Part 695

"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. {2137} 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.