CHAPTER XXXIV. Hermann Boerhaave of Leyden, Holland, One of the Most

HERMANN BOERHAAVE OF LEYDEN, HOLLAND, ONE OF THE MOST DISTINGUISHED PHYSICIANS OF THE SEVENTEENTH CENTURY

Hermann Boerhaave, who was born at Voorhont, near Leyden, Holland, on December 31, 1668, was the son of a poor but highly educated clergyman; and it was owing to this circumstance that he received in early youth a most careful training in Latin and Greek and in belles-lettres. At the age of fourteen he entered the public school of Leyden, and made such rapid progress in his studies--history, mathematics, the different branches of natural philosophy, Hebrew and Chaldean languages, and metaphysics--that he was soon able to follow regularly the lectures given at the university. He was only fifteen at the time when his father died, leaving him absolutely penniless; but Van Alphen, the Burgomaster of Leyden, befriended him and furnished all the funds needed for a continuance of his studies at the university. But young Boerhaave, who was not willing to be entirely dependent on the aid thus provided, contributed to his own support not a little by giving private instruction to young students of the wealthy class. In 1690 he received the degree of Doctor of Philosophy, the subject of his dissertation being a refutal of the doctrines of Epicurus, Hobbes and Spinosa. His original intention had been to prepare himself for the ministry, but, after continuing his studies in theology for a short time, he determined that the better course for him would be to choose the career of physician. Accordingly he began, at the age of twenty-two, to study the anatomical treatises of Vesalius, Fallopius and Bartholinus, and at the same time he followed a course of instruction in dissecting, under the guidance of the anatomist Nuck, and also occasionally attended the lectures given by Drelincourt, who at that time was Professor of the Theory of Medicine. In his reading of medical literature he showed a decided preference for the writings of Hippocrates and Sydenham; and he devoted a large portion of his time to the study of botany and chemistry, two branches of the science of medicine in which he took a very strong interest all through life. In 1693 he received the degree of Doctor of Medicine from the University of Harderwyk. In 1701 he was appointed Associate Professor of the Theory of Medicine in the University of Leyden, and it was in this capacity that he began building up that great reputation which in a very few years brought crowds of students from all parts of the world to Leyden. As already stated on a previous page, he owed a large part of his fame to the admirable manner in which he conducted his clinical teaching. To show how widely he was known throughout Europe the story is told that a letter which had been sent to him from a mandarin living in China and which bore the address, “To the illustrious Boerhaave, Physician in Europe,” reached him in due course.

Soon after his first appointment at Leyden, he received other most flattering offers, such as that of William the Third, Hereditary Prince of the Netherlands, to accept the position of Court Physician at The Hague, and a call from the University of Groningen (1703) to occupy the Chair of Medicine. He declined these offers as he preferred to remain at Leyden; but, a few years later, in 1709, he accepted the full professorship of the Practice of Medicine in the institution with which he was already connected. From the vantage ground of this more responsible position he was able most successfully to teach the students the best methods of observing, identifying and treating the different diseases; and as a further result of this promotion in rank his private practice grew rapidly, monarchs and princes coming from every country in Europe to consult him about their maladies. Boerhaave was also most popular among his fellow townsmen. It is related of him, for example, that on one occasion, after he had been confined to the house for about six months by an illness of a gouty nature, the citizens of Leyden manifested their joy at his recovery by inaugurating a general illumination of the town during the evening of the day on which he made his first appearance on the street. He had two relapses of the gouty affection, one in 1727 and another in 1729, and he finally died from disease of the heart on September 23, 1738. The monument raised in his honor by the city of Leyden bears the inscription: “Salutifero Boerhaavii genio sacrum” (Sacred to the memory of the health-giving genius of Boerhaave).

Some idea of the lucrative character of Boerhaave’s private practice may be gained from the fact that he left to his only child, a daughter, the sum of about four million francs. And yet he was noted for the generous gifts which he made during his lifetime to all sorts of scientific and benevolent objects.

Boerhaave, says Dezeimeris, exercised during his career, and also for a long time after his death, an immense influence upon medical thought. He is justly ranked, he adds, among the iatromathematicians, and it is correct to say that he was largely instrumental in overthrowing the chemical system which de le Boë (Sylvius) had developed. His own treatise on this branch of knowledge (“Elementa Chemiae”), which was published toward the end of his life, soon became the standard work on this subject, and it retained its popularity for many years. “It is to be regretted that, possessing as Boerhaave unquestionably did, remarkable powers of observation, he should have allowed himself, in opposition to the very principles which he advocated so strongly, to indulge in the making of systems and hypotheses. He commenced by advocating with enthusiasm the method of Hippocrates, and ended by following the brilliant but not very trustworthy example of Galen.” (Dezeimeris.)

The number of treatises which Boerhaave published is quite large, the most important among them being the following: “Oratio de commendando studio Hippocratico,” 1701; “Institutiones medicae in usus annuae exercitationis domesticos,” 1708; “Aphorismi de cognoscendis et curandis morbis in usum doctrinae medicae,” 1709 (English version printed in London in 1742); and “Elementa chemiae,” 1732 (English translation by Peter Shaw, London, 1741).

Of the “Aphorisms,” one of the most widely known of Boerhaave’s published treatises, I shall take the liberty of saying a few words. This work is in reality a very concise statement of the author’s views regarding pathology, pathological anatomy and therapeutics, and I believe that the following paragraphs, although few in number, will suffice to give our readers a fair idea of the general character of the book. At the same time I must confess that I have not found it an easy matter to understand and satisfactorily digest many of the individual aphorisms, the text of which has been compressed into such a small space. It therefore does seem surprising to learn from one critic that, if one wishes to ascertain what Boerhaave’s views are with regard to the science of medicine, one should read by preference the Commentaries of Van Swieten, who was Boerhaave’s favorite pupil and assistant.

The following four or five aphorisms are typical specimens belonging to the earlier sections of the book:--

(7.) A disease when present in a body, must needs be the bodily effect of a particular cause directed to that body.

(8.) Which effect being entirely removed, health is recovered.

(9.) It may be removed by correcting the illness itself in particular, viz., by the applications of medicines to the particular diseased part, or by some remedies which operate equally upon the whole: the first we’ll call a particular, the latter a general cure.

(10.) The way to both is discovered either by observation, or by comparing one case with another, or by a true reasoning from them both.

(13.) He who doth, with the greatest exactness imaginable, weigh every individual thing that shall happen or hath happened to his patient and may be known from the observations of his own or of others, and who afterward compareth all these with one another, and puts them in an opposite view to such things as happen in an healthy state; and lastly, from all this, with the nicest and severest bridle upon his reasoning faculty, riseth to the knowledge of the very first cause of the disease, and of the remedies fit to remove them; he, and only he, deserveth the name of a true physician.

Then Boerhaave proceeds to make a classification of diseases, and among the very first groups which one finds in this classified list are the following: “Distempers of a lax and weak fibre”; “Distempers of the stiff and elastic fibre”; “Distempers of the less and larger vessels”; “Distempers of weak and lax entrails”; “Distempers of the too strong and stiff entrails”; etc.--from which it is apparent that the old doctrine of the strictum and the laxum, which was taught by the Methodists in the early centuries of our era, has here been adopted by Boerhaave in all its essential characters; and also that the treatment which he recommends for some of these classes of maladies does not materially differ from that advocated by this ancient school of medicine. The following extracts, I believe, will suffice to give the reader a fairly clear understanding of what Boerhaave means by the expressions “distempers of the solid simple fibre,” “distempers of a lax and weak fibre,” and “distempers of the stiff and elastic fibre,” and will at the same time show what methods he employed for overcoming these distempers. At the time when Boerhaave made use of the term “fibre” (fibra) in the very uncertain sense in which he here employs it, Leeuwenhoek and Malpighi were demonstrating, by aid of the newly perfected microscope, that the so-called simple tissues were in reality quite complex structures; and one’s first impulse, therefore, is to express surprise that a physician of such high standing as our author should have used the term. But we moderns must not forget that, in those early days, it took decades for knowledge of this nature to spread even a very short distance, as from Delft to Leyden, and then to exert its legitimate influence upon medical thought--that is, to be digested and afterward permanently appropriated. There can be scarcely any doubt that, at the time (1709) when Boerhaave wrote these aphorisms, he had already heard about the existence and the capabilities of the recently perfected microscope, but it is not at all likely that he had as yet digested the gains in anatomical knowledge which had been acquired through the assistance of this instrument. The extracts referred to above are the following:--

DISTEMPERS OF THE SOLID SIMPLE FIBRE

(21) Those parts (which, being separated from the fluid contained in the vessels, are applied and sticking to each other by the strength of the living body, and make the least fibre) are the least, the simplest, earthy, and hardly changeable from or by virtue of any cause, which are found in our living bodies.

DISTEMPERS OF A LAX AND WEAK FIBRE

(24) The weakness of the fibre is that cohesion of the minutest parts described (21), which is so loosely linked that it may be pulled asunder even by that degree of motion which is requisite in healthy bodies, or not much exceeding it.

(26) The weakness produceth easily a stretching and a breaking of the small vessels made up of those weak fibres (24), and consequently abates of their power over the fluids therein contained; from which distensions arise tumors, from the stagnating or extravasated liquids putrefactions, and, farther, all such innumerable ills as are the consequences of them both.

(28) [In distempers of a lax and weak fibre] the cure must be obtained, 1. By aliments that abound in such matter as is described in section 21, and which [should] be almost so prepared beforehand as they are in a strong and healthy body; such are milk, eggs, flesh-broths, panadoes rightly prepared of well-fermented bread; and rough wines. All which must be given in small quantities, but often. 2. By increasing and invigorating the motion of the solids and fluids by means of frictions with a flesh-brush, or with flannel; by riding on horseback, and in a coach, or by being carried in a boat; and lastly by walking, running and other bodily exercises. 3. By a gentle pressure or a bandage upon the vessels, and a moderate repelling of the liquids therein contained. 4. By medicines both acid and austere, or such as are spirituous and well fermented, but applied with great caution and gentleness. 5. By any means that will remove and remedy the too great pulling of them.

DISTEMPERS OF THE STIFF AND ELASTIC FIBRE

(35) [In distempers of this group] the cure is effected, 1. By such meat and drink as is thin and watery, without any roughness, chiefly by the continued use of milk-whey, of the softest herbs and salads, barley-water, thin gruel, and unfermented liquors. 2. By avoiding of exercise, and dwelling in a moist, coolish air, and taking long sleeps. 3. By the taking or outwardly applying watery, lukewarm, tasteless medicines, and such as contain the lightest and softest oils.

In the second half of the volume I find abundant evidence of Boerhaave’s ability to treat efficiently some of the acute and chronic maladies; and, after a perusal of the text which deals with these affections, I have no difficulty in understanding how he came to be looked upon as one of the leading medical practitioners of the period during which he lived. I should be glad to reproduce here such portions of the aphorisms as would corroborate the statement that I have just made, but unfortunately the small amount of space that I can command does not permit me to do this. At every step, as I advance, I am warned against the danger of exceeding the limits permitted, and I shall, therefore, in the present instance, have to rest satisfied with quoting the larger part of a single paragraph in which is given an account of the treatment employed in a case of acute pleurisy.

(890) ... If the same pleurisy be recent before the end of the third day, yet violent from the many and strong symptoms, and dry, in a strong, exercised, dry body, without the hopes of the presence of (887 and 888) [a resolution or a concoction and excretion of the cause], then let the patient immediately be blooded largely, with a quick running stream out of a great vessel, and a large orifice, keeping his body quiet and leaning backwards, enforcing his breathing all the while with coughing or panting, fomenting the side at the same time, and gently rubbing it; which bleeding ought to be continued till the pain seems to abate pretty considerably, unless a fainting fit forces you to leave off sooner; at whose approach the vein must immediately be stopped. Bleeding ought to be repeated according as these symptoms do return upon whose account it was done the first time; and when that skin doth not any longer appear upon the surface of the blood, it is time to forbear more bleeding.

From the beginning ought to be used fomentations, bathings, warm streams, liniments, plaisters, and the like; which may be of use as they loosen, resolve, mitigate, and avert....

As only extracts of considerable length would suffice to give our readers a satisfactory idea of the attractive manner in which Boerhaave deals with the subject of chemistry, I prefer to omit them altogether, and to recommend to those who are specially interested in this branch of science, that they consult Peter Shaw’s excellent English translation of the “Elementa Chemiae.”

Albert von Haller, the celebrated Swiss physiologist and historian of medical literature, speaks of Boerhaave as “my beloved preceptor, a man of refined taste and a speaker or lecturer so logical and charming that one more gifted can hardly be imagined.”