A History of Science, vol 4 by Henry Smith Williams (best novels to read for beginners txt) 📖
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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 BOERHAAVEAt 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 HAHNEMANNJust 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
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