after complete theoretical systems. The influence of the iatro-physical school was by no means exhausted; and in England, especially through the indirect influence of Sir Isaac Newton’s (1642–1727) great astronomical generalizations, it took on a mathematical aspect, and is sometimes known as iatro-mathematical. This phase is most clearly developed in Archibald Pitcairne (1652–1713), who, though a determined opponent of metaphysical explanations, and of the chemical doctrines, gave to his own rude mechanical explanations of life and disease almost the dogmatic completeness of a theological system. His countryman and pupil, George Cheyne (1671–1743), who lived some years at Bath, published a new theory of fevers on the mechanical system, which had a great reputation. Their English contemporaries and successors, John Freind, William Cole, and Richard Mead, leaned also to mechanical explanations, but with a distrust of systematic theoretical completeness, which was perhaps partly a national characteristic, partly the result of the teaching of Sydenham and Locke. Freind (1675–1728) in his Emmenologia gave a mechanical explanation of the phenomena of menstruation. He is also one of the most distinguished writers on the history of medicine. Cole (1635–1716) (see above) published mechanical hypotheses concerning the causation of fevers which closely agree with those of the Italian iatro-mechanical school. More distinguished in his own day than any of these was Mead (1673–1754), one of the most accomplished and socially successful physicians of modern times. Mead was the pupil of the equally popular and successful John Radcliffe (1650–1714), who had acquired from Sydenham a contempt for book-learning, and belonged to no school in medicine but the school of common sense. Radcliffe left, however, no work requiring mention in a history of medicine. Mead, a man of great learning and intellectual activity, was an ardent advocate of the mathematical doctrines. “It is very evident,” he says, “that all other means of improving medicine have been found ineffectual, by the stand it was at for two thousand years, and that, since mathematicians have set themselves to the study of it, men already begin to talk so intelligibly and comprehensibly, even about abstruse matters, that it is to be hoped that mathematical learning will be the distinguishing mark of a physician and a quack.” His Mechanical Account of Poisons, in the first edition (1702), gave an explanation of the effects of poisons, as acting only on the blood. Afterwards he modified his hypothesis, and referred the disturbances produced to the “nervous liquor,” which he supposed to be a quantity of the “universal elastic matter” diffused through the universe, by which Newton explained the phenomena of light—i.e. what was afterwards called the luminiferous ether. Mead’s treatise on The Power of the Sun and Moon over Human Bodies (1704), equally inspired by Newton’s discoveries, was a premature attempt to assign the influence of atmospheric pressure and other cosmical causes in producing disease. His works contain, however, many original experiments, and excellent practical observations. James Keill (1673–1719) applied Newtonian and mechanical principles to the explanation of bodily functions with still greater accuracy and completeness; but his researches have more importance for physiology than for practical medicine.
Boerhaave.—None of these men founded a school—a result due in part to their intellectual character, in part to the absence in England of medical schools equivalent in position and importance to the universities of the Continent. An important academical position was, on the other hand, one of the reasons why a physician not very different in his way of thinking from the English physicians of the age of Queen Anne was able to take a far more predominant position in the medical world. Hermann Boerhaave (1668–1738) was emphatically a great teacher. He was for many years professor of medicine at Leiden, where he lectured five hours a day, and excelled in influence and reputation not only his greatest forerunners, Montanus of Padua and Sylvius of Leiden, but probably every subsequent teacher. The hospital of Leiden, though with only twelve beds available for teaching, became the centre of medical influence in Europe. Many of the leading English physicians of the 18th century studied there; Gerard Van Swieten (1700–1772), a pupil of Boerhaave, transplanted the latter’s method of teaching to Vienna, and founded the noted Vienna school of medicine. As the organizer, and almost the constructor, of the modern method of clinical instruction, the services of Boerhaave to the progress of medicine were immense, and can hardly be overrated. In his teaching, as in his practice, he avowedly followed the method of Hippocrates and Sydenham, both of whom he enthusiastically admired. In his medical doctrines he must be pronounced an eclectic, though taking his stand mainly on the iatro-mechanical school. The best-known parts of Boerhaave’s system are his doctrines of inflammation, obstruction and “plethora.” By the last named especially he was long remembered. His object was to make all the anatomical and physiological acquisitions of his age, even microscopical anatomy, which he diligently studied, available for use in the practice of medicine. He thus differed from Sydenham, who took almost as little account of modern science as of ancient dogma. Boerhaave may be in some respects compared to Galen, but again differed from him in that he always abstained from attempting to reduce his knowledge to a uniform and coherent system. Boerhaave attached great importance to the study of the medical classics, but rather treated them historically than quoted them as canonical authorities. It almost follows from the nature of the case that the great task of Boerhaave’s life, a synthesis of ancient and modern medicine, and the work in which this is chiefly contained, his celebrated Institutions, could not have any great permanent value. Nearly the same thing is true even of the Aphorisms, in which, following the example of Hippocrates, he endeavoured to sum up the results of his long experience.
Hoffmann and Stahl.—We have now to speak of two writers in whom the systematic tendency of the 18th century showed itself most completely.
Friedrich Hoffmann (1660–1742), like Boerhaave, owed his influence, and perhaps partly his intellectual characteristics, to his academical position. He was in 1693 appointed the first professor of medicine in the university of Halle, then just founded by the elector Frederick III. Here he became, as did his contemporary and rival Stahl, a popular and influential teacher, though their university had not the European importance of Leiden. Hoffmann’s “system” was apparently intended to reconcile the opposing “spiritual” and “materialistic” views of nature, and is thought to have been much influenced by the philosophy of Leibnitz. His medical theories rest upon a complete theory of the universe. Life depended upon a universally diffused ether, which animals breathe in from the atmosphere, and which is contained in all parts of the body. It accumulates in the brain, and there generates the “nervous fluid” or pneuma—a theory closely resembling that of Mead on the “nervous liquor,” unless indeed Mead borrowed it from Hoffmann. On this system are explained all the phenomena of life and disease. Health depends on the maintenance of a proper “tone” in the body—some diseases being produced by excess of tone, or “spasm”; others by “atony,” or want of tone. But it is impossible here to follow its further developments. Independently of his system, which has long ceased to exert any influence, Hoffmann made some contributions to practical medicine; and his great knowledge of chemistry enabled him to investigate the subject of mineral waters. He was equally skilful in pharmacy, but lowered his position by the practice, which would be unpardonable in a modern physician, of trafficking in secret remedies.
George Ernest Stahl (1660–1734) was for more than twenty years professor of medicine at Halle, and thus a colleague of Hoffmann, whom he resembled in constructing a complete theoretical system, though their systems had little or nothing in common. Stahl’s chief aim was to oppose materialism. For mechanical conceptions he substituted the theory of “animism”—attributing to the soul the functions of ordinary animal life in man, while the life of other creatures was left to mechanical laws. The symptoms of disease were explained as efforts of the soul to rid itself from morbid influences, the soul acting reasonably with respect to the end of self-preservation. The anima thus corresponds partly to the “nature” of Sydenham, while in other respects it resembles the archeus of Van Helmont. Animism in its completeness met with little acceptance during the lifetime of its author, but influenced some of the iatro-physical school. Stahl was the author of the theory of “phlogiston” in chemistry, which in its day had great importance.
Haller and Morgagni.—From the subtleties of rival systems it is a satisfaction to turn to two movements in the medicine of the 18th century which, though they did not extinguish the spirit of system-making, opened up paths of investigation by which the systems were ultimately superseded. These are physiology in the modern sense, as dating from Haller, and pathological anatomy, as dating from Morgagni.
Albrecht von Haller (1708–1777) was a man of even more encyclopaedic attainments than Boerhaave. He advanced chemistry, botany, anatomy, as well as physiology, and was incessantly occupied in endeavouring to apply his scientific studies to practical medicine, thus continuing the work of his great teacher Boerhaave. Besides all this he was probably more profoundly acquainted with the literature and bibliography of medicine than any one before or since. Haller occupied in the new university of Göttingen (founded 1737) a position corresponding to that of Boerhaave at Leiden, and in like manner influenced a very large circle of pupils.
