Stahl's doctrine has been called animism, and was a reaction against the chemical and mechanical theories of the seventeenth century. He gained a considerable number of followers, the most notable of them among the French being Sauvages (1706-1767), the forerunner of Pinel and an opponent of pure mechanics, who animated the mechanical system of the body with Stahl's "soul." This was, par excellence, the age of artificial systems, and so Sauvages in his classification supplied a system which had ten classes of diseases, each of which had several orders, and some as many as two hundred and ninety-five genera, and two thousand four hundred species of disease!! Even Linnæus had three hundred and twenty-five genera of disease, while Cullen had only four classes with one hundred and forty-nine genera.
The mechanico-dynamic system was a sort of compromise or mixed system, which was held in high honor by the most eminent physicians and better minds of the last century, and has even been prized by Sprengel as the best of all. It was originated by Friedrich Hoffmann (1660-1742). Hoffmann's father was a physician, and he was himself born in Halle, whose university he attended. He acquired lasting reputation as an oculist, and was made Professor of Anatomy, Surgery, Medicine, Physics, and Chemistry at his alma mater. Our commonplace "Hoffmann's anodyne" is named after him. He was one of the most erudite professors of his day, more easily understood than Stahl, widely known for his fluent diction and amiable temper, and, accordingly, won great renown for his university. His good fortune as a practitioner was so great that even Boerhaave declared him his own equal. As a writer he was voluminous, one edition of his works comprising twenty-seven large volumes.
According to Hoffmann's views, life was simply mechanical movement, especially of the heart; death, the cessation of heart-action, putrefaction thereupon resulting. Health meant regularity of movements; disease, a disturbance of the same. He used the word "tonus" extensively. Ether he regarded as an important factor, producing and maintaining movements of the body, itself extremely volatile, corresponding largely to the "pneuma" of the ancients; it was, in fact, a motor principle and, at the same time, the perceptive soul. Ether was stored in the medulla, and circulated in a double way in the body; spasm was the consequence of too strong, atony of too feeble, influx of ether. Fever was a general spasm of the arteries and veins, having its cause in the spinal cord. Hoffmann's therapeutics were simple, and poor in drugs. These latter were intended to weaken, alter, or evacuate, and he was especially partial to the use of vinous remedies. The strong and toxic drugs he used but little.
William Cullen (1712-1790), a Scotchman, rose from the deepest poverty to the greatest celebrity. First a barber, he afterward became an apothecary, then a ship-surgeon, then a village practitioner, finally entering into partnership with William Hunter as a general practitioner. Both of these eminent men being in equally poor circumstances, they agreed to live in the same place and that, while one was studying, the other should take care of the practice. In this way Cullen was enabled to graduate in 1740. Six years later he taught chemistry in Glasgow, and in ten years more came to Edinburgh as Professor of Medicine. He continued very active and famous up to the time of his death, but died as he had been born,—in poverty. Among his numerous other charitable deeds, he supported the widow of Robert Burns and published the latter's poems.
Cullen was the father of modern Solidism,—a system based upon the solid parts of the body, the nerves being the chief agents. The life-giving element was, in his view, an undefined, dynamic something (different from Hoffmann's ether or Stahl's soul), which he called nerve-force, or nerve-principle; animal force; and brain-energy, and in it he included the spinal cord. His nerve-principle was supposed to produce spasms and atony, either actively or passively. The causes of disease, while of a debilitating character, were supposed to awaken reaction of the healing powers of Nature; fever was a reparative effort of Nature, even in its cold stage, the blood playing no part in it. He constructed a very arbitrary classification of fevers, as, in fact, he did of all diseases, his system of nosology being the secret of his reputation. His explanation of gout was famous. That disorder, he said, depended upon an atony in the digestive organs against which was periodically set up a reparative effort in form of a joint inflammation. In scrofula he had to assume, in contradiction to his nervous pathology, a peculiar acridity, and in putrid fever a putridity of the humors of the body. His therapeutics were simple and salutary, because of his renunciation of venesection, which was much abused in his day.
The most celebrated pupils and successors of Hoffmann were Gregory, of Edinburgh, Gardiner, and, in Germany, the famous Thaer (1752-1828), who finally abandoned the practice of medicine because it promised more than it could perform, and who became a "father of husbandry."
A composite of the doctrine of Hippocrates, Sydenham, and Boerhaave was represented in the so-called Old Vienna School, whose connection with the lives of Maria Theresa and Joseph II deserves, at least, mention. Its founder was Baron Van Swieten (1700-1772), of Leyden, a descendant of a noble Jansenist family of the Netherlands, who graduated under Boerhaave after having studied at Louvain. After the death of his patron he was called to the assistance of the Archduchess Maria Anna, of Austria, who was suffering from an abortion, and gave such satisfaction that she recommended him to her sister, Maria Theresa, who up to this time had remained sterile. To her and to her husband he gave advice which resulted in sixteen successive pregnancies, and then, as the result of his success, came to Vienna in 1745 as President of the General Medical Department of Austria. He was also made censor, in which position he incurred the enmity especially of the Jesuits and of Voltaire, whom he robbed of their influence. He was made baron, and became, next to Kaunitz, the most influential counselor of the empress. His chief care was dedicated to the elevation of medical affairs in Austria, and especially to the improvement of the medical faculty. He had just seen success crown his efforts when he died of senile gangrene, with the reputation of being a great physician and benefactor of the poor. One of the greatest of his services was improving the treatment of syphilis, in which he, after the example of Paracelsus, recommended the internal use of corrosive sublimate.
More eminent as a physician than for personal character was de Haën (1704-1776), of The Hague,—a pupil of Boerhaave. At the suggestion of Van Swieten, he was called, in 1754, to Vienna as president of the clinic of the city hospital, which at that time afforded accommodation for only twelve patients. He was the real founder of the so-called Old Vienna School, whose merit, in contrast to the so-called new school, is to be sought in practical and diagnostic services. As de Haën quarreled with every one, he also did with Stoerck (1749-1803), the successor of Van Swieten in the direction of the Austrian Medical Department, and with Stoll (1742-1787),—a clinical teacher who was especially famous as an epidemiologist.
Stoll lectured with great popularity until 1784, upon the completion of the Allgemeines Krankenhaus, when he fell into the background and was badly treated. He was the subject of numerous intrigues by his enemies, and had a wife who embittered his life, and who even had him buried in the dress of a Jesuit in order to injure his reputation after his death. To his credit be it said that, changing his views of the constituents of disease later in life and his original therapeutics becoming no longer of use to him, he abandoned them entirely. Nevertheless his therapeutic system flourished for a long time after him.
There were in vogue during this period numerous other doctrines, some of which were too puerile or insubstantial to gain any foothold at all; others exerted a certain amount of influence during the life-time of their originators or for a generation afterward. With many of these I do not care in any way to deal. A few others, I think, ought to be at least mentioned in such a history as I am endeavoring to present.