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.