About this time, too, Casserius and others studied the auditory apparatus and described the ossicles, the small muscles of the internal ear, and the semicircular canals; they even followed the acoustic nerve. By the researches of a number of French and Italian anatomists it was likewise established that the true seat of hearing lies within the internal ear, the external parts being merely of assistance in conducting sound.
Thomas Willis was one of the first to consider the brain as an assemblage of organs and to assign special functions to certain of its divisions; he thus became a pioneer in cerebral localization, although most of his conjectures were inaccurate or fanciful. The workings of the brain were also studied by Pinel and others, who observed that in certain conditions of mania or partial insanity some of the mental faculties—such as memory, judgment, imagination, or will—were abolished or suspended, while other faculties were preserved; hence it was inferred that each faculty must have its own seat. The views thus enunciated were carried to an absurd degree by Gall, and later by Spurzheim, who made an entirely new classification, believing the cranium to be molded in a reasonably exact manner upon the brain, and that, by inspection of the exterior, the character of a given individual could be read. They thus founded the pseudoscience denominated phrenology, which we now know has practically nothing to justify itself.
About the middle of the seventeenth century Glisson (a professor in the University of Oxford) recognized a property pertaining to all living tissue, which he termed irritability, and which he regarded as sufficient cause for all the phenomena of life; he enunciated certain views that, in times past, have had an important bearing upon the pathology of disease, but which were forgotten for sixty years or more until revamped by the Dutch anatomist, Goerter. It was the latter, with the great Haller, who, by a series of very ingenious experiments, elevated the suppositions of Glisson to the dignity of demonstrated facts. In 1747 the results of Haller's researches were published under the modest title of First Lines in Physiology; the author was, in fact, the great exponent of the doctrine of irritability in neurophysiology, and for this deserves to be remembered wherever the history of our art is spoken of. This theory of irritability was applied to pathology by Fabre, of Paris, who refuted the mechanical theory of Boerhaave on inflammation, proving that the latter proceeds not from obstruction of the capillaries, but from exaltation of their irritability. It was also applied in many ways by Bichat, who enjoyed a brief, though memorable, career. The theory of irritability, along with the truths established by John Hunter in his researches on the blood, made a very distinct advance in the physiological knowledge of the seventeenth century, and the researches of those who contributed so much to its advance are well worthy of study even at the present day. In this line of investigation should, perhaps, also be mentioned the names of Winslow, Albinus, the two Monroes, besides vicq d'Azyr, and others already named.
I have so far discussed the development of theories and researches of individuals. During the earlier portion of the seventeenth century there happened something which gave to materia medica a remedy so valuable, and which attracted such wide-spread attention, that it deserves special mention, I refer to the discovery of that great febrifuge, Peruvian bark. Malarial fevers had been known as early as the time of Hippocrates, and were universally treated largely with purgatives, sometimes with venesections. There had been no notable improvement in the management of pyrexias of this class down to 1638, when the Countess of Cinchon, wife of the Viceroy of Peru, became a prey to a fever which nothing could remove. It is said a Spaniard learned from the natives the secret of the bark, and advised its employment, whereby the countess recovered her health. This is the generally received account, although it has been widely discredited, and Humboldt expresses decided doubts as to the source whence the first knowledge of the bark was derived. Be this as it may, however, it is certain that, in 1639, the countess and her physician, de Vega, imported into Spain a quantity of ground Peruvian bark, and distributed it to various persons, though it was not made an article of general commerce until ten years later, when it was exploited by the Jesuits, who had received a large supply; in Spain it was known as the "countess's powder," and in Italy as "Jesuit" or "cardinal" powder. Being very high-priced, it was soon so sophisticated as to be quite unreliable. Condamine, the botanist, having been sent to America for other purposes, determined the botanical position of the tree and described several species of cinchona, one of which is known by his name. To him is due the generic title bestowed in acknowledgment of the services rendered by the countess, who introduced the bark into Europe. Many vain attempts were made to determine the chemical composition of the powder, and it remained for two French chemists to isolate and separate its most important alkaloid. The first who wrote upon the therapy of cinchona was Barba, a Spanish physician, whose work was printed in Seville in 1642. After its introduction into England Peruvian bark fell into disrepute, owing to improper administration, whereby death was caused in certain instances; and it was this latter fact that instigated Sydenham to investigate it still more accurately. There has never been introduced into medicine any one drug which has proved itself so generally valuable and so widely effective as cinchona and its products.
As little progress had been made in obstetrics as in other branches of applied medicine or surgery. The custom of employing midwives was general, and these, for the most part, were ignorant and filthy old women, slaves of routine procedures that had obtained from time immemorial. Educated accoucheurs were called only in extraordinary cases; but with progress the prejudice which excluded educated physicians from the practice of midwifery gradually gave way, and there was opened for obstetrics a new era. In the beginning of the seventeenth century the initiative was taken by Louise Bourgeois, the sage femme of Marie de Medicis, who in 1626 published a collection of observations concerning sterility, abortion, fecundity, accouchement, and diseases of women and children generally; it embodied several distinctly new ideas. A little later (in 1668), Mauriceau, of Paris, chief accoucheur to the Hôtel-Dieu, published his treatise on diseases of pregnancy and childbirth, which was translated into all the languages of Europe and became a powerful agent for good, not alone that it represented an advance in knowledge, but it stimulated such rivals and successors as Devanter, Peu, Paul Portal, and Delamotte to further research. About this time the Chamberlains, an English family devoted to the practice of midwifery, invented an instrument to facilitate the extraction of the foetal head when arrested, and one of them went to Paris, and, failing of success there, went on to Holland, where he sold his secret to two Dutch practitioners, who kept it only too faithfully. In 1721, Palfvn, a surgeon of Ghent, while seeking to fathom the device of the Chamberlains, conceived a tire tête (literally a head-drawer) composed of two steel spoons, and hastened to publish an account thereof,—a praiseworthy act, whereby he merits distinction as the inventor of the forceps. As modified by Smellie in England and Levret in France, the obstetrical forceps ranks among the most useful discoveries of modern surgery, and, although not in common use until about a century ago, it may be said that the invention has been the means of saving the lives of countless women and children.
Medical jurisprudence also seems to have had its beginning during this century. It had long been the practice to summon physicians to court in order to enlighten the judiciary in questions demanding particular knowledge in physics and medicine; indeed, the practice began under the first Christian emperors, and owes its origin to ecclesiastical authority. Charlemagne confirmed in this regard what Justinian was perhaps the first to ordain. The tribunal of Châtelet, according to Renouard, appears to have been the first which comprehended the great utility of consultation with expert physicians; an edict of Philip le Bel, in 1311, qualified Master John Potard with the title "Sworn Surgeon of Châtelet", and the constitution promulgated by Charles V, in 1552, gave great importance to medical jurisprudence, as it treated in detail of infanticide, wounds, poisons, abortion, and other such crimes. Early in the seventeenth century Fidelis collated all that had been written on this subject, and thus published the first special treatise on legal medicine.
Some writers claim to have discovered traces of clinical teaching in the history of Arabian universities, but, as Renouard says, the presence of a few pupils during visitations and consultations no more constituted real clinical teaching than the practice adopted by some practitioners of ancient Rome of being ever surrounded by a group of spectators whom they dignified with the title of disciples. The first attempt at real clinical teaching appears to have been in the hospital of St. Francis, in Padua, in 1558, by Botoni and Oddi. About the beginning of the seventeenth century Otto de Heurne, of the University of Leyden, introduced bedside instruction, which was continued by le Boe, sometimes called Sylvius, with the result of drawing-large crowds of students to Leyden from 1658 to 1672. Notwithstanding the success attained, the practice was neglected by the successors of Sylvius until renewed by Boerhaave, who, invested with several functions at the University of Leyden, also occupied the chair of medicine. So great was the renown of Boerhaave that, despite the poverty of the resources of the Leyden hospital, people came to consult him from the most distant countries, and he was a correspondent of several crowned heads, even of the Pope, although himself a Protestant. During his life and long afterward he exerted an immense influence in medicine, and while, perhaps, inferior in genius to some of his contemporaries, he had a wider reputation, and his doctrines prevailed longer. The great success of his clinics decided in favor of this method of teaching, and in 1715 the Pope established in Rome a similar institution, under the direction of the celebrated Lancisi. Soon Edinburgh, Vienna, Pavia, and other universities followed suit, the first clinical chair in Paris being held by Corvisart, and the first in Vienna by Van Swieten. After the demise of Boerhaave, the school of Leyden rapidly declined, while those of Edinburgh and Vienna became rivals for the first place. It is thus seen that after an interruption of more than two thousand years clinical teaching was revived and became more brilliant than ever before.
I now propose to recount the methods and deeds of some of those concerned in the development of systems, so called, and make mention of the most prominent medical men in national and historical order. This will not prevent going back to philosophical conclusions or reflections upon the philosophy of the history of medicine, when it may seem wise so to digress.
First, of the system of J. B. Van Helmont, which in its day was most highly regarded, and which seems to have been, in some measure, a rearrangement of the views of Paracelsus into a mystic and pietistic system based upon mechanical principles. Van Helmont was born in Brussels in 1578, and was so precocious that he entered the University of Louvain at an age which would have enabled him, had he so desired, to obtain the degree of Magister when only seventeen years old, he deemed the degree frivolous. He had studied mathematics, astronomy, philosophy, and astrology. Going now to the Jesuits, who at that time, even, taught music, he soon became dissatisfied, and turned to the study of stoical philosophy. Believing that the Capuchins (who were mere lascivious gluttons, and considered even washing unchristian) were the true stoics, he sought to join this order, but ere long abandoned them and resumed his studies in law, botany, and medicine. For the latter Van Helmont had at first little respect, since his studies in this line did not enable him to rid himself of the itch. He soon again lapsed to the monastics, and came to the conclusion that wisdom, like the grace of God, was obtainable only by fasting, supplication, and poverty; accordingly he practiced medicine among the poor as a labor of love (having received his degree of Doctor in 1599). During his travels he became familiar with the writings of Paracelsus, which he studied zealously. Finally he settled down in Vilvorde, where he practiced medicine and chemistry until his death (in 164-4).
Like most "systems," that of Van Helmont is valued only as an expression of the spirit of the age, since it embodied largely the pantheism of Paracelsus, merely cloaked with a more religious or monkish dress. He held that the general cause of disease was the fall of man; though there also figured a subsidiary cause, which he denominated Archeus,—a faculty of appetite seated in the spleen or in the stomach; thus dropsy was a hindrance of renal excretion by the enraged Archeus. Demons, witches, and ghosts were included in Van Helmont's system as causes of disease. Indeed, the man seems to have been a second Paracelsus, lacking only in the dishonesty and bombast of the latter. He had no followers of any prominence, and the "system" soon lapsed into obscurity.