Sylvius was one of the earliest defenders of Harvey’s great discovery, and he was also one of the first to call attention to the part played by chemistry in elucidating some of the problems in physiology and pathology. At the same time he was always ready to acknowledge the importance of the part played by mechanics in respiration, in the circulation of the blood, in the movements of the intestines, etc., in which respects he was in entire agreement with the iatrophysicists or iatromathematicians.[80]
Finally, there is one more respect in which Sylvius is entitled to great credit: he paid most careful attention to the work of giving clinical instruction. Recognizing, as I do, the importance of this branch of medicine, I shall not hesitate to devote here a page or two to a brief review of the manner in which it came to hold the honorable position which it occupies to-day in all the best schemes for medical education.
During the sixteenth century, as Puschmann assures us, an attempt was made at Padua, Italy, to render clinical instruction an essential part of the physician’s education, but the difficulties which were encountered proved so much greater than was anticipated that it was soon found necessary to abandon the plan; and then for many years no further effort was made, either at Padua or at any of the other Italian medical schools, to introduce clinical teaching. After the lapse of nearly a century, Johannes Heurnius (1543–1601), Professor of Medicine at the University of Leyden, made an effort to introduce the plan of teaching medicine at the bedside; and a few years later (1630) two other professors of the same university—viz., Otho Heurnius, son of Johannes, and E. Schrevelius—formally introduced clinical instruction at the city hospital. The plan which they adopted was the following: The students in turn were permitted first to question the patient about his ailment and then afterward to make whatever physical examination appeared to be necessary; next, each one of them stated briefly what he believed to be the nature of the malady, and also gave his views as to the prognosis, symptoms and treatment; after which the professor commented on these different reports, pointing out both the correct and the incorrect features in each case. After a short trial of the plan it became clear that it would have to be abandoned, for the students did not like to have attention called in such a public manner to their mistakes. Then, a few years later, Sylvius, who at that time was the Professor of Medicine, introduced a system of clinical teaching which is thus briefly described by his colleague, Lucas Schacht:—
When, followed by his pupils, he approached the bedside of a patient, he assumed the air of one who is entirely ignorant of the nature of that person’s malady, of the accompanying symptoms, and of the treatment which was being carried out. Then he began to ask first one and then another of the students a great variety of questions respecting the case that was under consideration,—questions which at first seemed to have been propounded in a haphazard fashion, but which in reality were so cleverly formulated as to elicit from the class all the information needed for the making of a correct diagnosis, while leaving on the minds of the students the impression that they, and not the professor, had worked out the problem to a successful result.
This system, if such it may be termed, proved extremely successful, and the knowledge of this success spread rapidly from one end of Europe to the other, causing students and physicians to flock to Leyden from Russia, Poland, Hungary, Germany, Denmark, Sweden, France, Italy and England. So long as this particular university continued to possess, as a member of its faculty, a professor of medicine who was clever enough to carry on clinical instruction with the same profound knowledge of human nature as had been displayed by Sylvius, just so long did this institution remain without a rival in this part of the field of medical education. Then Sylvius was followed, in the work of clinical teaching, by Boerhaave, a man admirably fitted, both by nature and by the training which he had received, to keep the University of Leyden in the first rank of medical schools as regards this most useful form of discipline. After 1738, the year in which Boerhaave died, other universities besides that of Leyden began to provide fairly satisfactory facilities for clinical study, and among the number of such institutions those of Utrecht, Rome, Edinburgh, Paris and Halle deserve to be mentioned. The lack of funds and doubtless also the lack of the right sort of teachers were the principal reasons why these schools were not able to vie with Leyden in furnishing the facilities needed for clinical instruction. That the fault—at least in the case of the University of Halle—was not to be attributed to a failure on the part of the Medical Faculty to appreciate the value of such instruction is clearly shown by the saying attributed to Friedrich Hoffmann, who at that period was the Professor of Medicine:—
By a mere attendance upon medical lectures no man will ever succeed in becoming a properly equipped practitioner of that art; it is indispensable, in addition, that he should receive clinical instruction.
The fairly permanent establishment of this fundamental branch of medical teaching was not effected until about the middle of the eighteenth century, when Van Swieten, one of Boerhaave’s most distinguished pupils, was given full authority by the Empress Maria Theresa to furnish, at the University of Vienna, all the facilities required for successfully carrying on such instruction. From that time onward, to a quite recent date, Vienna has been the Mecca of all the younger physicians who aspired to become fully equipped in the practical branches of the science of medicine.
Georg Ernst Stahl.—Georg Ernst Stahl was born at Anspach, Germany, in 1660. Little is known about his early life beyond the fact that he pursued his studies at the University of Jena, received the degree of Doctor of Medicine from that institution in 1684, and shortly afterward began giving private courses in medicine which proved to be very popular and soon brought him into public notice. In 1687 he was given the position of Court Physician at Weimar. In 1694, upon the recommendation of Friedrich Hoffmann, who was at that time the incumbent of the regular Chair, he was appointed Associate Professor of Medicine in the recently founded University of Halle, Prussian Saxony; the understanding being that he was to devote his attention more particularly to the physiological, pathological, chemical and botanical aspects of the subject. He held this position up to the year 1716, when he was appointed one of the attending physicians of Frederick William the First, King of Prussia, and thereafter was obliged to reside in Berlin, in which city he died in 1734.
Stahl was a tireless worker, and wrote a large number of treatises (two hundred and forty-four in all) on physiological and pathological topics—all of them in Latin. Albert Lemoine, who has written an elaborate monograph on one of these treatises (that relating to animism), says that, despite the obscure style in which this and most of his other treatises are written, one may, upon careful study, satisfy himself that Stahl is a very close reasoner and possesses a clear mind. His most conspicuous faults, Lemoine adds, are these: he is opinionated and vain, and objects strongly to any criticisms that his opponents make; and yet he is careful to take up these criticisms one by one and subject them to a close analysis. His vanity led him to maintain that he was the only person then living who was capable of lifting medicine out of the rut in which it was at that time rigidly held. He manifested a sovereign contempt, not only for the men whose opinions differed from his, but also for those who complained of the difficulty of comprehending the Latin in which his treatises are written. Finally, Lemoine states that Stahl is addicted to mysticism, as is shown by the invocations of all sorts with which he begins and ends most of his writings. Haeser adds that Stahl possessed a gloomy, reticent and overbearing spirit, in striking contrast with the charming sweetness of temper of his colleague Hoffmann.
Among Stahl’s numerous contributions to medical literature there is only one in which our readers are likely to take any particular interest; I refer to the treatise which bears the title “Theoria medica vera”—the true theory upon which the science of medicine is based. It is in this work more particularly that Stahl expounds the doctrine of animism. As I have tried in vain to obtain a really satisfactory conception of this doctrine, which occupied so great a place in the thoughts of the physicians of the period between 1650 and 1750, I have decided to rest satisfied with merely reproducing here the interpretation which William Cullen of Edinburgh, one of Stahl’s contemporaries and also one of the greatest English physicians of that period, gives in his celebrated “First Lines of the Practice of Physic”:—