Eighteenth Century Medicine

Dr Felix James.V

George Ernst Stahl (1661 –1734)
In his opinion soul and body were closely blended and the source of all vital movement was the soul or ‘anima’. Putrefaction only takes place after death in a soulless body. Death occurs when the body become unsuitable for the habitation of the soul.

Joseph Barthez of Montpellier (1734 –1806)
He found difficulty in advocating the claim of the ‘soul’ and introduced a new conception of a dominant force ‘vital principle’

Friedrich Hoffman (1660 – 1742)
His system of medicine was based upon the belief that the universe was pervaded by a vital substance which is finer than all other matter but not exactly spirit, soul or mind, which maintained the body in a state of “tonic equilibrium”. In Hoffman’s views disease resulted from excess or deficiency of tonus.

Giovanni Battista Morgagni (1682 – 1771).
The man who created the science, who taught us to think anatomically of disease, was Morgagni, whose “De sedibus et causis morborum per anatomen indagatis” is one of the great books in our literature. During the seventeenth century, the practice of making post-mortem examinations had extended greatly, and in the “Sepulchretum anatomicum” of Bonetus (1679), these scattered fragments are collected, But the work of Morgagni is of a different type, for in it are the clinical and anatomical observations of an able physician during a long and active life.

Born in 1682, Morgagni studied at Bologna under Valsalva and Albertini. In 1711, he was elected professor of medicine at Padua. He published numerous anatomical observations and several smaller works of less importance. The great work which has made his name immortal in the profession, appeared in his eightieth year, and represents the accumulated experience of a long life. Though written in the form of letters, the work is arranged systematically and has an index of exceptional value.

From no section does one get a better idea of the character and scope of the work than from that relating to the heart and arteries — affections of the pericardium, diseases of the valves, ulceration, rupture, dilation and hypertrophy and affections of the aorta are very fully described. The section on aneurysm of the aorta remains one of the best ever written. It is not the anatomical observations alone that make the work of unusual value, but the combination of clinical with anatomical records.

What could be more correct than this account of angina pectoris — probably the first in the literature? “A lady forty-two years of age, who for a long time, had been a valetudinarian, and within the same period, on using pretty quick exercise of body, she was subject to attacks of violent anguish in the upper part of the chest on the left side, accompanied with a difficulty of breathing, and numbness of the left arm; but these paroxysms soon subsided when she ceased from exertion. In these circumstances, but with cheerfulness of mind, she undertook a journey from Venice, purposing to travel along the continent, when she was seized with a paroxysm, and died on the spot. I examined the body on the following day…. The aorta was considerably dilated at its curvature; and, in places, through its whole tract, the inner surface was unequal and ossified. These appearances were propagated into the arteria innominata. The aortic valves were indurated….” He remarks, “The delay of blood in the aorta, in the heart, in the pulmonary vessels, and in the vena cave, would occasion the symptoms of which the woman complained during life; namely, the violent uneasiness, the difficulty of breathing, and the numbness of the arm.”

The profession was literally ravaged by theories, schools and systems — iatromechanics, iatrochemistry, humoralism, the animism of Stahl, the vitalistic doctrines of Van Helmont and his followers — and into this metaphysical confusion Morgagni came like an old Greek with his clear observation, sensible thinking and ripe scholarship. Using the approach they learned from De Sedibus, Morgagni’s successors formulated the basic principles that lie at the core of all modern clinical medicine.

Hermann Boerhaave(1668 – 1738).
Oftenspoken of as the Dutch Hippocrates, Boerhaave has inspired a group of distinguished students. After teaching botany and chemistry, Boerhaave succeeded to the chair of physic in 1714. With an unusually wide general training, a profound knowledge of the chemistry of the day and an accurate acquaintance with all aspects of the history of the profession, he had a strongly objective attitude of mind towards disease, following closely the methods of Hippocrates and Sydenham. He adopted no special system, but studied disease as one of the phenomena of nature.

His clinical lectures, held bi-weekly, became exceedingly popular and were made attractive not less by the accuracy and care with which the cases were studied than by the freedom from fanciful doctrines and the frank honesty of the man. He was much greater than his published work would indicate, and, as is the case with many teachers of the first rank, his greatest contributions were his pupils. No other teacher of modern times has had such a following. Among his favorite pupils may be mentioned HALLER, the physiologist, and VAN SWIETEN and ANTON DE HAEN (1704 – 1776), the founders of the Vienna school.
His chief works are “ INSTITUTIONES MEDICAE” (1708) and “APHORISMI” (1710) both of which had many editions.

Albrecht Von Haller (1708-1777)
A student of Boerhaave and Celebrated as a physician, he was proficient in various fields, being equally famed in his own time as poet, botanist, and statesman, and dividing his attention between art and science.

As a child Haller was so sickly that he was unable to amuse himself with the sports and games common to boys of his age, and so passed most of his time poring over books. When ten years of age he began writing poems in Latin and German, and at fifteen entered the University of Tubingen. At seventeen he wrote learned articles in opposition to certain accepted doctrines, and at nineteen he received his degree of doctor.

Soon after this he visited England, where his zeal in dissecting brought him under suspicion of grave-robbery, which suspicion made it expedient for him to return to the Continent. After studying botany in Basel for some time he made an extended botanical journey through Switzerland, finally settling in his native city, Berne, as a practising physician. During this time he did not neglect either poetry or botany, publishing anonymously a collection of poems.

In 1736 he was called to Gottingen as professor of anatomy, surgery, chemistry, and botany. During his labors in the university he never neglected his literary work, sometimes living and sleeping for days and nights together in his library, eating his meals while delving in his books, and sleeping only when actually compelled to do so by fatigue. During all this time he was in correspondence with savants from all over the world, and it is said of him that he never left a letter of any kind unanswered.
Haller’s greatest contribution to medical science was his famous doctrine of irritability, which has given him the name of “father of modern nervous physiology”.

The principle of general irritability had been laid down by Francis Glisson (1597-1677) from deductive studies, but Haller proved by experiments along the line of inductive methods that this irritability was not common to all “fibre as well as to the fluids of the body,” but something entirely special, and peculiar only to muscular substance. He distinguished between irritability of muscles and sensibility of nerves. In 1747 he gave as the three forces that produce muscular movements: elasticity, or “dead nervous force”; irritability, or “innate nervous force”; and nervous force in itself.

And in 1752 he described one hundred and ninety experiments for determining what parts of the body possess “irritability”–that is, the property of contracting when stimulated. His conclusion that this irritability exists in muscular substance alone and is quite independent of the nerves proceeding to it aroused a controversy that was never definitely settled until late in the nineteenth century, when Haller’s theory was found to be entirely correct.

It was in pursuit of experiments to establish his theory of irritability that Haller made his chief discoveries in embryology and development. He proved that in the process of incubation of the egg the first trace of the heart of the chick shows itself in the thirty-eighth hour, and that the first trace of red blood showed in the forty-first hour. By his investigations upon the lower animals he attempted to confirm the theory that since the creation of genus every individual is derived from a preceding individual–the existing theory of preformation, in which he believed, and which taught that “every individual is fully and completely preformed in the germ, simply growing from microscopic to visible proportions, without developing any new parts.”

In physiology, besides his studies of the nervous system, Haller studied the mechanism of respiration, refuting the teachings of Hamberger (1697-1755), who maintained that the lungs contract independently. Haller, however, in common with his contemporaries, failed utterly to understand the true function of the lungs. The great physiologist’s influence upon practical medicine, while most profound, was largely indirect. He was a theoretical rather than a practical physician, yet he is credited with being the first physician to use the watch in counting the pulse.
He advocated proving on healthy human beings.

His ELEMENTA PHYSIOLOGIAE IN 8 volumes was a great work (1759 –1766)

Anton De Haen (1704 – 1776)
He was the author of treatise on therapeutics in which he highly condemned the excess drugging which was prevalent at that time. He came to Vienna and reconstructed the medical school along with GERHARD VAN SWIETEN, both of them being students of Boerhaave.

Sir Robert Sibbald (1641 – 1722)
He was famous as the founder of Royal college of Physician at Edinburgh.

Alexander Monro Secundus ( 1733 – 1817)
He discovered the ‘foramen of Monro’ and published the original observation of the “Bursae Mucosae” and on “lymphatics”.

Benjamin Bell (1749 – 1806)
The first of Edinburgh Scinetific Surgeon. He wrote a book “ system of surgery”

Robert Whytt (1714 –1766)
He was the first to localize the seat of Reflex action in the spinal cord and to demonstrate that it was independent of the brain. His description of Tuberculous meningitis and Diphtheria are a medical classics.

John Pringle (1707 – 1782)
He was appointed as the professor of Medical philosophy. He got his MD from Leyden. In 1742, he was appointed physician to the Earl of Stair, then in command of the British army. At the battle of Dettingen in 1743, between France and England, based on his suggestion it was agreed that the military hospitals to be considered as sanctuaries and be protected mutually by both sides. This arrangement to protect eventually lead to the formation of “red cross”. He published in 1752 his observation on the “DISEASES OF THE ARMY”. Another work was that “ EXPERIMENTS UPON SEPTIC AND ANTISEPTIC SUBSTANCE” in which the word antiseptic is used for the first time.

Joseph Lind (1716 – 1794)
He was surgeon to the British navy. He wrote a book on the “TREATISE ON SCURVEY”, which was a classic literature in medicine. He was the first person to advocate the use of lemon or lime juice for scurvey.

William Giffard
First to use the Extractor or Forceps in Obstetrics.

Sir Fielding Ould
He was from Ireland, famous for rendering help to establish ‘ Dublin School of Midwifery’

William Smellie (1697 – 1763)
He studied in Glasgow and after a short training settled in London in the year 1739. He wrote a book on ‘treatise on MIDWIFERY’ which gave a detailed account of the mechanism of labor and corrected many errors practised during the time. He was the foremost person to use forceps.

William Cheselden (1688 – 1752)
He was the first man to perform Iridectomy and he had nice hand , for removing stones. He was very famous and had the opportunity to attend Sir Issac Newton and Alexander Pope.

PERCIVAL POTT (1714 – 1788)
He tried to put surgery on a rational basis keeping in conformity with the development of Physiology and Medicine. He has described ‘Pott’s disease’ and ‘Pott’s Fracture’. He has written a number of treatises on Hernia, Head injury, Hydrocele, Fistulo-in-ano, Fracture and dislocation, Chimney a sweep cancer, Palasy from spinal caries.

Giovanni Maria Lancisi
Lancisi, one of the early students of disease of the heart, left an excellent monograph on the subject, and was the first to call special attention to the association of syphilis with cardio-vascular disease.

Giorgio Baglivi
A younger contemporary of his at Rome, Baglivi, was unceasing in
his call to the profession to return to Hippocratic methods, to stop reading philosophical theories and to give up what he calls the “fatal itch” to make systems.

Wiliam Cullen (1712 – 1790)
He was born at Hamilton in Lankashire. From the grammer school of Hamilton, he proceeded to Glasgow University. During that period, there was no medical faculty, so he became an apprentice to a surgeon and later to an apothecary in London. He had a good friendship with William Hunter. During his practice time he was keen in lecturing not only in Chemistry, but also in Botany, Materia Medica and Physics. He is regarded as the founder of Glasgow school of Medicine. At different time he had the privilege of occupying the highest chair of the institution of Theory of Medicine and Professor of Medicine. He was the author of a textbook known as “ FIRST LINES OF THE PRACTICE OF THE PHYSIC” and also “treatise on materia medica”.
Cullen’s theory of spasm and atony exercised a profound influence on practice, particularly in this country, where it had the warm advocacy of Benjamin Rush. Even more widespread became the theories of a pupil of Cullen’s,

John Brown (1735 – 1788)
He was born in Scotland. He was twice the president of the Royal Medical Society. John Brown, regarded excitability or continous stimulation as the fundamental property of all living creatures. The stimulants were warmth, food, muscular movement, intellectual energy, emotion etc; too much of this excitability produced what were known as STHENIC maladies, too little, ASTHENIC.. The treatment was aimed to apply large and heroic doses of medicine specially stimulating drugs. This was called by the name ‘Brunonian System’. Few systems of medicine have ever stirred such bitter controversy, particularly on the Continent, and in Charles Creighton’s account of Brown we read that as late as 1802 the University of Göttingen was so convulsed by controversies as to the merits of the Brunonian system that contending factions of students in enormous numbers, not unaided by the professors, met in combat in the streets on two consecutive days and had to be dispersed by a troop of Hanoverian horse.

William Hunter (1718-1783)
William Hunter must always be remembered as one of the greatest physicians and anatomists of the eighteenth century, and particularly as the first great teacher of anatomy in England; but his fame has been somewhat overshadowed by that of his younger brother John.

Hunter had been intended and educated for the Church, but on the advice of the surgeon William Cullen he turned his attention to the study of medicine. His first attempt at teaching was in 1746, when he delivered a series of lectures on surgery for the Society of Naval Practitioners. These lectures proved so interesting and instructive that he was at once invited to give others, and his reputation as a lecturer was soon established. He was a natural orator and story-teller, and he combined with these attractive qualities that of thoroughness and clearness in demonstrations, and although his lectures were two hours long he made them so full of interest that his pupils seldom tired of listening. He believed that he could do greater good to the world by “publicly teaching his art than by practising it,” and even during the last few days of his life, when he was so weak that his friends remonstrated against it, he continued his teaching, fainting from exhaustion at the end of his last lecture, which preceded his death by only a few days.

For many years it was Hunter’s ambition to establish a museum where the study of anatomy, surgery, and medicine might be advanced, and in 1765 he asked for a grant of a plot of ground for this purpose, offering to spend seven thousand pounds on its, erection besides endowing it with a professorship of anatomy. Not being able to obtain this grant, however, he built a house, in which were lecture and dissecting rooms, and his museum. In this museum were anatomical preparations, coins, minerals, and natural-history specimens.

Hunter’s weakness was his love of controversy and his resentment of contradiction. Hunter is said to have excused his own irritability on the grounds that being an anatomist, and accustomed to “the passive submission of dead bodies,” contradictions became the more unbearable. Many of the physiological researches begun by him were carried on and perfected by his more famous brother, particularly his investigations of the capillaries, but he added much to the anatomical knowledge of several structures of the body, notably as to the structure of cartilages and joints.

John Hunter (1728 –1793)
In Abbot Islip’s chapel in Westminster Abbey, close to the resting-place of Ben Jonson rest the remains of John Hunter, famous in the annals of medicine as among the greatest physiologists and surgeons that the world has ever produced.

Until about twenty years of age young Hunter had shown little aptitude for study, being unusually fond of out-door sports and amusements; but about that time, realizing that some occupation must be selected, he asked permission of his brother William to attempt some dissections in his anatomical school in London. To the surprise of his brother he made this dissection unusually well; By his second year in dissection he had become so skilful that he was given charge of some of the classes in his brother’s school; in 1754 he became a surgeon’s pupil in St. George’s Hospital, and two years later house-surgeon. Having by overwork brought on symptoms that seemed to threaten consumption, he accepted the position of staff-surgeon to an expedition to Belleisle in 1760, and two years later was serving with the English army at Portugal.

During all this time he was constantly engaged in scientific researches, many of which, such as his observations of gun-shot wounds, he put to excellent use in later life. On returning to England much improved in health in 1763, he entered at once upon his career as a London surgeon, and from that time forward his progress was a practically uninterrupted series of successes in his profession.
Hunter’s work on the study of the lymphatics was of great service to the medical profession. In 1758, he was the first to discover the lymphatics in the neck of birds, although it was his brother William who advanced the theory that the function of these vessels was that of absorbents.

In 1767 he met with an accident by which he suffered a rupture of the tendo Achillis. From observations of this accident, and subsequent experiments upon dogs, he laid the foundation for the now simple and effective operation for the cure of club feet and other deformities involving the tendons.

In 1772 he moved into his residence at Earlscourt, Brompton, where he gathered about him a great menagerie of animals, birds, reptiles, insects, and fishes, which he used in his physiological and surgical experiments. With the help of students he collected almost 30,000 specimens. Here he performed a countless number of experiments–more, probably, than “any man engaged in professional practice has ever conducted.” These experiments varied in nature from observations of the habits of bees and wasps to major surgical operations performed upon hedgehogs, dogs, leopards, etc. It is said that for fifteen years he kept a flock of geese for the sole purpose of studying the process of development in eggs.

Hunter began his first course of lectures in 1772, being forced to do this because he had been so repeatedly misquoted, and because he felt that he could better gauge his own knowledge in this way. Lecturing was a sore trial to him, as he was extremely diffident, and without writing out his lectures in advance he was scarcely able to speak at all. In this he presented a marked contrast to his brother William, who was a fluent and brilliant speaker.

He discovered the “collateral circulation” of the blood, which led, to successful operation upon aneurisms. The thorough understanding of this collateral circulation is one of the most important steps in surgery, for until it was discovered amputations were thought necessary in such cases as those involving the artery supplying a leg or arm, since it was supposed that, the artery being stopped, death of the limb and the subsequent necessity for amputation were sure to follow. Hunter solved this problem by a single operation upon a deer, and his practicality as a surgeon led him soon after to apply this knowledge to a certain class of surgical cases in a most revolutionary and satisfactory manner.

What led to Hunter’s far-reaching discovery was his investigation as to the cause of the growth of the antlers of the deer. Wishing to ascertain just what part the blood-supply on the opposite sides of the neck played in the process of development, or, perhaps more correctly, to see what effect cutting off the main blood-supply would have, Hunter had one of the deer of Richmond Park caught and tied, while he placed a ligature around one of the carotid arteries. He observed that shortly after this the antler (which was only half grown and consequently very vascular) on the side of the obliterated artery became cold to the touch. There was nothing unexpected in this, and Hunter thought nothing of it until a few days later, when he found, to his surprise, that the antler had become as warm as its fellow, and was apparently increasing in size. Puzzled as to how this could be, and suspecting that in some way his ligature around the artery had not been effective, he ordered the deer killed, and on examination was astonished to find that while his ligature had completely shut off the blood-supply from the source of that carotid artery, the smaller arteries had become enlarged so as to supply the antler with blood as well as ever, only by a different route.

He accidentally inoculated himself with lues and purposely delayed treatment in order to study the disease in his own system. He described shock, phlebitis, pyemia and intussusception. He differentiated between hard chancre and chancroid ulcer.

His literary works include “ Natural history of the Human Teeth” (1771)
“On venereal diseases” (1786)
“ Observations on the certain parts of the animal economy”
“ Treatise on blood, inflammation and Gunshot wounds”
The great services of Hunter were recognized both at home and abroad, and honors and positions of honor and responsibility were given him.
In 1776 he was appointed surgeon-extraordinary to the king;
In 1783 he was elected a member of the Royal Society of Medicine and of the Royal Academy of Surgery at Paris;
In 1786 he became deputy surgeon-general of the army; and
in 1790 he was appointed surgeon-general and inspector-general of hospitals. All these positions he filled with credit, and he was actively engaged in his tireless pursuit of knowledge and in discharging his many duties when in October, 1793, he was stricken while addressing some colleagues, and fell dead in the arms of a fellow-physician.

William Hewson (1739-1774),
One of John Hunter’s pupils, he was first to give an account, in 1768, of the lymphatics in reptiles and fishes, and added to his teacher’s investigations of the lymphatics in birds. He described that the coagulation of the blood is not because of solidification of the corpuscles but due to a substance he called it as “FOBROGEN”.

John Abernethy (1764 – 1831)
He was a pupil of John Hunter. He was the first person to ligate the external iliac artery for operation of aneurism. Abernethy was of the opinion that all diseases which were not surgical or external were due to Digestive troubles and he gave his own favourite remedies (calomel and blue pills)for it.

Asteley Cooper (1768 – 1841)
He has done ligation of the aorta in case of an aneurysm. He was the first to amputate hip joint. He received the Copley Medal in 1802.

Antonio Scarpa (1747- 1832)
He was a good anatomist from Pavia. Scarpa is memorable for his discovery of membranous labyrinth, the nasopalatine nerve, and the triangle of the high, that bears his name. He wrote important treatise on hernia and eye diseases and originated the procedure for iridodialysis and made shoes for clubfoot which is still the model for orthopaedics.

Domenico Cotugno (1736 – 1822)
He discovered the Cerebro-spinal and Labyrinthine fluid and gave a presentive theory of hearing. He had written a famous article on sciatica.

Joseph Desault (1744 – 1795)
He had devised a better technique of amputation and treating fractures.

Francois Xavier Bichat (1771 – 1802)
He was the pupil and assistant to Desault in Paris. Bichat founded the science of histology. He studied the Pathological changes occurred in the tissue or the membrane of twenty-one type. His views were published in 1800. He was of the opinion that pathological changes occurred in the tissue rather than in the organ.

Mathew Baillie
He is the nephew of John Hunter. He published a book on Morbid Anatomy with illustrations. He described transposition of the viscera, hydrosalpinx, dermoid cyst of the ovary and pxeynibua, distinguished ordinary renal cyst from renal hydatids. He gave a nice description of endocarditis and in the second edition gave a description of rheumatism of heart.

Lady Wortley Montagu
Wife of Birtish Ambassador in Turkey, introduced “inoculation” in England against Small pox. First tried successfully upon the criminals and then the members of the royal family were inoculated.

Thomas Dimsdale (1712 –1800)
He was a quack physician and one of the famous inoculators

Edward Jenner (1749 – 1823)
Before the eighteenth century closed practical medicine had made great advance. Smallpox, though not one of the great scourges like plague or cholera, was a prevalent and much dreaded disease, and in civilized countries few reached adult life without an attack. Edward Jenner, a practitioner in Gloucestershire, and the pupil to whom John Hunter gave the famous advice: “Don’t think, try!” had noticed that milkmaids who had been infected with cowpox from the udder of the cow were insusceptible to smallpox. I show you here the hand of Sarah Nelmes with cowpox, 1796. A vague notion had prevailed among the dairies from time immemorial that this disease was a preventive of the smallpox. Jenner put the matter to the test of experiment. Let me quote here his own words: “The first experiment was made upon a lad of the name of Phipps, in whose arm a little

Hand of Sarah Nelmes, inoculated with cowpox vaccine virus was inserted, taken from the hand of a young woman who had been accidentally infected by a cow. Notwithstanding the resemblance which the pustule, thus excited on the boy’s arm, bore to variolous inoculation, yet as the indisposition attending it was barely perceptible, I could scarcely persuade myself the patient was secure from the Small Pox. However, on his being inoculated some months afterwards, it proved that he was secure.” The results of his experiments were published in a famous small quarto volume in 1798. the title of the bool ‘ AN INQUIRY INTO THE CA– USES AND EFFECTS OF THE VARIOLAE VACCINE, A DISEASE DISCOVEREOUS INSOME OF THE WESTERN COUNTRIES OF ENGLAND, PARTICULARLY GLOCUESTERHIRE AND KNOWN BY THE NAME OF ‘COW POX’. From this date, smallpox has been under control.

John Fothergill (1712 –1780)
He was and assistant to Monro. In 1748 he wrote a treatise on “ACCOUNT ON SORE THROAT” which came out from a malignant form of scarlatina. He was an authority on materia medica and used Chinchona bark extensively, advised conium for neuralgia. He directed his effort for registration of birth and death though until 1837 it did not become compulsory.

Richard Mead (1673 – 1754)
He made some original observations on snake venom in his work ‘ A mechanical account of poisons’.

William Heberden (1710 – 1801)
Was a graduate from Cambridge and a great physician. He wrote commentaries of a large number of case records of different diseases like Angina Pectoris. He wrote “ there is a disorder of the heart marked with strong and peculiar symptoms, considerable for the danger belonging to it and not extremely rare. The seat of it, and the sense of strangling and anxiety with which it is attended, may make it not improperly called Angina Pectoris. The termination is remarkable. The patients all suddenly fall down, and perish almost immediately”

William Withering (1741 – 1799)
He graduated in Edinburgh in 1766 and started to practise for 10 years. He showed that dropsy might be due to cardiac disease and DIGITALIS if carefully used and stopped, might be an excellent remedy.

John Floyer (1649 – 1734)
He introduced PULSE WATCH. It had recorded the seconds on the dial.

Thermometer James Currie (1756 – 1805)
Currie checked the results after treating typhoid fever with THERMOMETER, PERCUSSION AND AUSCULTATION.

Leopold Auenbrugger (1722 – 1809)
He was a physician to the Military Hospital of Vienna. He was the son of an innkeeper of Graz and had often used Percussion to asses the level of wine in his father’s casks. This principle he applied to human chest when he was attached to a military hospital as a physician. He published a monograph on the title ‘ INVENTUM NOVUM EXPERCUSSIONE THORACIS GUMANT UT SINGO ABSTRUSOS INTERNT PECTORIS MORBOS DETEGENDI “ in the year 1761.

Dr Felix James. V BHMS,MD(Hom)
Medical Officer,Department of Homeopathy. Govt. of Kerala