The cover image was created by the transcriber and is placed in the public domain.

THE DAWN OF MODERN MEDICINE

FROM THE EARLY PART OF THE EIGHTEENTH

CENTURY TO ABOUT 1860

CONTINUATION OF THE ACCOUNT GIVEN IN THE WORK

ENTITLED “THE GROWTH OF MEDICINE”

PUBLISHED ON THE FOUNDATION

ESTABLISHED IN MEMORY OF

WILLIAM CHAUNCEY WILLIAMS

OF THE CLASS OF 1822, YALE MEDICAL SCHOOL

AND OF

WILLIAM COOK WILLIAMS

OF THE CLASS OF 1850, YALE MEDICAL SCHOOL

PORTRAIT OF ANTOINE LAURENT LAVOISIER
The French chemist and biologist who contributed more than anyone
else to our knowledge of the chemistry and physiology of oxygen.
(Copied from the frontispiece of Volume I of Lavoisier’s “Works,”
published by the French Government in 1864.)

THE DAWN OF MODERN
MEDICINE

AN ACCOUNT OF THE REVIVAL OF THE SCIENCE

AND ART OF MEDICINE WHICH TOOK PLACE

IN WESTERN EUROPE DURING THE LATTER

HALF OF THE EIGHTEENTH

CENTURY AND THE FIRST PART

OF THE NINETEENTH

BY

ALBERT H. BUCK, B.A., M.D.

FORMERLY CLINICAL PROFESSOR OF DISEASES OF THE EAR, COLUMBIA

UNIVERSITY, NEW YORK: CONSULTING AURAL SURGEON,

NEW YORK EYE AND EAR INFIRMARY, ETC.

NEW HAVEN: YALE UNIVERSITY PRESS

LONDON: HUMPHREY MILFORD

OXFORD UNIVERSITY PRESS

MDCCCCXX

Copyright, 1920, by

Yale University Press

THE WILLIAMS MEMORIAL PUBLICATION FUND

The present volume is the third work published by the Yale University Press on the Williams Memorial Publication Fund. This Foundation was established June 15, 1916, by a gift made to Yale University by Dr. George C. F. Williams, of Hartford, a member of the Class of 1878, Yale School of Medicine, where three generations of his family studied—his father, Dr. William Cook Williams, in the Class of 1850, and his grandfather, Dr. William Chauncey Williams, in the Class of 1822.

PREFACE

This work is in the main a continuation of the volume entitled “The Growth of Medicine,” but it is also intended to serve as an amplification of the latter part of that work, which, owing to various circumstances that were in large measure beyond my control, lacked completeness. The most troublesome of these adverse circumstances was the fact that I had failed, during a recent visit to Europe, to find those sources of trustworthy information upon which alone such a narrative could properly be based; and later still, when I made my first attempts to construct the text of the present volume, I again encountered the same kind of obstacles, but in an even greater degree, and was then strongly disposed to abandon the undertaking altogether. At this juncture of affairs, however, I was much surprised and pleased to receive from Mrs. Charles F. Norton, the librarian of Transylvania College at Lexington, Ky., a letter in which she stated that the college had in its possession a large collection of medical works which had been purchased at Paris, France, in 1819, at which period of its history the institution bore the title of Transylvania University and possessed a flourishing medical department; and that the president of the institution would be happy to extend to me every possible facility for utilizing this great mass of historical material. Shortly afterwards, in reply to my request that I might be furnished with a partial list of the books contained in this collection, in order that I might determine how many of them related to the period in the history of French medicine in which I was at that time particularly interested,—the period, mainly, from about 1760 to 1830,—I received a card catalogue of the titles of over 100 French, English and Latin treatises. This information removed all doubts from my mind concerning the wisdom of my visiting Lexington, and I accordingly signified my prompt acceptance of the cordial invitations extended to me by President Crossfield.

As I write these lines I am prompted to add the further statement that during my stay at Lexington, which covered a period of seven months, I received every assistance from the Transylvania College authorities that I could possibly desire; and in particular I wish to express my deep sense of gratitude to the librarian, Mrs. Norton, for the interest which she manifested in my work and for the valuable assistance which she rendered in hastening its completion.

Cuvier, the celebrated naturalist, in a memoir which he read before the Royal Institute of France, makes the following statement: “It is not through a perusal of the insufficient extracts that are commonly made from the published works of distinguished men, nor through the incomplete indications which the recital of their discoveries may furnish, that we derive the greatest pleasure from the eulogies pronounced after the death of these men. This desirable result is more likely to be obtained when we are made intimately acquainted with their individual traits of character,—when we are, so to speak, permitted to know these men in a social way; when we are given the opportunity of contemplating, close at hand, their distinct qualities, their virtues, yes, even their faults,—provided the facts are plainly stated by one who is skilled in such portraiture. Furthermore, the reader is sure to derive the greatest pleasure, and also to be the most benefited, when every page of the eulogy furnishes evidence of the genuine happiness and wonderful serenity which characterize the lives of those who devote themselves to the culture of the sciences. Compare these men with those who have been intent on securing glory through devastating the world, and note how frequently they live to be septuagenarians or even octogenarians.” Deeply impressed by the wisdom of the advice thus briefly given by the celebrated French naturalist, I have striven, in the following chapters, to act upon it as circumstances might permit.

After making several unsuccessful attempts to classify my chapters according to the special fields in which the different men attained distinction, I came to the conclusion that the difficulties which stand in the way of adopting such a classification are well-nigh insurmountable; and chief among these difficulties may be mentioned the fact that many of the leading physicians attained distinction in two or more different fields. Botany, for example, was frequently combined with anatomy and surgery; chemistry with physiology; and so on. On the whole, therefore, it seemed better to rest satisfied, wherever this was found to be practicable, with the simple subdivision according to geographical districts—viz., Northern and Central Germany, Austria, Italy, France, Switzerland and England.

The relatively few Americans who played an important part in advancing the science and art of medicine during the latter half of the eighteenth century and the early part of the nineteenth make it preferable, as it seems to me, to omit all reference to them in the present work, leaving to the writer of a volume devoted to modern medicine, the duty of honoring their achievements.

Albert H. Buck.

Cornwall, Orange County, N. Y.

October 3, 1919.

CONTENTS

BOOK I

THÉOPHRASTE RENAUDOT, PHYSICIAN, FOUNDER OF THE FIRST FRENCH NEWSPAPER

BOOK II

STATE OF MEDICINE IN WESTERN EUROPE AT THE BEGINNING OF THE EIGHTEENTH CENTURY

BOOK III

THE VIENNA SCHOOL OF MEDICINE

BOOK IV

MEDICINE IN ITALY

BOOK V

SMALL-POX, ONE OF THE WORLD’S GREATEST SCOURGES

BOOK VI

AWAKENING OF THE CHEMISTS, PHYSIOLOGISTS AND PATHOLOGISTS

BOOK VII

MEDICINE IN ENGLAND

BOOK VIII

MEDICINE IN FRANCE

BOOK IX

MEDICINE AT THE HEIGHT OF THE FRENCH REVOLUTION

BOOK X

BROUSSAIS AND BROUSSAISM

BOOK XI

THE GOLDEN AGE OF SURGERY IN FRANCE

BOOK XII

DESGENETTES AND LARREY, FRANCE’S MOST CELEBRATED MILITARY SURGEONS

BOOK XIII

A FEW OF THE IMPORTANT HOSPITALS AND THE PRINCIPAL ORGANIZATIONS IN PARIS FOR TEACHING MEDICINE AND MIDWIFERY

LIST OF ILLUSTRATIONS

BOOK I

FOUNDATION OF THE FIRST NEWSPAPER IN PARIS, FRANCE, AND THE ESTABLISHMENT OF PRIVATE AGENCIES FOR AIDING THE POOR

CHAPTER I

THÉOPHRASTE RENAUDOT, PHYSICIAN, PHILANTHROPIST, AND FOUNDER OF THE FIRST FRENCH NEWSPAPER (1586–1653)

Prefatory Remarks.—As the present volume purports to deal with events that occurred chiefly during the eighteenth century, the reader may think it strange that I should introduce here a sketch which relates to a physician whose life covers a period nearly one century earlier. My reason for departing, in this instance, from the proper chronological order, in the arrangement of my text, is of a twofold nature. In the first place, I did not discover Gilles de la Tourette’s interesting memoir—almost the only satisfactory source of information available concerning Renaudot—until about February 1, 1918—that is, nearly one year after “The Growth of Medicine” had been published; and, second, on looking over the principal treatises on the history of medicine, I failed to find any adequate account of the remarkable work accomplished by Renaudot. Puschmann, so far as I have been able to learn, is the only authority who gives this great philanthropist due credit for the important part which he played in reflecting honor upon our profession.

Théophraste Renaudot was born at Loudon, a small town in Western France, picturesquely situated on a high hill about thirty miles northwest of Poitiers. His parents, who were wealthy Protestants, died while he was still a mere lad. Théophraste, who inherited the entire fortune left by his parents, developed at a remarkably early age strong humanitarian ideas, and it was under the stimulus of these that he shaped his course in life. With a clear idea of the kind of training that would best fit him for the work which he proposed to undertake, he decided to study medicine, as this career, better than any other, would enable him to accomplish his purpose. Accordingly he went to Montpellier, took the regular course of instruction in the university, and received the degree of Doctor of Medicine in 1606, before he had reached his twentieth year. Recognizing the fact that a physician should be of a certain age before he can reasonably expect to command the confidence of his fellowmen, he decided to utilize the time following his graduation in visiting some of the more important capitals of Europe. The first country which he visited was Italy, where he undoubtedly gained some familiarity with the manner in which the monts-de-piété (the prototypes of our modern pawnbrokers’ shops) were managed under the guiding control of the popes. It is also highly probable that he visited in turn the universities of Holland and Belgium as well as the two great English universities—Oxford and Cambridge. Then, upon his return to France, he went to Paris and began the study of chemistry at the Collège de Saint-Côme. During his stay in the French metropolis, he was made painfully aware of the prevalence of poverty, the streets being filled everywhere with shameless beggars, and Hôtel-Dieu, the great city hospital, being overcrowded with the sick, among whom were large numbers of children affected with contagious diseases and infants starving to death from lack of wet-nurses. The first thought that occurred to the practical mind of Renaudot was to find work for many of these poor people; but when he set about doing this he at once encountered many obstacles; and finally, in despair over his lack of success, was forced to abandon further efforts in this direction and return to his home in Loudon. While there, he frequently met the influential Capucin Monk Leclerc du Tremblay, commonly known as his “Gray Eminence,” and through him he was brought to the notice of Cardinal Richelieu, then or soon afterward, Secretary of State of Marie de Médicis, the queen-mother of Louis XIII. Although the cardinal, for political reasons, antagonized the Huguenots, he personally entertained no unfriendly feelings toward men of the Protestant faith, and consequently he was quite prepared to aid Renaudot when he laid before him, as he did shortly after his return to Paris, his schemes for the betterment of the poor in that great city. One of these schemes called for the establishment of a “bureau d’adresse ou de rencontre,” an office depot where, by the payment of three sous, anybody was entitled to have the address of his place of business entered upon the registers of the bureau; and where also employer and employee might meet for arranging terms. If any person wished to learn the address of any given place of business, the desired information would be furnished upon the payment of a fee of the same value; but no charge whatever was to be made in the case of a poor person. This scheme proved a complete success in a very short time. Then, as a further step in the development of his bureau, Renaudot joined what he termed “ventes à grâce troque ou rachapt”—that is, “sales with the privilege of exchange or redemption.” This was the first step toward the establishment of his “mont-de-piété,” an institution which was not fully organized by him at Paris until 1637. The tax upon loans was fixed at 3 per cent—just enough to pay the expenses of running the bureau. His motto was: “Loan money without expectation of profit.” His solution of the social problem was summed up in the following aphorism: “In every organized community or state the rich shall afford aid to the poor, all harmony between the two classes ceasing when one of them grows richer at the expense of the other.”

Loudun. This photograph, which was taken from one of the highest points in the village of Loudun, shows its elevated position above the surrounding country and affords a bird’s-eye view of the adjacent river, the Martray. (Courtesy of Monsieur le Pasteur Paul Barnaud, of Sainte Foy la Grande [Gironde], France.)

At the time when Renaudot came to Paris, there existed no such thing as the “Journal”—that is, a printed periodical such as he contemplated and afterward founded. At an interview with Cardinal Richelieu, the Secretary of State of Louis XIII., Renaudot proposed that all the news received from the outside world, the king’s edicts, and treaties made with other nations should be brought together and published at stated intervals in a single printed sheet. The cardinal at once saw how important the proposed journal would be for his own interest, especially if its management were intrusted to a man who agreed with him in regard to political questions. Then, in addition, the mere fact that it was an official sheet, the only strictly French periodical, would be of special value at that moment, when the princes of the blood were forming alliances with the enemy. So, on May 30, 1631, Louis XIII. granted to Renaudot “the privilege to make, print and sell, through any agent whom he might select and wherever it seemed to him best to sell copies, the news, the official appointments and accounts of all events occurring both within and outside the kingdom.” The first number of the “Gazette de France”—which was the name that Renaudot gave to his periodical—appeared on the day mentioned above. The price at which this sheet of four pages sold was two liards.[^[1]]

One year later, the size of the Gazette was increased by the addition of four separate pages which bore the title, “Nouvelles,” and simultaneously the price of the entire journal (8 pages) was increased to one sou. It is scarcely necessary to state that the Gazette was directly inspired by Richelieu, and that even the king occasionally took a hand in editing it. Gilles de la Tourette, the author of the memoir from which I have compiled the present brief sketch, says that he examined all the issues of the Gazette from 1631 to 1653 but failed to find in them a single réclame—advertisement or editorial puff.

From the very day on which it was first published, the Gazette proved a brilliant success. I should have mentioned, at the beginning of this sketch, the fact that for a certain length of time Renaudot contributed liberally from his own funds toward the support of his pet schemes of benevolence, but it does not appear, in the account given by de la Tourette, whether the Gazette enterprise should not be counted as one of these schemes. At the same time, the thought naturally suggests itself that this physician’s motive in advocating the publishing of an official newspaper like the Gazette was probably a strong desire to win for his humanitarian schemes the strong support which the Cardinal and the King would be able to grant. Whether this be true or not, the idea of creating an official newspaper under the protection of the highest authority in France certainly showed far-sighted wisdom on the part of Renaudot. In 1640,—i.e., nine years after the founding of the Gazette as an official dispenser of political and civic news,—Renaudot changed its scope by adding to it the character of a medical journal. After 1640, therefore, the Gazette may rightly be classed as representing the first attempt to publish a medical periodical in France.

CARDINAL DUC DE RICHELIEU
(From a portrait engraved on copper by Nanteuil in 1655.)

Another important feature was added by Renaudot to his philanthropic scheme in this same year 1640. He obtained from the King a decree authorizing him to establish a “Bureau de Consultations Charitables pour les Pauvres Malades.” The manner in which this Bureau was to be conducted may be briefly explained in the following words. At certain fixed hours fifteen physicians, all of them friends of the founder, and a smaller number of apothecaries presented themselves at the Bureau, where, seated at a few separate tables, the physicians listened to the statements made by the poor people who had come there in the hope of obtaining relief from their maladies. In the simpler cases, a single physician was fully equal to the task of prescribing whatever the patient’s condition called for, but in those of a more obscure nature, two or three of the physicians present joined in a consultation. After the question of a suitable treatment had been decided, one of the apothecaries in attendance prepared the remedy or remedies which had been prescribed, and at the same time a written statement of the diagnosis was handed to the patient. If the ailment happened to be of a surgical nature, the measures required for its treatment were carried out on the spot. Some of the patients who presented themselves at the Bureau were easily able to pay for professional advice; and, when such a person appeared, an opportunity was afforded for dropping into a suitable box the fee which he or she was disposed to give. This money was utilized in paying for the remedies furnished the poor. In exceptional cases, it was perfectly evident that drugs alone could not afford the desired relief; the need was rather for more and better food. Fully realizing this need, and acting under his strongly benevolent impulses, Renaudot not infrequently placed money in the hands of these suffering dispensary patients when they were about to return to their homes. The exact amount of these gifts is not known, but they must in the aggregate have been large; for his biographer says that, in addition to the sums which his more prosperous patients placed in his hands for the benefit of the poor, he contributed annually out of his own purse, toward the maintenance of these free consultations, the sum of 2,000 livres (the “livre” being of about the same value as the franc). The success of the Bureau was so great that in the course of a few months it became necessary that a certain number of physicians should be at the consulting rooms of the institution at all times during the day.

As a natural result of this increase in the Bureau’s popularity the celebrity of Renaudot also increased, until it extended to every part of the kingdom; and, as a further result, the institution itself now began to take on the character of a school for clinical instruction—an entirely new feature; for at that period no facilities of this kind were provided by the Paris Faculty of Medicine. When Renaudot observed this new and unexpected development of the work carried on at the Bureau he petitioned the King for permission to erect, at his own expense, in the Faubourg St. Antoine, the most populous quarter of the City of Paris, a “Hostel des Consultations Charitables”—in other words, a free hospital for the poor.

Statue of Théophraste Renaudot at Loudun, France. (Courtesy of Monsieur le Pasteur Paul Barnaud, of Sainte Foy la Grande [Gironde], France.)

Up to the year 1638 Renaudot had got along very amicably with the Paris Faculty. He had often consulted with them and he had entered the names of his two sons, Isaac and Eusebius, as students at the medical school. Furthermore, there could not have existed any prejudice against him on religious grounds as—upon the advice of Richelieu and Father Joseph (Leclerc du Tremblay, or “His Gray Eminence”)—his two sons had been educated in the Roman Catholic faith. It appears, however, that these favorable considerations were not strong enough to prevent professional jealousy, on the part of the Paris physicians, from setting to work to undermine all Renaudot’s good work. The real truth—viz., that the newcomer’s success was robbing them of some of their paying practice—was not confessed by these men openly, but instead they objected to his having, with the King’s permission (granted in 1640), established furnaces for the manufacture of chemical remedies. They also claimed that he was injuring the profession of medicine through his doctrine that good effects were obtainable from the employment of both opium and antimony as internal remedies, and also through his maintenance of the new doctrine (1616) of the circulation of the blood. Were not these professional sins, they claimed, sufficiently heinous to justify them in summoning him before the magistrates as an impostor? They believed that they were fully justified in so doing; and accordingly they proceeded without further delay to bring suit against Renaudot.

It would require much additional space to furnish here even a condensed account of the events which characterized this disgraceful attack by the Paris Faculty—and especially by Guy Patin, who was at that time its Dean—against Renaudot, and I have therefore no hesitation in omitting all but one or two further details of this part of Renaudot’s history. In the first place, Cardinal Richelieu and the King stood firmly by Renaudot to the very end; and, on July 14, 1641, the King’s Council condemned the Faculty on all points of their charge, and in this manner granted complete authorization to Renaudot’s work. He himself, notwithstanding the great victory which he had won over his unscrupulous enemies, all of them physicians of high social position, resumed his efforts to win them over to a friendly attitude—not toward himself individually, but toward the benevolent schemes which he was doing his best to establish on a firm footing. All his efforts, however, toward pacification proved of no avail.

Not long afterward Renaudot’s two sons, both of whom had by this time completed the regular course of studies at the Medical Schools, made a respectful request to the Faculty for permission to appear before them for the examination to which all candidates for the degree of Doctor of Medicine were obliged to submit. In the meantime, as if to show his approval of the request which Renaudot’s sons had made, Richelieu had taken Eusebius with him as his physician-in-ordinary when he joined Louis XIII. at the seat of war in the southern part of France. But neither this kindly act on the part of the Cardinal, nor any of the other efforts made by Renaudot’s friends in behalf of his two sons, seemed to make any impression upon the Faculty. They refused point blank to grant the desired opportunity for an examination. As a last resort, Isaac appealed to Parliament “to issue a decree to the effect that the Faculty of Medicine must confer the degree of M.D. on both Isaac and Eusebius Renaudot within fifteen days; and declaring that, if the decree should not be obeyed within the prescribed limits of time, the decree itself should serve as full equivalent for the title in question.” The Faculty duly entered the decree upon their registers, but in secret they determined that the two Renaudot brothers should be excluded from all their official meetings. Théophraste Renaudot protested and the Faculty of the University of Montpellier pleaded warmly in his behalf, but it was of no avail. After the death of Richelieu the Paris Faculty had no difficulty in thwarting nearly all the excellent schemes of Renaudot. He was obliged to abandon the plan of building, at his own expense, a hospital, and his two sons were not permitted to practice medicine in Paris. He continued, however, to edit the Gazette up to the time of his death in 1653.

Gilles de la Tourette, in his interesting memoir, makes the following reflection upon the career of this pioneer journalist:—“All the innocent inventions of this benefactor of humanity are prospering to-day. In addition to his plan for building a hospital, he was the first to organize the whole scheme of Public Assistance—viz., charitable consultations (not unlike our dispensary work) and gratuitous visits at the residences of the poor. And, in addition to these, he introduced the Monts-de-Piété into Paris and also his Bureau of Addresses of exchange and redemption. To this man whose guiding maxim was ‘Lend money to the poor without expecting any return,’ posterity owes some reparation, and I hope that soon it will be possible to erect in one of our public squares a monument that will perpetuate the memory of the greatest philanthropist of the seventeenth century.”[^[2]]

BOOK II

MEDICINE IN NORTHERN AND CENTRAL GERMANY DURING THE EIGHTEENTH CENTURY

CHAPTER II

LOW STATE OF MEDICAL AFFAIRS IN GERMANY AT THE BEGINNING OF THE EIGHTEENTH CENTURY

The intellectual activity of Germany was very low during the first half of the eighteenth century, and this statement applies with equal truth to all the departments of learning. It was only at the time of the French Revolution and for a few months previous to this period that the signs of an awakening began to show themselves. The prevailing unrest and turmoil in the political world are commonly assumed to have furnished ample cause for this widespread intellectual inactivity; and yet, on the other hand, it is conceivable that it was these very disturbances in the domain of politics which had the effect of stimulating the marked increase in mental activity which soon followed. This certainly seems to have been true of general literature, for it was toward the end of the period named that what are admitted to be the classical works of German authors—for instance, the writings of Klopstock, Lessing, Herder, Gellert, Wieland, Goethe, Schiller and the philosopher Kant—were first published. In medicine, says August Hirsch, one of the leading German historical authorities, other influences, beside those of a political nature, contributed powerfully toward the advancement of the science of medicine. The medical students and the younger practitioners, according to his statements, began at this period to show evidences of a wish to become more learned in things relating to their calling and to possess greater refinement in their manners and habits. Trips were made by them more and more frequently to the leading cities of France, Italy and England for the purpose of acquiring additional knowledge of medical science. Thus, little by little, the medical profession of Germany gained increased standing and respect from the community. Beginning with Prussia the governments of the different German states, one after the other, established examinations for the purpose of determining the fitness of the applicants for the right to practice medicine. Then, following the example of their rulers, members of the aristocracy adopted the practice of taking a physician with them on their travels, and the wish to be chosen for this privileged office acted upon the younger physicians as a decided stimulus to acquire greater skill and knowledge. Thus gradually the family physician, in many instances, came to be considered an adviser of greater importance than the clergyman. Then, beside, the knowledge that he had acquired this increased power and that he was held in greater esteem by society, reacted upon the physician’s character, rendering him more and more ambitious to excel and to deserve confidence.

While, during the earlier part of the eighteenth century, medical affairs in Northern and Central Germany were in the condition described above, there was taking place at Vienna, the capital of Austria, the most effective revival of medical science of which we possess any record. Of this important event, however, I will say nothing further at present. A reasonably full account will be found in one of the later chapters.

Although I have spoken of the early and middle portions of the eighteenth century as constituting a barren or stagnant period in the history of medicine, I would not wish to convey to my readers the impression that it was a colorless and uneventful period. Far from it. There was nothing colorless, for example, in Hahnemann’s eventful career, and yet to all appearances he was not contributing in any way to the genuine and solid advance of the science of medicine. Then, again, Hufeland is not commonly supposed to have contributed in any material degree to the advance of medical science, and yet his “Makrobiotik,” his “Art of Prolonging Life,” is a veritable mine of useful information that the practitioner of medicine can scarcely afford to classify as trivial. Hufeland also deserves the credit of having founded one of the earliest medical journals, a periodical which still, in many of its numbers that were issued during the later years of the eighteenth century, furnishes reading matter that to-day possesses the power to entertain even a twentieth-century reader. At a somewhat later date (1779) J. Peter Frank founded the first journal or archives distinctly devoted to hygiene and medico-legal science. Farther on I will supply a few details concerning these two rather important contributions to medical knowledge.

Finally, there are a few men who, during this same relatively barren period of German medical science, made permanently valuable contributions to our stock of knowledge. Among these stands out conspicuously Johann Christian Reil (1759–1813). Although lack of space prevents me from doing anything like full justice to these worthy representatives of our profession, I will endeavor to furnish in the next chapter at least sufficient information concerning their work and characters to enable the reader to place them in their proper niches in the history of medicine.

CHAPTER III

PHYSICIANS WHO ATTAINED DISTINCTION IN SOME OF THE DEPARTMENTS OF MEDICINE DURING THE FIRST HALF OF THE EIGHTEENTH CENTURY

In looking over the list of medical men who attained distinction during the first half of the eighteenth century, one can scarcely fail to note two important facts, viz., that they hailed from widely separated localities in Western Europe,—for example, from England, Holland, Northern Germany, France, Austria, Switzerland and Italy,—and also that the advances which they effected in medical knowledge were not confined to one or two departments of this science but included very nearly all the fundamental branches. Hence it could not rightly be claimed by a citizen of any one of these countries that his own nation was entitled to be considered the leader in this advance. It would be a waste of time, and would require more space than can be spared for such a purpose, to furnish here even an incomplete list of the anatomists, biologists, chemists, pharmacologists, diagnosticians, therapeutists and surgeons who during the period named took a very active part in the work. Probably Boerhaave of the University of Leyden, Holland, of whose career I have given some account in the preceding volume, deserves to be reckoned one of the first physicians who exerted a strong stimulating influence upon the movement as a whole. From a superficial examination of his writings the modern physician finds it difficult to understand why Boerhaave attained so great a degree of popularity as he indisputably did,—a popularity, too, which was of the best sort; for during the period of his professorship both students and practicing physicians flocked to Leyden from all parts of Europe, and they never tired of speaking about the great benefit which they derived from Boerhaave’s teaching. Many of them attributed this popularity more especially to his practice—which at that time was a novelty—of laying great stress upon bedside teaching and upon the importance of studying disease from direct observation of its manifestations in the living subject. Then, in addition, there is evidence that, as a teacher, Boerhaave undoubtedly possessed the gift of exerting a personal charm upon his auditors.[^[3]]

Not a few of those who were privileged to receive instruction from this celebrated physician became themselves distinguished afterward as teachers or authors, and thus Boerhaave’s method of teaching was perpetuated. Among the physicians to whom reference has just been made were such men as Albrecht von Haller, of Berne, Switzerland, Van Swieten, of Vienna, and Hoffmann, of Halle, Prussian Saxony, many of whom are well known to-day in a general way to students of the history of medicine, but who, nevertheless, in at least a few instances, are worthy of having their careers described in further detail. In the following pages I propose to supply biographical sketches of these men and to show in what respects they exerted a beneficial influence upon the great body of their confrères, and also to what extent they made contributions to the science of medicine in its various branches.

It will undoubtedly surprise some of my readers, as it did me, to learn that during the comparatively barren period of the eighteenth century, to which brief reference has been made on a previous page, there were in Northern and Central Germany several anatomists and biologists who did creditable work as original investigators in these departments of medicine. Of this small number, however, I shall mention here only one—Reil. While he spent the greater part of his life in Germany, he was in reality a native of Holland.

Johann Christian Reil was born at Rhaude, East Friesland, in 1759. His father, who was the pastor of the village church, gave his son an excellent preliminary training, which enabled him, at the age of ten, to enter the high school (Gymnasium) in the neighboring town of Norden. On attaining his twentieth year, Johann entered the University of Goettingen, but he remained there only a short time, as he had become convinced that the Halle University offered greater facilities for those who intended, as did Reil, to follow a medical career. Three years later, armed with the degree of Doctor of Medicine, he began the practice of his profession at Norden. In the course of five years he managed to build up such a reputation as a successful practitioner that the University of Halle invited him to occupy the position of Professor Extraordinary of Clinical Medicine. Then, after the lapse of only a short year from the time of his acceptance of this invitation, he was promoted to the full professorship. Almost simultaneously he was appointed (1789) to the position of City Physician of Halle. It was probably while serving in the latter capacity that he began to reveal to the Government that he was not only an excellent physician but also possessed, at the same time, unusual executive ability.

Between the years 1789 and 1806, at which latter date the German army met with a disastrous defeat at the hands of the French (battle of Jena), the almost constant warfare brought all official university work to a stop. But Reil was not idle during this long period, for it was at this time that he devoted himself chiefly to laboratory research work with reference to the anatomy and physiology of the brain and nerves. The products of this work are recorded in the Archives of Physiology which Reil published in 1796 in association with Autenrieth, and they are pronounced by Sudhoff to be masterly. One of the cerebral structures which Reil was the first to describe is that known to all anatomists as “the island of Reil.”

Another important series of studies which were made by Reil were published by him under the title: “On the Diagnosis and Treatment of Fevers” (Halle and Berlin, 1799–1816; 3d edition, 1820–1828).

Finally, mention should be made of a memoir on “Vital Force” which Reil published in the first volume of his Archives, in July, 1795; an essay which—according to Sudhoff—should be read with very close attention, for it, more than all his other published writings, has carried Reil’s name (and will continue so to carry it in the future) triumphantly through the history of the science of biology. The author states his final conclusion as to the nature of vital force in the following words: “Every part of an organism accomplishes its work through its own inherent power, and the latter is a characteristic phenomenon that is dependent upon the manner in which the material of which it is composed is mixed and also upon the form that it takes.” Dezeimeris gives a slightly different rendering of this passage, viz., “It is absurd to search for the source of life (vital force) elsewhere than in the tissues themselves, and in them the vital phenomena vary partly according to the manner in which their elements are mixed and partly according to the form in which they are arranged.” Farther on in this volume, as I shall show, Claude Bernard, the distinguished French biologist, furnishes a third definition of “vital force.”

When the terrible fighting that occurred at the battle of Leipzig in 1813 necessitated the rapid construction and organization of hospitals large enough to accommodate the many thousands of sick and wounded[^[4]] that had accumulated after this battle, the King of Prussia promptly assigned to Reil the entire management of this important business; and the result proved that he had entrusted this work to the right man.

Reil’s death from typhus fever occurred at Halle on November 12, 1813.

Sudhoff thus sums up the most striking traits of this distinguished physician’s character: “He was never satisfied with half-way measures, and bold schemes and great undertakings occupied his thoughts at all times. At the bedside he gave himself up unreservedly to the interests of the patient.”

Samuel Hahnemann was born at Meissen, Saxony, in 1755. Although his parents were poor he managed to obtain a good education, not only in the fundamentals usually taught at the schools, but also in the knowledge of the various languages, such as Latin, Hebrew, Arabic, Spanish, English, French and Italian. In his medical training he advanced so rapidly that already at the comparatively early age of thirty-five he was recognized as one of the leading physicians of Germany. Even Hufeland, who at this period (about 1790) was the highest medical authority in the nation, accorded him full confidence both as a man and as a chemist; and yet at the same time there is no evidence to show that he frankly adopted his teachings with regard to the new doctrine of homoeopathy.

Hahnemann’s first experiments in relation to the action of drugs—says Wheeler, the most recent translator of the “Organon”—were made upon cinchona bark, which at that period was universally admitted to possess remarkable power in relieving and curing “ague,” as the usual form of malarial disease was then termed. “Hahnemann’s experiment”—he goes on to say—“consisted in taking a large dose of cinchona bark while he was in good health and noting its effects upon his healthy body. To his surprise he found reproduced upon himself all the chief phenomena (and even many of the minor symptoms) of a paroxysm of ague. When the attack passed off, a second dose produced a second paroxysm, and Hahnemann was presently face to face with the fact that this drug, which so often cured ague, was capable of reproducing in his own healthy body the phenomena of ague. Like, in fact, cured like.... As soon as the cinchona experiment suggested to Hahnemann the possibility that the principle of like to like (similia similibus) might prove a general law of healing, he began a systematic study of the records of medicine in the search for instances.... Over and over again he found that a drug prescribed empirically had proved itself capable of curing conditions similar to those which it could produce. The records of medicine, in fact, gave plenty of encouragement to his now dawning belief that similia similibus is a genuine Law of Cure.”

It is at this point, as it seems to me, that Hahnemann displays the first and most important defect in his reasoning machinery. He allowed what seemed to him to be a most important and highly beneficent therapeutic truth immediately to take possession of his whole being,—indeed, to take such complete possession that, from this moment forward, throughout the remainder of his life, he was utterly unable to weigh with a calm and unprejudiced mind the various facts and considerations which ultimately relegated homoeopathy to its proper place in the medico-historical museum, alongside those hoary relics of methodism, incantations, the weaving of charms, Stahlism, Brunonianism, etc. In short, he lacked those immensely important mental characteristics which enabled Harvey to discover the more important facts relating to the circulation of the blood, and which made it possible for Jenner to place in the hands of his fellow men an effective weapon of defense against the deadly ravages of small-pox. If asked to say what are these characteristics, I would reply: A state of mind so open and so unprejudiced that it can weigh with absolute fairness all the evidence laid before it, and an imagination so clever and so fertile in resources that it is able to invent the means of reproducing at will all those phenomena which it is desirable to study more closely. These, I believe, are the characteristics which Hahnemann lacked and which are absolutely necessary for the creation of a permanently useful creed and principles of therapeutics.

In Hahnemann’s “Organon,” he provides quite a long series of aphorisms in which the new doctrine is somewhat fully developed. I have transcribed, below, a few of these in order that my readers may be able to learn at first hand just what their author had in mind when he wrote them.[^[5]]

Aphorism 5.—It may be granted that every disease must depend upon an alteration in the inner working of the human organism. This disease can only be mentally conceived through its outward signs and all that these signs reveal; in no way whatever can the disease itself be recognized.

Aphorism 6.—... A thing or a condition demands a first proximate cause only in order to come into existence; where the thing or condition actually exists it requires no further originating, no first and proximate cause, for its continued existence. Thus a disease, once established, endures independently of its proximate, exciting, primal cause: endures without further need of its cause: endures even if its cause no longer exists. How, then, can the removal of the cause be held to be the principal condition of the cure of the disease?

Aphorism 8.—The unprejudiced observer ... is unable, however acute he may be, to take note of anything, in any single case of disease, except the changes in the condition of the body and soul which are perceptible by the senses, the so-called disease phenomena, symptoms in fact; in other words, he can note only such fallings away from a former state of health as are recognizable by the patient himself, the friends in attendance, and the physician. All these perceptible signs make up together the picture of the disease.

Aphorism 9.—... And thus this symptom-complex ... is the only means whereby it is possible to discover a remedy for it (the disease), the only means which can indicate the most appropriate agent of cure.

Aphorism 13.—Now since, when cure is effected through the removal of the whole range of the perceptible signs and symptoms, the inward change which caused the symptoms is also removed (that is, the totality of the disease), it follows that the physician has only to clear away the entire symptom-complex in order also to get rid of the inward alteration—in other words, to remove the whole disease, the disease itself, a feat which must always be the only aim of the rational healer; for the essence of the art of medicine consists in compassing the restoration of health, not in searching for the change in the inward and hidden things; a quest which can tend to nothing but fruitless speculation.

And then follows, in the form of an “Author’s Note,” the subjoined commentary by Hahnemann:—

It is only through a misuse of the desire to reach the eternal, sown in the spirit of man for nobler purposes, that these impudent attempts have been made upon the realm of the impossible, those speculative broodings over the essential nature of the medicinal powers of drugs, over vitality, over the invisible working of the organism in health and over the changes of this hidden inner working which constitute disease—in other words, over the inner nature and essence of illness.... When the physician maintains that research into such things is necessary, then he shows a misconception of the capacities of men and a misunderstanding of the requisites for the work of healing.

... If only it had served the practice of medicine in the slightest degree,—if all this subtile investigation had revealed the true remedy for the least of diseases, it might yet pass for desirable!

Aphorism 31.—The great homeopathic law of cure rests on this law of man’s nature, revealed by experience, that diseases are only destroyed and cured by similar diseases. The homeopathic law may be thus formulated: that a disease can only be destroyed and cured by a remedy which has the tendency to produce a similar disease, for the effects of drugs are in themselves no other than artificial diseases.

The preceding more or less disconnected portions of the text of Hahnemann’s great work—“Organon of the Rational Art of Healing”—are quoted here, not with the idea that they will convey to the reader a very clear idea of the doctrine of homoeopathy and of the way in which it is to be applied in the practice of medicine, but rather for the purpose of showing the extraordinary manner in which Hahnemann utilized his reasoning powers in his efforts to create a new pathology and a new system of therapeutics that would harmonize with this new doctrine.

A further inquiry into the manner in which the disciples of Hahnemann acted upon these principles of homoeopathy in the practice of their profession establishes the fact that they believed in the remedial efficiency of doses that contained as small a quantity as the billionth or the decillionth of a grain of the drug. In a report which he makes to the Medico-Chirurgical Society of Edinburgh, James J. Simpson, the distinguished professor of midwifery in the University of that city, comments (1851–1852) upon these infinitely small doses in the following terms:—

If a grown-up man were gravely and seriously to assert to the world that two and two make five, the world would be inclined to look upon him as doubtfully rational, inasmuch as he defied the principles of common sense. And when other grown-up men tell the world that they can cure this or that disease with a billionth or decillionth of a grain of this or that common and probably inert drug, they express an opinion perhaps even more intensely and directly absurd than the doctrine of two and two making five; but they do not equally see through the absurdity and impossibility of the more complicated, but equally ridiculous idea, of the billionth or decillionth of a grain of oyster-shell, or chamomile, or belladonna, or the like, having any possible effect whatever upon the economy, for, resting contented with the mere name, they never once think or dream of what in reality a billionth or a decillionth amounts to.... For it is a sum the mere figures of which can scarcely give us any conception of its infinitesimal amount, viz., 1 followed by sixty ciphers.... Surely men holding such fantastical doctrines, are not men mentally fit to be members of such a Society as this.

In further corroboration of Dr. Simpson’s remarks, I may be permitted to furnish here a few brief extracts from Jahr’s “Manual of Homoeopathic Medicine” (Vol. I., pp. 386 et seq.):—

Symptoms produced by common House-Salt.—Rigidity of all the joints, which crack when they are moved,... Bad effects of a disappointment.... Frightful dreams of quarrels, murders, fire, thieves, etc.... Typhus fever with debility.... Awkwardness.... Numbness and insensibility of one side of the nose.... Speech embarrassed in consequence of the heaviness of the tongue.... Loss of appetite, especially for bread, and repugnance to tobacco smoke.... Numerous flaws in the nails.... Redness of the great toe, etc. (The list contains at least thirty additional symptoms.)

At the present day it is hard to believe that as recently as during the first half of the nineteenth century there existed an editor who was willing to publish such childish reading matter as the above. And yet one is obliged at the same time to admit that the appearance of text like this in a reputable book furnishes good evidences that there was no lack of readers to whom the information imparted proved acceptable.

Between the years 1850 and 1860, homoeopathy assumed a good deal of prominence in the city of New York. Many of the leading families during this period turned their backs on the regular practitioners,—the “Allopaths,” as they were then frequently called,—and confided themselves and their maladies to the care of members of the new school. This naturally led to much bitterness of feeling between the two groups of physicians, just as had happened at an earlier date in the larger towns of England and Scotland; and this condition of things lasted for at least twenty years. Hostile action on the part of the county and state medical societies proved of very little use in diminishing the popularity of the new method of treating diseases; and so it was finally decided to withdraw all further opposition to the new sect and to see what an attitude of indifference and the stopping of all persecution would accomplish. Thanks largely to this wise and sensible policy, homoeopathy gradually lost its short-lived ascendancy, and the more sensible members of the community returned to their former allegiance. What I have said in regard to the rise and fall of homoeopathy in New York is, I am confident, true in a general way of its fate in most of the other large cities of the United States, but I am personally familiar only with the conditions that prevailed in my native city.

I wish that I might speak with a larger measure of authority in regard to the causes that led to the favorable reception of this new sect in New York, but I am not able to do this, and I doubt whether anybody among my contemporaries is able to do much better than merely to suggest some of the more obvious causes which favored the popularity of the new school of practice. Among such causes I may mention the fact that in those days the practitioners of the regular school were in the habit of prescribing drugs in large doses and with very little effort to render them palatable. Take, for example, senna tea, of which bad-tasting medicine the patient was expected to take a large teacupful shortly after the early crowing of the cock; and if, a day or two later, a repetition of the same dose was ordered by the attending physician, can anybody wonder if the remedy was quickly pronounced by the patient much worse than the disease? Experiences like the one just narrated were by no means uncommon, and, as a consequence, many families did not hesitate to transfer their patronage to a class of physicians who never prescribed any remedy that had a bad smell or taste or that caused the slightest bodily discomfort. Then, beside, it is a well-known fact that, during the period now under consideration, the regular practitioners had, in not a few instances, been guilty of prescribing therapeutic measures which actually inflicted harm. Such, for example, were the giving of mercurial preparations in too large doses, the too frequent resort to bloodletting, etc. For all these reasons, it is not at all strange that for a period of several years (1850–1875) homoeopathy flourished in New York. In all fairness, therefore, it may be said that the great improvement in the manner of administering drugs which took place, both here and in European countries, during the period from 1860 to 1880, may be attributed indirectly to the influence of the new sect.

Hahnemann died in Paris in 1843, at the age of eighty-eight.

HUFELAND
(From Eugen Hollaender’s “Medizin und Plastik,” by permission.)

Christoph Wilhelm Hufeland, who was born in 1762, at Langensalza, in the district of Thuringia, Central Germany, founded, about the year 1795, a medical journal that bore the title, “Hufeland’s Journal der Practischen Heilkunde,”—the first German medical journal that was devoted largely to matters of interest to the practitioner. It was published regularly every month and was in almost every respect similar to the best medical journals of the present day. It was kept in active circulation up to the time of the founder’s death in 1836, and was highly appreciated by physicians generally. Hufeland’s reputation, however, rested less upon this journal, notwithstanding its great popularity, than it did upon his famous treatise entitled “The Art of Prolonging Life” (Makrobiotik). This book, which has been translated into every modern language, and which during the past century and a half has never had a rival in the field of which it treats, continues to-day to furnish entertaining reading to hundreds of men and women, laymen as well as physicians, who desire to learn the well-established facts regarding human longevity. Farther on, I will furnish a few extracts from both of these publications, thus enabling those of my readers who have not yet had an opportunity to become acquainted with Hufeland’s writings or with his work as a journalist, to learn something more definite about the man.

So far as I am able to ascertain, Hufeland’s only other important activities were those connected with the positions which he held in the Universities of Jena (1793–1798) and Berlin (1798–1835). In the former institution, he held the Chair of Medicine; in the latter he held the same chair, but he was also acknowledged to be the guiding spirit in all matters relating to the organization and management of that important centre of medical education.

Among the items of special interest in Hufeland’s “Makrobiotik,” I find the following:—

On the 2nd of August, 1790, a carabinier named Petit jumped into the Rhine from one of the windows of the Military Hospital at Strassburg. Half an hour later,—as nearly as could be learned from an inquiry that was made at the time of the occurrence,—his body was taken from the water and carried into the hospital. To all appearances the man was dead; no evidences of life were discovered. Nevertheless, efforts were made to revive him. The body was placed in a thoroughly warmed bed, with the head lying high up on a pillow, the arms resting on the trunk, and the legs extended side by side. The only other measures adopted were the following: At short but regular intervals of time heated cloths were placed over the region of the stomach and over the legs; and heated stones wrapped in cloths were placed in different parts of the bed. At the end of seven or eight minutes a slight twitching of the man’s upper eyelids was observed, and a short time afterward his lower jaw, which up to that moment had been in firm contact with the upper jaw, became separated from it and permitted a little frothy mucus to escape between the lips. After this discovery had been made, a little wine was cautiously introduced into the man’s mouth. Apparently it was swallowed, and then other small doses of wine were administered, all of them apparently being swallowed. Under this stimulation the pulse beats at the wrist became perceptible, and at the end of one hour the man was able to answer questions.

In his comments upon this interesting case of restoration of life after apparent death from drowning, Hufeland makes the following remarks:—

It is evident, therefore, that artificial heat acts with the same vigor immediately after the appearance of what seems to be death as it does at the very first dawn of life; it gradually fans into a living flame the few vital sparks which may still be present in the body.

In the preceding account of the means adopted for resuscitating the soldier who was believed to be dead from the effects of drowning, no mention is made of friction of the surface of the body as a procedure of some value. Hufeland, very properly, lays great stress upon the need of applying heat. Friction, however, if employed intelligently, may prove a most efficient adjunct; and, when I use the expression “intelligently,” I mean that friction may be utilized as a powerful agent for propelling toward the heart the artificially heated blood contained in the cutaneous blood-vessels, thus contributing in no small degree toward the reëstablishment of the circulation. The kind of friction required—it seems scarcely necessary to say—should always be directed from the extremities toward the heart.

In another part of the same work Hufeland gives an account of several instances of exceptional longevity. One of these relates to Terentia, the wife of Cicero, who, despite the sore trials to which she was subjected, and despite the occasional attacks of gout with which she was afflicted, attained the great age of 103. A second instance is that of Livia, the wife of the Emperor Augustus, a woman who possessed a domineering and passionate character, but who, nevertheless, was blessed with a full share of happiness. At the time of her death she was ninety years old. Two other Roman women are mentioned by Hufeland as having attained a great age. They were both of them distinguished actresses. The first one, whose name was Luceia, began her theatrical career at a very early age and was 112 years old on the occasion of her last appearance on the stage; her entire theatrical career having covered a period of one hundred years. Galeria Copiala is the name of the other actress, who was at the same time famous as a danseuse. Ninety years after her first appearance on the stage she took part in a complimentary performance in honor of Pompey; and even at a still later date she acted in a play which was intended to celebrate the distinguished reign of the Emperor Augustus.

Hufeland mentions further instances of great longevity which he had gleaned from Jewish history, and from these I select the following: Abraham lived to be 175 years old, and his wife, Sarah, the only woman of that remote period of time of whom we possess a precise knowledge, died at the age of 127; Isaac attained the age of 180; Jacob lived to be 147; Ishmael, a son of Hagar (one of Abraham’s hand-maids) and a man of warlike habits, attained the age of 137; and Joseph, the next to the youngest of Jacob’s sons, a political leader and a man of great wisdom, died at the age of 110. Moses, a man of conspicuous intellectual capacity and possessing a strong will, lived to be 120 years old. But even he complained that “the life of a man usually lasts only seventy years, or, in exceptional instances, eighty years”—a statement, says Hufeland, which justifies the belief that 3000 years ago the duration of human life was about the same as it is to-day. Joshua, who led a very active life and was a good deal of a warrior, died at the age of 110; Eli, the High Priest, a man of a phlegmatic temperament, lived to be a little over ninety years of age; and Elisha, who despised all the conventionalities of life and cared nothing for wealth, lived far beyond the limit of 100 years.

The Greek philosopher Pythagoras, who recommended care in the choice of one’s food, moderation in eating, and the cultivation of gymnastic exercises, attained a good old age. He claimed that after a man reached his eightieth year, no matter how great an age he might afterward attain, he should be reckoned among those who have ceased to live.

The measures which Hufeland enumerates as being specially conducive to longevity are those with which my readers—it may safely be assumed—are already familiar. The list comprises both those things which a man or a woman should carefully avoid, and those which often prove helpful in prolonging the period of one’s life, and which may be summed up in that old device: “Moderation in all things.”

On turning over the pages of the volume of Hufeland’s Journal in which are contained the issues of the first half of the year 1833, I came across the report of a very unusual case that was observed by a Dr. Heymann in the village of Oldendorf. His report reads as follows:—

A very poor working-woman, who in addition to her poverty was obliged to live in a house that was overrun with mice, retired to her bed one night in company with her child who was about three years old. One of the last things she did, after going to bed, was to hand to the latter a crust of bread, in the hope that the little one might thus, by quieting its hunger, fall asleep more readily. Having done this the mother herself soon fell asleep. But shortly afterward she was awakened by the terrified cries of the child, who insisted that there was a mouse in its throat. Having quickly obtained a light the mother discovered that not only was the child retching violently, but that it was bringing up visible quantities of blood from the stomach. In the contortions caused by the pain the child indicated the pit of the stomach as the source of all its agony. The severe pain persisted for about two hours and then suddenly ceased, but the retching and bringing up of blood continued at intervals for some time longer. On the following morning the child was given plenty of sweetened milk to drink. At the end of forty-eight hours the remains of the mouse were found in the stool. The creature’s body presented a collapsed appearance and the skin lacked its covering of fur in several places.

For quite a long time subsequently the child remained in an ailing condition, with symptoms of disordered digestion. Its death, however, which occurred at a somewhat later period, was apparently dependent upon an entirely different disease,—one that had no connection whatever with the incident just described.

After reviewing all the evidence in this extraordinary case, Hufeland sees no reason for doubting the correctness of the preceding report in all its essential features. As to the manner in which a mouse may find its way into the human stomach, the following statement is permissible. To begin with, it is a matter of common knowledge that mice often run about an occupied bedroom at night in search of food, and that their sense of smell is extraordinarily acute. Furthermore, it is easy to understand how a mouse, after tracing the odor of food to the partially open mouth of a sleeping child, would not hesitate, if pressed by hunger, to enter that cavity for the purpose of securing possession of the particles of food lodged therein; and it is also easy to understand how the intruder might then be caught as in a trap by the closing of the mouth which spontaneously followed. Under such circumstances the creature’s choice of the oesophageal route into the stomach as a way of escape was most natural, and equally so were the efforts made by the beast—as shown by the pain at the pit of the stomach and by the retching of a bloody fluid—to gnaw its way through the gastric mucous membrane.

Although Hufeland yielded to the prevailing tendency among German physicians of the eighteenth century to adopt doctrines, both in pathology and in therapeutics, which are based upon hypotheses rather than upon facts established by experimentation, or by direct observation at the bedside or at the autopsy, and which as a consequence played a very small part in the genuine advance of the science of medicine, he nevertheless, as I have tried to show in the preceding pages, should be classed as a most useful and honorable member of our profession.

Remember—he is reported to have said to his younger confrères—that there are two maxims which you should keep in mind, viz.:—

1. Natura sanat, medicus curat morbos;
(Nature cures disease, the physician merely does what he can to facilitate the operations of nature);

and

2. Ne noceas, si prodesse credis.
(In your efforts to afford relief be careful not to do permanent harm.)

CHAPTER IV

DISTINGUISHED SWISS PHYSICIANS WHO PLAYED A PROMINENT PART IN THE DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE IN GERMANY

Among the men who may properly be included in the present class of distinguished German physicians I have no hesitation in naming von Haller and Zimmermann, notwithstanding the fact that both of them were natives of Switzerland—that is, German Switzerland.

ALBRECHT VON HALLER

Albrecht von Haller, whose many contributions to the science of medicine have assured him a permanent and very high position in the temple of fame, was born October 16, 1708, of parents who belonged to two of the old patrician families of Berne, Switzerland. In childhood he suffered from rachitic symptoms and was constantly ailing; but, despite these drawbacks, he manifested at a very early age evidences of possessing to an unusual degree certain intellectual gifts and of having a genuine love for work. Thus, for example, he began—shortly after he had learned to write—recording in alphabetical order all the words that he had been taught and the meaning of which had been explained to him. At the age of ten he prepared for his own use a vocabulary composed of Chaldean, Hebrew and Greek words, and two years later he compiled, from the dictionaries of Moreri and Bayle, a collection of concise biographies of the men who had achieved celebrity in the more important branches of science, and he surprised his teachers by his ability to compose verses in Latin as well as in his native language, German. Before he reached his fifteenth year he had attained considerable distinction, both as an anatomist and as a poet, a combination of gifts extraordinarily rare. He received his early training in anatomy and general medicine at the University of Tübingen, under the guidance of the two Duverneys, father and son, and of Elias Camerarius, all three of whom were professors of considerable celebrity in their respective departments. Jean Guichard Duverney (1691–1759), for example, was the first anatomist to furnish a complete and very thorough description of the solar plexus.

An incident which occurred during his student days at Tübingen reveals so strikingly von Haller’s strength of purpose and his unwillingness to permit anything to divert him from the path which he had decided to follow, that I shall not hesitate to relate it briefly here. In company with a few of his fellow students he participated in one of those beer-drinking bouts which are of such frequent occurrence in German university towns, and was in due course of time made acquainted with the legitimate effects that follow such excessive indulgence—effects that are felt as “seediness” and a sense of physical misery (symptoms to which the Germans have given the striking but untranslatable name of Katzenjammer). This single experience sufficed to impress upon von Haller’s mind the folly of such indulgence and he never afterward permitted himself to take part in an excess of this nature.

Although von Haller, upon the death of his father, had been left with very slender financial means, he managed, under the guidance of Albinus, on leaving Tübingen in 1725, to visit Leyden, in Holland, where he was able to prosecute his anatomical researches and at the same time to follow the instruction of Boerhaave, who was still at that period in full possession of his powers as a teacher. Extraordinary as it will appear to the physicians of to-day, von Haller, when only nineteen years old, passed successfully the required examinations at Leyden and was given the degree of Doctor of Medicine (1727).

From Holland von Haller went first to London, where he accepted the invitation of James Douglas, the anatomist, to assist him in his studies of the structure of the bones. Then from there he next visited Paris (1728), where he had for his teachers Le Dran, the distinguished French surgeon, and Winslow, the well-known anatomist. It was his original intention to make a prolonged stay in the French metropolis, but, unfortunately, his ambition to get ahead as fast as possible in the study of anatomy led him to disregard certain precautions which, in the early part of the eighteenth century, it was not at all safe for men interested in this branch of medical science to neglect. Recognizing the fact that, in order to advance his knowledge of anatomy, he must have a certain amount of human dissecting material at his command, and finding that he could procure this material in no other way than by the process commonly known as “body-snatching,” he decided, in association with one of the prosectors of the medical school, to adopt that method of procuring the material needed. The plan was successfully carried out, the disinterred body was transferred to von Haller’s apartment, and the two enthusiastic anatomists had already done a certain amount of dissecting when an unexpected obstacle was encountered. The layman who occupied the adjoining room overheard enough of the conversation that was being carried on between von Haller and his friend to suspect strongly the true nature of the work in which they were engaged. But, to make sure that his surmise was correct, he bored a peek-hole through the partition wall, and thus was able to remove from his mind all doubt about the nature of this work. The police were promptly notified, and von Haller was summoned to appear before the authorities to answer the charge of having disobeyed the law relating to dissections of the human body. Not being able to furnish a satisfactory reply to this charge, and wishing to escape from the severe penalties that would certainly have been inflicted upon him had he been apprehended, von Haller went at once into hiding in Paris and eventually succeeded in making his way over the border into Switzerland.

LAUSANNÆ,
Vignette from the title-page of Haller’s “Elementa Physiologiæ,” Lausanne,
1757

In 1729 he began the practice of medicine in his native city, after having taught anatomy for a short time in Basel; but he took only a subordinate interest in the treatment of disease, his preference being strongly for the scientific and literary parts of medicine. In 1734 or soon afterward he published a collection of his own odes and letters in German verses. These reveal very fully the nobility of his character, his good sense and the high standard of his philosophy. Dezeimeris says that von Haller offers the very first example of a man who has been able to develop to an equal degree his talents of poet and of anatomist.

In 1735 he was appointed Chief Custodian of the Public Library at Berne, and while he held this office he prepared a catalogue raisonné of all the books contained in that collection. At the same time he wrote a classified, chronologically arranged list of the 5000 or more coins and medals which are preserved in the library.

In 1736 the Hanover Regency offered him the professorship of anatomy, botany and surgery in the University of Goettingen, and agreed at the same time to furnish all the money needed for carrying out the extensive plans which he had formed for improving the facilities for teaching these branches of medical science. Von Haller unhesitatingly accepted the invitation, and during the following seventeen years (1736–1753) devoted his time and his best efforts to the fulfilment of the duties which his triple chair involved. Not only did anatomy, botany and surgery greatly thrive during this long period of time, but the university through his intelligent efforts gained in many other directions. It was upon his advice, for example, that the beautiful anatomical theatre at Goettingen was built and equipped. The botanical garden was another of the creations at Goettingen which owed its existence to von Haller. If I were to furnish a list of the improvements which, one after the other, were carried out in the university at his suggestion I would certainly be obliged to mention among other things the following: an establishment in which pupils might receive proper training in anatomical and botanical drawing; the creation of a cabinet of anatomical specimens and of a college of surgery; and finally the founding of a school for midwives. In short, it was largely due to von Haller’s enlightened conception of what such an institution of learning requires and to his untiring efforts that the University of Goettingen became, toward the end of the eighteenth century and during the first half of the nineteenth, one of the leading universities of Europe. Indeed he might justly be called its founder.

Von Haller’s health suffered under this long strain, and he was therefore more than justified in asking the Regency of Hanover for permission to resign and take up his residence in Switzerland. His request was unhesitatingly granted; and, after resting for a few months from his recent labors, von Haller resumed those quiet literary undertakings which he loved so keenly and which enabled him to publish such famous works as the following:—

“Primae Lineae Physiologiae” (First Lines of Physiology), Goettingen, 1747 (also 1751)—the very first systematic treatise on physiology of which we have any knowledge. A German edition was not published until 1759–1776.

Commentaries on Boerhaave’s “Institutiones Medicinae,” 1739–1744.

“Elementa Physiologiae Corporis Humani,” 8 vols., Lausanne, 1757–1766; the most important of all his works.

“Bibliotheca Anatomica,” 2 vols., 1774–1777.

“Bibliotheca Chirurgica,” 2 vols., 1774–1775.

“Bibliotheca Medicinae Practicae,” 4 vols., 1776–1788.

“Expériences sur les Parties Sensibles et Irritables,” 4 parts, Lausanne, 1759.

These titles represent only a small part of the numerous books and elaborate essays published by this tireless worker. In 1749 he was ennobled by the Emperor, thus gaining the right, so highly esteemed in Germany, of placing a “von” before his name.

In the middle of the eighteenth century there appears to have existed considerable confusion in the minds of scientific men regarding the distinction between the terms “sensibility” and “irritability,” and to von Haller is due the credit of having once and for all defined the correct meaning of these words. As early as in 1747, when he published the first edition of his treatise on physiology, von Haller taught that the contractile force of muscles is supplied by the nerves, and that in this way they acquire irritability, a force which they cannot exercise except through the influence of the nerves. Irritability, therefore, is not a characteristic that originates in muscular tissue but is conferred upon it by the nerves. Von Haller’s experiments reveal the fact that the heart possesses the maximum degree of irritability. Next in order come the intestines and the diaphragm, the ordinary red muscles possessing a lesser degree of irritability.

In order that the reader may form at least some idea of von Haller’s manner of treating physiological topics I give below a rough translation[^[6]] of the first three paragraphs which occur in Chapter XX of his Primae Lineae Physiologiae (edition of 1751):—

Sleep

564.—The power which a person in perfect health possesses freely to exercise the different senses and to perform voluntary movements is called wakefulness or the state of being awake; the absence of the power to make voluntary movements and to utilize the different senses, combined with the quietude of all of them, bears the name of sleep.

565.—In sleep the mind either stops thinking entirely of the things which have been stored up by the individual in his memory or which are well-known facts, or else it busies itself exclusively with certain ideas or with impressions that produce upon the mind, at the time, pictures almost as vivid as the actual things or occurrences which they represent would produce. The term “insomnia” is employed when it is desired to designate the latter condition of the mind, and the mental pictures thus presented produce the effect that—although voluntary motions are at the time all in abeyance, and although the mind is absolutely quiet in all other respects—there remain certain directions in which it continues to operate actively, thus producing an elevation of the spirits (i.e., a certain degree of excitement) and more or less wakefulness. Sometimes a certain number of voluntary movements are associated with these mental impressions, and this may occur in such a degree that the organs of speech and many of the joints—indeed at times all of them—are compelled to act in harmony with the mental impressions. When this degree of insomnia is reached the person so affected is called a “somnambulist.”

566.—But in sleep the distribution of the humors of the body goes on without let or hindrance; and, similarly, the circulation of the blood, the peristaltic action of the stomach, intestines and sphincters, and the respiratory movements continue their activity. This complex state of affairs—viz., the coexistence of quietude of certain parts of the body with continued motion in other parts—has made it difficult to ascertain the mechanical cause of sleep.[^[7]]

In his investigations into these subjects, von Haller placed his reliance mainly on vivisections and on experiments made upon animals. “A single experiment of this nature,” he said, “is often sufficient to disprove the deceptive conclusions or views that have prevailed through a period of years.” It is to John Hunter of England, however, says Puschmann, that the greatest credit is due for the introduction of the experimental method as a means of ascertaining the truth in questions of pathology; and von Haller was unquestionably one of the first German physicians to adopt the method.

Von Haller died at Berne on December 12, 1777.

Johann Georg Zimmermann was born in 1728 at Brugg in the Canton de Berne, Switzerland. Left an orphan at the age of eighteen, and obliged without aid from outside to choose the career which he would follow, he decided to study medicine; and with this object in view he went to Goettingen, Germany, where he was received into the family of Albrecht von Haller, who was at that time a professor in the university. Five years later (1751), when he took his doctor’s degree, he chose for the subject of his thesis, at von Haller’s suggestion, the doctrine of irritability. Upon his return to Berne in 1752, he began the practice of medicine and shortly afterward accepted the position of official physician for his native town of Brugg. It was during this period of his life that he wrote those treatises which made his name famous throughout Germany, viz., “On Solitude,” Zuerich, 1756; “On Experience in the Practice of Medicine,” Zuerich, 1763 and 1767; “On National Pride,” Zuerich, 1768 (5th edition); and “On the Epidemic of Dysentery which prevailed during the year 1765,” Zuerich, 1767 (later edition in 1789).

In 1768, through the influence of Dr. Tissot, of Lausanne, he was given the appointment of Physician to the King of England at the Court of Hanover. During the last years of his life he took a great interest in political events, recognizing with remarkable foresight the approach of an immense revolution. So strong was his belief that current events pointed to the approach of such a catastrophe, and so depressing were the effects of this belief upon his naturally hypochondriac type of mind, that the last years of his life were thereby rendered most painful. He died on October 7, 1795, not long after the full effects of the Reign of Terror had developed in France.

Tissot, who had known Zimmermann well for more than forty years, has written a most interesting notice of his life and has placed a just estimate upon the value of his writings. (Dezeimeris.) Sprengel, the author of a well-known and highly esteemed history of medicine, speaks in the following terms of Zimmermann’s treatise “On Experience in the Practice of Medicine”:—

The manly and brilliant style in which it is written, its fascinating eloquence, and the special talent which the author displays in rendering marvelously clear—without at the same time robbing them of any of their accuracy—the most obscure topics, make this book of Zimmermann’s a veritable chef-d’oeuvre.... The importance of genuine experience, its difference from false or blind routine, the advantages which real erudition confers and the necessity of combining it with experience, the nature of the obstacles which an observing spirit must overcome, the absolute need of good observations and the useful qualities which they should possess, the effects of genius, and the manner in which conclusions are to be drawn by analogy and by induction—these are the questions with which the author of this classical treatise deals.

CHAPTER V

THE EARLIEST PUBLICATION IN EUROPE OF A SYSTEMATIC TREATISE ON HYGIENE, PUBLIC HEALTH AND MEDICO-LEGAL SCIENCE

In the early part of the eighteenth century municipal and private-house sanitation existed in comparatively few cities of Europe, and then only in the wealthier quarters. Such a thing as sanitary police was practically unknown, and public health was considered only when the inhabitants were threatened with a serious epidemic like that of cholera, the plague, or leprosy. This indifference to public sanitation persisted down to the end of the nineteenth century. On arriving in Paris in the spring of 1857, at a time when the city was overcrowded with travelers, my friend and I were glad to secure a room on the fourth story of a modest hotel situated in the central part of the city, quite near the Palais Royal. We found no good reason to complain of the room itself; it was clean and adequately well ventilated. But the toilet facilities were such as one might expect to find in a hotel of the fourteenth or fifteenth century. On the roof of our building a lean-to had been constructed alongside a broad brick chimney, and this shack, which was distant at least forty feet from the doorway that led by a short stair-case to the fourth story of the hotel, could be reached only over a narrow plank walk that was wholly unprotected by a railing. Then again, on a bicycling trip which I made in 1896, through the central part of France, my friend and I experienced more than one surprise of a similar nature. For example, in several of the smaller towns we found that the ancient practice of throwing the slops out of the second-story windows into the middle of the narrow street, still persisted. But, in a matter of this kind, nothing is to be gained by entering into many details; “enough is as good as a feast.” I merely wish to emphasize the fact that even France, where civilization was so far advanced in many respects, was fearfully slow in adopting the first principles of house and municipal sanitation. It was only toward the end of the nineteenth century that London, the birthplace of the finest types of house and municipal sanitation, began to give serious attention to this subject. During the early part of the eighteenth century, however, even this great metropolis was very backward in manifesting any marked desire to improve the sanitary condition of its dwellings; for, was it not the Earl of Chesterfield who, at this very period of time (about 1750) made the statement, in a letter to his natural son, that “the lanes or narrow passage-ways in Holland are cleaner than the houses are in London?”

It was in Germany, many of my readers will doubtless be surprised to learn, that the first really serious attempt was made to present to the world a scientific treatise on this subject, a work which was published in several consecutive volumes and which even to-day is consulted as a most trustworthy and remarkably complete authority on municipal and private-house sanitation. The work referred to was written by J. P. Frank.

Johann Peter Frank, more commonly spoken of as Peter Frank, was born in 1745 at Rothalben, a village located in territory which at that time belonged to the Grand Duchy of Baden. He received a good preliminary training at the High School of Pont-à-Mousson, and then afterward took courses at the Universities of Heidelberg and Strassburg. His medical degree was bestowed upon him in 1766 by the first of these institutions, the subject of his thesis being “Medical Police.” Two years later he commenced the practice of his profession at the city of Baden-Baden, and in 1769 was appointed Court Physician at Rastatt.

During these early years of his career he did not lose interest in the subject which he had chosen for his thesis, but continued to work upon it until, in 1768, he was ready to submit to a bookseller the manuscript of Vol. I. The latter, after receiving from a so-called medical expert an unfavorable report on the quality of the text, expressed his unwillingness to publish the work. Frank’s discouragement over this result was so great that he proceeded without delay to throw the manuscript into the fire. Then, after further reflection, he decided to begin work afresh on the same theme, and thus it came about that he devoted the following eleven years to the preparation of a new text for Vol. I. In 1779 this first volume was published. In 1780, 1783, 1788 and 1813 four more volumes were issued. Volume VI and two supplementary volumes were issued between the years 1817 and 1819.

“Notwithstanding its defects,” says Puschmann, “this work is one of the most important, one of the greatest and most creditable pieces of medical literature of which the Germans may rightfully boast. Blumenbach called it a classic, the first treatise of its kind and indeed possessing a unique character.”

Of the other works published by Peter Frank, works which deal with pathology and the practice of medicine, the most important is that entitled “De Curandis Hominum Morbis Epitome” (“An abridged treatise on the diseases to which man is liable”). As he progressed with the writing of this treatise Frank undoubtedly discovered that he could not, with any degree of satisfaction, accomplish his original design of compressing what he had to say into an “epitome”; and so, from this time forward, he carried on the work, without paying any further attention to his original plan of an abridgment, until the book had reached its sixth volume; and even then it was not completed.[^[8]] Despite its incompleteness this work passed through several editions, for it was highly appreciated for its practical character and for the clearness of its descriptions of disease.

In 1785 Frank accepted an invitation to take charge of the clinical instruction at the University of Pavia, in the place of Tissot who had resigned. Through Frank’s advice and persistent efforts the medical department of the Pavia University was enriched by the addition of a chair of physiology and comparative anatomy, an anatomical theatre capable of seating 400 auditors, and a collection of pathologico-anatomical preparations to which all the hospitals of that part of Lombardy were obliged to contribute suitable specimens. The establishment of a surgical clinic was another of the improvements in the teaching facilities of the University that should be credited to Peter Frank. The length of the medical course was at his suggestion extended to five years. Among his associates in the Faculty at this period were the following distinguished men: Scarpa, in the chair of surgery, Scopoli, in that of pharmacology, and Volta in physics.

In November, 1795, Frank returned to Vienna and was almost immediately appointed Director of the Allgemeine Krankenhaus and Professor of the Medical Clinic with a salary of 5,000 florins and the privilege of occupying rent-free a house that was located in the immediate neighborhood of the hospital. At the same time the title of Aulic Councillor (Hofrath) was conferred upon him. One of the first improvements which he effected in the clinic was to have the small wards for male and female patients materially enlarged so that when twenty-five or thirty patients were present, as was often the case, the air might not become noticeably contaminated and thus rendered unfit for all who were present to breathe.

In his teaching Frank never forgot, on all possible occasions, to impress upon the students the importance of thinking independently on the subjects that were brought before them, as in this way they would learn to distinguish the false from the true. Whenever he discovered that he had made a mistake in one of his statements he did not hesitate to confess the fact. His son, Joseph, is responsible for the statement that his father never seemed to him happier than when he had an opportunity of making to his auditors some such speech as the following: “Gentlemen! Strike out this or that line in one of the volumes of my work! When I wrote it I believed that it was correct; but now I am convinced that the very opposite is the truth!” When Brunonianism was first transplanted from Great Britain to the Continent and was received enthusiastically by many physicians, Frank was not disposed immediately to accept its teachings, and yet at the same time he did not believe that it was quite fair to ignore the thing altogether. Not a few men inferred from this hesitating attitude on his part that he rather favored Brown’s system. As a matter of fact he was an eclectic in his views and was always ready to appropriate whatever seemed to him good in any system or school of doctrines. As Director of the Allgemeine Krankenhaus he adopted the plan of having the leading physicians and surgeons of the Clinic first report publicly once a week what were the important diseases that had come under observation during that period; and then he would call upon the auditors to discuss the subject freely.

Peter Frank died at his home in Vienna on April 24, 1821.

CHAPTER VI

TWO EMINENT GERMAN SURGEONS OF THE PRE-ANTISEPTIC PERIOD

Johann Friedrich Dieffenbach, born in 1794 at Koenigsberg, an important city of Northern Prussia, received his early medical education in France; first under Boyer, Dupuytren, Larrey and Magendie, at Paris, and then later at Montpellier, under Delpech. After his return to Germany in 1823 he devoted his efforts largely to surgery, and soon distinguished himself so greatly in this department of medicine that in 1840, after the death of Karl von Graefe, he was chosen his successor in the office of Director of the University Surgical Clinic at Berlin. His death occurred in 1847.

Dieffenbach was universally considered a very clever operator, particularly in the field of plastic surgery. He was distinguished by a high degree of manual skill, remarkable presence of mind under the most trying circumstances, and boldness combined with prudence. His triumphs in the reconstruction of damaged parts of the body, effected largely by the transplantation of flaps of normal skin, were quite remarkable; he seemed to know just what steps were required for restoring a mutilated soft palate, ear, nose, eyelid, etc. But his interest was not confined to plastic surgery; he also performed successful operations in tenotomy, myotomy, transfusion of blood, and the injection of drug infusions into the veins.

The Schleswig-Holstein campaign, says George Korn in his “Progress of Medicine during the Nineteenth Century,” furnished a great stimulus to the advance of German surgery, by providing an extensive field for the activity of such men as von Langenbeck, Stromeyer and his son-in-law, Esmarch. The scantiness of available space, as well as of satisfactory sources of information, compels me to give here only the briefest details concerning these three distinguished surgeons.

The founder of modern German surgery, says George Korn, was Bernhard von Langenbeck (1810–1887). When he began active work as a surgeon he was already thoroughly familiar with human anatomy, physiology and pathology, and with the experimental methods of research. His first appearance as a teacher was at the University of Goettingen, where he remained for a few years, and then moved to Berlin, to occupy the chair of surgery vacated in 1847 by the death of Johann Friedrich Dieffenbach. In 1882 he gave up his professorship in Berlin and retired to Wiesbaden, where he spent the remainder of his life in quietude.

Before von Langenbeck’s day much stress was laid in Germany upon the importance of anatomy in its relationship to the science of surgery. It was a common practice in the medical schools, for example, to combine in one the two chairs of anatomy and surgery, and, imbued with the idea that this viewpoint was the correct one for them to adopt, the leaders in surgery, with few exceptions, strove to make advances in their branch of knowledge by cultivating energetically the study of anatomy. The efforts of von Langenbeck and his followers, on the other hand, were directed to giving new life to surgery by calling to its aid physiology, pathological anatomy and pathological histology, as well as experiments upon animals, sources of information which before von Langenbeck’s time had been very little utilized by the surgeons. Korn, in his comments upon the preceding statement, begs the reader not to interpret it as signifying that von Langenbeck permitted himself to neglect anatomy in the slightest degree. Quite the contrary, he continued to insist upon it that a knowledge of anatomy was the most useful foundation upon which a surgeon could build. As corroborative evidence of the correctness of Korn’s statement I will quote here the remarks made by an English physician who visited Goettingen in 1818 (London Quarterly Journal of Foreign Medicine and Surgery, Vol. 1, 1818–1819):—

We were pleased in observing the great attention which Professor von Langenbeck paid in these clinical exercises to relative anatomy. He omitted no opportunity of impressing on the students that the mere dissection of bodies could never make them good anatomists, and that, as surgery without the knowledge of anatomy would be a dangerous art, so anatomy without a constant reference and application to the living body would be vain and futile....

The foundation of the surgical hospital at Goettingen is entirely due to Professor von Langenbeck. In 1807, at his representations, a certain sum was appropriated to its support from the Cloister-fund. In 1808 the professor built the present hospital, which is still his own property, the Hanoverian Government paying him a yearly rent for it. The beautiful collection of surgical instruments also belongs to the professor.... The whole as it now (1818) stands is undoubtedly the first in Germany. It comprises all instruments that have ever been used in surgery from the earliest days to the present time.

Professor von Langenbeck, as a practical surgeon, is unrivalled in Germany. We have seldom seen a man so enthusiastically devoted to any pursuit, or who brought to the profession of surgery more capability of excelling in it.... As an operator, he is unrivalled in his own country, and we are not aware that he is excelled in any. He is clear and decisive in his judgments.

This account certainly places von Langenbeck on a very high pedestal, and reveals the true reasons of his great popularity as a teacher. Upon a close analysis these reasons may be stated thus: they were whole-heartedness in his chosen work; readiness to sacrifice himself, if necessary, in order to secure every possible advantage for his pupils; and the possession of the rare gift of knowing how best to impart knowledge to those who show a strong desire to acquire it. It is not to be wondered at, therefore, that von Langenbeck was such a favorite with such pupils as Hueter, Trendelenburg, Gurlt, Luecke, von Esmarch and Billroth, all of whom in time acquired celebrity as surgeons.

One more point deserves to be mentioned here: von Langenbeck was an accomplished master in the technique of operative work, and he took pains to transmit his skill to his pupils. One of his great feats, as narrated by those who often witnessed incidents of this nature, is briefly described as follows:—von Langenbeck would appear from time to time at the operating table dressed in a light summer suit of clothes, and would immediately proceed to his work without putting on a gown or taking other measures to protect himself from the soiling which so frequently is associated with operative work; and yet, when the operation was completed, the closest observation failed to discover a single spot of blood or other pathological product upon his clothes. The narrator of this tale evidently believed, and perhaps rightly, that the incident showed how thoroughly familiar von Langenbeck was with the distribution of the blood-vessels that supplied the region upon which he was operating and also how skilful he was in the handling of his scalpel. The incident, it should be remembered, occurred many years before it was thought necessary to take certain precautions against the spread of infection.

CHAPTER VII

A GENERAL SURVEY OF GERMAN MEDICINE AT THE END OF THE EIGHTEENTH CENTURY

Among those who read the present chapter there may be some who will express surprise at the gloomy character of the picture which I draw of the state of medical affairs in Germany at the period of time now under consideration. In answer to this implied criticism I would state that I am in no degree responsible for the unpleasant impression conveyed by the picture, as I have simply reproduced, without the slightest exaggeration, the account which such excellent authorities as August Hirsch, of Berlin, and George Korn, of Munich, give in their published writings. Furthermore, I have not hesitated to quote, wherever I could do so without obscuring the clarity of my account, the actual statements of these authors. However gloomy, therefore, the picture here presented may appear, this unattractive characteristic must be attributed to the actual condition of medical affairs in Germany during the period named.

At the end of the eighteenth century and at the beginning of the nineteenth culture entered upon an entirely new phase of development in all parts of the civilized world; more quickly in certain parts than in others because the seeds of such development had already begun there to take root. In this work of development John Locke, the English philosopher, was a conspicuous leader. His philosophy formed the starting-point of the new development of the natural sciences, first in France and afterward in Germany and other European countries. Voltaire was the first among the French philosophers to advocate the teachings of Locke in opposition to those of Descartes (i.e., realistic rather than as the result of a priori reasoning). Condillac, another great French philosopher (1715–1780), also expressed himself as approving the views set forth by Voltaire,—that is, in favor of Locke’s philosophy. Diderot and others among the encyclopaedists sanctioned the same teachings. As Hirsch expresses it:—

These ideas broke like a thunderstorm over the thinking classes of France and spread rapidly to the other countries; the French Revolution cleared the atmosphere in all the different walks of life; it cast off the fetters of feudalism or at least materially loosened their hold; it greatly increased tolerance of religious beliefs and placed limits upon superstition.

At this period of time Germany was still living under deplorable conditions. The after-effects of the Thirty Years’ War still lingered. Those Germans who wished to lay some claim to culture were obliged to think, speak and write in French. The great mass of the people, however, were still bound hand and foot under the dominion of their spiritual and state tyrants. The learned classes still cultivated a barbaric Latin in their university lectures and in their writings. They considered it beneath their dignity to cultivate their own tongue. In the schools and universities the teaching had reached a decidedly low ebb. “The humanistic spirit” had vanished; the teaching was directed to the acquisition of the science of bread-winning. The Roman Catholic Church at this time was entirely in the hands of the Jesuits; the Protestant Church was no longer guided by the high ideals of its founder. A hollow dogmatism had put a stop to all further search for the truth; the one important thing was orthodoxy. There had developed a Protestant hierarchy that exerted as stupefying an influence upon the great mass of the people as did the Jesuits in the Roman Catholic Church. Superstition and charlatanry permeated the medical profession. These superstitious beliefs found lodgment in the minds of even such otherwise great physicians as Friedrich Hoffmann, Georg Ernst Stahl and Anton de Haen, one of Boerhaave’s distinguished pupils and a celebrated clinical teacher.

After the lapse of a few years—that is, in 1842—there was founded a new German periodical, the Archiv für Physiologische Heilkunde, under the management of Wunderlich and Roser. According to the Prospectus it was to be devoted to physiological medicine, or—to be more precise—to the cultivation of physiological methods in the treatment of disease. The introductory article in the first number of this new periodical bore the title: “The Defects of German Medicine as Taught to-day and the Importance of Giving it a Decidedly Scientific Tendency.” From the convincing style in which the article is written there can be no mistake, says Petersen, in ascribing its authorship to Karl August Wunderlich (1815–1877), a member of the Tübingen Faculty of Medicine. The following brief extracts from this article will suffice to give the reader a fair idea of this writer’s views on the subject of which he treats:—

We are establishing to-day an organ which is intended to promote the interests of physiological medicine. Henceforth it should be the aim of all enlightened minds to place pathology upon a physiological basis.[^[9]] Nothing of a dogmatic character may be tolerated in these pages; every law here promulgated must be accompanied by proofs showing that it is justified; all the facts, observations and experiments that have led to its acceptance as a law must form a part of the account. Although for a long time past the necessity of following the course here outlined has been appreciated and has been unostentatiously adopted by all good observers, nevertheless, it is believed that the time has now come when this important fundamental truth should be announced loudly and in no uncertain terms, and should be defended again and again with untiring energy, until it shall have received universal acceptance.... People are already beginning to make a distinction between the doctrines taught in the books and those which are derived from a direct observation of what takes place in nature.... But this scepticism is only too often based upon mere assumptions and consequently fails to produce any useful results.... We believe that the time has at last arrived when this sort of scepticism should be organized into something like a system, and that intelligent criticism should persevere in testing the correctness of those observations which have been cited as actual facts and as the bases upon which the hitherto prevailing medical theories, so it is claimed, deserve to receive acceptance.

We further believe that to-day is the time when an attempt should be made to construct, out of the clinical materials that are now in our possession and that have been brought together with great care and without bias, a positive science, a science which in the course of time cannot fail to lead to sound therapeutic methods. This is what we mean by the expression “Physiological Medicine.”

Up to this point in his article Wunderlich says nothing to which any of my readers are likely to object. Quite the contrary; the first impression which the text makes is something like this: At last Wunderlich has discovered a road by following which closely one may eventually develop a really scientific practical medicine. But, when one reaches the end of the article, one can scarcely fail to experience no small degree of disappointment on finding that it does not furnish the slightest evidence of the manner in which the author’s seemingly admirable scheme is to be realized; nor—as we are assured by Petersen—is any further enlightenment upon this subject to be found in any of the succeeding volumes, either in the seven which were published under the joint editorship of Wunderlich and Roser, or in those which were issued after Wilhelm Griesinger had been accepted as an associate in the management of the Archiv. The old evil which carried Broussais as it were by storm into the dictatorship of medical thinking and of medical practice in France was here being reëstablished in Germany. Men seemed to find it impossible to go on patiently collecting facts; they could not resist the temptation to build theories first. So far at least as the treatment of disease is concerned, we are forced to admit that the collecting of any large body of facts is well-nigh an impossibility. Only after the lapse of very many years would it be possible to realize the desirable results which Wunderlich had in mind.

BOOK III

THE VIENNA SCHOOL OF MEDICINE

CHAPTER VIII

GERHARD VAN SWIETEN

(1700–1772)

A short time before his death the Hollander, Gerhard van Swieten, who was one of the last physicians of European celebrity to give up the habit of conversing in Latin with his professional brethren, made the following remark, in a letter which he wrote to one of his friends in the Medical Faculty of Halle: “Praxis medica quotidie me convincit quot et quanta sint quae ignoro.” (In my medical practice I realize more and more clearly every day how many and how important are the things concerning which I am ignorant.) This epigrammatic remark, which throws such a flood of light upon the character of van Swieten, may appropriately be placed at the head of the following brief biographical sketch of this distinguished founder of the Vienna School of Medicine.

GERARD FREYHERR VAN SWIETEN

Van Swieten’s Early Professional Career.—Gerhard van Swieten was born at Leyden, Holland, on May 7, 1700. His parents, who died while he was still a child, left to him an ample fortune, which enabled him to obtain an excellent education. His guardians, however, were either negligent or quite incompetent to look after his best interests during the period of youth and early manhood; but, despite this fact, his own industriousness, his native talents, his ambition to excel and his purity of mind carried him safely and creditably through these early years. At the age of sixteen he entered the High School of Louvain, near Brussels, and during the following two years the study of Latin and Greek and of philosophy chiefly engaged his attention. Then, upon his return to Leyden, he began in earnest to prepare himself for the career which he had chosen—viz., that of the practice of medicine. Boerhaave, who, at that period of time, represented by universal consent the leading medical authority of the world, was the regular professor of medicine in the university (1710–1738), and was held in such high esteem as a teacher that students flocked by hundreds from all parts of Europe to benefit from his instruction. Among this number were two young men,—Albrecht von Haller, of Berne, Switzerland, and the subject of the present sketch,—both of whom afterward became celebrated for the important parts which they played in the advancement of medical science. Boerhaave appears to have taken a special liking for the latter and to have entertained great confidence in his ability as a physician. In 1727, when Boerhaave, by reason of a gouty affection of his legs, began to experience considerable difficulty in attending to his official duties in the university, van Swieten, upon whom the degree of Doctor of Medicine had been conferred only two years previously, was from time to time authorized by his superior to lecture in his place. As the years passed by, and as the pupil showed more and more clearly that he was entirely competent to perform this important duty in behalf of his teacher, van Swieten came eventually to be accepted as the worthy interpreter of Boerhaave’s teachings. This practice continued for nearly twenty years, and with ever increasing confidence in and affection for the pupil on the part of his distinguished teacher. Boerhaave’s death in 1738, however, put an end to van Swieten’s substitute professorship. All the available evidence goes to show that Boerhaave hoped that, in the event of his death, van Swieten would be chosen his successor; but the records of the university fail to show that the latter held at any time an official position in the teaching body. During Boerhaave’s lifetime no opposition of any kind was offered to van Swieten’s continued yet officially unauthorized occupancy of the Chair of Medicine, although it was well known that he was a Roman Catholic; but, after Boerhaave’s death, the most active opposition to van Swieten’s candidacy was immediately organized by his rivals. The claim was made by them that he could not legally be chosen to fill the vacant chair, by reason of the fact that the university had been founded on a Protestant basis and that consequently it would not be either legal or proper to elect a Roman Catholic to fill the vacancy. When the personal friends of van Swieten and a large body of the students begged that, despite the legal obstacle, he might be chosen the regular successor of Boerhaave, he himself at once exerted all his authority to stop the movement. Nevertheless, he felt keenly the loss of his position in the University of Leyden, for he loved the work of teaching which he had carried on so successfully during the previous two decades.

Van Swieten’s retirement from the duties of a teacher in the university brought with it certain important compensations. In the first place he was now able to devote himself fully to his private practice which had by this time grown to be very large, and the way was also opened for him to begin work at once upon his “Commentaries,”—a book of which he completed the first volume in 1742, and which contained matter of decided importance in promoting an advance in the science of medicine. Some authorities claim that if one wishes to obtain a clear understanding of Boerhaave’s teachings, he will have to read van Swieten’s elaborate work, which in its completed state consists of five large volumes.[^[10]] Strange as it may appear, a Dutch translation of the work has never been published; from which fact two conclusions are warranted: first, that already as early as 1754 van Swieten must have severed all connection with his native land; and, second, that the number of physicians in Holland who might be tempted to purchase a Dutch version of the work was undoubtedly very small.

In November of the year 1744 van Swieten was called to Brussels to see, in consultation with her regular medical attendants, the Archduchess Marianne, wife of Charles Alexander of Lorraine, and the sister of Maria Theresa, Empress of Germany. She had recently been confined, after having been in poor health for several months before this event. It was therefore not surprising that at the delivery, on November 5, the child was found to be dead. Shortly after the confinement the condition of the Archduchess became rapidly worse, and it was then that Maria Theresa sent her own physician, Dr. Engel, from Vienna to consult with van Swieten and with her sister’s regular medical attendants. It appears that these two leading physicians frequently disagreed as to what was the best treatment to adopt; but van Swieten was so tactful in his advocacy of the measures which he thought advisable and so courteous in his intercourse with his professional associates that Prince Kaunitz, the Imperial Austrian Chancellor, who happened to be in Brussels at this time, wrote to the Empress in strongly commendatory terms of the impression which van Swieten had made upon him. However, the hope which the latter had held out with regard to the patient’s ultimate recovery was not realized; she died on December 12. Notwithstanding his failure to predict correctly the outcome of the Archduchess’ illness van Swieten had succeeded so completely in impressing all the patient’s immediate friends with his skill as a physician and with a genuine esteem for his personal character that they had only praise to bestow upon the man in their reports to the Empress. Maria Theresa’s mind was now entirely made up as to the wisdom of calling van Swieten to Vienna and entrusting to him the work of reorganizing the hospital management and the university medical teaching in her capital, matters in which she took a very deep interest. As soon as the decision reached by the Empress became generally known in Vienna certain physicians of that city lost no time in taking steps to thwart her plan. Scheming of this sort, however, had to be done very cautiously, for it was not safe openly to oppose the will of the sovereign. The first evidence of the existence of this intrigue to prevent the appointment of van Swieten to a position of such commanding importance in the medical world of Vienna appeared in a Frankfort newspaper of January 9, 1745. After announcing the death of the Archduchess Marianne at Brussels the article in question added the following remarks: “The fatal issue, it appears, is to be attributed to the unsuccessful treatment that was carried out by the local physicians with whom van Swieten of Leyden was associated as the chief consultant; it having been predicted from the very first by Dr. Engel, the imperial Austrian physician, that this treatment, if adopted, would terminate badly.” The Empress closed her ears to this and all similar calumnious reports, and wrote to van Swieten that it was her warmest wish that, when he came to Vienna, he might not experience any unpleasantness. “I would rather,” she added, “abandon completely my personal interest in this matter than have you made unhappy by the contemplated visit to Vienna.” While these gracious words from the Empress were greatly appreciated by van Swieten he was not willing to appear in Vienna in the rôle of a censor or a reformer; and so one is not surprised to learn that he did not take up his residence in the Austrian capital before June 7, 1745.

Van Swieten’s Work as a Medical Reformer.—So far as the teaching of medicine was concerned van Swieten found everything in the University in a state of confusion; indeed, nothing worthy the name of medical science existed in Vienna at that period of time. He had left a city in which the teaching of this branch of knowledge had reached a high degree of development and had come to one where the very foundations of such work had yet to be laid. He recognized at the first glance just what steps would have to be taken, and he was much encouraged by the thought that he could count upon the powerful support which Maria Theresa was only too glad to give him. According to Mueller, he realized that the most serious obstacle in his way was sure to be the very great influence wielded by the Jesuits, who had for many years controlled all educational matters in the Austrian Empire. He began his work by delivering a course of lectures on methods of treatment and on Boerhaave’s Principles of Medicine (“Institutions”), and he managed within a comparatively short time to attract large numbers of auditors, in whose minds was thus created a strong interest in the personality of the lecturer. At the same time van Swieten remained conscious of the fact that many of the members of the Faculty had not ceased to look upon him with keenly jealous eyes. In his memorial to the Empress on the progress which had thus far been made in the study of medicine he wrote: “Although the Faculty have not included my ‘Commentaries’ in the list of books which they recommend to the students, they emphasize by this very act the fact that physicians everywhere—as shown by the publication of five separate editions and two translations of my book in only six years—do not agree with these gentlemen in regard to the value of this work.” The continued favor shown to van Swieten by the Empress and the consciousness that he was doing his full share toward advancing the science of medicine compensated in large measure for the ungenerous spirit which animated his colleagues.

Reorganization of the Vienna Medical School.—But van Swieten rendered valuable services to the university in other ways than by lecturing, by acting as the Director of the Royal Library, and by serving as the private physician of the Empress, its great patron. For example, it was his duty, after a certain time had elapsed, to select additional professors for the Medical Department, and in this work he also manifested excellent judgment; but he was not called upon to exercise this particular function until after he had been settled in Vienna for about four years. As the first step in building up the teaching force van Swieten invited Anton de Haen (1703–1776), a native of Leyden and one of Boerhaave’s former pupils, to carry on the clinical teaching which he himself had already in some measure organized at the university. Speaking of de Haen’s qualifications for this important office, Hecker, the author of a history of modern medicine and a person entirely competent to pass judgment upon a matter of this kind, makes the following comments: “Vienna has seen few teachers as well fitted as de Haen for inspiring enthusiasm and for making clinical teaching effective, and few so capable as he was of showing his auditors with persuasive force how they should study Nature by direct observation, and not from books or lectures. Possessing no inclination whatever to indulge in social pleasures or in amusements of any kind, he found his chief enjoyment in tireless work. Knowledge was the priceless treasure which, by the aid of an unfailing memory and remarkable skill, he sought to win. Possessing, as he did, a quick temper, he became at times very angry under even slight provocation. Although such outbursts of temper did not conduce to his popularity they enabled him to boast that he had attained his lofty position wholly through merit, and not—as was in some measure true of van Swieten—through abstention from self-assertion.” Despite all his faults, adds Hecker, de Haen was a great physician and an extraordinarily clever teacher. He gained considerable reputation from the treatise which he published under the title: “Ratio Medendi” (The Philosophy of Treatment). He was a violent opponent of the practice of inoculation.

The next six men selected by van Swieten were also distinguished teachers, well fitted to uphold the growing celebrity of the Vienna Medical School. They were: Anton von Stoerck, commonly spoken of as van Swieten’s favorite pupil; Maximilian Stoll, one of de Haen’s pupils; Lorenz Grasser;[^[11]] Heinrich Crantz, another of van Swieten’s talented pupils; Robert Laugier; and Nikolaus Joseph Jacquin. While the addition of these unquestionably strong names to the list of professors in the medical department of the university was recognized as a move in the right direction, the retention of a few incompetent teachers led to considerable worry on the part of van Swieten. Although he was convinced that it would be better for the University to get rid of these men he did not dare to act on his own responsibility, fearing the disturbance that was likely to result from their dismissal. Maria Theresa, to whom the situation was fully explained, begged him not to hesitate any longer, but to take whatever steps seemed best for the good of the university and the public. Thus encouraged, van Swieten proceeded to remove first one and then another of the men who seriously interfered with his plans for improving the teaching in the Medical School. In 1757, on the death of Archbishop Trautson, who held the position of “Protector of the Studies in the University,” this office was abolished. Already in the preceding year, at van Swieten’s suggestion, the Rector of the Jesuits was no longer permitted by the Empress to take part in the regular conferences of the Consistory of the University. Gradually other members of the Jesuit Order were excluded from the management of the affairs of the University. Finally, in 1759, van Swieten accepted the office of Censor of Medical and Philosophical Writings, and up to the day of his death he performed the duties of his office most satisfactorily to all concerned. Thus was he made the virtual Commander-in-Chief of the teaching forces in the Vienna Medical School.

While the changes described above were taking place the Empress, under the inspiration given by van Swieten, inaugurated certain improvements in the housing and equipment of the Medical School. In 1752 she gave the necessary orders for constructing a new building that was to contain a fine anatomical theatre, a chemical laboratory, lecture rooms for the different professors, a general assembly hall, etc. This fine structure was completed and formally inaugurated in April, 1756.

Finally, all the hospitals in Vienna were greatly improved during this period of time, not only as regards their accommodations and equipment, but also in respect to their management.

Inauguration of Clinical Teaching.—As the sequel showed, Vienna, under the inspiring cooperation of the Empress, continued for a long series of years the Mecca toward which physicians and medical students turned their steps from all parts of Central and Northern Europe and even from the United States of America and from Canada. It is now universally recognized that this extraordinary popularity of the Vienna Medical School, which began toward the middle of the eighteenth century and has continued almost up to the present time, was chiefly due to the clinical teaching which de Haen inaugurated at van Swieten’s suggestion. Sylvius and, after him, Boerhaave had already given this method a trial at Leyden, but for various reasons it had not proved entirely satisfactory. De Haen’s plan was to let each student, at the bedside of the patient, make his own diagnosis and then whisper it to the professor, who in turn announced it to the remainder of the class. If the diagnosis proved to be correct the professor found it unnecessary to say anything additional on the subject; but, if it happened to be incorrect, he presented the truth to the class in such a manner as not to give the slightest offence to the student who had committed the error. This plan encouraged his pupils to feel confidence that, whenever they made an erroneous diagnosis, they would not be subjected to ridicule on the part of their classmates. This exercise in diagnosis was duly followed by an exposition of the treatment adopted; and, whenever it happened that a patient whose case had been studied by the class, subsequently died, a post-mortem examination was conducted in their presence, and appropriate explanatory remarks were made by the instructor.

In further explanation of the extraordinary popularity which the clinical teaching at Vienna attained it is interesting to learn that de Haen (and probably also Stoll, who succeeded him) was in the habit of rising at an early hour that he might visit the hospital and learn, in advance of the arrival of the students, how the patients in the section set apart for teaching purposes were getting on, how their condition differed from that which they presented at the time of his visit on the preceding day, and what special provision, if any, should be made for the approaching clinical lesson. In short, no pains were spared to make each séance as attractive and as instructive as possible to the students.

While I am here giving to de Haen and Stoll all the credit that is their due for the very wise and skilful manner in which they carried out the teaching of medicine at Vienna it must be remembered that van Swieten was the real founder of clinical instruction in the famous university; de Haen and Stoll having simply put in practice the ideas introduced by him.

At this point in my sketch the question may with propriety be asked, Where may one find in history another instance of such beneficent interference on the part of a queen in behalf of a higher standard of medical education? Certain it is that, without the powerful and sympathetic assistance which Maria Theresa granted him at every stage of his work, van Swieten could not have accomplished in so short a period of time the extraordinary results which I have here briefly recorded.

Van Swieten’s Contributions to Therapeutics.—In his treatment of disease van Swieten practiced conservative methods and prescribed remedies with great caution and with strong common sense. In the case of small-pox, for instance, he did not approve of the practice of inoculation as a method of diminishing the mortality of that disease or possibly of rendering the severity of its manifestations less pronounced. He evidently believed the attendant risk to be too great. It was particularly in his treatment of syphilis, however, that he accomplished results of a most beneficial character. In St. Mark’s Hospital, in which patients affected with this disease were lodged, it had been the rule—previous to the date of van Swieten’s arrival in Vienna—to subject all the cases, without regard to the severity of the infection, to a course of mercurial salivation. As a natural result of this plan of treatment it happened not infrequently that a patient’s life was severely threatened or that he was left with lifelong sequelae of a lamentable character. The physician under whose management this mode of treatment flourished was dismissed from his position by van Swieten as soon as he was able to overcome the obstacles which stood in his way as he advanced toward the accomplishment of this end. Maximilian Locher, who was put in charge of the hospital after the dismissal of his predecessor, was instructed to use a solution of the bichloride of mercury in the treatment of the cases that came under his care; and the results that followed were so astonishingly good that the remedy soon came to be known everywhere as “Swieten’s” liquor.[^[12]] For many subsequent years this solution retained its popularity among European physicians.

As regards the other remedies which van Swieten was in the habit of employing in his treatment of various maladies it is stated that he clung persistently to those advocated by Boerhaave and enumerated at the end of Vol. V of the Commentaries,—remedies which were characterized by their simplicity and by the fewness of the ingredients that entered into their composition.