Chapter LXXIV: Part 74

"The aborigines of South America appear, except perhaps in one
locality, to have been ignorant of the virtues of Peruvian
bark. This sovereign remedy is absent in the wallets of
itinerant doctors, whose materia medica has been handed down
from father to son, since the days of the Yncas. It is
mentioned neither by the Ynca Garcilasso de la Vega, nor by
Acosta, in their lists of Indian medicines. It seems probable,
nevertheless, that the Indians were aware of the virtues of
Peruvian bark in the neighborhood of Loxa, 230 miles south of
Quito, where its use was first made known to Europeans; and
the local name for the tree quina-quina, 'bark of bark,'
indicates that it was believed to possess some special
medicinal properties. … In 1638 the wife of Don Luis
Geronimo Fernandez de Cabrera Bobadilla y Mendoza, fourth
Count of Chinchon, and Viceroy of Peru, lay sick of an
intermittent fever in the palace of Lima. … The news of her
illness at Lima reached Don Francisco Lopez de Canizares, the
Corregidor of Loxa, who had become acquainted with the
febrifuge virtues of the bark. He sent a parcel of it to the
Vice-Queen, and the new remedy, administered by her physician,
Dr. Don Juan de Vega, effected a rapid and complete cure. …
The Countess of Chinchon returned to Spain in the spring of
1640, bringing with her a supply of that precious quina bark
which had worked so wonderful a cure upon herself, and the
healing virtues of which she intended to distribute amongst
the sick on her husband's estates. It thus gradually became
known in Europe, and was most appropriately called Countess's
powder (Pulvis Comitissæ). By this name it was long known to
druggists and in commerce. … In memory of the great service
to humanity performed by the Countess of Chinchon, Linnæus
named the genus which yields Peruvian bark, Chinchona.
Unfortunately the great botanist was misinformed as to the
name of her whom he desired to honour. This is to be accounted
for by his having received his knowledge of the Countess
through a foreign and not a Spanish source. Thus misled,
Linnæus spelt the word Cinchona … and Cinhona, … omitting
one or two letters. … After the cure of the Countess of
Chinchon the Jesuits were the great promoters of the
introduction of bark into Europe. In 1670 these fathers sent
parcels of the powdered bark to Rome, whence it was
distributed to members of the fraternity throughout Europe, by
Cardinal de Lugo, and used for the cure of agues with great
success. Hence the name of 'Jesuits' bark,' and 'Cardinal's
bark;' and it was a ludicrous result of its patronage by the
Jesuits that its use should have been for a long time opposed
by Protestants, and favoured by Roman Catholics. In 1679 Louis
XIV. bought the secret of preparing quinquina from Sir Robert
Talbor, an English doctor, for 2,000 louis-d'or, a large
pension, and a title. From that time Peruvian bark seems to
have been recognised as the most efficacious remedy for
intermittent fevers."

_C. R. Markham,
Peruvian Bark,
chapters 2-4._

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MEDICAL SCIENCE: 17th Century.
Sydenham, the Father of Rational Medicine.

"Sydenham [Thomas Sydenham, 1624-1689], the prince of
practical physicians, whose character is as beautiful and as
genuinely English as his name, did for his art what Locke did
for the philosophy of mind—he made it, in the main,
observational; he made knowledge a means, not an end. It would
not be easy to over-estimate our obligations as a nation to these
two men, in regard to all that is involved in the promotion of
health of body and soundness of mind. They were among the
first in their respective regions to show their faith in the
inductive method, by their works. They both professed to be
more of guides than critics, and were the interpreters and
servants of Nature, not her diviners and tormentors." Of
Sydenham, "we must remember in the midst of what a mass of
errors and prejudices, of theories actively mischievous, he
was placed, at a time when the mania of hypothesis was at its
height, and when the practical part of his art was overrun and
stultified by vile and silly nostrums. We must have all this
in our mind, or we shall fail in estimating the amount of
independent thought, of courage and uprightness, and of all
that deserves to be called magnanimity and virtue, which was
involved in his thinking and writing and acting as he did.
'The improvement of physic [he wrote] in my opinion, depends,
1st, Upon collecting as genuine and natural a description or
history of diseases as can be procured; and, 2d, Upon laying
down a fixed and complete method of cure. With regard to the
history of diseases, whoever considers the undertaking
deliberately will perceive that a few such particulars must be
attended to: 1st, All diseases should be described as objects
of natural history, with the same exactness as is done by
botanists, for there are many diseases that come under the
same genus, and bear the same name, that, being specifically
different, require a different treatment. The word carduus or
thistle, is applied to several herbs, and yet a botanist would
be inaccurate and imperfect who would content himself with a
generic description. Furthermore, when this distribution of
distempers into genera has been attempted, it has been to fit
into some hypothesis, and hence this distribution is made to
suit the bent of the author rather than the real nature of the
disorder. How much this has obstructed the improvement of
physic any man may know. In writing, therefore, such a natural
history of diseases, every merely philosophical hypothesis
should be set aside, and the manifest and natural phenomena,
however minute, should be noted with the utmost exactness. The
usefulness of this procedure cannot be easily overrated, as
compared with the subtle inquiries and trifling notions of
modern writers. … If only one person in every age had
accurately described, and consistently cured, but a single
disease, and made known his secret, physic would not be where
it now is; but we have long since forsook the ancient method
of cure, founded upon the knowledge of conjunct causes,
insomuch that the art, as at this day practised, is rather the
art of talking about diseases than of curing them.' … His
friend Locke could not have stated the case more clearly or
sensibly. It is this doctrine of 'conjunct causes,' this
necessity for watching the action of compound and often
opposing forces, and the having to do all this not in a
machine, of which if you have seen one, you have seen all, but
where each organism has often much that is different from, as
well as common with, all others. … It is this which takes
medicine out of the category of exact sciences, and puts it
into that which includes politics, ethics, navigation and
practical engineering, in all of which, though there are
principles, and those principles quite within the scope of
human reason, yet the application of these principles must, in
the main, be left to each man's skill, presence of mind, and
judgment, as to the case in hand. … It would not be easy to
over-estimate the permanent impression for good, which the
writings, the character, and the practice of Sydenham have
made on the art of healing in England, and on the Continent
generally. In the writings of Boerhaave, Stahl, Gaubius,
Pinel, Bordeu, Haller, and many others, he is spoken of as the
father of rational medicine; as the first man who applied to
his profession the Baconian principles of interpreting and
serving nature, and who never forgot the master's rule, 'Non
fingendum aut excogitandum, sed inveniendum, quid natura aut
faciat aut ferat.' … Like all men of a large practical
nature, he could not have been what he was, or done what he
did, without possessing and often exercising the true
philosophizing faculty. He was a man of the same quality of
mind in this respect with Watt, Franklin, and John Hunter, in
whom speculation was not the less genuine that it was with
them a means rather than an end."

_Dr. John Brown,
Locke and Sydenham and other Papers,
pages 54-90._

ALSO IN:
_T. Sydenham,
Works;
translated by R. G, Latham._

MEDICAL SCIENCE: 17th Century.
Closing period of the Humoral Pathology.
The Doctrines of Hoffmann, Stahl and Boerhaave.

"If we take a general survey of medical opinions, we shall
find that they are all either subordinate to, or coincident
with, two grand theories. The one of these considers the solid
constituents of the animal economy as the elementary vehicle
of life, and consequently places in them the primary seat of
disease. The other, on the contrary, sees in the humors the
original realization of vitality; and these, as they determine
the existence and quality of the secondary parts, or solids,
contain, therefore, within themselves, the ultimate principle
of the morbid affection. By relation to these theories, the
history of medicine is divided into three great periods.
During the first, the two theories, still crude, are not yet
disentangled from each other; this period extends from the
origin of medicine to the time of Galen. The second
comprehends the reign of Humoral Pathology—the interval
between Galen and Frederic Hoffmann. In the last the doctrine
of the Living Solid is predominant; from Hoffmann it reaches
to the present day. … By Galen, Humorism was first formally
expounded, and reduced to a regular code of doctrine.
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Four elementary fluids, their relations and changes, sufficed
to explain the varieties of natural temperament, and the
causes of disease; while the genius, eloquence, and unbounded
learning with which he illustrated this theory, mainly
bestowed on it the ascendency, which, without essential
alteration, it retained from the conclusion of the second to
the beginning of the eighteenth century. Galenism and Humorism
are, in fact, convertible expressions. Not that this
hypothesis during that long interval encountered no
opposition. It met, certainly, with some partial contradiction
among the Greek and Arabian physicians. After the restoration
of learning Fernelius and Brissot, Argenterius and Joubert,
attacked it in different ways. … Until the epoch we have
stated, the prevalence of the Humoral Pathology was, however,
all but universal. Nor was this doctrine merely an erroneous
speculation; it exerted the most decisive, the most pernicious
influence on practice.—The various diseased affections were
denominated in accommodation to the theory. In place of saying
that a malady affected the liver, the peritonæum, or the
organs of circulation, its seat was assumed in the blood, the
bile, or the lymph. The morbific causes acted exclusively on
the fluids; the food digested in the stomach, and converted
into chyle, determined the qualities of the blood; and poisons
operated through the corruption they thus effected in the
vital humors. All symptoms were interpreted in blind
subservience to the hypothesis; and those only attracted
attention which the hypothesis seemed calculated to explain.
The color and consistence of the blood, mucus, feces, urine,
and pus, were carefully studied. On the other hand the
phenomena of the solids, if not wholly overlooked, as mere
accidents, were slumped together under some collective name,
and attached to the theory through a subsidiary hypothesis. By
supposed changes in the humors, they explained the association
and consecution of symptoms. Under the terms, crudity,
coction, and evacuation, were designated the three principal
periods of diseases, as dependent on an alteration of the
morbific matter. In the first, this matter, in all its
deleterious energy, had not yet undergone any change on the
part of the organs; it was still crude. In the second, nature
gradually resumed the ascendant; coction took place. In the
third, the peccant matter, now rendered mobile, was evacuated
by urine, perspiration, dejection, &c., and æquilibrium
restored. When no critical discharge was apparent, the
morbific matter, it was supposed, had, after a suitable
elaboration, been assimilated to the humors, and its
deleterious character neutralized. Coction might be perfect or
imperfect; and the transformation of one disease into another
was lightly solved by the transport or emigration of the
noxious humor. … Examinations of the dead body confirmed
them in their notions. In the redness and tumefaction of
inflamed parts, they beheld only a congestion of blood; and in
dropsies, merely the dissolution of that fluid; tubercles were
simply coagula of lymph; and other organic alterations, in
general, naught but obstructions from an increased viscosity
of the humors. The plan of cure was in unison with the rest of
the hypothesis. Venesection was copiously employed to renew
the blood, to attenuate its consistency, or to remove a part
of the morbific matter with which it was impregnated; and
cathartics, sudorifics, diuretics, were largely administered,
with a similar intent. In a word, as plethora or cacochymia
were the two great causes of disease, their whole therapeutic
was directed to change the quantity or quality of the fluids.
Nor was this murderous treatment limited to the actual period
of disease. Seven or eight annual bloodings, and as many
purgations—such was the common regimen the theory prescribed
to insure continuance of health; and the twofold depletion,
still customary, at spring and fall, among the peasantry of
many European countries, is a remnant of the once universal
practice. In Spain, every village has even now its Sangrador,
whose only cast of surgery is blood-letting; and he is rarely
idle. The medical treatment of Lewis XIII, may be quoted as a
specimen of the humoral therapeutic, Within a single year this
theory inflicted on that unfortunate monarch above a hundred
cathartics, and more than forty bloodings.—During the fifteen
centuries of Humorism, how many millions of lives did medicine
cost mankind? The establishment of a system founded on the
correcter doctrine of Solidism, and purified from the
crudities of the Iatro-mathematical and Iatro-chemical
hypotheses was reserved for three celebrated physicians toward
the commencement of the eighteenth century—Frederic
Hoffmann—George Ernest Stahl—and Hermann Boerhaave. The
first and second of this triumvirate were born in the same
year, were both pupils of Wedelius of Jena, and both
professors, and rival professors, in the University of Halle;
the third was eight years younger than his contemporaries, and
long an ornament of the University of Leyden."

_Sir W. Hamilton,
Discussions on Philosophy and Literature,
pages 246-249._

"The great and permanent merits of Hoffmann [1660-1742] as a
medical philosopher, undoubtedly consisted in his having
perceived and pointed out more clearly than any of his
predecessors, the extensive and powerful influence of the
Nervous System, in modifying and regulating at least, if not
in producing, all the phenomena of the organic as well as of
the animal functions in the human economy, and more
particularly in his application of this doctrine to the
explanation of diseases. … It was reserved for Hoffmann …
to take a comprehensive view of the Nervous System, not only
as the organ of sense and motion, but also as the common
centre by which all the different parts of the animal economy
are connected together, and through which they mutually
influence each other. He was, accordingly, led to regard all
those alterations in the structure and functions of this
economy, which constitute the state of disease, as having
their primary origin in affections of the nervous system, and
as depending, therefore, upon a deranged state of the
imperceptible and contractile motions in the solids, rather
than upon changes induced in the chemical composition of the
fluid parts of the body."

_J. Thomson,
Account of the Life, Lectures and Writings of William Cullen,
pages 195-196._

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"George Ernest Stahl (1660-1734), chemist, was professor of
medicine at Halle (1694) and physician to the King of Prussia
(1716). He opposed materialism, and substituted 'animism,'
explaining the symptoms of disease as efforts of the soul to
get rid of morbid influences. Stahl's 'anima' corresponds to
Sydenham's 'nature' in a measure, and has some relationship to
the Archeus of Paracelsus and Van Helmont. Stahl was the author
of the 'phlogiston' theory in chemistry, which in its time has
had important influence on medicine. Phlogiston was a
substance which he supposed to exist in all combustible
matters, and the escape of this principle from any compound
was held to account for the phenomenon of fire. According to
Stahl, diseases arise from the direct action of noxious powers
upon the body; and from the reaction of the system itself
endeavouring to oppose and counteract the effects of the
noxious powers, and so preserve and repair itself. He did not
consider diseases, therefore, pernicious in themselves, though
he admitted that they might become so from mistakes made by
the soul in the choice, or proportion of the motions excited
to remove them, or the time when these efforts are made.
Death, according to this theory, is due to the indolence of
the soul, leading it to desist from its vital motions, and
refusing to continue longer the struggle against the
derangements of the body. Here we have the 'expectant
treatment' so much in vogue with many medical men. 'Trusting
to the constant attention and wisdom of nature,' they
administered inert medicines as placebos, while they left to
nature the cure of the disease. But they neglected the use of
invaluable remedies such as opium and Peruvian bark, for which
error it must be admitted they atoned by discountenancing
bleeding, vomiting, etc. Stahl's remedies were chiefly of the
class known as 'Antiphlogistic,' or anti-febrile."

_E. Berdoe,
The Origin and Growth of the Healing Art,
book 5, chapter 7._

"The influence of Boerhaave [1668-1738] was immense while it
lasted—it was world-wide; but it was like a ripple on the
ocean—it had no depth. He knew everything and did everything
better than any of his contemporaries, except those who made
one thing, not everything, their study. He was familiar with
the researches of the great anatomists, of the chemists, of
the botanists, of historians, of men of learning, but he was
not a great anatomist, chemist, or historian. As to his
practice, we cannot pronounce a very decided opinion, except
that he was a man of judgment and independence. Here his
reputation made his success: a prescription of his would no
doubt effect many a cure, although the patient had taken the
remedy he prescribed fifty times without any benefit. His
greatness depended upon his inexhaustible activity. He had the
energy of a dozen ordinary men, and so he was twelve times as
powerful as one. He mentions quite incidentally how he was in
the habit of frequently spending whole nights in botanical
excursions on foot; and we know he had no time to sleep in the
day. He took an interest in everything, was always on the
alert, had a prodigious memory, and indefatigable industry. On
these great homely qualities, added to a kind disposition and
an unaffected piety, his popularity was founded. It was all
fairly won and nobly worn. It is startling, however, to find
that a man whose name one hundred years ago was familiar to
the ear as household words, and of whom historians predicted
that he would always be regarded as one of the greatest as
well as best of men, an example to his race, should be already
almost forgotten. An example is of no use unless it is known;
Boerhaave is now unknown. The reason is plain;—he was not the
founder of any system, nor did he make any discovery. He
simply used with supreme success the thoughts and discoveries
of others; as soon as he ceased to live, his influence began
therefore to decline; and before his generation had passed
away, his star had waned before the genius of Cullen, who
succeeded in fixing the attention of Europe, and who, in his
turn, was soon to be displaced by others."

_J. R. Russell,
History and Heroes of the Art of Medicine,
pages 297-298._

MEDICAL SCIENCE: 17-18th Centuries.
Introduction of the Microscope in Medicine.
First glimmerings of the Germ Theory of Disease.

"Since Athanasius Kircher [1601-1680] mistook blood and pus
corpuscles for small worms, and built up on his mistake a new
theory of disease and putrefaction, and since Christian Lange,
the Professor of Pathological Anatomy in Leipzig, in the
preface to Kircher's book (1671) expressed his opinion that
the purpura of lying-in-women, measles, and other fevers were
the result of putrefaction caused by worms or animalculæ, a
'Pathologia Animata' has, from time to time, been put forward
to explain the causation of disease. … Remarkable as were
Kircher's observations, still more wonderful were those of
Anthony van Leeuwenhoek, a native of Delft in Holland, who in
his youth had learned the art of polishing lenses, and who was
able, ultimately, to produce the first really good microscope
that had yet been constructed. Not only did Leeuwenhoek make
his microscope, but he used it to such good purpose that he
was able to place before the Royal Society of London a series
of most interesting and valuable letters giving the result of
his researches on minute specks of living protoplasm. … The
world that Leeuwenhoek … opened up so thoroughly was rapidly
invaded by other observers and theorists. The thoughtful
physicians of the time believed that at last they had found
the 'fons et origo mali,' and Nicolas Andry, reviewing
Kircher's' Contagium Animatum,' replaced his worms by these
newly-described animalculæ or germs, and pushing the theory to
its legitimate and logical conclusion, he also evolved a germ
theory of putrefaction and fermentation. He maintained that
air, water, vinegar, fermenting wine, old beer, and sour milk
were all full of germs; that the blood and pustules of
smallpox also contained them, and that other diseases, very
rife about this period, were the result of the activity of
these organisms. Such headway did he make, and such conviction
did his arguments carry with them, that the mercurial
treatment much in vogue at that time was actually based on the
supposition that these organisms, the 'causæ causantes' of
disease, were killed by the action of mercury and mercurial
salts. With a kind of prophetic instinct, and certainly as the
result of keen observation, Varro and Lancisi ascribed the
dangerous character of marsh or swamp air to the action of
invisible animalculæ; in fact the theory was so freely and
forcibly propagated that even where no micro-organisms could
be found their presence was inferred with the inevitable
result, as Löffler points out, that these 'inconceivable'
worms became the legitimate butts for the shafts of ridicule;
and in 1726 there appeared in Paris a satirical work, in which
these small organisms received the name of 'fainter,'
'body-pincher,' 'ulcerator,' 'weeping fistula,' 'sensualist';
the whole system was thus laughingly held up to satire, and
the germ theory of disease completely discredited.
{2139}
Linnæus [1707-1778], however, with his wonderful powers of
observation and deduction, considered that it was possible
that there might be rescued from this 'chaos' small living
beings which were as yet insufficiently separated and
examined, but in which he firmly believed might lie not only
the actual contagium of certain eruptive diseases, and of
acute fevers, but also the exciting causes of both
fermentation and putrefaction. The man, however, who of all
workers earliest recognized the importance of Linnæus'
observations was a Viennese doctor, Marcus Antonius Plenciz.
… He it was who, at this time, insisted upon the specific
character of the infective agent in every case of disease; for
scarlet fever there was a scarlet fever seed or germ—a seed
which could never give rise to smallpox. He showed that it was
possible for this organism to become disseminated through the
air, and for it to multiply in the body; and he explained the
incubation stage of a febrile disease as dependent on the
growth of a germ within the body during the period after its
introduction, when its presence had not yet been made
manifest. … As regards putrefaction, having corroborated
Linnæus' observations and found countless animalculæ in
putrefying matter, he came to the conclusion that this process
was the result of the development, multiplication, and
carrying on of the functions of nutrition and excretion by
these germs; the products of fermentation being the volatile
salts set free by the organisms, which, multiplying rapidly by
forming seeds or eggs, rendered the fluid in which they
developed thick, turbid, and foul. This theory, admirable as
it was, and accurate as it has since been proved to be, could
not then be based on any very extensive or detailed
observation, and we find that some of the most prominent and
brilliant men of the period did not feel justified in
accepting the explanation that Plenciz had offered as to the
causes of disease and fermentation processes."

_G. S. Woodhead,
Bacteria and their Products,
chapter 3._

MEDICAL SCIENCE: 17-18th Centuries.
Hahnemann and the origin of the System of Homœopathy.

Samuel Hahnemann, originator of the system of medicine called
"Homœopathy," was born in 1755, at Meissen, in Saxony. He
studied medicine at Leipsic, and afterwards at Vienna. In 1784
he settled in Dresden, but returned to Leipsic in 1789. "In
the following year, while translating Cullen's Materia Medica
out of English into German, his attention was arrested by the
insufficient explanation's advanced in that work of the cure
of ague by cinchona bark. By way of experiment, he took a
large dose of that substance to ascertain its action on the
healthy body. In the course of a few days he experienced the
symptoms of ague; and it thus occurred to him that perhaps the
reason why cinchona cures ague is because it has the power to
produce symptoms in a healthy person similar to those of ague.
To ascertain the truth of this conjecture, he ransacked the
records of medicine for well-attested cures effected by single
remedies; and finding sufficient evidences of this fact, he
advanced a step further, and proposed, in an article published
in Hufeland's Journal, in the year 1797, to apply this new
principle to the discovery of proper medicines for every form
of disease. Soon afterwards he published a case to illustrate
his method. It was one of a severe kind of colic cured by a
strong dose of veratrum album. Before this substance gave
relief to the patient it excited a severe aggravation of his
symptoms. This induced Hahnemann, instead of drops or grains,
to give the fraction of a drop or grain, and he thus
introduced infinitesimal doses. Some years later he applied
his new principle in the treatment of scarlet fever; and
finding that belladonna cured the peculiar type of that
disease, which then prevailed in Germany, he proposed to give
this medicine as a prophylactic, or preventive against scarlet
fever; from that time it has been extensively employed for
this purpose. In the year 1810 he published his great work,
entitled Organon of Medicine, which has been translated into
all the European languages, as well as into Arabic. In this
book he fully expounded his new system, which he called
Homœopathy. His next publication was a Materia Medica,
consisting of a description of the effects of medicines upon
persons in health. These works were published between the
years 1810 and 1821, at Leipsic, where he founded a school,
and was surrounded by disciples. As his system involved the
administration of medicines, each separately by itself, and in
doses infinitely minute, there was no longer any need of the
apothecaries' intervention between their physician and the
patient. In consequence of this the Apothecaries Company
brought to bear upon Hahnemann an act forbidding physicians to
dispense their own medicines, and with such effect that he was
obliged to leave Leipsic. The Grand Duke of Anhalt Köthen,
appointed him his physician, and invited him to live at
Köthen. Thither, accordingly, he removed in the year 1821, and
there he prepared various new editions of his Organon, and new
volumes of his Materia Medica for publication. In 1835 he
married a second time; his wife was a French lady of
considerable position; and in the same year he left Köthen,
and settled in Paris, where he enjoyed a great reputation till
his death, which took place in the year 1843."

_W. Bayes,
Origin and Present Status of Homœopathy
(Translation of the Homœopathic Medical Society
of the State of New York, 1869, article 21)._

ALSO IN:
_W. Aneke,
History of Homœopathy._

_J. C. Burnett,
Ecce Medicus;
or Hahnemann as a man and as a physician._

MEDICAL SCIENCE: 18th Century.
The work of John Hunter in surgery and anatomy.

"John Hunter [born 1728, died 1793] was not only one of the
most profound anatomists of the age in which he lived, but he
is by the common consent of his successors allowed to be one
of the greatest men that ever practised surgery. One of the
most striking discoveries in this part of his profession—
indeed one of the most brilliant in surgery of his
century—was the operation for the cure of popliteal aneurism
by tying the femoral artery above the tumour in the ham, and
without interfering with it. He improved the treatment of the
rupture of the tendo achillis, in consequence of having
experienced the accident himself when dancing. He invented the
method of curing fistula lacrymalis by perforating the os
unguis, and curing hydrocele radically by injection. His
anatomical discoveries were numerous and important—amongst
others the distribution of the blood-vessels of the uterus,
which he traced till their disappearance in the placenta.
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He was the first who demonstrated the existence of lymphatic
vessels in birds; described the distribution of the branches
of the olfactory nerve, as well as those of the fifth pair;
and to him we owe the best and most faithful account of the
descent of the testicle in the human subject, from the abdomen
into the scrotum. Physiology is also indebted to him for many
new views and ingenious suggestions. … 'Before his time
surgery had been little more than a mechanical art, somewhat
dignified by the material on which it was employed. Hunter
first made it a science; and by pointing out its peculiar
excellence as affording visible examples of the effects and
progress of disease, induced men of far higher attainments
than those who had before practised it to make it their
study.' The best monument of his genius and talents, however,
is the splendid museum which he formed by his sole efforts,
and which he made, too, when labouring under every
disadvantage of deficient education and limited means. It
shows that as an anatomist and physiologist he had no
superior."

_W. Baird,
Hunter (The Imperial dictionary of universal biography)._

ALSO IN:
_S. D. Gross,
John Hunter and his Pupils._

MEDICAL SCIENCE: 18th Century.
Preventive Inoculation against Smallpox.

"One of the most notable events of the 18th century, or for
that matter, in the history of medicine, was the introduction
of the systematic practice of preventive inoculation against
small-pox. We are so generally taught that this is entirely
due to the efforts of Jenner, or rather we are so often
allowed to think it without being necessarily taught
otherwise, that the measure deserves a historical sketch. The
communication of the natural disease to the healthy in order
to protect them from the same natural disease, in other words,
the communication of small-pox to prevent the same, reaches
back into antiquity. It is mentioned in the Sanskrit Vedas as
then performed, always by Brahmins, who employed pus procured
from small-pox vesicles a year before. They rubbed the place
selected for operation until the skin was red, then scratched
with a sharp instrument, and laid upon the place cotton soaked
in the variolous pus, moistened with water from the sacred
Ganges. Along with this measure they insisted upon most
hygienic regulations, to which in a large measure their good
results were due. Among the Chinese was practised what was
known as 'Pock-sowing,' and as long ago as 1000 years before
Christ they introduced into the nasal cavities of young
children pledgets of cotton saturated with variolous pus. The
Arabians inoculated the same disease with needles, and so did
the Circassians, while in the states of north Africa incisions
were made between the fingers, and among some of the negroes
inoculation was performed in or upon the nose. In
Constantinople, under the Greeks, the custom had long been
naturalized and was practised by old women instructed in the
art, who regarded it as a revelation of St. Mary. The first
accounts of this practice were given to the Royal Society by
Timoni, a physician of Constantinople, in 1714. The actual
introduction of the practice into the West, however, was due
to Lady Mary Wortley Montagu, who died in 1762, and who was
wife of the English ambassador to the Porte in 1717. She had
her son inoculated in Constantinople by her surgeon Maitland,
and after her return to London, in 1721, it was also performed
upon her daughter. During the same years experiments were
undertaken by Maitland upon criminals; and as these turned out
favorably, the Prince of Wales and his sisters were inoculated
by Mead. The practice was then more or less speedily adopted
on this side of the ocean as well as on that, but suffered
occasional severe blows because of unfortunate cases here and
there, such as never can be avoided. The clergy, especially,
using the Bible, as designing men always can use it, to back
up any view or practice, became warm opponents of vaccination,
and stigmatized it as a very atrocious invasion of the Divine
prerogative of punishment. But in 1746 the Bishop of Worcester
recommended it from the pulpit, and established houses for
inoculation, and thus made it again popular. In Germany the
operation was generally favored, and in France and Italy a
little later came into vogue."

_Roswell Park,
Lectures on the History of Medicine (in MS.)._

MEDICAL SCIENCE: 18th Century.
Jenner and the discovery of Vaccination.

Many before the English physician, Dr. Jenner, "had witnessed
the cow-pox, and had heard of the report current among the
milkmaids in Gloucestershire, that whoever had taken that
disease was secure against smallpox. It was a trifling, vulgar
rumor, supposed to have no significance whatever; and no one
had thought it worthy of investigation, until it was
accidentally brought under the notice of Jenner. He was a
youth, pursuing his studies at Sodbury, when his attention was
arrested by the casual observation made by a country girl who
came to his master's shop for advice. The smallpox was
mentioned, when the girl said, 'I can't take that disease, for
I have had cow-pox.' The observation immediately riveted
Jenner's attention, and he forthwith set about inquiring and
making observations on the subject. His professional friends,
to whom he mentioned his views as to the prophylactic virtues
of cow-pox, laughed at him, and even threatened to expel him
from their society, if he persisted in harassing them with the
subject. In London he was so fortunate as to study under John
Hunter [1770-1773] to whom he communicated his views. The
advice of the great anatomist was thoroughly characteristic:
'Don't think, but try; be patient, be accurate.' Jenner's
courage was greatly supported by the advice, which conveyed to
him the true art of philosophical investigation. He went back
to the country to practise his profession, and carefully to
make observations and experiments, which he continued to
pursue for a period of twenty years. His faith in his
discovery was so implicit that he vaccinated his own son on
three several occasions. At length he published his views in a
quarto of about seventy pages, in which he gave the details of
twenty-three cases of successful vaccination of individuals,
to whom it was found afterwards impossible to communicate the
smallpox either by contagion or inoculation. It was in 1798
that this treatise was published; though he had been working
out his ideas as long before as 1775, when they began to
assume a definite form. How was the discovery received? First
with indifference, then with active hostility. He proceeded to
London to exhibit to the profession the process of vaccination
and its successful results; but not a single doctor could be
got to make a trial of it, and after fruitlessly waiting for
nearly three months, Jenner returned to his native village.
{2141}
He was even caricatured and abused for his attempt to
'bestialize' his species by the introduction into their
systems of diseased matter from the cow's udder. Cobbett was
one of his most furious assailants. Vaccination was denounced
from the pulpit as 'diabolical.' It was averred that
vaccinated children became 'ox-faced,' that abscesses broke
out to 'indicate sprouting horns,' and that the countenance
was gradually 'transmuted into the visage of a cow, the voice
into the bellowing of bulls.' Vaccination, however, was a
truth, and notwithstanding the violence of the opposition
belief in it spread slowly. In one village where a gentleman
tried to introduce the practice, the first persons who
permitted themselves to be vaccinated were absolutely pelted,
and were driven into their houses if they appeared out of
doors. Two ladies of title,—Lady Ducie and the Countess of
Berkeley,—to their honor be it remembered,—had the courage
to vaccinate their own children; and the prejudices of the day
were at once broken through. The medical profession gradually
came round, and there were several who even sought to rob Dr.
Jenner of the merit of the discovery, when its vast importance
came to be recognized. Jenner's cause at last triumphed, and
he was publicly honored and rewarded. In his prosperity he was
as modest as he had been in his obscurity. He was invited to
settle in London, and told that he might command a practice of
£10,000 a year. But his answer was, 'No! In the morning of my
days I have sought the sequestered and lowly paths of
life,—the valley, and not the mountain,—and now, in the
evening of my days, it is not meet for me to hold myself up as
an object for fortune and for fame.' In Jenner's own lifetime
the practice of vaccination had been adopted all over the
civilized world; and when he died, his title as Benefactor of
his kind was recognized far and wide. Cuvier has said, 'If
vaccine were the only discovery of the epoch, it would serve
to render it illustrious forever."

_S. Smiles,
Self-help,
chapter 4._

ALSO IN:
_J. Barron,
Life of Edward Jenner._

MEDICAL SCIENCE: 18th Century.
The Brunonian System of Stimulation.

"John Brown, born of obscure parents in a village of Berwick,
in Scotland, was remarkable, from his early youth, for an
extraordinary aptitude for acquiring languages, a decided
inclination for scholastic dispute, a pedantic tone and
manner, and somewhat irregular conduct. Having abandoned
theology for medicine, he fixed his residence in Edinburgh.
… He was particularly entertained and countenanced by
Cullen, who even took him into his family in the character of
preceptor of his children. This agreeable relation subsisted
during twelve consecutive years between these two men, whose
characters and minds were so different. … But some trifling
matters of mutual discontent grew at length into coldness, and
changed the old friendship which had united them into an
irreconcilable hatred. Their rupture broke out about the year
1778, and in a short time after, Brown published his Elements
of Medicine. … Brown employed some of the ideas of his
master to develop a doctrine much more simple in appearance,
but founded entirely on abstract considerations; a doctrine in
which every provision seems to be made for discussion, but
none for practice. Cullen had said that the nervous system
receives the first impression of excitants, and transmits it
afterwards to the other organs endowed with motion and
vitality. Brown explains thus, the same thought: 'Life is only
sustained by incitation. It is only the result of the action
of incitants on the incitability of organs.' Cullen regarded
the atony of the small vessels as the proximate cause of
fever. Brown, improving on this hypothesis, admits, with
hardly any exceptions, only hyposthenic diseases. … The
Scotch physiologist distinguished only two pathological
states—one consisting in an excess of incitability, which he
names the sthenic diathesis; the other, constituted by a want,
more or less notable, of the same faculty, which he designates
as the asthenic diathesis. Besides, Brown considers these two
states as affecting the entire economy, rather than any organ
in particular. … After having reduced all diseases to two
genera, and withdrawn from pathology the study of local
lesions, Brown arrives, by a subtile argumentation, to
consider the affections of the sthenic order as prevailing in
a very small number of instances, so that the diseases of the
asthenic type comprehend nearly the totality of affections.
According to this theory, a physician is rarely ever mistaken
if he orders in all his cases, remedies of an exciting nature.
… Never since the days of Thessalus (of charlatan memory)
had anyone simplified to such a point the study and practice
of medicine. We may even say that in this respect the Scotch
pathologist left far in the rear the physician of Nero. To
this attraction, well calculated to tempt students and
practitioners, the doctrine of Brown joined the advantage of
being presented in an energetic and captivating style, full of
imagery, which suffices to explain its rapid progress. But
this doctrine, so seductive in its exposition, so easy in its
application, is one of the most disastrous that man has been
able to imagine, for it tends to propagate the abuse of
diffusible stimulants, of which spirituous liquors make a
part, an abuse excessively injurious to health in general, and
the intellectual faculties in particular—an abuse to which
man is too much inclined, naturally, and which the sophisms of
Brown may have contributed to spread in all classes of English
society. … Notwithstanding its defects, the system of Brown
made rapid progress, principally in Germany and Italy."

_P. V. Renouard,
History of Medicine,
pages 555-560._

MEDICAL SCIENCE: 18th Century.
The System of Haller.

"About the time when we seniors commenced the study of
medicine, it was still under the influence of the important
discoveries which Albrecht von Haller [1708-1777] had made on
the excitability of nerves; and which he had placed in
connection with the vitalistic theory of the nature of life.
Haller had observed the excitability in the nerves and muscles
of amputated members. The most surprising thing to him was,
that the most varied external actions, mechanical, chemical,
thermal, to which electrical ones were subsequently added, had
always the same result; namely, that they produced muscular
contraction. They were only quantitatively distinguished as
regards their action on the organism, that is, only by the
strength of the excitation; he designated them by the common
name of stimulus; he called the altered condition of the nerve
the excitation, and its capacity of responding to a stimulus
the excitability, which was lost at death.
{2142}
This entire condition of things, which physically speaking
asserts no more than the nerves, as concerns the changes which
take place in them after excitation, are in an exceedingly
unstable state of equilibrium; this was looked upon as the
fundamental property of animal life, and was unhesitatingly
transferred to the other organs and tissues of the body, for
which there was no similar justification. It was believed that
none of them were active of themselves, but must receive an
impulse by a stimulus from without; air and nourishment were
considered to be the normal stimuli. The kind of activity
seemed, on the contrary, to be conditioned by the specific
energy of the organ, under the influence of the vital force.
Increase or diminution of the excitability was the category
under which the whole of the acute diseases were referred, and
from which indications were taken as to whether the treatment
should be lowering or stimulating. The rigid one-sidedness and
the unrelenting logic with which … [John] Brown had once
worked out the system was broken, but it always furnished the
leading points of view."

_H. Helmholtz,
On Thought in Medicine
(Popular Lectures, series 2, lecture 5)._

MEDICAL SCIENCE: 18th. Century.
Physiological Views of Bichat.

Marie Francis Xavier Bichat, was born in 1771 and died in
1802, accomplishing his extraordinary work as an anatomist and
physician within a lifetime of thirty-one years. "The peculiar
physiological views of Bichat are to be found stated more or
less distinctly in all his works; and it is a merit of his
that he has always kept in sight the necessary connexion of
this part of the science of medicine with every other, and, so
far as he has developed his ideas upon the subjects of
pathology, materia medica, and therapeutics, they seem all to
have been founded upon and connected with the principles of
physiology, which he had adopted. … Everything around living
bodies, according to Bichat, tends constantly to their
destruction. And to this influence they would necessarily
yield, were they not gifted with some permanent principle of
reaction. This principle is their life, and a living system is
therefore necessarily always engaged in the performance of
functions, whose object is to resist death. Life, however,
does not consist in a single principle, as has been taught by
some celebrated writers, by Stahl, Van Helmont, and Barthez,
&c. We are to study the phenomena of life, as we do those of
other matter, and refer the operations performed in living
systems to such ultimate principles as we can trace them to,
in the same way that we do the operations taking place among
inorganic substances. … His essential doctrine … is that
there is no one single, individual, presiding principle of
vitality, which animates the body, but that it is a collection
of matter gifted for a time with certain powers of action,
combined into organs which are thus enabled to act, and that
the result is a series of functions, the connected performance
of which constitutes it a living thing. This is his view of
life, considered in the most general and simple way. But in
carrying the examination farther, he points out two remarkable
modifications of life, as considered in different relations,
one common both to vegetables and animals, the other peculiar
to animals. … Those which we have in common with the
vegetable, which are necessary merely to our individual,
bodily existence, are called the functions of organic life,
because they are common to all organized matter. Those, on the
other hand, which are peculiar to animals, which in them are
superadded to the possession of the organic functions, are
called the functions of animal life. Physiologically speaking,
then, we have two lives, the concurrence of which enables us
to live and move and have our being; both equally necessary to
the relations we maintain as human beings, but not equally
necessary to the simple existence of a living thing. … The
two lives differ, in some important respects, as to the organs
by which their functions are performed. Those of the animal
life present a symmetry of external form, strongly contrasted
with the irregularity, which is a prominent characteristic of
those of organic life. In the animal life, every function IS
either performed by a pair of organs, perfectly similar in
structure and size, situated one upon each side of the median
dividing line of the body, or else by a single organ divided
into two similar and perfectly symmetrical halves by that
line. … The organs of the organic life, on the contrary,
present a picture totally different; they are irregularly
formed, and irregularly arranged. … This symmetry of the
form is accompanied by a corresponding harmony in the
functions of the organs of the animal life. … The functions
of the organic life are constantly going on; they admit of no
interruption, no repose. … In those of the animal life, the
case is widely different. They have intervals of entire
repose. The organs of this life are incapable of constant
activity, they become fatigued by exercise and require rest.
This rest, with regard to any particular organ, is the sleep
of that organ. … Upon this principle, Bichat founds his
theory of sleep. General sleep is the combination of the sleep
of particular organs. Sleep then is not any definite state,
but is more or less complete rest of the whole system in
proportion to the number of organs which require repose. …
The two lives differ also in regard to habit; the animal being
much under its control, the organic but slightly. … But the
principal and most important feature in the physiological
system of Bichat, is the complete, and entire, and exclusive
explanation of all the phenomena of the living system upon the
principles of vitality alone. Former physiologists have not
always kept this distinctly in view. … The human body has
been regarded, too often, as a mass of matter, organized to be
sure, but yet under the direction of physical laws, and the
performance of its functions has been ascribed to the powers
of inorganic matter. Hence, physiology has generally been
somewhat tinctured by the favorite science of the age, with
some of its notions. … With Bichat the properties of life
were all in all. The phenomena of the system, whether in
health or disease, were all ascribed to their influence and
operation."

_J. Ware,
Life and Writings of Bichat
(North American Review, July, 1822)._

{2143}

MEDICAL SCIENCE: 18-19th Centuries.
Pinel and the Reform in treatment of the Insane.

Philippe Pinel, "who had attained some distinction as an
alienist, was appointed, 1792, to fill the post of
superintendent of the Bicêtre, which then contained upwards of
200 male patients, believed not only to be incurable, but
entirely uncontrollable. The previous experience of the
physician, here stood him in good stead. He had been a
diligent student of the authorities of his own and foreign
countries on diseases of the mind, and in his earlier years
had been appointed by the French government to report on the
condition of the asylums at Paris and Charenton. On assuming
the oversight of the Bicêtre, he found 53 men languishing in
chains, some of whom had been bound for a great number of
years. These were regarded by the authorities as dangerous and
even desperate characters; but the sight of men grown gray and
decrepit as the result of prolonged torture, made a very
different impression on the mind of Pinel. He addressed appeal
after appeal to the Commune, craving power to release, without
delay, the unhappy beings under his charge. The authorities
tardily and unwillingly yielded to the importunity of the
physician. An official, who was deputed by the Commune to
accompany the superintendent and watch his experiment, no
sooner caught sight of the chained maniacs than he excitedly
exclaimed: 'Ah, ça! citoyen, es-tu fou toi-même de vouloir
déchaîner de pareils animaux?' The physician was not to be
deterred, however, from carrying out his benevolent project,
and did not rest satisfied until all of the 53 men had been
gradually liberated from their chains. Singular as it may
appear, the man who had been regarded as the most dangerous,
and who had survived forty years of this severe treatment, was
afterwards known as the faithful and devoted servant of Pinel.
The reforms of Pinel were not confined to the Bicêtre, an
establishment exclusively for men, but extended to the
Salpêtrière, an institution for women. There is, perhaps, no
more touching event in history than that of this kind-hearted
and wise physician removing the bands and chains from the
ill-fated inmates of this place of horrors. The monstrous
fallacy of cruel treatment once fully exposed, the insane came
to be looked upon as unfortunate human beings, stricken with a
terrible disease, and, like other sick persons, requiring
every aid which science and benevolent sympathy could provide
with a view to cure. Governmental inquiries were instituted
with a view to the attainment of better treatment, and in
different countries, almost simultaneously, the provision of
suitable and adequate accommodation for the insane was
declared to be a State necessity."

_W. P. Letchworth,
The Insane in Foreign Countries,
chapter 1._

MEDICAL SCIENCE: 19th Century.
The Discovery of Anæsthetics.