_Age of Rénovation--(continued).--Iatromechanical School: Santoro,
15611635. Borelli, 1608-1679. Sydenham, 1624-1689. Sir Thomas Browne,
1605-1682.--Surgery: Denis, f 1704. F. Collot, f 1706. Dionis, f!718.
Baulot (Frère Jacques), 1671-1714. Scultetus, 1595-1645. Rau, f 1719.
Wiseman, 1625-1686. Cowper, 1666-1709. Sir C. Wren the Discoverer of
Hypodermatic Medication. Anatomical Discoveries. General Condition of
the Profession during the Seventeenth Century. The Eighteenth
Century. Boerhaave, 1668-1738. Gaub, 1705-1780.--Animism: Stahl,
1660-1734.--Mechanico-dynamic System: Hoffmann, 1660-1742. Cullen,
1712-1790.--Old Vienna School: Van Swieten, 1700-1772. De Haën,
1704-1776.--Vitalism: Borden, 1732-1796. Erasmus Darwin, 1731-1802._
The physiology{171} of the Iatromathematical, or Iatro-mechanical, or
Iatrophysical School devoted chief consideration to the solid parts
of the economy, whose form and function it strove to discover and
demonstrate by the aid of exact methods,--that is, by calculation
and physical apparatus. Thus, it explained digestion as mechanical
trituration; secretions were referred to variation in resistance of
parts in the vascular system; warmth was supposed to be due to friction
of the blood-corpuscles; health consisted in the undisturbed performance
of the physical and mechanical processes of the body. Diseases were
explained inversely: the blood, under diseased conditions, was held to
contain pointed and angular crystals, which irritated as they passed
through the pores, or disturbed because they could not so pass.
The first to enunciate these views was Santoro, or Sanctorius, who
flourished from 1561 to 1635, and was for a while professor at Padua.
He taught how to investigate the pulse by an instrument of his own
contrivance, and how to study the temperature by means of a species of
thermometer, which was probably his own invention. (This instrument, by
the way, was invented about this time; Drebbel [1572-1634] is regarded
as the inventor of the air-thermometer, Galileo [1574-1642] of
the{172} spirit-thermometer, and Roemer [1644-1710] of the mercurial
thermometer.) Santoro studied the phenomenon of transpiration, and
constructed apparatus for bathing bed-ridden individuals; he found
that in twenty-four hours the insensible transpiration through the skin
amounted to 1 1/4 kilogrammes,--which result, compared with the results
of the present day, determined by the most complete observations,
is only twenty per cent, too high, and proves how accurately he
investigated. The important rôle of the perspiration, which he pointed
out, was made use of by the iatrochemists to vindicate their terrific
sweat-cures.
Borelli (1608-1679), of Naples, is usually regarded, however, as the
founder of the iatromechanical school. Of a quarrelsome disposition, he
could not stay long in any one place, though he ultimately settled
in Rome, where he joined the circle of _savants_ who gathered round
Christina, the daughter of Gustavus Adolphus, who had become a convert
to Catholicism. Finally Borelli entered a monastery. His services
related mainly to physiology, where, like Descartes, he followed purely
mathematical principles; he explained the action of the muscles by the
laws of the lever, calculated the mechanical work done by the heart, and
correctly ascribed inspiration to muscular action. He was the opponent
of iatrochemistry, and claimed there was no such thing as corruption
of the blood. His pupils and followers--like Bellini (1643-1704). of
Florence, who became professor in Pisa at the early age of nineteen,
and Baglivi (1668-1707), a pupil of Malpighi, and a man of universal
education--carried out and elaborated the first expressions of this
author. Borelli was the author of the oft-quoted maxim: "He who
diagnoses well cures well."
The iatromathematical system held ground for some time in Italy, and
also found followers elsewhere. For instance, Dodart (1664-1707). of
Paris, explained the voice on the mechanical principles enunciated by
Borelli and by{173} Quesnay (1694-1774). the tirst permanent secretary
of the Academy of Surgery in Paris. In England this explanation was
adopted by a number of followers, none of whom, however, was eminent
enough to justify special mention here. In Germany it obtained a certain
amount of favor, but seems not to have attracted any very eminent
disciples.
The iatromechanical school ran a course not unprofit' able to science,
yet was unfruitful of real advance in the domain of practical medicine.
The man of this particular age, who, more than any other, exerted
an influence destined to be prolonged even to the present time, and
probably much longer, who had a cool, clear, and unprejudiced spirit,
and who sought the true value of medicine, and recompense for the
same in the benefits which it brings to the sick, without scorning or
neglecting its scientific side, was Thomas Sydenham, bora at Winford
Eagle in 1624. a student at Oxford in 1642, and recipient of a
bachelor's degree of medicine in 1648.
[Illustration: 0193]
The next{174} fifteen years of his life we know practically nothing
of, save that he spent some time in Montpellier pursuing his medical
studies. In 1663 he became a member of the Royal College of Physicians,
but did not take his degree of Doctor until 1676,--thirteen years before
his death. His chief work--_Medical Observations_--is said to have
been originally written in English, and translated into Latin; it first
appeared in 1666,--the year when fire and plague devastated London. He
died of gout in 1689, and was buried in Westminster Abbey. During the
earliest years of the plague in London he fled, as was the general
custom of that day.
His model was Hippocrates. In pathology he was a humoralist without
being a theorist. He knew only one standard,--observation and
experience. Sharing the opinions of his day, he laid but little weight
upon anatomy and physiology; yet he recognized their value when employed
in the production of hypotheses. He conceived of disease as active,
operative,--a natural effort of the body to remove morbid material from
the blood; if this effort is violent and speedy, we have to do, he
says, with an acute disease, but if slow and difficult, the condition is
chronic. Fever was supposed to result mostly from cold or from epidemic
influences. As causes of disease, he considered unknown influences
and changes of the atmosphere very important. In his special pathology
"inflammation of the blood" played the chief rôle, and upon it were made
to depend nearly all acute and some chronic diseases. He arrived at what
he called the "healing power of Nature," for which he made great claims
in his description and observation of epidemics: but he believed there
always remained a good deal for the physician to do, and in treating
syphilis he even gave mercury until two kilogrammes of saliva were
discharged daily. As compared with the therapeutics of that day his
were manifestly simple,--and yet he employed, for example,{175} eighteen
different herbs in one prescription, and that merely an ointment. The
unreliability of the action of drugs induced him to rely upon specifics,
as did Paracelsus, but he acknowledged only one such,--the then new
discovery, cinchona,--not even allowing mercury such a position in
the treatment of syphilis. Such drugs as he chose were mainly from the
vegetable kingdom.
The great importance of Sydenham, and all his statements, so far as we
are concerned, centres about his struggle for the elucidation of
the healing power of Nature, and for simple observation and simpler
treatment, as opposed to the overgrown luxuriance of previous systems
and theories. He became the standard-bearer of his age in his return to
Hippocrates's method and art of healing, which are founded on the nature
of things and on the limits of human ability.
Sydenham was vehemently opposed by Richard Morton (1625-1648), of
London, who, like Fernel, considered all diseases to be a poisoning of
the vital spirits. Sydenham was also antagonized by Gideon Harvey, who
ridiculed his medical contemporaries without stint, because most of
them, for febrile disease, gave cathartics from the second day, and
began treatment with emetics. With delightful satire Harvey divided the
physicians of the day into six classes: the Ferrea, Asinaria, Jesuitica,
Aquaria, Laniaria, and Stercoraria, according as their favorite systems
of treatment were the administration of iron, asses' milk, cinchona,
mineral water, venesection, or purgatives.
Sir Thomas Browne (1605-1682), who still enjoys a great reputation,
was the author of the works entitled _Religlo Medici and Inquiries into
Vulgar and Common Errors_. The latter appeared in 1646, but does
not seem to have protected its author from the worst error of his
age,--viz., superstition,--since, in 1664, he swore that two condemned
old women were actual witches.
Having{176} considered the progress of medicine during the seventeenth
century, it may be well to glance likewise at surgical progress. Among
the Italians Santoro, already spoken of as the inventor of various
instruments, should be mentioned; also Valsalva, who obtained a sound
reputation as an operator, employed the ligature, and recommended a
starvation plan for treating aneurism; Magati (1579-1647). who contended
against the abuses of treating wounds by filling them with plasters,
balsam, poultices, tents, etc., and of changing the dressing several
times a day.--once in four days was better, he said; Severino
(1580-1656), first a lawyer, then a professor at Xaples, and later an
eminent surgeon, a good anatomist, and a particular friend of the actual
cautery; Marchetti (1589-1673), a bold, versatile operator of Padua; and
Borri, of Milan (1625-1695), skilled as an operator and an oculist but
better known because of his sad fate, since he died in the prison of the
Inquisition, alter a prison-life of twenty-five years, on account of too
liberal religious views. There were also numerous other Italian surgeons
who made a name, especially in plastic surgery, and particularly in
that branch of it named rhinoplasty, by whose efforts one method of
manufacturing a new nose came to be known as the "Italian method."
France, we must remember, was the home, during this century of
Richelieu. Mazarin. Louis XIV. Corneille. Racine. Molière. Fénelou. La
Fontaine. Boileau, Bossuet, and many other men eminent in literature
and science. During this century the French laid the foundation for that
leadership in surgery which they maintained for nearly two centuries.
Let us mention, among their surgeons. Morel, who invented the tourniquet
at the siege of Besançon, in the year 1674. There was also Jean Baptiste
Denis (who died in 1704), physician to Louis XIV. who performed the
first transfusion of blood in man. (Transfusion of the blood of the
young into the veins of the old for the purposes of rejuvenation,{177}
was recommended by Libavius, in 1715, and Colle, of Padua, gave it
new support by describing a method for its performance. In 1729 Boyle
practiced transfusion on dogs. The London faculty sought the value of
the operation after excessive haemorrhage, and Edmund King, physician to
Charles II, in 1665 practiced transfusion from vein to vein. But Denis
was the first to carry out the operation with lamb's blood upon a
patient sinking under excessive venesection,--an operation which was
very much abused at this time.) It was in this century that the French
family of lithotomists--the Collots--distinguished themselves in their
special line. The last member of the family, Francois, died in 1706.
Their specialty must have found, at that time, considerable more
material than comes to the front to-day.
Among the general surgeons of France were de Marque (1618), who
distinguished himself as a bandager; Bienaise, who invented the bistoury
caché (1601-1631); de Launay (1649), monk and lithotomist; Goursaud,
who survived his century, and who was the first to describe stercoral
incarceration; Duverney, who demonstrated the growth and nutrition of
the bones by periosteum; Lambert, who practiced injections in hydrocele;
Andry, of Lyons, who wrote of orthopaedic surgery and originated the
name _orthopaedics_; Pierre Dionis (who died in 1718), surgeon to the
Empress Maria Theresa, famous in his art, and who first emphasized the
effects of rickets upon the pelvis; and Boulot, better known as Beaulieu
(1671-1714). who advanced himself from being a soldier and a day-laborer
to become a physician, a famous lithotomist and surgeon. He finally
joined the Franciscan order, where he obtained the name of Frère
Jacques, under which title he passed for the inventor of lateral
lithotomy. Then there were Saviard (1656-1702), surgeon-in-chief in
the Hôtel-Dieu, who, among other things, determined the seat of hernial
strangulation to be often in the neck of the sac; and Georges{178}
Mareschal (1658-1736), surgeon to Louis XIV, one of the founders of the
Academy of Surgery, who has a record of eight lithotomies performed in
half an hour, and who became famous for his services in improving the
schools of surgery in France.
In this (the seventeenth) century, also, ophthalmology was much
cultivated in France, although it was assigned to the despised surgeons.
Those who won most renown in this line were Maitre Jean and Brisseau,
who divide the honor of first recognizing the seat of true cataract.
During this period, also, Duverney, Professor of Anatomy at Paris, was
the first to systematically describe diseases of the ear in accordance
with their anatomical seat.
In Spain scholarship sank more rapidly during this century than among
any other people in history, due mainly to the loss of their political
supremacy and their commerce to the Dutch and English, and to the utter
failure, at home, of their efforts to introduce true unity of faith. In
these efforts the industrious Moors were excluded, under Philip III. In
art they maintained their standing,--attaining, in fact, in Murillo,
the acme of their fame; but in other branches of industry they rapidly
degenerated. Students of history will readily understand how little
leisure the Spaniards had at this time to devote to the cultivation
of science, including medicine and surgery. Of the two men who are
mentioned during this century as Spanish surgeons, namely, Almeida and
Ayala, we know practically nothing.
The Germans gained no such store of knowledge from their experience
during the Thirty Years' War as did the French during their campaigns.
The barber-surgeons, for the most part, still reigned supreme, and their
guild contained some men of ability and independence of thought. The
most notable man of the times was Fabricius Hildanus (1560-1634). Of
him, however, I have already spoken as belonging rather to the previous
century. He was the first learned{180} German surgeon recognized and
esteemed as such by his contemporaries. He was distinguished, also, as
an oculist and aurist, and removed a particle of iron from the cornea by
means of a magnet. A man of great operative genius, and a born surgeon,
was Purmann (1648-1721), who greatly lamented the low condition of
surgery in Germany, and regarded a knowledge of anatomy as the prime
requisite for the surgeon; he employed the speculum in the diagnosis
of syphilis, although it has been Ricord's boast that this was his own
idea. Scultetus (1595-1645), of Ulm, was a famous surgical writer of
this period, and a bandage of his devising is still in frequent use,
and bears his name. Murait, of Zürich, was also a capable surgeon
(1655-1733).
[Illustration: 0199]
The Dutch had but few men during this century who enjoyed any reputation
as surgeons. The best among them was Rau (1658-1719), who, from being
a poor boy, became a barber, traveled extensively, and was finally made
Professor of Anatomy and Surgery in Leyden, where he introduced the
innovation of teaching practical surgery upon the cadaver. He was
especially famous as a lithotomist after the method of Frère Jacques,
although he did not give instruction on this subject in his lectures.
By the way, it is an interesting fact that the clinical histories of
many operations for stone during the seventeenth century were related
in verse, and illustrated with plates. Harvey's vivisections were also
related in verse.
Now, for the first time, do we begin to hear of English surgeons and
English surgery. The most prominent, as well as almost the earliest,
was Richard Wiseman (1595-1686), ordinary surgeon of James I, called
sometimes the "Pride of England" and sometimes the "Paré of England,"--a
bold, judicious operator, who took hold of every novelty and who
accepted the ligature of Paré (always having the actual cautery at
hand, in case the ligature should fail); he also amputated through sound
parts,{182} favored operating for strangulated hernia, and employed
the trephine zealously. The first recorded operation for external
urethrotomy for the relief of stricture is mentioned in Wiseman's
writings.
[Illustration: 0201]
There were also William Cowper (1666-1709), a famous anatomist and
surgeon; and Woolhouse, a famous, but ignorant, itinerant oculist. Sir
Christopher Wren, architect of St. Paul's, was the first who devoted
attention to injecting medicine into the veins,--a subject studied again
much later and recently once more taken up. His example (in 1667) was
followed by others, whose experiments demonstrated, as we know to-day,
that the effects which follow the intravenous administration of drugs
are the same as follow administration by the mouth.
Midwifery during the seventeenth century advanced even more rapidly than
its mother-science surgery. The accouchement of women was intrusted in
many cases to the care of educated men, who contributed not a little
to the art. Anatomy and physiology contributed also their quota to a
clearer knowledge of these diseases. The obstetric forceps were for so
long a time kept secret that they were of small benefit at first to
the obstetric art. Among the French who were especially prominent as
promoters of midwifery must be mentioned Marguerite de la Marche, chief
midwife of the Hôtel-Dieu; Francois Mauriceau, President of the College
of St. Come; Jules Clement Delamotte, who was also a skillful surgeon;
and Portal, who first proposed version by one foot Among the Germans a
few midwives distinguished themselves as independent observers, most of
all Justine Siegemundin, daughter of a minister, who devoted herself
to midwifery with such success that she became court midwife; she
recommended puncture of the membranes for the production of artificial
delivery, and especially advocated bimanual version.
But, perhaps, the most significant advances were made in the direction
of studies in anatomy, physiology, and pathology.{183} The history
of the circulation we have already taken up. After Harvey's time, and
largely because of his researches, physiologists were divided into two
parties with regard to the origin of life. These parties were known as
_animists_ and _animalculists_. It was largely by the later researches
of Highmore (1613-1685) upon the anatomy of the testis and the
epididymis, supplemented by those of Aubrey in Florence concerning the
ovaries (which had been previously considered as female testicles), and
the researches of Stenon concerning the muscular nature of the uterus,
that a better knowledge of reproduction was established. De Graaf
(1641-1673), a physician of Delft, Holland, pointed out the ovarian
follicles, known to-day under his name, while Swammerdam (1637-1686)
studied the comparative anatomy of the ovaries,--and was, by the way,
the first to prove that the queen bee is a female. Needham, the London
anatomist and physician, and Hoboken, of Utrecht, described more
accurately the placenta and the coverings of the ovum.
Anatomical discoveries crowded along about this time. For instance,
Wharton (1610-1673) discovered the sub-maxillary duct, named after him;
Glisson (1647-1671) studied the liver and recognized its capsule, that
still bears his name; Nuck injected the lymphatics with quicksilver, and
studied the glands especially; Stenson discovered the excretory duct
of the parotid, and Rivinius (his name being translated in German,
Bachmann) found the sublingual duct; Peyer, Schafhausen, and Brunner,
the latter a professor in Heidelberg, discovered the intestinal glands
which bear their names; Wirsung, of Bavaria (who was assassinated
in 1643 by another physician), discovered in the dissecting-room of
Vesalius, at Padua, the excretory duct of the pancreas; Pacchioni
found the bodies named after him in the dura mater; Havers, of London,
discovered the synovial glands and the so-called Haversian canals;
Cowper, already mentioned, discovered the small glands named after{184}
him, located in front of the prostate, and Bartholin yet other glands,
in the labia, which bear his name; Mei-bom, professor in Helmstàdt,
discovered the small glands in the eyelids which are named after him.
Besides these, many other discoveries might be recorded here, did time
permit. One other, however, deserves to be mentioned, with which the
name of Schneider (1614-1680) must always be honorably connected. He
described the mucous membrane of the nose and demonstrated anatomically
and clinically that not the brain, but this membrane, secretes the
mucous discharge during fluxes from the nose. This overthrew at once
and forever the ancient doctrine, which included so many and various
"catarrhal" diseases. I might add also that the best and most complete
description of the{186} entire central nervous system which had been
given up to this time was furnished by Vieussens.
Description of Fig. 26.--"Of the corruption of the bones of
the arm and shin, even as far as the marrow; of the shin-
bone broken with a wound and the bones sticking out and
bound with swathe-bands brought circularly about; and of the
cutting off of the end of the hand or foot. I represents the
corruption of the bone and of the marrow of the shin-bone,
II represents the shin-bone wholly corrupted and rotten. III
represents the place where the corrupt bone was situated and
was now pulled forth with the pincers. V is that shin-bone
corrupted, which the patient laid up for a memorial. VI is
the bone of the right arm corrupted. VII represents the bone
of the arm totally corrupted and sharp, which was pulled
away with the pullers, but by pieces, without any noise or
pain. VIII shows the place where the corrupt bone of the arm
lay, which was now pulled forth, which Nature filled up with
a callous, so that the patient could perform country
business without any impediment. The patient was a
countryman of Pappatavia, whose arm a souldier broke in four
places, without any wound, anno 1636. IX is a fracture of
the shin-bone with a wound, and laying the bone naked. X is
the bone of the shin with a wound, broken, with bones
sticking forth, and bound with bands not crosswise, but
circularly brought about and laid within the capsula as it
ought to be. XI is a hand affected with a secret canker
which is cut off in the sound part, namely at the end of the
radius and cubit bone. XII is a hand that is sphacelated,
which, being laid upon the block (D), is amputated in the
sound ends of the radius and arm-bone with a chizel (E),
contrary to Hildanus, with good success. XIII is a basin
filled with oxyerat, in which swims a bladder, which, being
wet, must be applied to the mutilated part. XIV are two
swathe-bands wrapt together (F and O), whereof each hath two
ends, to bind the arm, whereof the hand at the end is cut
off. XV represents a foot that is sphacelated, which is
taken off in the mortified part, near the sound part with a
pair of pinccrs. The mortified part being removed, the rest
of the putrefaction is consumed with red-hot irons until the
patient feels the force of the fire. After this two plagets
are anointed with Hildanus, his unguent Egyptiae, which are
applied to the escar; lastly, long plaisters (7) being laid
upon it, the foot mutilated is bound with a wet band (Q} as
far as the knee, as the hand is unto the middle of the arm.
XVI are divers sorts of iron instruments and made red hot,
both to consume the remainder of the putrefied part and are
also fit to stop the flux of blood."
[Illustration: 0205]
By the middle and latter portions of the seventeenth century most of the
better physicians and surgeons had either assumed offices and positions
in which they were supported by the State, or were settled in permanent
residences, which was not the case with the mass of physicians in the
sixteenth century. As a result the reputation of the entire profession
began to improve, while the unlimited license and absolute freedom of
practice prevailing during the Middle Ages were almost entirely done
away with. By this time the clerical element had disappeared almost
entirely from medical circles, or only dabbled in certain specialties.
The Thirty Years' War was fatal to the supremacy of the clergy in
matters of public health. Moreover, the increase of international
intercourse favored the communication of medical knowledge.
The physicians of this period were more occupied with chemistry and
physics than had ever been the case before. Nevertheless, this was also
the special age of _alchemists_ and of _impecuniosity_. According to one
of the classifications of the time, the regular profession was
supposed to include physicians, surgeons, barbers, regimental surgeons,
lithotomists, bath-keepers, midwives, nurses, apothecaries, druggists,
and even confectioners and grocers. Another list of impostors and
quacks, equally official, was made to include old women, village
priests, hermits, quacks,--
Description of Fig. 27.--"I represents the breast affected
with an ulcerated canker, the basis whereof is thrust
through with two needles drawing after them a twisted flaxen
thread. II shews how the chyrurgeon takes hold with his left
hand, of the ends of the threads that were thrust through,
and with his right hand he takes the knife and with that he
cutteth the canker out by the roots. III shews a canker cut
from the breast weighing six physical pounds. IV shews how
the chyrurgeon, after the cutting off of a breast ulceratcd,
doth lightly cautcrize the place with a red-hot iron at
least to corroborate the parts. V is the instrument of
Hierom Fabritius ab Aquapendente wherewith a fistula of the
thorax is perforated. VI is Sostratus, his band, which is
most convenient where the breast is affected with any
disease that requires binding. VII shews how Celsus cured
the sticking forth of the navil by manual operation. VIII is
a truss for the navil made of a double: cotton linncn
cloth."
[Illustration: 0207]
--uroscopists,{187} Paracelsists, Jews, calf-doctors, executioners,
crystallomancers (a class of people--chiefly Italian--who sought after
crystals), mountebanks, vagrants, magicians, exorcists, monsters,
rat-catchers, jugglers, and gypsies. Veterinary physicians were also at
that time included in this class.
Anatomy{188} was now studied more from human bodies, and was authorized
by statute. This was especially the case in non-German institutions, to
which for this reason students flocked in great numbers. In Dresden, so
early as 1617, there was a dissecting-room in which stuffed birds, at
that time a great rarity, and similar curiosities were preserved. The
study of anatomy was at a low ebb in Germany; so that when Rolfink,
in 1629, arranged at Jena, which was then the most popular German
university, for two public dissections upon executed malefactors, it was
considered such an event that the very highest authorities were present.
But the peasantry took such fright at this occurrence that for a long
time afterward they watched their cemeteries by night lest the corpses
should be dug up and, as they said, "Rolfinked." Vienna did not possess
a skeleton until 1658. Strassburg obtained one of a male in 1671, and
several years later one of a female. In Edinburgh an anatomical theatre
was first erected in 1697 in Surgeons' Hall. It is worthy of remark that
anatomical plates, designed to be lifted off in layers, existed even at
this period. About the middle of this century there arose a dispute at
the bedside of the Margrave of Baden, between two learned professors and
the regular court physician, whether a plaster to be applied over the
patient's heart should be placed in the middle of the chest, according
to Galen, or upon the left side. The dispute was settled by opening,
before the eyes of the noble patient, a hog, by means of which it was
demonstrated that, as a matter of fact, the heart of the hog lay on
the left side. So convinced was his excellency that he dismissed the
ordinary physician, who had held a contrary opinion as to the position
of a nobleman's heart.
The general barbarity and immorality of this century were conspicuous,
especially among the upper classes, and by its close had spread from
France, became naturalized in both Germany and Italy, and extended even
to the universities,{189} their professors, and their students. The
life of the latter during this period was more vulgar and rude than ever
before, and almost more so than ever since. Pennalism--that is to say,
barbarity toward junior students--became unbounded, so that outbreaks
occurred even during lectures. At last the State authorities were
compelled to interfere. Student outrages were very frequent and often
fatal, and their outbursts were disgraceful in the extreme.
Only in France was instruction in surgery well regulated, for this was
the only country which possessed a proper surgical college. Practical
instruction was imparted to mid wives--in Paris through a special
institution, in Germany through the Midwives' Guild; the barbers, too,
continued to receive instruction from their guilds; while instruction in
pharmacy was given by the master-apothe-caries, too often dogmatically
and even farcically, serving as objects for the keen satire of Molière.
The expenses of graduation were very great, and the ceremonies sometimes
lasted two days.
In another way this same seventeenth century might be characterized
as one of aggrandizement for physicians,--that is, as one during
which their position was improved in the eyes of the public and
better supported by the State. The physicians proper--the "_medici
pitri_"--were still persons of the profoundest gravity, with fur-trained
robes, perukes, canes, and swords, when matters were prosperous, who
for their lives would do nothing more than write prescriptions in formal
style, everything else being considered beneath their dignity,--even as
they affect in England to*day. They demanded to be called in every case,
however, even though they knew nothing about it, claiming that only by
means of their presence could things certainly go right. Nevertheless,
in dangerous cases--for example, during the plague--they left the
surgeons alone, while they looked upon the sick through the windows.
In spite of this, however, they were generally esteemed and often{190}
sought for, as well in public as in private. Some of them were supplied
with large libraries by their patrons or through their positions under
the government, and most of them enjoyed moderate prosperity. Their pay
was, for the most part, regulated in accordance with a definite tariff,
while the State gradually cut down the doctor's honorarium to the pay of
a day-laborer. During that century a certain physician to a countess
in Munich received $25 as his annual stipend. For being present at a
post-mortem and rendering an opinion thereon, each physician received
$1.75. Surgeons who were zealous and eager were always highly esteemed;
they were often better educated, in many respects, because of their
extensive travels; but the social emancipation of the surgeons was not
completed until the eighteenth century. About this time amputation of
the arm was supposed to be worth 31 marks ($7.75); of the leg, 41 marks;
or, if a patient died, half this price. Lithotomy cost 51 marks, or
half of that if the patient died. For cataract operation on one eye the
surgeon received 17 marks; for a like operation on both eyes, 25 marks.
We find in medicine, as in other branches of knowledge, that each
succeeding century presents its added quota of imperishable facts,
making it still more important than its predecessor. We may say that the
fifteenth century had prepared the way for a reforming idealism which
was the principal characteristic of the sixteenth; and that in the
seventeenth century the realistic reaction against this same idealism
showed itself in the church and the State by struggles against
constituted authority, and in medical science by the domination of
inductive philosophy. The idealism of the eighteenth century was not
reformative and humanistic, but revolutionary and humanitarian. The
unsettled character of the century's events may be charged, in
some degree, to the American and French revolutions, with their
interpretation (and their attempted attainment) of the{191} so-called
"rights of man." The masses were now supposed to be released, and
philosophers created new doctrines, which had a greater influence upon
the times than ever had philosophical doctrines before. Rousseau, for
instance, aroused a revolution in politics and education, while skeptics
and materialists alike strove for general enlightenment, which was sadly
needed. Among the higher classes extravagance and immorality prevailed
extensively, among the lower classes poverty and ignorance. In Germany
the rulers even sold their subjects, as when Hesse-Cassel sold to the
English seventeen hundred mercenary soldiers, and other States sold
smaller numbers. A criminal code, published in 1769, contained seventeen
copper-plate engravings, illustrating various methods of torture. A
physician was always present when torture was inflicted, to see that the
victim's sufferings were not greater than he could bear. This inhuman
mode of eliciting testimony was last practiced in Europe in 1869, in the
Swiss Canton of Zug. Popular education was a myth, and the children of
bondmen were not permitted to learn. No wonder the French revolution was
hailed with joy along the Rhine, where it swept away at once and forever
the petty rulers, abbots, and bishops, who were the "bloodsuckers" of
the people. The numerous wars of the century had no great influence upon
the development of medicine, except in the direction of surgery.
The eighteenth century was revolutionary also in the introduction of
freedom of religious thought, so that clerical physicians disappeared
entirely from the ranks, save a few who officiated as lithotomists, like
Frère Come, or as oculists, like Wrabetz, the latter of whom was even a
professor in Prague.
This was the century, too, of Leibnitz and Kant, of Linnæus and
Lavoisier, as well as of Bach, Haydn, Beethoven, and Goethe. During it
the most conspicuous services in nearly all branches of learning were
rendered by the Germans,{192} instead of by the Italians and English, as
during' the preceding century. In fact, Germany was then at the zenith
of her glory, and supplied an impulse for all other nations.
The influence of philosophy and the natural sciences became also more
and more marked. At the head of its philosophers must be placed Leibnitz
(164:6-1716), who, by his own writings and those of his pupils, created
a philosophical school, whose influence is still every where felt.
His doctrine was dualistic: Matter is created once for all, and has no
further need of the Creator. As concerns the spiritual world, he assumed
minute, indivisible, intelligent beings, called monads,--constituents of
all bodies and all beings. In close relation with him stood Kant,
while in England Locke and Hume became leaders of the opposed and
materialistic school, declaring the brain to be an organ for the
secretion of thought.
Among the universities founded during the eighteenth century were those
of Breslau, 1702; Bonn, 1771; Stuttgart, 1781; Pesth, 1794; Gottingen,
1737; and Erlangen, 1743. Medicine was also cultivated in learned
societies, which increased constantly in numbers. In 1744 Frederick the
Great united two other societies into his Royal Academy. In Switzerland,
in 1751, was founded an association of physicians and naturalists,
while in France royal scientific societies were founded at
Bordeaux, Montpellier, Lyons, and Dijon, and the Royal Medical Society
of Paris lived from 1717 until 1788. In spite of all these opportunities
for enlightenment, everything was not yet enlightened. Then de Haën
defended the existence of demons, and Maerz, a well-known theological
teacher, in 1760 devoted a book to witches and magic. That witches were
burned publicly is a matter of history, even in America. So late as 1821
there was a statute regarding witches in Ireland, and they were burned
in Mexico as recently as 1877. But these are flying pictures of
the eighteenth century, which are meant{193} only for the moment
to illustrate the more serious topic, to which we must now address
ourselves.
[Illustration: 0213]
First of all, the _medical systems and theories of the century_. Many
hundred years previously Galen had originated a method, which deserves,
perhaps, the title of pure eclecticism. The first purely eclectic system
similar to his originated with Boerhaave (1688-1738), perhaps the
most famous physician of his or any other century. He was the son of
a clergyman near Leyden, Holland, and was one of thirteen children.
Originally intended for the clerical profession, he had studied
philosophy, history, logic, metaphysics, philology, mathematics, as well
as theology, with great diligence. His education was, later, directed
to the study of medicine, because of the statement that the purity
of certain theological doctrines was endangered by him. So he studied
chemistry and botany, and then anatomy and medicine,{194} graduating in
1693. He practiced in Leyden with great success, and was offered a court
position. In 1709 he was tendered the chair of Medicine and Botany,
and in 1714 that of the Practice of Medicine; in 1718 he was also made
Professor of Chemistry. In all of these positions he displayed the
greatest capacity. He was a clinical teacher of rare talent, and soon
acquired such reputation as to attract to Leyden students from all parts
of the world in such numbers that no lecture-room in the university
could contain them. He was the first to give separate lectures on the
subject of ophthalmology, and employed the magnifying-glass in examining
the eye. As a practitioner he was no less popular, and he left an estate
valued at two million dollars. He was so famous that, when a Chinese
official addressed a letter "To the Most Famous Physician in Europe,"
it reached him safely. He made no distinction in his patients, and
compelled Peter the Great to wait a whole night for his turn to consult
him. His most eminent pupils were: Haller, Van Swieten, de Haën. Gaub,
and Cullen.
Boerhaave's influence and dignity, which were astonishing, even in a
physician, were based no less upon his encyclopaedic attainments than
upon the benevolence and purity of his character. He was free from
disputatiousness and vanity, although everywhere regarded as an oracle.
His universal maxim was: "Simplicity is the seal of truth," although he
never manifested this in his therapeutics. He employed the thermometer
in the axilla in examining his cases, as did the iatrophysicists of the
previous century.
His doctrines did not form a new system, but rather a composite of
earlier systems, he stands also in the anomalous position of one who had
the whole world at his feet, and yet contributed little or nothing which
has been of essential importance. In fact, his peculiar views have been
so universally given up that they are of only meagre historic interest.
He looked upon disease as a condition in which{195} bodily action or
natural activities, being disturbed or unsettled, could take place
only with difficulty; the reverse of this, of course, constituted good
health. Fever he regarded as an effort of Nature to ward off death.
Digestion was explained, like the circulation, upon mechanical
principles. In his therapeutics, besides his efforts to sweeten
the acid, to purify the stomach, to get rid of acridities, he made
Hippocrates and Sydenham his models. His biographers say that his
medicines were less effective than his personal appearance. He left many
adherents, but no school of followers. It must be said, however, to
his credit, that, while not the first to give clinical instruction, he
permanently established a clinical method in teaching.
Gaub (1705-1780), professor in Leyden from 1731, was but little inferior
to his master, Boerhaave, in fame as a teacher. He wrote the first
complete work on the exclusive subject of general pathology. In general
therapeutics he considered the healing power of Nature amply sufficient
to remove sickness, but attributed this power sometimes to the soul and
sometimes to the body.
There arose, naturally, strenuous opposition to the views and teachings
of Boerhaave, and his principal opponent was Stahl (1660-1734), who was
one of the most important systematists of any age, a profound thinker,
and a pioneer chemist. He began lecturing in Jena at once upon his
graduation, at the age of twenty-five, and moved through two or three
different university positions until he came to Berlin at the age of
fifty-six. He was a great pietist, of uncouth manners, faithful to his
laboriously acquired convictions, and bitter and relentless against
those who could not accept them. Indeed, he regarded his convictions
as revelations from God. He looked upon the success of another as a
personal injury to himself, and from being first a croaker he became
finally a confirmed misanthrope, until he fell into actual melancholia.
Pecuniary profit he had never sought, and its pursuit he scorned.{196}
His views were dynamico-organic, pietistic, and antagonistic.
He regarded the soul as the supreme principle, life-giving and
life-preserving, not to be confounded with the spirit; when hindered or
obstructed in its operation, disease was present. The soul governed
the organism chiefly by way of the circulation; consequently, plethora
played an important rôle. To get rid of this plethora the soul employed
either fever or convulsive movements; for example, in children plethora
produces a pressure of blood to the head, and, by way of compensation,
the soul provides a haemorrhage from the nose. For reasons easily
appreciated, he regarded bleeding piles as safety-valves of the utmost
importance. Fever was a salutary effort of the soul to preserve the
body; this was true even of intermittents, and, accordingly, he never
gave cinchona. He scorned anatomy and physiology, saying, in one place,
that medicine had profited as much by the knowledge of the bones in the
ear as by a knowledge of snow which had fallen ten years previously. But
Stahl was one of the most eminent chemists of the age, and did a
great deal to liberate chemistry from the glamour of alchemy and the
domination of pharmacy, and to transform it into an independent science.
Stahl's doctrine has been called _animism_, and was a reaction against
the chemical and mechanical theories of the seventeenth century. He
gained a considerable number of followers, the most notable of them
among the French being Sauvages (1706-1767), the forerunner of Pinel and
an opponent of pure mechanics, who animated the mechanical system of
the body with Stahl's "soul." This was, par excellence, the age of
artificial systems, and so Sauvages in his classification supplied a
system which had ten classes of diseases, each of which had several
orders, and some as many as two hundred and ninety-five genera, and
two thousand four hundred species of disease!! Even Linnæus had three
hundred and twenty-five genera of disease,{197} while Cullen had only
four classes with one hundred and forty-nine genera.
The mechanico-dynamic system was a sort of compromise or mixed system,
which was held in high honor by the most eminent physicians and better
minds of the last century, and has even been prized by Sprengel as
the best of all. It was originated by Friedrich Hoffmann (1660-1742).
Hoffmann's father was a physician, and he was himself born in Halle,
whose university he attended. He acquired lasting reputation as an
oculist, and was made Professor of Anatomy, Surgery, Medicine, Physics,
and Chemistry at his _alma mater_. Our commonplace "Hoffmann's anodyne"
is named after him. He was one of the most erudite professors of his
day, more easily understood than Stahl, widely known for his fluent
diction and amiable temper, and, accordingly, won great renown for his
university. His good fortune as a practitioner was so great that even
Boerhaave declared him his own equal. As a writer he was voluminous, one
edition of his works comprising twenty-seven large volumes.
According to Hoffmann's views, life was simply mechanical movement,
especially of the heart; death, the cessation of heart-action,
putrefaction thereupon resulting. Health meant regularity of
movements; disease, a disturbance of the same. He used the word "tonus"
extensively. Ether he regarded as an important factor, producing
and maintaining movements of the body, itself extremely volatile,
corresponding largely to the "pneuma" of the ancients; it was, in fact,
a motor principle and, at the same time, the perceptive soul. Ether was
stored in the medulla, and circulated in a double way in the body; spasm
was the consequence of too strong, atony of too feeble, influx of ether.
Fever was a general spasm of the arteries and veins, having its cause in
the spinal cord. Hoffmann's therapeutics were simple, and poor in drugs.
These latter were intended to weaken, alter, or evacuate, and he{198}
was especially partial to the use of vinous remedies. The strong and
toxic drugs he used but little.
William Cullen (1712-1790), a Scotchman, rose from the deepest poverty
to the greatest celebrity. First a barber, he afterward became an
apothecary, then a ship-surgeon, then a village practitioner, finally
entering into partnership with William Hunter as a general practitioner.
Both of these eminent men being in equally poor circumstances, they
agreed to live in the same place and that, while one was studying, the
other should take care of the practice. In this way Cullen was enabled
to graduate in 1740. Six years later he taught chemistry in Glasgow,
and in ten years more came to Edinburgh as Professor of Medicine. He
continued very active and famous up to the time of his death, but died
as he had been born,--in poverty. Among his numerous other charitable
deeds, he supported the widow of Robert Burns and published the latter's
poems.
Cullen was the father of modern Solidism,--a system based upon the solid
parts of the body, the nerves being the chief agents. The life-giving
element was, in his view, an undefined, dynamic something (different
from Hoffmann's ether or Stahl's soul), which he called _nerve-force, or
nerve-principle; animal force; and brain-energy_, and in it he included
the spinal cord. His nerve-principle was supposed to produce spasms and
atony, either actively or passively. The causes of disease, while of a
debilitating character, were supposed to awaken reaction of the healing
powers of Nature; fever was a reparative effort of Nature, even in
its cold stage, the blood playing no part in it. He constructed a very
arbitrary classification of fevers, as, in fact, he did of all
diseases, his system of nosology being the secret of his reputation. His
explanation of gout was famous. That disorder, he said, depended upon
an atony in the digestive organs against which was periodically set up
a reparative effort in form of a{190} joint inflammation. In scrofula
he had to assume, in contradiction to his nervous pathology, a peculiar
acridity, and in putrid fever a putridity of the humors of the body. His
therapeutics were simple and salutary, because of his renunciation of
venesection, which was much abused in his day.
The most celebrated pupils and successors of Hoffmann were Gregory, of
Edinburgh, Gardiner, and, in Germany, the famous Thaer (1752-1828), who
finally abandoned the practice of medicine because it promised more than
it could perform, and who became a "father of husbandry."
A composite of the doctrine of Hippocrates, Sydenham, and Boerhaave was
represented in the so-called Old Vienna School, whose connection with
the lives of Maria Theresa and Joseph II deserves, at least, mention.
Its founder was Baron Van Swieten (1700-1772), of Leyden, a descendant
of a noble Jansenist family of the Netherlands, who graduated under
Boerhaave after having studied at Louvain. After the death of his
patron he was called to the assistance of the Archduchess Maria Anna, of
Austria, who was suffering from an abortion, and gave such satisfaction
that she recommended him to her sister, Maria Theresa, who up to this
time had remained sterile. To her and to her husband he gave advice
which resulted in sixteen successive pregnancies, and then, as the
result of his success, came to Vienna in 1745 as President of the
General Medical Department of Austria. He was also made censor, in
which position he incurred the enmity especially of the Jesuits and
of Voltaire, whom he robbed of their influence. He was made baron, and
became, next to Kaunitz, the most influential counselor of the empress.
His chief care was dedicated to the elevation of medical affairs in
Austria, and especially to the improvement of the medical faculty. He
had just seen success crown his efforts when he died of senile gangrene,
with the reputation of being a great physician and benefactor of
the poor. One of the greatest of his{200} services was improving the
treatment of syphilis, in which he, after the example of Paracelsus,
recommended the internal use of corrosive sublimate.
More eminent as a physician than for personal character was de Haën
(1704-1776), of The Hague,--a pupil of Boerhaave. At the suggestion
of Van Swieten, he was called, in 1754, to Vienna as president of the
clinic of the city hospital, which at that time afforded accommodation
for only twelve patients. He was the real founder of the so-called Old
Vienna School, whose merit, in contrast to the so-called new school, is
to be sought in practical and diagnostic services. As de Haën quarreled
with every one, he also did with Stoerck (1749-1803), the successor of
Van Swieten in the direction of the Austrian Medical Department, and
with Stoll (1742-1787),--a clinical teacher who was especially famous as
an epidemiologist.
Stoll lectured with great popularity until 1784, upon the completion of
the Allgemeines Krankenhaus, when he fell into the background and was
badly treated. He was the subject of numerous intrigues by his enemies,
and had a wife who embittered his life, and who even had him buried in
the dress of a Jesuit in order to injure his reputation after his death.
To his credit be it said that, changing his views of the constituents of
disease later in life and his original therapeutics becoming no longer
of use to him, he abandoned them entirely. Nevertheless his therapeutic
system flourished for a long time after him.
There were in vogue during this period numerous other doctrines, some
of which were too puerile or insubstantial to gain any foothold at all;
others exerted a certain amount of influence during the life-time of
their originators or for a generation afterward. With many of these I do
not care in any way to deal. A few others, I think, ought to be at least
mentioned in such a history as I am endeavoring to present.
There was another Hoffmann--Christopher Ludwig
Hoffmann{201} (1721-1807), of Westphalia, who devised a so-called
humoral theory in which the "acridities" of Boer-haave were mingled with
the "putridities" of the pneu-matists and the "irritability" of Glisson.
His treatment and remedies for diseases were supposed to be antiseptic,
as was very proper when dealing with putridities.
The theory known as the "Doctrine of Infarctus" had its origin with
Kampf, who died in 1753. By infarctus Kampf understood impacted fæces,
which he thought originated in the humors of the body, portal vessels,
and intestines; he recognized two kinds,--the black bilious and the
mucous. From this theory a wide-spread clyster fashion developed, and
lords and ladies vied with each other in belaboring their infarcti and
in administering enemas. As Baas says: "We cannot deny to the author
of this doctrine at least an extensive knowledge of human nature. He
supplied a universal remedial procedure, and gratified the apothecaries
with the bulkiness of the herbs required for its practice."
Quite antagonistic to the views of the Vienna School were those of the
School of Montpellier, inaugurated by Bordeu (1732-1796), and generally
known as _vitalism_. Bordeu died in the enjoyment of great reputation,
but at variance with all his colleagues. He maintained the existence
of a general life of the body,--a composite life,--resulting from the
harmonious working of the individual lives and powers of all the organs,
which were supposed to be associated with each other, but each for its
own definite function; the most important organs--the stomach, heart,
and brain--being called "the tripod of life." In pathology he laid great
weight upon crises, which were supposed to proceed from the glands.
The most important representative of vitalism was Barthez (1734-1806),
of Montpellier,--a man of great gifts and eager for knowledge. He
recognized a vital principle as the cause of the phenomena of life, but
acknowledged that{202} its nature was unknown, although he endowed it
with motion and sensibility different from a thinking mind.. Plants were
supposed to possess it likewise. Disease, he believed, was the result of
an affection of this vital principle. Every disease was divisible into
certain disease-elements, viewed as parts of the whole, and these were
again divisible into secondary elements. He explained putrid fevers as
specific vital diseases,--in which view, of course, he embodied humoral
ideas.
In Germany, at about this time, a similar doctrine obtained,--a doctrine
of vital forces,--which the versatile Reil (1759-1813) elaborated into a
system.
Meantime, in England, a doctrine was elaborated by Erasmus Darwin
(1731-1802) which partook, in a certain degree, of the doctrines of
Stahl, Hoffmann, Haller, Brown, and Bordeu. Erasmus Darwin distinguished
himself, not only as a physician, but as a poet, philosopher, and
physiologist. He was a friend of James Watt. Of his life it is said
that by his practice and very fortunate marriages he became wealthy, ate
much, and drank nothing but water. His chief work--entitled _Zoonomia,
or the Laws of Organic Life_--was published in 1784, and is well worthy
of perusal to-day. He recognized two fundamental substances--spirit and
matter. But it is not so much for his doctrine as for his researches
into animal and plant physiology, and, reflexly, because of his more
celebrated descendant of the same name, that we owe him most gratitude.