Age of RÉnovation—(continued).—Iatromechanical School: Santoro, 15611635. Borelli, 1608-1679. Sydenham, 1624-1689. Sir Thomas Browne, 1605-1682.—Surgery: Denis, f 1704. F. Collot, f 1706. Dionis, f!718. Baulot (FrÈre Jacques), 1671-1714. Scultetus, 1595-1645. Rau, f 1719. Wiseman, 1625-1686. Cowper, 1666-1709. Sir C. Wren the Discoverer of Hypodermatic Medication. Anatomical Discoveries. General Condition of the Profession during the Seventeenth Century. The Eighteenth Century. Boerhaave, 1668-1738. Gaub, 1705-1780.—Animism: Stahl, 1660-1734.—Mechanico-dynamic System: Hoffmann, 1660-1742. Cullen, 1712-1790.—Old Vienna School: Van Swieten, 1700-1772. De HaËn, 1704-1776.—Vitalism: Borden, 1732-1796. Erasmus Darwin, 1731-1802.

The physiology of the Iatromathematical, or Iatro-mechanical, or Iatrophysical School devoted chief consideration to the solid parts of the economy, whose form and function it strove to discover and demonstrate by the aid of exact methods,—that is, by calculation and physical apparatus. Thus, it explained digestion as mechanical trituration; secretions were referred to variation in resistance of parts in the vascular system; warmth was supposed to be due to friction of the blood-corpuscles; health consisted in the undisturbed performance of the physical and mechanical processes of the body. Diseases were explained inversely: the blood, under diseased conditions, was held to contain pointed and angular crystals, which irritated as they passed through the pores, or disturbed because they could not so pass.

The first to enunciate these views was Santoro, or Sanctorius, who flourished from 1561 to 1635, and was for a while professor at Padua. He taught how to investigate the pulse by an instrument of his own contrivance, and how to study the temperature by means of a species of thermometer, which was probably his own invention. (This instrument, by the way, was invented about this time; Drebbel [1572-1634] is regarded as the inventor of the air-thermometer, Galileo [1574-1642] of the spirit-thermometer, and Roemer [1644-1710] of the mercurial thermometer.) Santoro studied the phenomenon of transpiration, and constructed apparatus for bathing bed-ridden individuals; he found that in twenty-four hours the insensible transpiration through the skin amounted to 1 1/4 kilogrammes,—which result, compared with the results of the present day, determined by the most complete observations, is only twenty per cent, too high, and proves how accurately he investigated. The important rÔle of the perspiration, which he pointed out, was made use of by the iatrochemists to vindicate their terrific sweat-cures.

Borelli (1608-1679), of Naples, is usually regarded, however, as the founder of the iatromechanical school. Of a quarrelsome disposition, he could not stay long in any one place, though he ultimately settled in Rome, where he joined the circle of savants who gathered round Christina, the daughter of Gustavus Adolphus, who had become a convert to Catholicism. Finally Borelli entered a monastery. His services related mainly to physiology, where, like Descartes, he followed purely mathematical principles; he explained the action of the muscles by the laws of the lever, calculated the mechanical work done by the heart, and correctly ascribed inspiration to muscular action. He was the opponent of iatrochemistry, and claimed there was no such thing as corruption of the blood. His pupils and followers—like Bellini (1643-1704). of Florence, who became professor in Pisa at the early age of nineteen, and Baglivi (1668-1707), a pupil of Malpighi, and a man of universal education—carried out and elaborated the first expressions of this author. Borelli was the author of the oft-quoted maxim: "He who diagnoses well cures well."

The iatromathematical system held ground for some time in Italy, and also found followers elsewhere. For instance, Dodart (1664-1707). of Paris, explained the voice on the mechanical principles enunciated by Borelli and by Quesnay (1694-1774). the tirst permanent secretary of the Academy of Surgery in Paris. In England this explanation was adopted by a number of followers, none of whom, however, was eminent enough to justify special mention here. In Germany it obtained a certain amount of favor, but seems not to have attracted any very eminent disciples.

The iatromechanical school ran a course not unprofit' able to science, yet was unfruitful of real advance in the domain of practical medicine. The man of this particular age, who, more than any other, exerted an influence destined to be prolonged even to the present time, and probably much longer, who had a cool, clear, and unprejudiced spirit, and who sought the true value of medicine, and recompense for the same in the benefits which it brings to the sick, without scorning or neglecting its scientific side, was Thomas Sydenham, bora at Winford Eagle in 1624. a student at Oxford in 1642, and recipient of a bachelor's degree of medicine in 1648.

The next fifteen years of his life we know practically nothing of, save that he spent some time in Montpellier pursuing his medical studies. In 1663 he became a member of the Royal College of Physicians, but did not take his degree of Doctor until 1676,—thirteen years before his death. His chief work—Medical Observations—is said to have been originally written in English, and translated into Latin; it first appeared in 1666,—the year when fire and plague devastated London. He died of gout in 1689, and was buried in Westminster Abbey. During the earliest years of the plague in London he fled, as was the general custom of that day.

His model was Hippocrates. In pathology he was a humoralist without being a theorist. He knew only one standard,—observation and experience. Sharing the opinions of his day, he laid but little weight upon anatomy and physiology; yet he recognized their value when employed in the production of hypotheses. He conceived of disease as active, operative,—a natural effort of the body to remove morbid material from the blood; if this effort is violent and speedy, we have to do, he says, with an acute disease, but if slow and difficult, the condition is chronic. Fever was supposed to result mostly from cold or from epidemic influences. As causes of disease, he considered unknown influences and changes of the atmosphere very important. In his special pathology "inflammation of the blood" played the chief rÔle, and upon it were made to depend nearly all acute and some chronic diseases. He arrived at what he called the "healing power of Nature," for which he made great claims in his description and observation of epidemics: but he believed there always remained a good deal for the physician to do, and in treating syphilis he even gave mercury until two kilogrammes of saliva were discharged daily. As compared with the therapeutics of that day his were manifestly simple,—and yet he employed, for example, eighteen different herbs in one prescription, and that merely an ointment. The unreliability of the action of drugs induced him to rely upon specifics, as did Paracelsus, but he acknowledged only one such,—the then new discovery, cinchona,—not even allowing mercury such a position in the treatment of syphilis. Such drugs as he chose were mainly from the vegetable kingdom.

The great importance of Sydenham, and all his statements, so far as we are concerned, centres about his struggle for the elucidation of the healing power of Nature, and for simple observation and simpler treatment, as opposed to the overgrown luxuriance of previous systems and theories. He became the standard-bearer of his age in his return to Hippocrates's method and art of healing, which are founded on the nature of things and on the limits of human ability.

Sydenham was vehemently opposed by Richard Morton (1625-1648), of London, who, like Fernel, considered all diseases to be a poisoning of the vital spirits. Sydenham was also antagonized by Gideon Harvey, who ridiculed his medical contemporaries without stint, because most of them, for febrile disease, gave cathartics from the second day, and began treatment with emetics. With delightful satire Harvey divided the physicians of the day into six classes: the Ferrea, Asinaria, Jesuitica, Aquaria, Laniaria, and Stercoraria, according as their favorite systems of treatment were the administration of iron, asses' milk, cinchona, mineral water, venesection, or purgatives.

Sir Thomas Browne (1605-1682), who still enjoys a great reputation, was the author of the works entitled Religlo Medici and Inquiries into Vulgar and Common Errors. The latter appeared in 1646, but does not seem to have protected its author from the worst error of his age,—viz., superstition,—since, in 1664, he swore that two condemned old women were actual witches.

Having considered the progress of medicine during the seventeenth century, it may be well to glance likewise at surgical progress. Among the Italians Santoro, already spoken of as the inventor of various instruments, should be mentioned; also Valsalva, who obtained a sound reputation as an operator, employed the ligature, and recommended a starvation plan for treating aneurism; Magati (1579-1647). who contended against the abuses of treating wounds by filling them with plasters, balsam, poultices, tents, etc., and of changing the dressing several times a day.—once in four days was better, he said; Severino (1580-1656), first a lawyer, then a professor at Xaples, and later an eminent surgeon, a good anatomist, and a particular friend of the actual cautery; Marchetti (1589-1673), a bold, versatile operator of Padua; and Borri, of Milan (1625-1695), skilled as an operator and an oculist but better known because of his sad fate, since he died in the prison of the Inquisition, alter a prison-life of twenty-five years, on account of too liberal religious views. There were also numerous other Italian surgeons who made a name, especially in plastic surgery, and particularly in that branch of it named rhinoplasty, by whose efforts one method of manufacturing a new nose came to be known as the "Italian method."

France, we must remember, was the home, during this century of Richelieu. Mazarin. Louis XIV. Corneille. Racine. MoliÈre. FÉnelou. La Fontaine. Boileau, Bossuet, and many other men eminent in literature and science. During this century the French laid the foundation for that leadership in surgery which they maintained for nearly two centuries. Let us mention, among their surgeons. Morel, who invented the tourniquet at the siege of BesanÇon, in the year 1674. There was also Jean Baptiste Denis (who died in 1704), physician to Louis XIV. who performed the first transfusion of blood in man. (Transfusion of the blood of the young into the veins of the old for the purposes of rejuvenation, was recommended by Libavius, in 1715, and Colle, of Padua, gave it new support by describing a method for its performance. In 1729 Boyle practiced transfusion on dogs. The London faculty sought the value of the operation after excessive haemorrhage, and Edmund King, physician to Charles II, in 1665 practiced transfusion from vein to vein. But Denis was the first to carry out the operation with lamb's blood upon a patient sinking under excessive venesection,—an operation which was very much abused at this time.) It was in this century that the French family of lithotomists—the Collots—distinguished themselves in their special line. The last member of the family, Francois, died in 1706. Their specialty must have found, at that time, considerable more material than comes to the front to-day.

Among the general surgeons of France were de Marque (1618), who distinguished himself as a bandager; Bienaise, who invented the bistoury cachÉ (1601-1631); de Launay (1649), monk and lithotomist; Goursaud, who survived his century, and who was the first to describe stercoral incarceration; Duverney, who demonstrated the growth and nutrition of the bones by periosteum; Lambert, who practiced injections in hydrocele; Andry, of Lyons, who wrote of orthopaedic surgery and originated the name orthopaedics; Pierre Dionis (who died in 1718), surgeon to the Empress Maria Theresa, famous in his art, and who first emphasized the effects of rickets upon the pelvis; and Boulot, better known as Beaulieu (1671-1714). who advanced himself from being a soldier and a day-laborer to become a physician, a famous lithotomist and surgeon. He finally joined the Franciscan order, where he obtained the name of FrÈre Jacques, under which title he passed for the inventor of lateral lithotomy. Then there were Saviard (1656-1702), surgeon-in-chief in the HÔtel-Dieu, who, among other things, determined the seat of hernial strangulation to be often in the neck of the sac; and Georges Mareschal (1658-1736), surgeon to Louis XIV, one of the founders of the Academy of Surgery, who has a record of eight lithotomies performed in half an hour, and who became famous for his services in improving the schools of surgery in France.

In this (the seventeenth) century, also, ophthalmology was much cultivated in France, although it was assigned to the despised surgeons. Those who won most renown in this line were Maitre Jean and Brisseau, who divide the honor of first recognizing the seat of true cataract. During this period, also, Duverney, Professor of Anatomy at Paris, was the first to systematically describe diseases of the ear in accordance with their anatomical seat.

In Spain scholarship sank more rapidly during this century than among any other people in history, due mainly to the loss of their political supremacy and their commerce to the Dutch and English, and to the utter failure, at home, of their efforts to introduce true unity of faith. In these efforts the industrious Moors were excluded, under Philip III. In art they maintained their standing,—attaining, in fact, in Murillo, the acme of their fame; but in other branches of industry they rapidly degenerated. Students of history will readily understand how little leisure the Spaniards had at this time to devote to the cultivation of science, including medicine and surgery. Of the two men who are mentioned during this century as Spanish surgeons, namely, Almeida and Ayala, we know practically nothing.

The Germans gained no such store of knowledge from their experience during the Thirty Years' War as did the French during their campaigns. The barber-surgeons, for the most part, still reigned supreme, and their guild contained some men of ability and independence of thought. The most notable man of the times was Fabricius Hildanus (1560-1634). Of him, however, I have already spoken as belonging rather to the previous century. He was the first learned German surgeon recognized and esteemed as such by his contemporaries. He was distinguished, also, as an oculist and aurist, and removed a particle of iron from the cornea by means of a magnet. A man of great operative genius, and a born surgeon, was Purmann (1648-1721), who greatly lamented the low condition of surgery in Germany, and regarded a knowledge of anatomy as the prime requisite for the surgeon; he employed the speculum in the diagnosis of syphilis, although it has been Ricord's boast that this was his own idea. Scultetus (1595-1645), of Ulm, was a famous surgical writer of this period, and a bandage of his devising is still in frequent use, and bears his name. Murait, of ZÜrich, was also a capable surgeon (1655-1733).

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The Dutch had but few men during this century who enjoyed any reputation as surgeons. The best among them was Rau (1658-1719), who, from being a poor boy, became a barber, traveled extensively, and was finally made Professor of Anatomy and Surgery in Leyden, where he introduced the innovation of teaching practical surgery upon the cadaver. He was especially famous as a lithotomist after the method of FrÈre Jacques, although he did not give instruction on this subject in his lectures.

By the way, it is an interesting fact that the clinical histories of many operations for stone during the seventeenth century were related in verse, and illustrated with plates. Harvey's vivisections were also related in verse.

Now, for the first time, do we begin to hear of English surgeons and English surgery. The most prominent, as well as almost the earliest, was Richard Wiseman (1595-1686), ordinary surgeon of James I, called sometimes the "Pride of England" and sometimes the "ParÉ of England,"—a bold, judicious operator, who took hold of every novelty and who accepted the ligature of ParÉ (always having the actual cautery at hand, in case the ligature should fail); he also amputated through sound parts, favored operating for strangulated hernia, and employed the trephine zealously. The first recorded operation for external urethrotomy for the relief of stricture is mentioned in Wiseman's writings.

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There were also William Cowper (1666-1709), a famous anatomist and surgeon; and Woolhouse, a famous, but ignorant, itinerant oculist. Sir Christopher Wren, architect of St. Paul's, was the first who devoted attention to injecting medicine into the veins,—a subject studied again much later and recently once more taken up. His example (in 1667) was followed by others, whose experiments demonstrated, as we know to-day, that the effects which follow the intravenous administration of drugs are the same as follow administration by the mouth.

Midwifery during the seventeenth century advanced even more rapidly than its mother-science surgery. The accouchement of women was intrusted in many cases to the care of educated men, who contributed not a little to the art. Anatomy and physiology contributed also their quota to a clearer knowledge of these diseases. The obstetric forceps were for so long a time kept secret that they were of small benefit at first to the obstetric art. Among the French who were especially prominent as promoters of midwifery must be mentioned Marguerite de la Marche, chief midwife of the HÔtel-Dieu; Francois Mauriceau, President of the College of St. Come; Jules Clement Delamotte, who was also a skillful surgeon; and Portal, who first proposed version by one foot Among the Germans a few midwives distinguished themselves as independent observers, most of all Justine Siegemundin, daughter of a minister, who devoted herself to midwifery with such success that she became court midwife; she recommended puncture of the membranes for the production of artificial delivery, and especially advocated bimanual version.

But, perhaps, the most significant advances were made in the direction of studies in anatomy, physiology, and pathology. The history of the circulation we have already taken up. After Harvey's time, and largely because of his researches, physiologists were divided into two parties with regard to the origin of life. These parties were known as animists and animalculists. It was largely by the later researches of Highmore (1613-1685) upon the anatomy of the testis and the epididymis, supplemented by those of Aubrey in Florence concerning the ovaries (which had been previously considered as female testicles), and the researches of Stenon concerning the muscular nature of the uterus, that a better knowledge of reproduction was established. De Graaf (1641-1673), a physician of Delft, Holland, pointed out the ovarian follicles, known to-day under his name, while Swammerdam (1637-1686) studied the comparative anatomy of the ovaries,—and was, by the way, the first to prove that the queen bee is a female. Needham, the London anatomist and physician, and Hoboken, of Utrecht, described more accurately the placenta and the coverings of the ovum.

Anatomical discoveries crowded along about this time. For instance, Wharton (1610-1673) discovered the sub-maxillary duct, named after him; Glisson (1647-1671) studied the liver and recognized its capsule, that still bears his name; Nuck injected the lymphatics with quicksilver, and studied the glands especially; Stenson discovered the excretory duct of the parotid, and Rivinius (his name being translated in German, Bachmann) found the sublingual duct; Peyer, Schafhausen, and Brunner, the latter a professor in Heidelberg, discovered the intestinal glands which bear their names; Wirsung, of Bavaria (who was assassinated in 1643 by another physician), discovered in the dissecting-room of Vesalius, at Padua, the excretory duct of the pancreas; Pacchioni found the bodies named after him in the dura mater; Havers, of London, discovered the synovial glands and the so-called Haversian canals; Cowper, already mentioned, discovered the small glands named after him, located in front of the prostate, and Bartholin yet other glands, in the labia, which bear his name; Mei-bom, professor in HelmstÀdt, discovered the small glands in the eyelids which are named after him. Besides these, many other discoveries might be recorded here, did time permit. One other, however, deserves to be mentioned, with which the name of Schneider (1614-1680) must always be honorably connected. He described the mucous membrane of the nose and demonstrated anatomically and clinically that not the brain, but this membrane, secretes the mucous discharge during fluxes from the nose. This overthrew at once and forever the ancient doctrine, which included so many and various "catarrhal" diseases. I might add also that the best and most complete description of the entire central nervous system which had been given up to this time was furnished by Vieussens.

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By the middle and latter portions of the seventeenth century most of the better physicians and surgeons had either assumed offices and positions in which they were supported by the State, or were settled in permanent residences, which was not the case with the mass of physicians in the sixteenth century. As a result the reputation of the entire profession began to improve, while the unlimited license and absolute freedom of practice prevailing during the Middle Ages were almost entirely done away with. By this time the clerical element had disappeared almost entirely from medical circles, or only dabbled in certain specialties. The Thirty Years' War was fatal to the supremacy of the clergy in matters of public health. Moreover, the increase of international intercourse favored the communication of medical knowledge.

The physicians of this period were more occupied with chemistry and physics than had ever been the case before. Nevertheless, this was also the special age of alchemists and of impecuniosity. According to one of the classifications of the time, the regular profession was supposed to include physicians, surgeons, barbers, regimental surgeons, lithotomists, bath-keepers, midwives, nurses, apothecaries, druggists, and even confectioners and grocers. Another list of impostors and quacks, equally official, was made to include old women, village priests, hermits, quacks,—

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—uroscopists, Paracelsists, Jews, calf-doctors, executioners, crystallomancers (a class of people—chiefly Italian—who sought after crystals), mountebanks, vagrants, magicians, exorcists, monsters, rat-catchers, jugglers, and gypsies. Veterinary physicians were also at that time included in this class.

Anatomy was now studied more from human bodies, and was authorized by statute. This was especially the case in non-German institutions, to which for this reason students flocked in great numbers. In Dresden, so early as 1617, there was a dissecting-room in which stuffed birds, at that time a great rarity, and similar curiosities were preserved. The study of anatomy was at a low ebb in Germany; so that when Rolfink, in 1629, arranged at Jena, which was then the most popular German university, for two public dissections upon executed malefactors, it was considered such an event that the very highest authorities were present. But the peasantry took such fright at this occurrence that for a long time afterward they watched their cemeteries by night lest the corpses should be dug up and, as they said, "Rolfinked." Vienna did not possess a skeleton until 1658. Strassburg obtained one of a male in 1671, and several years later one of a female. In Edinburgh an anatomical theatre was first erected in 1697 in Surgeons' Hall. It is worthy of remark that anatomical plates, designed to be lifted off in layers, existed even at this period. About the middle of this century there arose a dispute at the bedside of the Margrave of Baden, between two learned professors and the regular court physician, whether a plaster to be applied over the patient's heart should be placed in the middle of the chest, according to Galen, or upon the left side. The dispute was settled by opening, before the eyes of the noble patient, a hog, by means of which it was demonstrated that, as a matter of fact, the heart of the hog lay on the left side. So convinced was his excellency that he dismissed the ordinary physician, who had held a contrary opinion as to the position of a nobleman's heart.

The general barbarity and immorality of this century were conspicuous, especially among the upper classes, and by its close had spread from France, became naturalized in both Germany and Italy, and extended even to the universities, their professors, and their students. The life of the latter during this period was more vulgar and rude than ever before, and almost more so than ever since. Pennalism—that is to say, barbarity toward junior students—became unbounded, so that outbreaks occurred even during lectures. At last the State authorities were compelled to interfere. Student outrages were very frequent and often fatal, and their outbursts were disgraceful in the extreme.

Only in France was instruction in surgery well regulated, for this was the only country which possessed a proper surgical college. Practical instruction was imparted to mid wives—in Paris through a special institution, in Germany through the Midwives' Guild; the barbers, too, continued to receive instruction from their guilds; while instruction in pharmacy was given by the master-apothe-caries, too often dogmatically and even farcically, serving as objects for the keen satire of MoliÈre. The expenses of graduation were very great, and the ceremonies sometimes lasted two days.

In another way this same seventeenth century might be characterized as one of aggrandizement for physicians,—that is, as one during which their position was improved in the eyes of the public and better supported by the State. The physicians proper—the "medici pitri"—were still persons of the profoundest gravity, with fur-trained robes, perukes, canes, and swords, when matters were prosperous, who for their lives would do nothing more than write prescriptions in formal style, everything else being considered beneath their dignity,—even as they affect in England to*day. They demanded to be called in every case, however, even though they knew nothing about it, claiming that only by means of their presence could things certainly go right. Nevertheless, in dangerous cases—for example, during the plague—they left the surgeons alone, while they looked upon the sick through the windows. In spite of this, however, they were generally esteemed and often sought for, as well in public as in private. Some of them were supplied with large libraries by their patrons or through their positions under the government, and most of them enjoyed moderate prosperity. Their pay was, for the most part, regulated in accordance with a definite tariff, while the State gradually cut down the doctor's honorarium to the pay of a day-laborer. During that century a certain physician to a countess in Munich received $25 as his annual stipend. For being present at a post-mortem and rendering an opinion thereon, each physician received $1.75. Surgeons who were zealous and eager were always highly esteemed; they were often better educated, in many respects, because of their extensive travels; but the social emancipation of the surgeons was not completed until the eighteenth century. About this time amputation of the arm was supposed to be worth 31 marks ($7.75); of the leg, 41 marks; or, if a patient died, half this price. Lithotomy cost 51 marks, or half of that if the patient died. For cataract operation on one eye the surgeon received 17 marks; for a like operation on both eyes, 25 marks.

We find in medicine, as in other branches of knowledge, that each succeeding century presents its added quota of imperishable facts, making it still more important than its predecessor. We may say that the fifteenth century had prepared the way for a reforming idealism which was the principal characteristic of the sixteenth; and that in the seventeenth century the realistic reaction against this same idealism showed itself in the church and the State by struggles against constituted authority, and in medical science by the domination of inductive philosophy. The idealism of the eighteenth century was not reformative and humanistic, but revolutionary and humanitarian. The unsettled character of the century's events may be charged, in some degree, to the American and French revolutions, with their interpretation (and their attempted attainment) of the so-called "rights of man." The masses were now supposed to be released, and philosophers created new doctrines, which had a greater influence upon the times than ever had philosophical doctrines before. Rousseau, for instance, aroused a revolution in politics and education, while skeptics and materialists alike strove for general enlightenment, which was sadly needed. Among the higher classes extravagance and immorality prevailed extensively, among the lower classes poverty and ignorance. In Germany the rulers even sold their subjects, as when Hesse-Cassel sold to the English seventeen hundred mercenary soldiers, and other States sold smaller numbers. A criminal code, published in 1769, contained seventeen copper-plate engravings, illustrating various methods of torture. A physician was always present when torture was inflicted, to see that the victim's sufferings were not greater than he could bear. This inhuman mode of eliciting testimony was last practiced in Europe in 1869, in the Swiss Canton of Zug. Popular education was a myth, and the children of bondmen were not permitted to learn. No wonder the French revolution was hailed with joy along the Rhine, where it swept away at once and forever the petty rulers, abbots, and bishops, who were the "bloodsuckers" of the people. The numerous wars of the century had no great influence upon the development of medicine, except in the direction of surgery.

The eighteenth century was revolutionary also in the introduction of freedom of religious thought, so that clerical physicians disappeared entirely from the ranks, save a few who officiated as lithotomists, like FrÈre Come, or as oculists, like Wrabetz, the latter of whom was even a professor in Prague.

This was the century, too, of Leibnitz and Kant, of LinnÆus and Lavoisier, as well as of Bach, Haydn, Beethoven, and Goethe. During it the most conspicuous services in nearly all branches of learning were rendered by the Germans, instead of by the Italians and English, as during' the preceding century. In fact, Germany was then at the zenith of her glory, and supplied an impulse for all other nations.

The influence of philosophy and the natural sciences became also more and more marked. At the head of its philosophers must be placed Leibnitz (164:6-1716), who, by his own writings and those of his pupils, created a philosophical school, whose influence is still every where felt. His doctrine was dualistic: Matter is created once for all, and has no further need of the Creator. As concerns the spiritual world, he assumed minute, indivisible, intelligent beings, called monads,—constituents of all bodies and all beings. In close relation with him stood Kant, while in England Locke and Hume became leaders of the opposed and materialistic school, declaring the brain to be an organ for the secretion of thought.

Among the universities founded during the eighteenth century were those of Breslau, 1702; Bonn, 1771; Stuttgart, 1781; Pesth, 1794; Gottingen, 1737; and Erlangen, 1743. Medicine was also cultivated in learned societies, which increased constantly in numbers. In 1744 Frederick the Great united two other societies into his Royal Academy. In Switzerland, in 1751, was founded an association of physicians and naturalists, while in France royal scientific societies were founded at Bordeaux, Montpellier, Lyons, and Dijon, and the Royal Medical Society of Paris lived from 1717 until 1788. In spite of all these opportunities for enlightenment, everything was not yet enlightened. Then de HaËn defended the existence of demons, and Maerz, a well-known theological teacher, in 1760 devoted a book to witches and magic. That witches were burned publicly is a matter of history, even in America. So late as 1821 there was a statute regarding witches in Ireland, and they were burned in Mexico as recently as 1877. But these are flying pictures of the eighteenth century, which are meant only for the moment to illustrate the more serious topic, to which we must now address ourselves.

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First of all, the medical systems and theories of the century. Many hundred years previously Galen had originated a method, which deserves, perhaps, the title of pure eclecticism. The first purely eclectic system similar to his originated with Boerhaave (1688-1738), perhaps the most famous physician of his or any other century. He was the son of a clergyman near Leyden, Holland, and was one of thirteen children. Originally intended for the clerical profession, he had studied philosophy, history, logic, metaphysics, philology, mathematics, as well as theology, with great diligence. His education was, later, directed to the study of medicine, because of the statement that the purity of certain theological doctrines was endangered by him. So he studied chemistry and botany, and then anatomy and medicine, graduating in 1693. He practiced in Leyden with great success, and was offered a court position. In 1709 he was tendered the chair of Medicine and Botany, and in 1714 that of the Practice of Medicine; in 1718 he was also made Professor of Chemistry. In all of these positions he displayed the greatest capacity. He was a clinical teacher of rare talent, and soon acquired such reputation as to attract to Leyden students from all parts of the world in such numbers that no lecture-room in the university could contain them. He was the first to give separate lectures on the subject of ophthalmology, and employed the magnifying-glass in examining the eye. As a practitioner he was no less popular, and he left an estate valued at two million dollars. He was so famous that, when a Chinese official addressed a letter "To the Most Famous Physician in Europe," it reached him safely. He made no distinction in his patients, and compelled Peter the Great to wait a whole night for his turn to consult him. His most eminent pupils were: Haller, Van Swieten, de HaËn. Gaub, and Cullen.

Boerhaave's influence and dignity, which were astonishing, even in a physician, were based no less upon his encyclopaedic attainments than upon the benevolence and purity of his character. He was free from disputatiousness and vanity, although everywhere regarded as an oracle. His universal maxim was: "Simplicity is the seal of truth," although he never manifested this in his therapeutics. He employed the thermometer in the axilla in examining his cases, as did the iatrophysicists of the previous century.

His doctrines did not form a new system, but rather a composite of earlier systems, he stands also in the anomalous position of one who had the whole world at his feet, and yet contributed little or nothing which has been of essential importance. In fact, his peculiar views have been so universally given up that they are of only meagre historic interest. He looked upon disease as a condition in which bodily action or natural activities, being disturbed or unsettled, could take place only with difficulty; the reverse of this, of course, constituted good health. Fever he regarded as an effort of Nature to ward off death. Digestion was explained, like the circulation, upon mechanical principles. In his therapeutics, besides his efforts to sweeten the acid, to purify the stomach, to get rid of acridities, he made Hippocrates and Sydenham his models. His biographers say that his medicines were less effective than his personal appearance. He left many adherents, but no school of followers. It must be said, however, to his credit, that, while not the first to give clinical instruction, he permanently established a clinical method in teaching.

Gaub (1705-1780), professor in Leyden from 1731, was but little inferior to his master, Boerhaave, in fame as a teacher. He wrote the first complete work on the exclusive subject of general pathology. In general therapeutics he considered the healing power of Nature amply sufficient to remove sickness, but attributed this power sometimes to the soul and sometimes to the body.

There arose, naturally, strenuous opposition to the views and teachings of Boerhaave, and his principal opponent was Stahl (1660-1734), who was one of the most important systematists of any age, a profound thinker, and a pioneer chemist. He began lecturing in Jena at once upon his graduation, at the age of twenty-five, and moved through two or three different university positions until he came to Berlin at the age of fifty-six. He was a great pietist, of uncouth manners, faithful to his laboriously acquired convictions, and bitter and relentless against those who could not accept them. Indeed, he regarded his convictions as revelations from God. He looked upon the success of another as a personal injury to himself, and from being first a croaker he became finally a confirmed misanthrope, until he fell into actual melancholia. Pecuniary profit he had never sought, and its pursuit he scorned. His views were dynamico-organic, pietistic, and antagonistic. He regarded the soul as the supreme principle, life-giving and life-preserving, not to be confounded with the spirit; when hindered or obstructed in its operation, disease was present. The soul governed the organism chiefly by way of the circulation; consequently, plethora played an important rÔle. To get rid of this plethora the soul employed either fever or convulsive movements; for example, in children plethora produces a pressure of blood to the head, and, by way of compensation, the soul provides a haemorrhage from the nose. For reasons easily appreciated, he regarded bleeding piles as safety-valves of the utmost importance. Fever was a salutary effort of the soul to preserve the body; this was true even of intermittents, and, accordingly, he never gave cinchona. He scorned anatomy and physiology, saying, in one place, that medicine had profited as much by the knowledge of the bones in the ear as by a knowledge of snow which had fallen ten years previously. But Stahl was one of the most eminent chemists of the age, and did a great deal to liberate chemistry from the glamour of alchemy and the domination of pharmacy, and to transform it into an independent science.

Stahl's doctrine has been called animism, and was a reaction against the chemical and mechanical theories of the seventeenth century. He gained a considerable number of followers, the most notable of them among the French being Sauvages (1706-1767), the forerunner of Pinel and an opponent of pure mechanics, who animated the mechanical system of the body with Stahl's "soul." This was, par excellence, the age of artificial systems, and so Sauvages in his classification supplied a system which had ten classes of diseases, each of which had several orders, and some as many as two hundred and ninety-five genera, and two thousand four hundred species of disease!! Even LinnÆus had three hundred and twenty-five genera of disease, while Cullen had only four classes with one hundred and forty-nine genera.

The mechanico-dynamic system was a sort of compromise or mixed system, which was held in high honor by the most eminent physicians and better minds of the last century, and has even been prized by Sprengel as the best of all. It was originated by Friedrich Hoffmann (1660-1742). Hoffmann's father was a physician, and he was himself born in Halle, whose university he attended. He acquired lasting reputation as an oculist, and was made Professor of Anatomy, Surgery, Medicine, Physics, and Chemistry at his alma mater. Our commonplace "Hoffmann's anodyne" is named after him. He was one of the most erudite professors of his day, more easily understood than Stahl, widely known for his fluent diction and amiable temper, and, accordingly, won great renown for his university. His good fortune as a practitioner was so great that even Boerhaave declared him his own equal. As a writer he was voluminous, one edition of his works comprising twenty-seven large volumes.

According to Hoffmann's views, life was simply mechanical movement, especially of the heart; death, the cessation of heart-action, putrefaction thereupon resulting. Health meant regularity of movements; disease, a disturbance of the same. He used the word "tonus" extensively. Ether he regarded as an important factor, producing and maintaining movements of the body, itself extremely volatile, corresponding largely to the "pneuma" of the ancients; it was, in fact, a motor principle and, at the same time, the perceptive soul. Ether was stored in the medulla, and circulated in a double way in the body; spasm was the consequence of too strong, atony of too feeble, influx of ether. Fever was a general spasm of the arteries and veins, having its cause in the spinal cord. Hoffmann's therapeutics were simple, and poor in drugs. These latter were intended to weaken, alter, or evacuate, and he was especially partial to the use of vinous remedies. The strong and toxic drugs he used but little.

William Cullen (1712-1790), a Scotchman, rose from the deepest poverty to the greatest celebrity. First a barber, he afterward became an apothecary, then a ship-surgeon, then a village practitioner, finally entering into partnership with William Hunter as a general practitioner. Both of these eminent men being in equally poor circumstances, they agreed to live in the same place and that, while one was studying, the other should take care of the practice. In this way Cullen was enabled to graduate in 1740. Six years later he taught chemistry in Glasgow, and in ten years more came to Edinburgh as Professor of Medicine. He continued very active and famous up to the time of his death, but died as he had been born,—in poverty. Among his numerous other charitable deeds, he supported the widow of Robert Burns and published the latter's poems.

Cullen was the father of modern Solidism,—a system based upon the solid parts of the body, the nerves being the chief agents. The life-giving element was, in his view, an undefined, dynamic something (different from Hoffmann's ether or Stahl's soul), which he called nerve-force, or nerve-principle; animal force; and brain-energy, and in it he included the spinal cord. His nerve-principle was supposed to produce spasms and atony, either actively or passively. The causes of disease, while of a debilitating character, were supposed to awaken reaction of the healing powers of Nature; fever was a reparative effort of Nature, even in its cold stage, the blood playing no part in it. He constructed a very arbitrary classification of fevers, as, in fact, he did of all diseases, his system of nosology being the secret of his reputation. His explanation of gout was famous. That disorder, he said, depended upon an atony in the digestive organs against which was periodically set up a reparative effort in form of a joint inflammation. In scrofula he had to assume, in contradiction to his nervous pathology, a peculiar acridity, and in putrid fever a putridity of the humors of the body. His therapeutics were simple and salutary, because of his renunciation of venesection, which was much abused in his day.

The most celebrated pupils and successors of Hoffmann were Gregory, of Edinburgh, Gardiner, and, in Germany, the famous Thaer (1752-1828), who finally abandoned the practice of medicine because it promised more than it could perform, and who became a "father of husbandry."

A composite of the doctrine of Hippocrates, Sydenham, and Boerhaave was represented in the so-called Old Vienna School, whose connection with the lives of Maria Theresa and Joseph II deserves, at least, mention. Its founder was Baron Van Swieten (1700-1772), of Leyden, a descendant of a noble Jansenist family of the Netherlands, who graduated under Boerhaave after having studied at Louvain. After the death of his patron he was called to the assistance of the Archduchess Maria Anna, of Austria, who was suffering from an abortion, and gave such satisfaction that she recommended him to her sister, Maria Theresa, who up to this time had remained sterile. To her and to her husband he gave advice which resulted in sixteen successive pregnancies, and then, as the result of his success, came to Vienna in 1745 as President of the General Medical Department of Austria. He was also made censor, in which position he incurred the enmity especially of the Jesuits and of Voltaire, whom he robbed of their influence. He was made baron, and became, next to Kaunitz, the most influential counselor of the empress. His chief care was dedicated to the elevation of medical affairs in Austria, and especially to the improvement of the medical faculty. He had just seen success crown his efforts when he died of senile gangrene, with the reputation of being a great physician and benefactor of the poor. One of the greatest of his services was improving the treatment of syphilis, in which he, after the example of Paracelsus, recommended the internal use of corrosive sublimate.

More eminent as a physician than for personal character was de HaËn (1704-1776), of The Hague,—a pupil of Boerhaave. At the suggestion of Van Swieten, he was called, in 1754, to Vienna as president of the clinic of the city hospital, which at that time afforded accommodation for only twelve patients. He was the real founder of the so-called Old Vienna School, whose merit, in contrast to the so-called new school, is to be sought in practical and diagnostic services. As de HaËn quarreled with every one, he also did with Stoerck (1749-1803), the successor of Van Swieten in the direction of the Austrian Medical Department, and with Stoll (1742-1787),—a clinical teacher who was especially famous as an epidemiologist.

Stoll lectured with great popularity until 1784, upon the completion of the Allgemeines Krankenhaus, when he fell into the background and was badly treated. He was the subject of numerous intrigues by his enemies, and had a wife who embittered his life, and who even had him buried in the dress of a Jesuit in order to injure his reputation after his death. To his credit be it said that, changing his views of the constituents of disease later in life and his original therapeutics becoming no longer of use to him, he abandoned them entirely. Nevertheless his therapeutic system flourished for a long time after him.

There were in vogue during this period numerous other doctrines, some of which were too puerile or insubstantial to gain any foothold at all; others exerted a certain amount of influence during the life-time of their originators or for a generation afterward. With many of these I do not care in any way to deal. A few others, I think, ought to be at least mentioned in such a history as I am endeavoring to present.

There was another Hoffmann—Christopher Ludwig

Hoffmann (1721-1807), of Westphalia, who devised a so-called humoral theory in which the "acridities" of Boer-haave were mingled with the "putridities" of the pneu-matists and the "irritability" of Glisson. His treatment and remedies for diseases were supposed to be antiseptic, as was very proper when dealing with putridities.

The theory known as the "Doctrine of Infarctus" had its origin with Kampf, who died in 1753. By infarctus Kampf understood impacted fÆces, which he thought originated in the humors of the body, portal vessels, and intestines; he recognized two kinds,—the black bilious and the mucous. From this theory a wide-spread clyster fashion developed, and lords and ladies vied with each other in belaboring their infarcti and in administering enemas. As Baas says: "We cannot deny to the author of this doctrine at least an extensive knowledge of human nature. He supplied a universal remedial procedure, and gratified the apothecaries with the bulkiness of the herbs required for its practice."

Quite antagonistic to the views of the Vienna School were those of the School of Montpellier, inaugurated by Bordeu (1732-1796), and generally known as vitalism. Bordeu died in the enjoyment of great reputation, but at variance with all his colleagues. He maintained the existence of a general life of the body,—a composite life,—resulting from the harmonious working of the individual lives and powers of all the organs, which were supposed to be associated with each other, but each for its own definite function; the most important organs—the stomach, heart, and brain—being called "the tripod of life." In pathology he laid great weight upon crises, which were supposed to proceed from the glands.

The most important representative of vitalism was Barthez (1734-1806), of Montpellier,—a man of great gifts and eager for knowledge. He recognized a vital principle as the cause of the phenomena of life, but acknowledged that its nature was unknown, although he endowed it with motion and sensibility different from a thinking mind.. Plants were supposed to possess it likewise. Disease, he believed, was the result of an affection of this vital principle. Every disease was divisible into certain disease-elements, viewed as parts of the whole, and these were again divisible into secondary elements. He explained putrid fevers as specific vital diseases,—in which view, of course, he embodied humoral ideas.

In Germany, at about this time, a similar doctrine obtained,—a doctrine of vital forces,—which the versatile Reil (1759-1813) elaborated into a system.

Meantime, in England, a doctrine was elaborated by Erasmus Darwin (1731-1802) which partook, in a certain degree, of the doctrines of Stahl, Hoffmann, Haller, Brown, and Bordeu. Erasmus Darwin distinguished himself, not only as a physician, but as a poet, philosopher, and physiologist. He was a friend of James Watt. Of his life it is said that by his practice and very fortunate marriages he became wealthy, ate much, and drank nothing but water. His chief work—entitled Zoonomia, or the Laws of Organic Life—was published in 1784, and is well worthy of perusal to-day. He recognized two fundamental substances—spirit and matter. But it is not so much for his doctrine as for his researches into animal and plant physiology, and, reflexly, because of his more celebrated descendant of the same name, that we owe him most gratitude.