CHAPTER XXXIII. The Three Leading Physicians of Germany During the Latter Half

THE THREE LEADING PHYSICIANS OF GERMANY DURING THE LATTER HALF OF THE SEVENTEENTH CENTURY: FRANZ DE LE BOË SYLVIUS, FRIEDRICH HOFFMANN AND GEORG ERNST STAHL

The seventeenth century, says Berendes, was one of the saddest periods in the history of Germany; but, during the greater part of this time, the neighboring countries--Holland, France, England and Italy--still continued to enjoy many of the blessings of the Renaissance,--such, for example, as an uninterrupted activity of artistic efforts, of scientific work, and of commerce;--but in Germany everything seemed to be in a state of confusion. A bloody religious war was at this period devastating the land, and the best powers of the people were being wasted. Instead of increasing cultivation of manners and sentiments, there was a steady growth of savagery. The Protestants, although they probably were numerically superior, were split up into factions. The Catholics, on the other hand, were united, and their power steadily increased. In 1618 the disturbances, which previously had been scattered in character, took on the form of what in time came to be known as “The Thirty Years’ War,” a struggle which proved to be most sanguinary, costing Germany a great deal in every respect. Finally, the war was brought to an end by the signing of the Westphalian Treaty of Peace at Lützen, in 1648. Some idea of the terribly destructive nature of this long war may be gathered from the fact that the population of Germany, which previously had been estimated at twenty millions, was found to have been reduced to about six millions. Whole towns and villages were laid in ashes, and as a consequence those who had survived the disaster lost confidence in themselves and were not able, at least for several years, to undertake anything in art, literature or science; and this depressing atmosphere affected in some degree the people of the Netherlands. Toward the end of the century, however, there came a marked awakening among the younger generation of physicians, and in the course of twenty or thirty years four men, only three of whom, however, were of German birth, succeeded in attaining a decided leadership in this department of science. The names of the Germans are Franz de le Boë (commonly spoken of as Sylvius), Friedrich Hoffmann and Georg Ernst Stahl. I shall now attempt to furnish, as nearly as possible in proper chronological order, very brief sketches of the lives of these distinguished physicians, together with an account of the contributions which they made to the science of medicine.

Franz de le Boë (Sylvius).--Franz de le Boë (Sylvius) was born at Hanau, Prussia, in 1614, of parents who belonged to the nobility and were wealthy, and who consequently were able to give their son every opportunity for acquiring an excellent education. Thus Franz first received a thorough training in philosophy and the classics and afterward visited in turn all the leading universities of Holland, France and Germany before he finally took his degree of Doctor of Medicine at Basel, Switzerland, in 1637. From this time forward, for a period of twenty-three years, he devoted himself to the practice of his profession, first in his native city and then in Leyden and Amsterdam. In 1660 he accepted an invitation to occupy the Chair of Medicine in the University of Leyden, and this position he held during the remainder of his life. He died in 1672.

As a teacher Sylvius was very popular, Boerhaave alone, at a later period, finding greater favor among the crowds of medical students and physicians who frequented this university. Haeser and Haller both attribute some portion of this popularity to the fact that Sylvius combined genuine eloquence with a wonderful charm of manner and a profound knowledge of chemistry, pharmacy and pathological anatomy. In the practice of medicine he followed Van Helmont very closely, but he was not willing to accept his teachings about an “archaeus insitus” and an “archaeus influus.” The system which he advocated was of a very simple character, and this fact undoubtedly contributed much to his popularity among the students. His therapeutic methods were also of a thoroughly practical nature.

Of the works which Sylvius published the following deserve to receive special mention: “Disputationes medicae,” a book in which are set forth his views regarding the fundamental principles of the science of medicine--physiology in particular; “De methodo medendi,” a treatise on therapeutics; and “Praxeos medicae idea nova,” a new idea concerning the practice of medicine.

Sylvius was one of the earliest defenders of Harvey’s great discovery, and he was also one of the first to call attention to the part played by chemistry in elucidating some of the problems in physiology and pathology. At the same time he was always ready to acknowledge the importance of the part played by mechanics in respiration, in the circulation of the blood, in the movements of the intestines, etc., in which respects he was in entire agreement with the iatrophysicists or iatromathematicians.

Finally, there is one more respect in which Sylvius is entitled to great credit: he paid most careful attention to the work of giving clinical instruction. Recognizing, as I do, the importance of this branch of medicine, I shall not hesitate to devote here a page or two to a brief review of the manner in which it came to hold the honorable position which it occupies to-day in all the best schemes for medical education.

During the sixteenth century, as Puschmann assures us, an attempt was made at Padua, Italy, to render clinical instruction an essential part of the physician’s education, but the difficulties which were encountered proved so much greater than was anticipated that it was soon found necessary to abandon the plan; and then for many years no further effort was made, either at Padua or at any of the other Italian medical schools, to introduce clinical teaching. After the lapse of nearly a century, Johannes Heurnius (1543–1601), Professor of Medicine at the University of Leyden, made an effort to introduce the plan of teaching medicine at the bedside; and a few years later (1630) two other professors of the same university--viz., Otho Heurnius, son of Johannes, and E. Schrevelius--formally introduced clinical instruction at the city hospital. The plan which they adopted was the following: The students in turn were permitted first to question the patient about his ailment and then afterward to make whatever physical examination appeared to be necessary; next, each one of them stated briefly what he believed to be the nature of the malady, and also gave his views as to the prognosis, symptoms and treatment; after which the professor commented on these different reports, pointing out both the correct and the incorrect features in each case. After a short trial of the plan it became clear that it would have to be abandoned, for the students did not like to have attention called in such a public manner to their mistakes. Then, a few years later, Sylvius, who at that time was the Professor of Medicine, introduced a system of clinical teaching which is thus briefly described by his colleague, Lucas Schacht:--

When, followed by his pupils, he approached the bedside of a patient, he assumed the air of one who is entirely ignorant of the nature of that person’s malady, of the accompanying symptoms, and of the treatment which was being carried out. Then he began to ask first one and then another of the students a great variety of questions respecting the case that was under consideration,--questions which at first seemed to have been propounded in a haphazard fashion, but which in reality were so cleverly formulated as to elicit from the class all the information needed for the making of a correct diagnosis, while leaving on the minds of the students the impression that they, and not the professor, had worked out the problem to a successful result.

This system, if such it may be termed, proved extremely successful, and the knowledge of this success spread rapidly from one end of Europe to the other, causing students and physicians to flock to Leyden from Russia, Poland, Hungary, Germany, Denmark, Sweden, France, Italy and England. So long as this particular university continued to possess, as a member of its faculty, a professor of medicine who was clever enough to carry on clinical instruction with the same profound knowledge of human nature as had been displayed by Sylvius, just so long did this institution remain without a rival in this part of the field of medical education. Then Sylvius was followed, in the work of clinical teaching, by Boerhaave, a man admirably fitted, both by nature and by the training which he had received, to keep the University of Leyden in the first rank of medical schools as regards this most useful form of discipline. After 1738, the year in which Boerhaave died, other universities besides that of Leyden began to provide fairly satisfactory facilities for clinical study, and among the number of such institutions those of Utrecht, Rome, Edinburgh, Paris and Halle deserve to be mentioned. The lack of funds and doubtless also the lack of the right sort of teachers were the principal reasons why these schools were not able to vie with Leyden in furnishing the facilities needed for clinical instruction. That the fault--at least in the case of the University of Halle--was not to be attributed to a failure on the part of the Medical Faculty to appreciate the value of such instruction is clearly shown by the saying attributed to Friedrich Hoffmann, who at that period was the Professor of Medicine:--

By a mere attendance upon medical lectures no man will ever succeed in becoming a properly equipped practitioner of that art; it is indispensable, in addition, that he should receive clinical instruction.

The fairly permanent establishment of this fundamental branch of medical teaching was not effected until about the middle of the eighteenth century, when Van Swieten, one of Boerhaave’s most distinguished pupils, was given full authority by the Empress Maria Theresa to furnish, at the University of Vienna, all the facilities required for successfully carrying on such instruction. From that time onward, to a quite recent date, Vienna has been the Mecca of all the younger physicians who aspired to become fully equipped in the practical branches of the science of medicine.

Georg Ernst Stahl.--Georg Ernst Stahl was born at Anspach, Germany, in 1660. Little is known about his early life beyond the fact that he pursued his studies at the University of Jena, received the degree of Doctor of Medicine from that institution in 1684, and shortly afterward began giving private courses in medicine which proved to be very popular and soon brought him into public notice. In 1687 he was given the position of Court Physician at Weimar. In 1694, upon the recommendation of Friedrich Hoffmann, who was at that time the incumbent of the regular Chair, he was appointed Associate Professor of Medicine in the recently founded University of Halle, Prussian Saxony; the understanding being that he was to devote his attention more particularly to the physiological, pathological, chemical and botanical aspects of the subject. He held this position up to the year 1716, when he was appointed one of the attending physicians of Frederick William the First, King of Prussia, and thereafter was obliged to reside in Berlin, in which city he died in 1734.

Stahl was a tireless worker, and wrote a large number of treatises (two hundred and forty-four in all) on physiological and pathological topics--all of them in Latin. Albert Lemoine, who has written an elaborate monograph on one of these treatises (that relating to animism), says that, despite the obscure style in which this and most of his other treatises are written, one may, upon careful study, satisfy himself that Stahl is a very close reasoner and possesses a clear mind. His most conspicuous faults, Lemoine adds, are these: he is opinionated and vain, and objects strongly to any criticisms that his opponents make; and yet he is careful to take up these criticisms one by one and subject them to a close analysis. His vanity led him to maintain that he was the only person then living who was capable of lifting medicine out of the rut in which it was at that time rigidly held. He manifested a sovereign contempt, not only for the men whose opinions differed from his, but also for those who complained of the difficulty of comprehending the Latin in which his treatises are written. Finally, Lemoine states that Stahl is addicted to mysticism, as is shown by the invocations of all sorts with which he begins and ends most of his writings. Haeser adds that Stahl possessed a gloomy, reticent and overbearing spirit, in striking contrast with the charming sweetness of temper of his colleague Hoffmann.

Among Stahl’s numerous contributions to medical literature there is only one in which our readers are likely to take any particular interest; I refer to the treatise which bears the title “Theoria medica vera”--the true theory upon which the science of medicine is based. It is in this work more particularly that Stahl expounds the doctrine of animism. As I have tried in vain to obtain a really satisfactory conception of this doctrine, which occupied so great a place in the thoughts of the physicians of the period between 1650 and 1750, I have decided to rest satisfied with merely reproducing here the interpretation which William Cullen of Edinburgh, one of Stahl’s contemporaries and also one of the greatest English physicians of that period, gives in his celebrated “First Lines of the Practice of Physic”:--

What is frequently spoken of as the power of nature--the “vis conservatrix et medicatrix naturae”--resides entirely in the rational soul. Stahl supposes that upon many occasions the soul acts independently of the body, and that, without any physical necessity arising from that state, the soul, purely in consequence of its intelligence, perceiving the tendency of noxious powers threatening, or of disorders any ways arising in the system, immediately excites such motions in the body as are suited to obviate the hurtful or pernicious consequences which might otherwise take place.

Barthélemy St. Hilaire of Paris (1805–1895) in one of his writings says: “I am convinced that the central idea in Stahl’s physiology was suggested to him by the reading of Aristotle’s ‘De anima,’ in which this great philosopher states that the soul nourishes the body, and also that nutrition is one of the four ways in which the soul manifests itself.”

Speaking of the effect of Stahl’s doctrines upon the actual practice of medicine as a whole, Cullen says that it was of a controlling character, leading physicians to propose the “art of curing by expectation”; the natural result of which was that they advocated for the most part the employment of only very inert and frivolous remedies. On the other hand, they zealously opposed the use of some of the most efficacious drugs, such as opium and the Peruvian bark, and resorted to bleeding and to the administration of emetics only in exceptional cases. Cullen adds that:--

The Stahlian system has often had a very baneful influence on the practice of physic, as either leading physicians into, or continuing them in, a weak and feeble practice, and at the same time superseding or discouraging all the attempts of art.... The opposition to chemical medicines in the sixteenth and seventeenth centuries, and the noted condemnation of antimony by the Medical Faculty of Paris, are to be attributed chiefly to those prejudices which the physicians of France did not entirely get the better of for near a hundred years after. We may take notice of the reserve it produced in Boerhaave with respect to the use of the Peruvian bark.

Stahl, after taking up his residence in Berlin, devoted himself energetically to the increase and spread of the knowledge of chemistry. The thing which brought him the greatest celebrity, both in his own lifetime and also during the years following his death, was his propounding of the “phlogiston” theory. This theory was to the effect that all combustible materials or substances contain (as he assumed) an element to which he gave the name of phlogiston. He was not able, however, to demonstrate the actual existence of this element; he simply assumed that it existed. At the same time the fact should here be stated that the terms “oxidation” and “reduction,” which came into use during the following century, developed out of this theory of phlogiston.

Friedrich Hoffmann.--Friedrich Hoffmann was born at Halle, Prussian Saxony, February 19, 1660, and received his medical education in his native city, largely under the direction of his father, who was himself a physician. In 1678 he attended lectures at the University of Jena, and in the following year visited Erfurt in order to benefit from the instruction of Caspar Cramer, who was at that time a distinguished authority in chemistry. At the end of two years he returned to Jena, took his degree of Doctor of Medicine, and acquired the right to deliver public lectures. Then, during the following three years, he visited Holland and England, and, upon his return in 1685, settled at Minden, Westphalia, as a general practitioner of medicine. In 1686 he was appointed District Physician of the Principality of Minden and also Court Physician of the Prince Elector; and two years later he accepted the position of District Physician at Halberstadt. After the inauguration of the new university at Halle, July 12, 1694, Hoffmann appears as one of the earliest professors chosen to serve the institution. In 1701, when Frederick the Third, Electoral Prince of Prussia, assumed the crown under the title of Frederick the First, King of Prussia, he extended to Hoffmann an invitation to come to Berlin and accept the position of Private Physician to His Majesty. Hoffmann was not at first willing to accept the invitation, but in 1708, when the King, who had then become seriously ill, renewed his request, Hoffmann accepted, on condition that he might retain his professorship. In 1712 he returned to Halle and remained there until he died in 1742.

Before Hoffmann’s time very little was known concerning the nature of carbonous (or carbonic) oxide and concerning the fatal effects which may be produced by inhalation of this gas. It was a common belief, for example, that the gas was given off by freshly plastered walls; and--as an even worse error--the theological authorities showed an inclination, in many of the fatal instances which probably were due to inhalation of carbonous oxide, but in which no recognizable cause of death had been discovered, to explain the event as due to the malign interference of the Devil. In our time it is well understood in the community that the fumes of carbonous oxide constitute the most dangerous gas that one is liable to encounter, but in Hoffmann’s day the people appear to have been less well informed concerning this danger than they were in ancient times. In the treatise on this subject which Hoffmann published in 1716, several of the earliest known instances of such poisoning are narrated, the first one being that mentioned very briefly by Aristotle (384–322 B. C.). Then follow two very short references to this subject in the “De rerum natura” of the Roman poet Titus Lucretius Carus (95–52 B. C.). They read as follows: (1) “The fumes of burning charcoal easily affect the brain if thou hast not first taken a drink of water.” (Book VI., verse 803.) (1) “If the fumes of the night lamp, after it has been extinguished, are inhaled rather deeply the effect experienced will be the same as if one had been struck down by a blow on the head.” (Book VI., verse 792.) The idea that the previous drinking of water is competent to prevent the effects of poisoning by charcoal fumes is declared by Neuburger, the translator of Hoffmann’s treatise, to be erroneous.

The earliest really satisfactory description of an instance of non-fatal poisoning by the fumes of burning charcoal is credited by Hoffmann to the Roman Emperor, Julian the Apostate, who reigned from 361 A. D. to 363 A. D. Before he was made Emperor, Julian was intrusted by Constantius II., in 355 A. D., with the government of the Province of Gaul, and in 357 he won a great battle against the Alamanni at Strassburg; after which he took up his residence in the little city of Lutetia, the present Paris. It was undoubtedly soon after this event that he wrote the Greek satire which bears the title “Misopogon,” and from which Hoffmann quotes the following account of Julian’s narrow escape from death through the poisonous effects of carbonous oxide:--

The little city which the Celts call Lutetia is built upon a small island in the midst of a river, and access to it from both sides is gained by means of wooden bridges. Ordinarily the winter climate in this region is mild, owing--as the people of the place claim--to the proximity of the Ocean. Good wine is produced there, and even fig-trees flourish provided care be taken to wrap them well in wheat straw or some similar protective material during the winter season. But my visit happened to have been made during an exceptionally severe winter, and as a result things which looked like slabs of Phrygian marble, closely packed together, were constantly floating down the river with the current, and, soon becoming jammed, they formed a sort of natural bridge. Although most of the houses--the one I occupied among the number--were provided with fireplaces and chimney-flues, and might therefore readily be heated, I was not willing that a fire should be kindled in my bedroom. I was very little sensitive to cold, and, in addition, I was desirous of becoming more and more hardened to its influence.... As the severity of the weather, however, showed no signs of letting up, I permitted the attendants to bring into the room a few glowing coals, just enough to render the air of the chamber less chilly. But, notwithstanding the very small degree of heat which these few burning coals supplied, it proved to be sufficient to draw out from the damp walls exhalations that caused my head to feel as if it were tightly held in a vice and also produced a sensation as if I were choking. I was immediately removed from the room, and the physicians who were promptly summoned administered an emetic which enabled me to get rid of the food which I had eaten a short time before. Soon afterward I had a refreshing sleep and was able on the following day to resume my work as usual. [Translated from the German version printed in Neuburger’s monograph.]

As will be seen from the reports which I have just quoted, there existed among the Germans, early in the eighteenth century, no fixed belief as to the real cause of death in many of these unexplained fatal cases; and it was therefore no small public service which Hoffmann rendered when he, in whose judgment about such matters the people at large placed the greatest confidence, published such a clear and simple explanation of the real cause of these deaths as that which is given in this interesting monograph.

Hoffmann also added not a little to his fame by the invention of a remedy which was first known as “Hoffmann’s drops,” but which to-day appears in the United States Pharmacopoeia under the name of “Hoffmann’s anodyne” or “spiritus aetheris compositus” (sulphuric ether, 325; alcohol, 650; ethereal oil, 25).