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yet.

Fauna and flora are here, and, thanks to Lamarck and Wallace and

Darwin, their development, through the operation of those

“secondary causes” which we call laws of nature, has been

proximally explained. The lowest forms of life have been linked

with the highest in unbroken chains of descent. Meantime,

through the efforts of chemists and biologists, the gap between

the inorganic and the organic worlds, which once seemed almost

infinite, has been constantly narrowed. Already philosophy can

throw a bridge across that gap. But inductive science, which

builds its own bridges, has not yet spanned the chasm, small

though it appear. Until it shall have done so, the bridge of

organic evolution is not quite complete; yet even as it stands

to-day it is perhaps the most stupendous scientific structure of

the nineteenth century.

 

VII. EIGHTEENTH-CENTURY MEDICINE

THE SYSTEM OF BOERHAAVE

At least two pupils of William Harvey distinguished themselves in

medicine, Giorgio Baglivi (1669-1707), who has been called the

“Italian Sydenham,” and Hermann Boerhaave (1668-1738). The work

of Baglivi was hardly begun before his early death removed one of

the most promising of the early eighteenth-century physicians.

Like Boerhaave, he represents a type of skilled, practical

clinitian rather than the abstract scientist. One of his

contributions to medical literature is the first accurate

description of typhoid, or, as he calls it, mesenteric fever.

 

If for nothing else, Boerhaave must always be remembered as the

teacher of Von Haller, but in his own day he was the widest known

and the most popular teacher in the medical world. He was the

idol of his pupils at Leyden, who flocked to his lectures in such

numbers that it became necessary to “tear down the walls of

Leyden to accommodate them.” His fame extended not only all over

Europe but to Asia, North America, and even into South America.

A letter sent him from China was addressed to “Boerhaave in

Europe.” His teachings represent the best medical knowledge of

his day, a high standard of morality, and a keen appreciation of

the value of observation; and it was through such teachings

imparted to his pupils and advanced by them, rather than to any

new discoveries, that his name is important in medical history.

His arrangement and classification of the different branches of

medicine are interesting as representing the attitude of the

medical profession towards these various branches at that time.

 

“In the first place we consider Life; then Health, afterwards

Diseases; and lastly their several Remedies.

 

“Health the first general branch of Physic in our Institutions is

termed Physiology, or the Animal Oeconomy; demonstrating the

several Parts of the human Body, with their Mechanism and

Actions.

 

“The second branch of Physic is called Pathology, treating of

Diseases, their Differences, Causes and Effects, or Symptoms; by

which the human Body is known to vary from its healthy state.

 

“The third part of Physic is termed Semiotica, which shows the

Signs distinguishing between sickness and Health, Diseases and

their Causes in the human Body; it also imports the State and

Degrees of Health and Diseases, and presages their future Events.

 

“The fourth general branch of Physic is termed Hygiene, or

Prophylaxis.

 

“The fifth and last part of Physic is called Therapeutica; which

instructs us in the Nature, Preparation and uses of the Materia

Medica; and the methods of applying the same, in order to cure

Diseases and restore lost Health.”[1]

 

From this we may gather that his general view of medicine was not

unlike that taken at the present time.

 

Boerhaave’s doctrines were arranged into a “system” by Friedrich

Hoffmann, of Halle (1660-1742), this system having the merit of

being simple and more easily comprehended than many others. In

this system forces were considered inherent in matter, being

expressed as mechanical movements, and determined by mass,

number, and weight. Similarly, forces express themselves in the

body by movement, contraction, and relaxation, etc., and life

itself is movement, “particularly movement of the heart.” Life

and death are, therefore, mechanical phenomena, health is

determined by regularly recurring movements, and disease by

irregularity of them. The body is simply a large hydraulic

machine, controlled by “the aether” or “sensitive soul,” and the

chief centre of this soul lies in the medulla.

 

In the practical application of medicines to diseases Hoffman

used simple remedies, frequently with happy results, for whatever

the medical man’s theory may be he seldom has the temerity to

follow it out logically, and use the remedies indicated by his

theory to the exclusion of long-established, although perhaps

purely empirical, remedies. Consequently, many vague theorists

have been excellent practitioners, and Hoffman was one of these.

Some of the remedies he introduced are still in use, notably the

spirits of ether, or “Hoffman’s anodyne.”

 

ANIMISTS, VITALISTS, AND ORGANICISTS

 

Besides Hoffman’s system of medicine, there were numerous others

during the eighteenth century, most of which are of no importance

whatever; but three, at least, that came into existence and

disappeared during the century are worthy of fuller notice. One

of these, the Animists, had for its chief exponent Georg Ernst

Stahl of “phlogiston” fame; another, the Vitalists, was

championed by Paul Joseph Barthez (1734-1806); and the third was

the Organicists. This last, while agreeing with the other two

that vital activity cannot be explained by the laws of physics

and chemistry, differed in not believing that life “was due to

some spiritual entity,” but rather to the structure of the body

itself.

 

The Animists taught that the soul performed functions of ordinary

life in man, while the life of lower animals was controlled by

ordinary mechanical principles. Stahl supported this theory

ardently, sometimes violently, at times declaring that there were

“no longer any doctors, only mechanics and chemists.” He denied

that chemistry had anything to do with medicine, and, in the

main, discarded anatomy as useless to the medical man. The soul,

he thought, was the source of all vital movement; and the

immediate cause of death was not disease but the direct action of

the soul. When through some lesion, or because the machinery of

the body has become unworkable, as in old age, the soul leaves

the body and death is produced. The soul ordinarily selects the

channels of the circulation, and the contractile parts, as the

route for influencing the body. Hence in fever the pulse is

quickened, due to the increased activity of the soul, and

convulsions and spasmodic movements in disease are due, to the,

same cause. Stagnation of the, blood was supposed to be a

fertile cause of diseases, and such diseases were supposed to

arise mostly from “plethora”—an all-important element in Stahl’s

therapeutics. By many this theory is regarded as an attempt on

the part of the pious Stahl to reconcile medicine and theology in

a way satisfactory to both physicians and theologians, but, like

many conciliatory attempts, it was violently opposed by both

doctors and ministers.

 

A belief in such a theory would lead naturally to simplicity in

therapeutics, and in this respect at least Stahl was consistent.

Since the soul knew more about the body than any physician could

know, Stahl conceived that it would be a hinderance rather than a

help for the physician to interfere with complicated doses of

medicine. As he advanced in age this view of the administration

of drugs grew upon him, until after rejecting quinine, and

finally opium, he at last used only salt and water in treating

his patients. From this last we may judge that his “system,” if

not doing much good, was at least doing little harm.

 

The theory of the Vitalists was closely allied to that of the

Animists, and its most important representative, Paul Joseph

Barthez, was a cultured and eager scientist. After an eventful

and varied career as physician, soldier, editor, lawyer, and

philosopher in turn, he finally returned to the field of

medicine, was made consulting physician by Napoleon in 1802, and

died in Paris four years later.

 

The theory that he championed was based on the assumption that

there was a “vital principle,” the nature of which was unknown,

but which differed from the thinking mind, and was the cause of

the phenomena of life. This “vital principle” differed from the

soul, and was not exhibited in human beings alone, but even in

animals and plants. This force, or whatever it might be called,

was supposed to be present everywhere in the body, and all

diseases were the results of it.

 

The theory of the Organicists, like that of the Animists and

Vitalists, agreed with the other two that vital activity could

not be explained by the laws of physics and chemistry, but,

unlike them, it held that it was a part of the structure of the

body itself. Naturally the practical physicians were more

attracted by this tangible doctrine than by vague theories “which

converted diseases into unknown derangements of some equally

unknown ‘principle.’ “

 

It is perhaps straining a point to include this brief description

of these three schools of medicine in the history of the progress

of the science. But, on the whole, they were negatively at least

prominent factors in directing true progress along its proper

channel, showing what courses were not to be pursued. Some one

has said that science usually stumbles into the right course only

after stumbling into all the wrong ones; and if this be only

partially true, the wrong ones still play a prominent if not a

very creditable part. Thus the medical systems of William Cullen

(1710-1790), and John Brown (1735-1788), while doing little

towards the actual advancement of scientific medicine, played so

conspicuous a part in so wide a field that the “Brunonian system”

at least must be given some little attention.

 

According to Brown’s theory, life, diseases, and methods of cure

are explained by the property of “excitability.” All exciting

powers were supposed to be stimulating, the apparent debilitating

effects of some being due to a deficiency in the amount of

stimulus. Thus “the whole phenomena of life, health, as well as

disease, were supposed to consist of stimulus and nothing else.”

This theory created a great stir in the medical world, and

partisans and opponents sprang up everywhere. In Italy it was

enthusiastically supported; in England it was strongly opposed;

while in Scotland riots took place between the opposing factions.

Just why this system should have created any stir, either for or

against it, is not now apparent.

 

Like so many of the other “theorists” of his century, Brown’s

practical conclusions deduced from his theory (or perhaps in

spite of it) were generally beneficial to medicine, and some of

them extremely valuable in the treatment of diseases. He first

advocated the modern stimulant, or “feeding treatment” of fevers,

and first recognized the usefulness of animal soups and beef-tea

in certain diseases.

THE SYSTEM OF HAHNEMANN

Just at the close of the century there came into prominence the

school of homoeopathy, which was destined to influence the

practice of medicine very materially and to outlive all the other

eighteenth-century schools. It was founded by Christian Samuel

Friedrich Hahnemann (1755-1843), a most remarkable man, who,

after propounding a theory in his younger days which was at least

as reasonable as most of the existing theories, had the

misfortune to outlive his usefulness and lay his doctrine open to

ridicule by the unreasonable teachings of his dotage,

 

Hahnemann rejected all the teachings of morbid anatomy and

pathology as useless in practice, and propounded his famous

“similia similibus curantur”—that all diseases were to be cured

by medicine which in health produced symptoms dynamically similar

to the disease under treatment. If a certain medicine produced a

headache when given to a healthy person, then this medicine was

indicated in case of headaches, etc. At the present time such a

theory seems crude enough, but in the latter part of the