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.

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.

Van Swieten’s Contributions to Medical Literature.—In addition to his famous “Commentaries” van Swieten wrote only one other treatise to which it seems desirable to call the reader’s attention. I refer to the book that bears the title “Constitutiones Epidemicae” and that was first published by Stoll after the author’s death. According to the statement of Mueller “this work is a sort of ‘Physician’s Day-Book,’ covering the period 1727–1744, and reveals the fact that van Swieten was a very close observer of the different diseases that came under his notice.... It constitutes a valuable supplement to the history of Boerhaave’s therapeutic methods.”

Finally, it should be stated, on the authority of Hecker, that van Swieten wrote a small manual for the use of military surgeons. It was published by Johann Thomas Trattnern, Court Printer and Bookseller, Vienna, Prague and Trieste, 1758. Van Swieten’s name—says Hecker—does not appear anywhere in the volume; and, furthermore, serious doubts have been expressed as to the correctness of the claim that van Swieten is the author of this little manual.

After van Swieten’s death in 1772, the bust of this distinguished physician, which already three years earlier the sculptor F. X. Messerschmied had been commissioned by the Empress to prepare, was set up in the auditorium of the Medical School; and in addition an elaborate monument in his honor was erected in the Hofkirche, the Royal Chapel.