixteenth Centuries. Ceremonials Previous to Dissection.--Reform Period:
The Seventeenth, Eighteenth, and Nineteenth Centuries. Modern Realism
in Medicine and Science. Introduction of the Cell-doctrine. Discovery
of the Circulation. William Harvey, 1578-1637. Malpighi, 1628-1694.
Leuwenhoek, 1632-1723. Correct Doctrine of Respiration. Discovery of
the Lymphatic Circulation. The Nervous System. Discovery of Cinchona.
Development in Obstetric Art, in Medical Jurisprudence, in Oral Clinical
Teaching. Van Helmont, 1578-1644.--The Iatrochemical System: Le Bôe,
1614-1672. Thomas Willis, 1622-1675._
For a{148} long time the Italian universities held the first rank; next
came the French; and last the German, although all were well attended.
The most famous were the medical faculties of Bologna, Pisa, Padua; then
Paris, Montpellier, and, finally, Basel.
A little of what concerned the student-life of this period may not be
amiss. The students chose the rector and officers of the universities,
sometimes even the teachers, and assisted in determining the curriculum
of study, the execution of which they watched. In some of the Scotch
universities even now the students choose the rector.
The students were divided, usually according to country, into bodies
denominated "nations" (some having special seals), which were the
parents of the present stu-dent-corps in German universities. Certain
representatives, known as vice-rectors, were chosen from each of these
corps and constituted a so-called college of rectors which negotiated
with the officials of the State, and possessed a power that was
preserved until the end of the sixteenth century.
The poorer class of students passed from one school to another,
supporting themselves by singing, begging, or stealing, and were
sometimes guilty of great barbarities. The younger scholars, called
"Schutzen," were compelled to perform{149} most menial duties for their
older comrades, the "Bacchanten,"--much like the system of fagging
still in vogue in English grammar-schools; and when the bacchantes were
admitted to the university proper they were required to pass through
an initiation, or hazing, which eclipsed anything known in these
days; indeed, the antiquity of fagging may be traced back even to the
philosophic schools of Athens. The habits of the traveling scholars
led many of them into dissolute and vicious ways, though some attained
respectable positions,--possibly even eminence. The students who were
better situated financially; for the most part entered the Italian
universities.
Already mention has been made of the enormous number of students
congregated during this age in Bologna and in Naples. In the small
University of Wettenburg there were, in 1520, only about six hundred
students; in Erfurt, three hundred, and this number dwindled two years
later to fifteen; in 1500 Leipzig had four hundred students; at the
same time there were about seven thousand in the University of Vienna.
Students and teachers migrated from one place to another, and faculties
were constantly changing. Great teachers were received with great
ceremony. Bitter struggles and disputes between teachers sometimes
occurred; it is related of Pistorius, who died in 1523, and Pollich,
deceased in 1513, that they conceived a violent enmity toward each other
because of antagonistic views relative to the epidemic or contagious
character of syphilis, and both ultimately left Leipzig for other
schools.
Some curious customs prevailed. In teaching anatomy, while the learned
teachers explained the parts as exposed, the dissections were left to
barbers as being unworthy of an educated medical gentleman. While the
cadavers were mainly the corpses of executed criminals, it was thought
that before and after each special dissection religious ceremonies were
appropriate, and such were often held; it was also believed that all
who came in contact with such a corpse{150} would be made disreputable
unless it were itself first made reputable; hence the professors first
read aloud a decree to that effect from the magistrate, and then, by
order of the senate of the faculty, stamped upon the breast of the
corpse the seal of the university. The body was next carried into
the anatomical hall, and the cover of the box in which it had been
transported was returned to the executioner, who remained at some
distance for this purpose. If the corpse was one that had been
decapitated, during these solemn ceremonies the head was placed between
its legs. Finally, an entertainment with music, often furnished by
itinerant actors, was given. But this folly was gradually discontinued,
and by the second half of the sixteenth century public dissection was
performed without recourse to such mummeries. The price of skeletons
in those days was high; the University of Hiedelberg, in 1669, paid
seventy-two dollars for one.
The practitioners of the sixteenth century were often quite as roving
as the students and professors, though those who held positions as State
physicians were bound by contract to a fixed residence for a certain
time. In 1519 the State physician of Heilbronn received a salary of
twenty-one dollars per year and his firewood, but could not leave
the city over night without permission of the burgomaster. Medical
attendants of the King of Spain were required to kneel down when they
felt the king's pulse. There were few physicians who acquired wealth,
although Fabricius ab Aquapendente left a fortune of two hundred
thousand ducats.
The Reform Period is the name which Renouard has given to the time
beginning with the commencement of the seventeenth century,--a time when
the domain of natural science was daily enlarged, and when observation
had enriched human knowledge with multitudes of new facts, some of which
harmonized with, and some of which were in opposition to, prevailing
doctrines. Men whose knowledge{151} equaled their genius began to need
a radical reform, and by such men intellectual improvement was begun
by which the decrepit theories of the schools of the Middle Ages were
eradicated and by which there were substituted for them others which
harmonized much better with known phenomena. To the period of worship of
ancient authority succeeded one characterized by a desire to shake
off the yoke of the same, and men now struggled, as it were, to free
themselves from the tyranny of the past. As Galileo was the torch-bearer
for regeneration of the knowledge of physics, and as Kepler, and
others already named, or to be named, did as much for other branches
of science, so there were not lacking those who broke away from the
restraint of authority in medicine, and began to beat or choose paths
for themselves among the facts which experimental science furnished
them.
With the approach of the seventeenth century there was evident
improvement in both the social and mental status of medical men. While
political humiliation and exhaustion were everywhere noted, in the field
of literature it was evident that the line had advanced. What may have
been the effect of thirty years of religious war, with other political
struggles carried on under the hypocritical cloak of religion, may be
imagined, if not fully described; the devastation of whole countries by
disease, and notably by the plague,--the poverty and hunger consequent
upon the ravages of perpetual war (it is stated that even so late as
1792 there were still in Saxony 535 wasted and extinct villages), to
say nothing of the barbarity and immorality resulting therefrom,--all
combined to make the early part of the seventeenth century a most
mournful epoch. It is not strange that, with poverty, superstition and
great rudeness of manners prevailed, or that trials for witchcraft and
persecutions by the Jesuit Inquisition were common. That any advance
should{152} have been made under such circumstances speaks well for the
progress of the human mind. That this advance was slight in Germany
and central Europe is not strange, though other countries were able
to quietly enlarge their scientific borders. Now it was that England,
Italy, and the Netherlands, which took but little part in the warlike
struggles of the century, acquired leadership in medicine, and were
seconded by the French. In Great Britain, science had been fostered
by various kings, and particularly by Charles II, who professed to be
something of a chemist; in fact, an epidemic of scientific interest fell
upon the English court.
The seventeenth century, in contrast to the idealistic sixteenth,
witnessed the advent of modern realism in almost all departments of
thought. Medicine furnished the first example in what we are accustomed
to-day to speak of as the exact method; hence, the century is of great
importance, in that physicists and chemists began to be original,
instead of mere followers of the past. The most notable feature
of medicine was the promulgation of three medical systems: the
pietistically colored Paracelsism of Van Hel-mont; the chemical
system of Sylvius; and the iatro-cliemical system of the physicist and
mechanician, Borelli. This period is, moreover, illumined by the life of
one great practitioner, whose name will be imperishable in the history
of our art,--namely, Sydenham.
The principal tendency of the time was toward skepticism, which had
begun in the preceding century with Montaigne, and was continued by
Charron, under the patronage of Queen Marguerite of Navarre; it was the
fundamental idea of Pierre Bayle, the author of the great dictionary.
Opposed thereto was the supernatural philosophy, or the theosophic,
cabalistic, or mystic. The leading exponent of the latter was Boehme,
who was a business colleague of the celebrated "Meistersinger," Hans
Sachs, in Germany, and of Blaise Pascal and his contemporary.
Malebranche,{153} in France. The doctrine of Lord Bacon, Lord Verulam
(1561-1626), a man who showed himself as exalted in mind as he was
mean in personal traits, was of great importance Bacon is a landmark
in history as the defender and eulogist of modern realism,--i.e., of
inductive philosophy. While personally contributing but little to the
advance of science, he taught a great method; as Gruen says, he was the
philosopher of patents and profit; he recognized the compass, the art of
printing, and gunpowder as great inventions, but placed little value on
the discovery of Copernicus, having little comprehension of mathematics.
Hobbes and Locke went farther into realistic philosophy, and the latter
was an exponent later of pure empiricism.
In the seventeenth century, also, zoology and botany were largely
extended. In it lived Swammerdam (1637-1680), famous as a naturalist,
physiologist, linguist, poet, and _savant_; there were others, also,
whose names are better known in the history of collateral science than
in medicine, and who left conclusive demonstrations in accordance with
their theories, and made daily use of the microscope, simple as it then
was. The term "cell" had been introduced by Hooke in 1667, and Malpighi
and Grew were the founders of the cell-doctrine. The astronomical laws
discovered by Copernicus changed the course of the world's thought; and
now appeared the brilliant Kepler (1571-1630), and Galileo (15641642),
the defender of the Copernican system, and the persecuted discoverer of
the law of falling bodies, of the thermometer, the telescope, and
the movements of Jupiter; also, Sir Isaac Newton (1642-1727), whose
discovery of the laws of gravitation in 1665 marked an era in the
history of science. This century, too, gave birth to Romer, who in 1675
calculated the velocity of light; Huyghens (1627-1693), who discovered
the polarization of light and the satellites of Saturn; James Gregory,
who in 1663 made{154} a reflecting telescope with a metallic concave
mirror; Torricelli, who in 1643 measured the weight of the air;
Gascoigne, who invented the micrometer in 1639; and Napier, who invented
logarithms in 1700.
Now chemistry, having ceased to be alchemy, began to don the dignity
of a science _per se_, and it may be claimed that medicine derived no
slight benefit therefrom. Scientific societies and journals arose at
this period, and were all of good service to medicine in their way.
The church scented danger to the faith in everything which related to
natural science, and founded certain secret associations, especially in
Italy; the Accademia Degli Lyncei, so called from its seal, which bore
the image of a fox or lynx, founded in Rome in 1603, was one of these.
Counter-societies, or, rather, societies with opposite purposes, were
also started, and the original and private so-called Invisible Society,
which was originated mainly by Milton, in 1645, and remodeled by Charles
II in 1662, is now the flourishing Royal Society. In France the Academy
was founded in 1665 by Colbert, but developed its first real activity
thirty-five years later.
Those who to-day are so familiar with the course of the circulation of
the blood through the arteries and veins find it difficult to understand
how the recognition of this phenomenon could have been so long
delayed; it seems so simple, yet to the ancients it was perfectly
incompre-hensible! Although every one had recognized that blood would
flow from an incision, few stopped to reason thereupon. From time
immemorial it had been supposed that the veins had their origin in
the liver, and were the only vessels which contained blood, since the
arteries were always found empty after death; the latter were held to
contain only air or spirit. The circulation was supposed to leave and
return to the liver through the venous canals by undulating movements
similar to those of the waves of the ocean; and this was the doctrine of
the Asclepiadæ,{155} and probably of Erasistratus. Galen modified this
view by showing that the arteries contained blood; he knew it was
poured into the right cavities of the heart by the great veins, but he
believed that only a small quantity passed from the right ventricle
into the lungs, and that the major portion reached the left ventricle by
passing through pores in the inner ventricular septum. This opinion was
uncontested until the middle of the sixteenth century.
Then the theologian, Michael Servetus, who, in 1553, perished as the
victim of Calvin's jealousy, denied the passage of the blood through
this septum, contending that it was returned from the lungs to the left
side of the heart by the pulmonary veins. This was a happy thought,
and a great step toward the truth. Soon after Columbus demonstrated
anatomically that the conjecture of Servetus was plausible, by showing
the function and real use of the valves of the heart. Cesalpinus came
still nearer to the truth, and explained, as did Columbus, the course
of the circulation through the lungs, but he opined that blood and vital
spirits passed from the arteries into the veins during sleep, because at
that time there was swelling of the latter and diminution of the pulse.
Valves in the veins were known, and it had been shown that ligature of
an artery in the living animal stopped the flow below it, while if a
vein were tied there was shrinkage above the ligature, and swelling
below it. Such was the state of science at the beginning of the
seventeenth century; there remained, practically, but one step to
take,--to find the true course of the blood.
[Illustration: 0176]
William Harvey was born in Folkestone, Kent, in 1578 and died in London
in 1637. He first studied at Cambridge, entering at the age of fifteen;
subsequently traveled in France, Germany, and Italy, remaining in
Padua from 1599 to 1602, in order to hear the lectures of Fabricius ab
Aquapendente. With the title of "Doctor" he returned{156} and settled in
London and soon became a member of the College of Medicine, of which he
was made a regent in 1613; in time he became physician to James I,
and, on the demise of this sovereign, to Charlçs I; to the latter he
dedicated his chief work. During the civil war he was driven from place
to place, and, finally, to Oxford, where he surrendered himself to the
Parliamentary troops, after which he again resided in London with his
brothers, who had become rich. Modesty led him to decline the high
distinction of President of the College of Physicians, and he lived
a quiet and retired life, occupied with his studies and, in his later
years, investigations in mathematics. Soon after 1613 he began, through
his lectures, to make known the doctrine of the circulation of the
blood; but he did not publish the results of his researches until 1628,
after submitting them to fifteen years of proofs and counterproofs{157}
of every kind. So bitter was the opposition of his contemporaries to the
new doctrine that he at one time lost a part of his practice, and
was even held to be demented. It is characteristic of the fate of new
truths, as well as of that age of dominant authority, that his first
publication--_Concerning the Motions of the Heart and the Blood_--was
unable to pass censorship in England, and therefore appeared in a
foreign country (Frankfort, in 1628) when he was fifty years old; but
his second treatise on the same subject, in reply to Riolan, a professor
in the Faculty of Paris, was published in Cambridge in 1649.
"So much care and circumspection in search for truth, so much modesty
and firmness in its demonstration, so much clearness and method in the
development of his ideas," says Renouard, "should have prepossessed
every one in favor of the theory of Harvey; but, on the contrary, it
caused a general stupefaction in the medical world, and gave rise to
great opposition."
This theory, which to-day appears so natural that we conceive with
difficulty why it was not sooner discovered, was nothing less than
a revolution in physiology; it excited a tremendous controversy that
continued more than twenty-five years, and in which mingled every one
possessed of any pretension to knowledge of anatomy or physiology; even
naturalists and philosophers took part in the dispute. René Descartes
was the first to declare in its favor and to support it by experiment;
John Walæus (Jan de Wale), the celebrated Professor of Anatomy in
the University of Leyden, confirmed it by new observations; finally
Plempius, of Louvain, for a time one of the most fiery of opponents,
succumbed to the truth, and in 1652 passed publicly to the ranks of
Harvey's followers--no small triumph!
During these long debates Harvey remained always dignified and firm,
although the early attacks rendered him unduly sensitive regarding
others which he anticipated.
About{158} his only answer to the arguments adduced against him, was to
add new proofs and new experiments to those already published. The only
one of his adversaries who obtained a direct response was Riolan,
who possessed immense influence among his contemporaries as a man of
attainments; Riolan combated with equal violence and obstinacy the other
great discovery of the age,--viz., the circulation of the lymph.
Harvey ultimately, however, had the satisfaction of seeing his theory
universally adopted. But his services were not limited to this one
discovery. He made most interesting observations on generation, both in
man and in animals; on midwifery; and on the structure and diseases of
the uterus.
The intermediary system and bond of union between the arteries and
veins, so very essential, yet up to this time unknown, was discovered by
the great Malpighi, who was born in 1628 near Bologna, became professor
in its university, and discovered in the lungs and mesentery of frogs,
in 1661, the capillary circulation. He first described the corpuscles
of the blood in 1665; he also discovered the lung-cells, as well as the
cutaneous glands, certain portions of the kidney, and the pigmentary
layer of the skin, named after him (_rete Malpighi_), which later
furnished the first explanation of the difference of color in different
races.
In 1690 Leuwenhoek (1632-1723), who had been making observations on
the larvæ of frogs and other small animals, was able to see with his
improved microscope the movements of the blood in the small vessels, and
gave the important testimony of his observations. In 1687 Cowper saw the
passage of the arterial into the venous current in the mesentery of a
cat. The capillary connection between the two vascular systems was first
demonstrated by Marchetti, but was best shown by Ruysch (1638-1731),
professor at Amsterdam, the famous inventor of minute injections, who
greatly advanced anatomy by the formation of collections, one of which
was brought into Russia by Peter{159} the Great at an expense of
about seventy-five thousand dollars. The Russian transporters of the
collection, however, drank the alcohol in which many of the preparations
were preserved, and a portion of the specimens was thus ruined.
Further illustration and amplification of Harvey's views came from
various sources; the last, perhaps, from Nich-olaus Steno (1638-1686),
who was first a professor in Copenhagen, then a bishop and peripatetic
converter of heretics. Steno first proved the heart to be a muscle that
contracts actively and expels the blood. The duct that bears his name
was discovered during his residence in Leyden or at Amsterdam. His name
is written also "Stenson."
While ancient anatomists were able to describe in a general way the form
of the lungs, their location, consistency, the ring-like structure of
the trachea, and the first division of the bronchi, they did not go
farther, but blindly accepted the prevalent theory that the bronchial
tubes anastomosed with the terminal pulmonary veins, and that in this
way atmospheric fluid was conveyed from the respiratory organs into the
heart. On such vague and erroneous data was constructed the theory that
the air was drawn into the lungs by the heat of the heart, which was the
reservoir of the vital spirits; that in penetrating through the smaller
tubes it was rarefied, its thinnest part passing into the heart, where
it served as material for the formation of the vital spirit, its grosser
part being exhaled. In other words, respiration was supposed to have two
purposes one to refresh the lungs, which, being porous and inflammable,
would otherwise take fire from the heart, or focus of animal heat; the
other to furnish the pneuma, or ether, which was employed by the heart
in the formation of animal spirits. Harvey's discovery upset all this,
in great measure.
Next it was shown that pulmonary veins carried nothing to the heart
except blood. And now, during this Reform{160} Period, the purpose of
the movements of the chest was better studied, for Borelli, Helvetius,
and Haller made many experiments, as the result of which it was
determined that during inspiration the thorax is enlarged in all
directions, and during expiration partly collapsed by relaxation of
muscles, and that there never is any empty space between the lungs and
the sides of the chest; further, that air is drawn into the chest by the
tendency of all gases or fluids to maintain an equilibrium, or, in
other words, because Nature abhors a vacuum. This being settled,
various pneumatic theories were adopted and abandoned, all of which had
subsequently to give way before a knowledge of what really occurs. The
truth was conceived of by Mayow in 1668. It had been noticed that blood
which appeared black in issuing from the veins, became red in contact
with the air, and direct observation proved a similar change of color
to take place during its passage from the pulmonary veins during life.
Goodwin, opening the thorax of a frog, was the first to see this, and
Hessenfratz filled a silk bladder with venous blood, and, plunging it
into an atmosphere of oxygen, saw the blood change from black to red.
In this way and by the later labors of Bichat and Lavoisier were
clearly established the mechanism and the purpose of the function of
respiration.
The discovery of the lymphatic vessels and their purpose was scarcely
less remarkable than that of the circulation, though marked by less
eclat because it was not the work of one man, but a matter of slow
development. Herophilus and Erasistratus had seen white vessels
connected with the lymph-nodes in the mesentery of animals, and supposed
them to be arteries full of air. Galen disputed this, for he believed
that the intestinal chyle was carried by the veins of the mesentery into
the liver. In 1563 Eustachius described the thoracic duct in the horse.
In 1622 Aselli, Professor of Anatomy at Milan, discovered the lacteal
vessels in a dog which had been killed immediately after partaking{161}
of food; having pricked one of these by mistake, he saw a white fluid
issue from it. Repeating the experiment, he became certain that the
white threads were vessels which drew the chyle from the intestines.
He observed the valves with which they are supplied, and supposed these
vessels all met in the pancreas and continued on into the liver. In
1647 Pecquet, while still a student at Montpellier, discovered the
lymph-reservoir, or _receptaculum chyli_, and the canal which leads from
it (the thoracic duct), which he followed to its termination in the
left subclavian vein. Having ligated the duct, he saw it swell below and
become empty above the ligature. He studied the courses of the lacteals,
and convinced himself that they all entered into the common reservoir.
This discovery gave the last blow to the ancient theory which attributed
to the liver the function of blood-making, and confirmed the doctrine of
Harvey. Strangely enough, the latter united with Riolan in opposing the
discovery of Pecquet and denying its significance. From this time the
lymphatic vessels and glands became objects of common interest and were
investigated by many anatomists,--by Bartholin, Ruysch, the Hunters,
Hewson, and, above all, by Mascagni, who was the first to give a graphic
description of the whole lymphatic apparatus.
The ancients confounded, under the name "neuron," nerves, tendons,
ligaments, and membranes; even Aristotle regarded the brain as an inert
mass devoid of sensation, and supposed the nerves to originate in the
heart. Rufus, of Ephesus, remarked that Herophilus distinguished
three sorts of nerves,--the first serving for sensation and motion
and proceeding from the brain and spinal marrow, the second and third
serving to unite bones and muscles.
Galen also shared in this error, but, nevertheless, described the
brain-membranes and the difference between white and gray matter; he
supposed the cerebrum to be the seat of the soul and origin of sensory
nerves, and that the cerebellum{162} gave rise to nerves of motion;
the pulsation of the cerebrum exposed was held to be a sort of brain
respiration. Galen came very near recognizing the distinction between
nerves and tendons, but nevertheless confused them. The anatomists of
the sixteenth century described certain portions of the nervous system
with, more exactness than did Galen, but not with such positiveness as
to prevent Cesalpinus from renewing the Aristotelian theory that the
heart was the origin of sensation and the seat of the soul. Nearly two
centuries later Baglivi advanced a theory which referred vital movement
to the heart and the dura mater.
The progress which accrued to comparative anatomy and physiology, and
the experiments which were made on animals, during this period, shed
a great deal of light upon the nervous system. The researches of
Vieussens, Haller, Meckel, Vicq d'Azyr, Scarpa, Soemmering, and others
had already rendered it manifest that the brain was the organ of
sensation and voluntary motion, and Bichat had proposed to divide the
nervous system into cerebrospinal and sympathetic branches.
Now, too, Kepler discovered that the crystalline lens was not the seat
of vision, as had been supposed, but that its function, like that of
other lenses, is the refraction of light. He observed that the image
of objects is depicted upon the retina, and (with Schemer) demonstrated
that the expansion of the optic nerve in the retina is the essential
part in the organ of sight. Obviously, also, interest in the anatomy of
the eye, which these observations everywhere stimulated, was, in a great
measure, aided by the researches of Newton on light and color.
About this time, too, Casserius and others studied the auditory
apparatus and described the ossicles, the small muscles of the internal
ear, and the semicircular canals; they even followed the acoustic nerve.
By the researches of a number of French and Italian anatomists it was
likewise{163} established that the true seat of hearing lies within
the internal ear, the external parts being merely of assistance in
conducting sound.
Thomas Willis was one of the first to consider the brain as an
assemblage of organs and to assign special functions to certain of its
divisions; he thus became a pioneer in cerebral localization, although
most of his conjectures were inaccurate or fanciful. The workings of
the brain were also studied by Pinel and others, who observed that
in certain conditions of mania or partial insanity some of the mental
faculties--such as memory, judgment, imagination, or will--were
abolished or suspended, while other faculties were preserved; hence it
was inferred that each faculty must have its own seat. The views thus
enunciated were carried to an absurd degree by Gall, and later by
Spurzheim, who made an entirely new classification, believing the
cranium to be molded in a reasonably exact manner upon the brain, and
that, by inspection of the exterior, the character of a given individual
could be read. They thus founded the pseudoscience denominated
phrenology, which we now know has practically nothing to justify itself.
About the middle of the seventeenth century Glisson (a professor in the
University of Oxford) recognized a property pertaining to all living
tissue, which he termed irritability, and which he regarded as
sufficient cause for all the phenomena of life; he enunciated certain
views that, in times past, have had an important bearing upon the
pathology of disease, but which were forgotten for sixty years or more
until revamped by the Dutch anatomist, Goerter. It was the latter,
with the great Haller, who, by a series of very ingenious experiments,
elevated the suppositions of Glisson to the dignity of demonstrated
facts. In 1747 the results of Haller's researches were published under
the modest title of _First Lines in Physiology_; the author was,
in fact, the great exponent of the doctrine of irritability in{164}
neurophysiology, and for this deserves to be remembered wherever the
history of our art is spoken of. This theory of irritability was applied
to pathology by Fabre, of Paris, who refuted the mechanical theory of
Boerhaave on inflammation, proving that the latter proceeds not
from obstruction of the capillaries, but from exaltation of their
irritability. It was also applied in many ways by Bichat, who enjoyed a
brief, though memorable, career. The theory of irritability, along with
the truths established by John Hunter in his researches on the blood,
made a very distinct advance in the physiological knowledge of the
seventeenth century, and the researches of those who contributed so much
to its advance are well worthy of study even at the present day. In this
line of investigation should, perhaps, also be mentioned the names
of Winslow, Albinus, the two Monroes, besides vicq d'Azyr, and others
already named.
I have so far discussed the development of theories and researches of
individuals. During the earlier portion of the seventeenth century there
happened something which gave to materia medica a remedy so valuable,
and which attracted such wide-spread attention, that it deserves special
mention, I refer to the discovery of that great febrifuge, Peruvian
bark. Malarial fevers had been known as early as the time of
Hippocrates, and were universally treated largely with purgatives,
sometimes with venesections. There had been no notable improvement in
the management of pyrexias of this class down to 1638, when the Countess
of Cinchon, wife of the Viceroy of Peru, became a prey to a fever which
nothing could remove. It is said a Spaniard learned from the natives
the secret of the bark, and advised its employment, whereby the countess
recovered her health. This is the generally received account, although
it has been widely discredited, and Humboldt expresses decided doubts
as to the source whence the first knowledge of the bark was derived. Be
this as it may, however,{165} it is certain that, in 1639, the countess
and her physician, de Vega, imported into Spain a quantity of ground
Peruvian bark, and distributed it to various persons, though it was not
made an article of general commerce until ten years later, when it was
exploited by the Jesuits, who had received a large supply; in Spain
it was known as the "countess's powder," and in Italy as "Jesuit" or
"cardinal" powder. Being very high-priced, it was soon so sophisticated
as to be quite unreliable. Condamine, the botanist, having been sent
to America for other purposes, determined the botanical position of the
tree and described several species of cinchona, one of which is known by
his name. To him is due the generic title bestowed in acknowledgment
of the services rendered by the countess, who introduced the bark
into Europe. Many vain attempts were made to determine the chemical
composition of the powder, and it remained for two French chemists to
isolate and separate its most important alkaloid. The first who wrote
upon the therapy of cinchona was Barba, a Spanish physician, whose work
was printed in Seville in 1642. After its introduction into England
Peruvian bark fell into disrepute, owing to improper administration,
whereby death was caused in certain instances; and it was this latter
fact that instigated Sydenham to investigate it still more accurately.
There has never been introduced into medicine any one drug which has
proved itself so generally valuable and so widely effective as cinchona
and its products.
As little progress had been made in obstetrics as in other branches
of applied medicine or surgery. The custom of employing midwives was
general, and these, for the most part, were ignorant and filthy
old women, slaves of routine procedures that had obtained from time
immemorial. Educated accoucheurs were called only in extraordinary
cases; but with progress the prejudice which excluded educated
physicians from the practice of midwifery gradually gave{166} way,
and there was opened for obstetrics a new era. In the beginning of the
seventeenth century the initiative was taken by Louise Bourgeois, the
_sage femme_ of Marie de Medicis, who in 1626 published a collection of
observations concerning sterility, abortion, fecundity, accouchement,
and diseases of women and children generally; it embodied several
distinctly new ideas. A little later (in 1668), Mauriceau, of Paris,
chief accoucheur to the Hôtel-Dieu, published his treatise on diseases
of pregnancy and childbirth, which was translated into all the languages
of Europe and became a powerful agent for good, not alone that it
represented an advance in knowledge, but it stimulated such rivals
and successors as Devanter, Peu, Paul Portal, and Delamotte to further
research. About this time the Chamberlains, an English family devoted
to the practice of midwifery, invented an instrument to facilitate the
extraction of the foetal head when arrested, and one of them went to
Paris, and, failing of success there, went on to Holland, where he sold
his secret to two Dutch practitioners, who kept it only too faithfully.
In 1721, Palfvn, a surgeon of Ghent, while seeking to fathom the device
of the Chamberlains, conceived a _tire tête_ (literally a head-drawer)
composed of two steel spoons, and hastened to publish an account
thereof,--a praiseworthy act, whereby he merits distinction as the
inventor of the forceps. As modified by Smellie in England and Levret in
France, the obstetrical forceps ranks among the most useful discoveries
of modern surgery, and, although not in common use until about a century
ago, it may be said that the invention has been the means of saving the
lives of countless women and children.
Medical jurisprudence also seems to have had its beginning during this
century. It had long been the practice to summon physicians to court
in order to enlighten the judiciary in questions demanding particular
knowledge in physics and medicine; indeed, the practice began{167} under
the first Christian emperors, and owes its origin to ecclesiastical
authority. Charlemagne confirmed in this regard what Justinian was
perhaps the first to ordain. The tribunal of Châtelet, according to
Renouard, appears to have been the first which comprehended the great
utility of consultation with expert physicians; an edict of Philip le
Bel, in 1311, qualified Master John Potard with the title "Sworn Surgeon
of Châtelet", and the constitution promulgated by Charles V, in 1552, gave
great importance to medical jurisprudence, as it treated in detail of
infanticide, wounds, poisons, abortion, and other such crimes. Early in
the seventeenth century Fidelis collated all that had been written on
this subject, and thus published the first special treatise on legal
medicine.
Some writers claim to have discovered traces of clinical teaching in the
history of Arabian universities, but, as Renouard says, the presence of
a few pupils during visitations and consultations no more constituted
real clinical teaching than the practice adopted by some practitioners
of ancient Rome of being ever surrounded by a group of spectators whom
they dignified with the title of disciples. The first attempt at real
clinical teaching appears to have been in the hospital of St. Francis,
in Padua, in 1558, by Botoni and Oddi. About the beginning of the
seventeenth century Otto de Heurne, of the University of Leyden,
introduced bedside instruction, which was continued by le Boe, sometimes
called Sylvius, with the result of drawing-large crowds of students
to Leyden from 1658 to 1672. Notwithstanding the success attained, the
practice was neglected by the successors of Sylvius until renewed by
Boerhaave, who, invested with several functions at the University of
Leyden, also occupied the chair of medicine. So great was the renown
of Boerhaave that, despite the poverty of the resources of the Leyden
hospital, people came to consult him from the most distant countries,
and he was a correspondent of several crowned heads, even of the Pope,
although{168} himself a Protestant. During his life and long afterward
he exerted an immense influence in medicine, and while, perhaps,
inferior in genius to some of his contemporaries, he had a wider
reputation, and his doctrines prevailed longer. The great success of
his clinics decided in favor of this method of teaching, and in 1715 the
Pope established in Rome a similar institution, under the direction
of the celebrated Lancisi. Soon Edinburgh, Vienna, Pavia, and other
universities followed suit, the first clinical chair in Paris being held
by Corvisart, and the first in Vienna by Van Swieten. After the demise
of Boerhaave, the school of Leyden rapidly declined, while those of
Edinburgh and Vienna became rivals for the first place. It is thus seen
that after an interruption of more than two thousand years clinical
teaching was revived and became more brilliant than ever before.
I now propose to recount the methods and deeds of some of those
concerned in the development of systems, so called, and make mention of
the most prominent medical men in national and historical order. This
will not prevent going back to philosophical conclusions or reflections
upon the philosophy of the history of medicine, when it may seem wise so
to digress.
First, of the system of J. B. Van Helmont, which in its day was most
highly regarded, and which seems to have been, in some measure, a
rearrangement of the views of Paracelsus into a mystic and pietistic
system based upon mechanical principles. Van Helmont was born in
Brussels in 1578, and was so precocious that he entered the University
of Louvain at an age which would have enabled him, had he so desired, to
obtain the degree of Magister when only seventeen years old, he deemed
the degree frivolous. He had studied mathematics, astronomy, philosophy,
and astrology. Going now to the Jesuits, who at that time, even, taught
music, he soon became dissatisfied, and turned to the study of stoical
philosophy. Believing that the{169} Capuchins (who were mere lascivious
gluttons, and considered even washing unchristian) were the true stoics,
he sought to join this order, but ere long abandoned them and resumed
his studies in law, botany, and medicine. For the latter Van Helmont had
at first little respect, since his studies in this line did not enable
him to rid himself of the itch. He soon again lapsed to the monastics,
and came to the conclusion that wisdom, like the grace of God, was
obtainable only by fasting, supplication, and poverty; accordingly he
practiced medicine among the poor as a labor of love (having received
his degree of Doctor in 1599). During his travels he became familiar
with the writings of Paracelsus, which he studied zealously. Finally
he settled down in Vilvorde, where he practiced medicine and chemistry
until his death (in 164-4).
Like most "systems," that of Van Helmont is valued only as an expression
of the spirit of the age, since it embodied largely the pantheism of
Paracelsus, merely cloaked with a more religious or monkish dress. He
held that the general cause of disease was the fall of man; though
there also figured a subsidiary cause, which he denominated Archeus,--a
faculty of appetite seated in the spleen or in the stomach; thus dropsy
was a hindrance of renal excretion by the enraged Archeus. Demons,
witches, and ghosts were included in Van Helmont's system as causes of
disease. Indeed, the man seems to have been a second Paracelsus, lacking
only in the dishonesty and bombast of the latter. He had no followers of
any prominence, and the "system" soon lapsed into obscurity.
The Chemical, or Iatrochemical, System was originated by le Bôe,
commonly known as Sylvius (but who must not be confounded with the great
anatomist of the same name). Le Bôe was born in Hanau in 161-4; studied
in Paris, Leyden, and Basel; received his doctorate from the latter
university at the age of twenty, and practiced in Switzerland with great
success until 1660, when he accepted{170} a professorship in Leyden;
here he was distinguished for his eloquence, wealth, and sociability,
as well as for the great number of pupils that were attracted by his
clinical method of teaching. His system embraced a peculiar phantasy,
being based upon the elements of chemistry, the new knowledge of the
circulation, the latest physiological teachings, and the old doctrine
of the spirituous or innate heat of the heart, which he claimed to
have felt with his finger. He asserted his theories were founded upon
experience, but the truth is, they were inaccurate deductions from
experimental observations, many of which were wholly irrelevant. The
majority of diseases, he taught, were produced by excess of acidity or
alkalinity. For him, the three great fluids of the body were the saliva,
the pancreatic fluid, and the bile, while health consisted in the
undisturbed performance in the body of the process of fermentation;
and the saliva was supposed to give rise to hectic fevers, because
such manifest exacerbation after eating. Stereotyped theory and equally
stereotyped therapeutics gained for him, for a short time, a large
following, but later raised numerous opponents, who alleged that his
system caused as many human lives as the whole thirty years' war. He
died in 1672.
To the same iatrochemical school is generally assigned Thomas Willis,
born in Oxford in 1622 (died in 1675), who rendered great service to
anatomy, especially to anatomy of the nervous system, although his
teaching was disfigured by certain unsupported theories. Like Van
Helmont, he had been destined for theology, but turned his attention to
medicine. Ultimately he became Professor of Philosophy in the University
of Oxford. He first described the so-called circle of Willis, whence
its name; also ascribed diseases, especially those of the blood, to
fermentation, in which the vital spirits played the chief part. He
accounted for hysteria, for instance, by the union of the spiritus with
imperfectly purified blood.