THE 
NEW-YORK QUARTERLY JOURNAL 
OF 
MEDICINE AND SURGERY. 
FOR OCTOBER, 1839. 
Art. I. A Comparative View of the State of Medicine in the 
Years 1733 and 1833, an Introductory Lecture. By 
Joseph Mather Smith, M.D., Prof. &c. 
It is a profitable, and at the same time, an agreeable occupation 
to look back into the history of the past, and to remark the 
changes which the healing art has undergone in advancing from 
age to age. In such a retrospect, it is curious to observe how 
tardily medical improvements have taken place, and how slight 
is the impression they produce on the mind, until, collectively, 
they have acquired a magnitude that renders them strikingly 
conspicuous. The periods within which great revolutions have 
occurred in medicine, vary exceedingly in length. Whilst 
some of them extend over long intervals of time, others embrace, 
comparatively, but a few years. Among these periods there is 
one, which, more than any other, has been, specially, fertile of 
various and signal improvements. I allude to that which com- 
prises the last one hundred years. As the advances of medicine 
in this space of time are worthy of being recounted on an occa- 
sion like the present, I would respectfully invite your attention 
to a notice of them, and especially to a review of the state of 
medical science at the two epochs which bound the period in 
question, namely, the year 1733, and the year 1833. 
It would be a subject of interesting inquiry, how far the pro- 246 
Smith’s Comparative View of 
[October, 
gress of medicine has been influenced by political power, popular 
opinions, discoveries in other departments of science, and im- 
provements in the arts. Such an inquiry would doubtless dis- 
close many of the causes which have promoted and impeded the 
progress of the healing art. Every important change, in the 
moral and political world, has a bearing more or less direct upon 
the interests of science. Circumstances apparently incidental, 
and, in themselves, at the time, of little moment, are sometimes 
ultimately productive of results far exceeding, in magnitude and 
importance, the boldest conceptions of the imagination. Influ- 
ences which are nascent to-day, may to-morrow annihilate those 
that have been in powerful action, and, at the same time, give 
energy and direction to others which had been feeble or slum- 
bering. It is thus that, at one time, we see political events ob- 
structing or advancing philosophy and the arts, and, at another, 
philosophy and the arts controlling or turning the course of po- 
litical events. The interests of learning are affected more, per- 
haps, than those of any other human pursuit by the ever-vary- 
ing circumstances with which they are proximately or remotely 
connected. Hence it is that, in flowing through successive ages, 
the great stream of science has not equally widened and deep- 
ened in equal periods of time, but has been slow or rapid in its 
enlargement, according as passing events have diverted from, or 
directed into its channel the currents of human thought. 
To illustrate the extent to which the progress of medicine has 
been influenced by the causes referred to, would require a wider 
scope of research than is afforded by the limits of an introduc- 
tory lecture. But though such an inquiry forms no part of our 
purpose, it may not be uninteresting to take a general view of 
the epoch with which, in reference to medicine, we design to 
compare the present. History is the more attractive when it 
assembles contemporary individuals and synchronistic events, 
and faithfully exhibits their distinguishing characters and rela- 
tions to one another. Leaving the present then, and returning 
back through the last one hundred years, let us contemplate the 
world as it was in 1773. 
In looking around on the state of things at this period, our at- 
tention is first arrested by the principal contemporary sovereigns. 
On the British throne is George II. in the seventh year of his 1839.] 
the State of Medicine. 
247 
reign. France is governed by Louis XV.; Spain by Philip V.; 
Germany by the Emperor Charles VI.; Poland by Augustus ; 
Prussia by Frederick William I.; Denmark by Christian VI.; and 
Russia by the Empress Anne. At the head of the Roman hier- 
archy is Clement XII., and Mahomet V. rules the Ottoman em- 
pire. Under the sway of these leading potentates the political, 
social, and religious concerns of every civilized nation are so 
regulated and governed as to secure the permanence of regal 
authority. 
Subject to the reigning princes, on every side, are men dis- 
tinguished in all the higher pursuits of life. It is the age in 
which flourish, as statesmen or warriors, Sir Robert Walpole, the 
Duke of Villars, Admiral Vernon, the Earl of Stair, Prince 
Eugene, Count de Saxe Maurice, the Earl of Bathurst, and 
Count de Belleisle. Among the writers, chiefly miscellaneous, 
are Montesquieu, Lord Kames, Fontenelle, Voltaire, Richardson, 
the Earl of Chesterfield, Bolingbroke, Rollin,' J. B. Rousseau, 
Swedenborg, and Cadwallader Colden. In the circle of junior 
writers of the same class, are Hume, Johnson, Fielding, and 
Franklin. Of the poets risen, or advancing to the summit of 
their reputation, are Pope, Blair, Swift, Allan Ramsay, Thom- 
son, Dyer, Young, Philips, and Metastasio. In divinity and eccle- 
siastical literature stand pre-eminent, Butler, Sherlock, Middle- 
ton, Mosheim, Hoadly, Warburton, Stackhouse, and Massillon. 
Below these in age, but equally gifted, are Doddridge, Wesley, 
Thomas Newton, and Edwards. In mathematics are Wolff, 
Simpson, Halley, Maupertius, Maclaurin, Euler, and Bradley. 
In architecture and the imitative arts of painting and statuary 
are, Zablia, Rysbrach, and Hogarth, all in the maturity of man- 
hood. In music, Handel, at the age of nearly half a century, is 
without a rival. 
Next to these eminent individuals, we may notice the more 
generally interesting events of 1733. The death of Augustus 
of Poland occurring in this year, gives rise to a new continental 
war. The Emperor resolves to place the Elector of Saxony on 
the throne of that kingdom, and is opposed in his scheme by 
France, Spain, and Sardinia; these latter powers favouring the 
claims of Stanislaus. Prince Eugene, at an advanced age, is 
again called to head the imperial troops, after being in retire- 248 
Smith’s Comparative View of 
[October, 
ment for fifteen years in Italy. It is in this year that the ac- 
complished and chivalrous Oglethorpe is engaged in founding 
the colony of Georgia; and that Berkeley, whose visit to Ame- 
rica a few years before, and whose liberal benefactions to our 
infant literary institutions render his name familiar to us all, 
is created Bishop of Cloyne. It is the year in which the publi- 
cation of the infidel writings of Voltaire occasions a warrant to 
be issued for his arrest, and his letters are ordered to be burnt. 
It is at this time, also, that we observe the origin of Protestant 
missions, in the project of the United Brethren for evangelising 
the world, and the embarkation of the first three missionaries for 
a foreign land. 
Such are some of the living individuals, and passing events 
of 1733,—individuals whose actions and works illustrate the 
end of the first third of the eighteenth century, and events of 
deep interest in reference to the future. A more detailed view 
of the state of things at this period, would show that the strong 
arm of power, however heavily it may press, here and there, 
upon the civil and religious rights of mankind, weighs but lightly 
upon the interests of literature, philosophy, and the arts. In 
these the votaries are numerous, and their achievements many 
and brilliant. 
But who, it may now be inquired, are the prominent phy- 
sicians of 1733, and how do they rank with their political, 
literary, and philosophical contemporaries? What are their 
doctrines, and their principles, and modes of practice? 
In the multitude of medical men that here crowd upon our 
notice, may readily be distinguished those most entitled to re- 
gard. They are known by the number and character of their 
works, and the exalted stations they occupy. First, in the list 
of pre-eminence, and above fifty years of age, are Stahl, Hoff- 
man, Boerhaave, Winslow, Cheyne, Mead, Petit, Morgagni, and 
Heister. Below the age of fifty, and above twenty-five, are Le 
Dran, Cheselden, Smellie, Alex. Monro, Albinus, Van SAvieten, 
Senac, Huxliam, Lieutaud, Gaubius, Sauvages, Pringle, and Lin- 
neus. To this catalogue must be added, Boylston and Nicoll 
in this country. In the genius and learning of these few indi- 
viduals, the medical profession is represented in its most favour- 
able character. There are others whose talents and labours give 1839.] 
the State of Medicine. 
249 
them a limited reputation, and place them above mediocrity; 
but, to name them would scarcely add lustre to the catalogue 
given. 
Of the occurrences relating to medicine at this time, a few 
particularly invite our attention. It is in 1733, that Heister, 
Professor at Helmstadt, publishes his Anatomy, a Compendium, 
highly valued, though inferior in merit to the system of Winslow, 
which appeared the year previous. At the same time, Chesel- 
den issues his splendid work on the bones, which he dedicated 
to Queen Caroline, to whom he had been appointed chief sur- 
geon. Simultaneously with these publications is the appearance 
of Cheyne’s “ English Malady, or Treatise on Nervous Dis- 
eases,” a very popular work, containing an interesting account 
of his own case. Occurring at this period, is an incident, in 
which arbitrary power is seen sternly exercised in dispiriting 
genius, and frustrating an object of laudable ambition. Lin- 
neus, at the age of twenty-six, after exploring the botany of 
Lapland, and publishing an account of its plants, being in po- 
verty, attempts to support himself by delivering private lectures 
at Upsal; but the statutes of the University allowing no one 
to lecture who is not a graduate, and Rosen, the professor of 
anatomy, informing against him, he is obliged to desist and 
seek other occupations. The annals of chemistry in this year 
are enriched by the discovery of the metallic nature of arsenic 
and cobalt. In regard to the epidemics of the period, the one 
to which the attention of physicians is universally called, is the 
influenza or epidemic catarrh. Commencing in America, the 
disease travels eastward, spreads over Europe, and ultimately 
extends to the Island of Bourbon, and probably over the whole 
earth. 
Turning to another view of the era we are contemplating, 
let us glance at the medical institutions and general character 
of the profession. 
In most of the countries of Europe are found sources of 
elementary instruction in the healing art. But the great foun- 
tains of medical knowledge are at Leyden, Halle, and Paris. 
Though infirmaries had their origin as far back as the time of 
Justinian, their number is yet small, and their organization and 
economy in many things defective. The only general hospitals 250 
Smith’s Comparative View of 
[October, 
in London are those of St. Thomas, Guy, St. Bartholomew, and 
Westminster. St. George’s was founded in the year on which 
our attention is fixed. In Paris are the Hopitaux, Hotel Dieu, La 
Pitie, La Charite, St. Louis, and a few others. The Royal In- 
firmary of Edinburgh, projected in 1721, and though not opened 
until several years afterwards, is rising into notice. These in- 
stitutions, and others of a similar character in different parts of 
Europe, in fulfilling the humane purposes of their creation, 
afford little or no systematic instruction in clinical medicine and 
surgery. The importance, however, of practical illustrations at 
the bed-side is beginning to be felt as essential in a medical 
education. 
In regard to the majority of those engaged in the practice of 
the healing art, little can be said in their favour. Excepting 
those who have enjoyed the advantages of a regular medical 
education, the greater number are distinguished by their igno- 
rance and imposing pretensions to skill. The line of distinction 
between medicine and surgery is, for the most part, well defined 
and jealously preserved. The physicians everywhere take pre- 
cedence, and, in England and Scotland, are incorporated into 
Royal Colleges; whilst the surgeons are incorporated with the 
barbers, and the apothecaries with the grocers. It is chiefly in 
the first of these classes are found the learning and science 
which give elevation to personal character, and claim for medi- 
cine the rank of a liberal profession. But, as if learning and 
science, in themselves, are undeserving of homage, it is curious 
to observe the extrinsic means resorted to by the most distin- 
guished physicians of the age, in common with the members of 
the other learned professions, to secure respect and reverence. 
The means alluded to are a gravity of deportment, and a style 
of dress, calculated to impose on common minds, and inspire' 
confidence in the mysteries of physic. This feature in the 
medical character of the day is not confined to the seniors of 
the profession, but is found in the youngest aspirants for prac- 
tice. Indeed, it is said, that “ the physicians in Hogarth’s prints 
are not caricatures; the full dress, with a sword and a great 
tie-wig, and the hat under the arm, and the doctors in con- 
sultation, each smelling to a gold-headed cane, shaped like a 
parish beadle’s staff, are pictures of real life in his time, and a 1839.] 
the State of Medicine. 
251 
young physician, thus equipped, walked the streets of London, 
without attracting the eyes of passengers.” Added to these 
means of impressing the public mind, is the general practice 
of writing and prescribing in Latin, the language, at this time, 
common to the professors of all the higher departments of 
learning. 
These more conspicuous objects of remark being examined, 
our attention is next invited to the actual state of medical science 
in 1733. In entering this field of observation, it is obvious, 
that our notice of particulars must be very brief and general. 
Anatomy being the basis of medical science, is of course the 
first study in every plan of medical education. Hence the 
importance of perfecting this department has always been ac- 
knowledged. The zeal and success with which it was cultivated 
in the earlier part of the eighteenth century, is creditable to the 
physicians of the times. We have before had occasion to men- 
tion the names of Heister, Winslow, and Cheselden. Availing 
themselves of the knowledge of their predecessors, and also of 
their great contemporary Ruysch, who died two years prior to 
the era we have in view, they were enabled to present to the 
profession systems of anatomy exceedingly correct and well 
arranged. Their works, however, are mostly confined to special 
anatomy, and consequently are defective in those minute views 
of the elementary textures and relations of parts from which are 
deduced many of the truths of physiology and pathology, and 
the rules of operative surgery. Among the more celebrated junior 
teachers of anatomy at this time, are Monro at Edinburgh, and 
Albinus at Leyden; the former having been appointed professor 
of that department at the age of twenty-three, and the latter at 
twenty. Of those more advanced in age, no one is more dis- 
tinguished than Morgagni of Padua. 
The chemistry of this period is nothing more than an assem- 
blage of facts observed as occurring, under certain circumstances, 
when bodies act on one another at insensible distances. The 
laws that govern the changes that take place during chemical 
action, as well as the nature of the changes themselves, are 
unintelligible. It is true, in some instances, theoretical expo- 
sitions are given; but they are, for the most part, fanciful. Such 
is the theory explanatory of the nature of fire and chemical 252 
Smith’s Comparative View of 
[October, 
inflammation, first suggested by Becker, and afterwards adopted 
and amplified by Stahl — a theory which supposes a principle, 
called phlogiston, to be present in all inflammable bodies, and 
which is separated from them in the process of combustion; 
whence they are entirely changed in their qualities. 
It is interesting to observe how many of the embarrassments 
in the medical researches of the time are referrible to deficiencies 
in chemical knowledge; and it is equally so, to remark how in- 
geniously a great amount of error is intermingled with truth and 
wrought up into plausible and even beautiful theories. The more 
prominent examples of this kind are the productions of Stahl, 
Hoffman, and Boeriiaave. To these illustrious men is as- 
signed, by common consent, the first rank of eminence. Their 
works are every where read; and their dogmata, promulgated, 
ex cathedra, carry with them an authority that commands gene- 
ral attention. 
Our limits precluding a particular analysis of their respective 
hypotheses* we shall merely advert to their cardinal principles. 
To understand these, however, it is important to premise that 
from the time of Hippocrates, and especially of Galen, every 
medical theory had been founded on the assumption that the 
humors of the body were the seats of disease. But though hu- 
moral doctrines had long prevailed, physicians had been divided 
into different sects, of these the principal were the Methodists, 
the Galenists, the Chemists, the Mechanicians or Mathema- 
ticians, the Spiritualists, and the Eclectics. These sects had their 
origin in the different views and modes of reasoning prevalent 
among physicians, in respect to the condition of the solids and 
fluids in the normal and morbid states of the system. They 
had successively risen, and though some of them had lost their 
distinctive characters, the principles of all of them were extant 
in the earlier years of the eighteenth century. 
Stahl, whose doctrines we shall first notice, was born in 
Franconia, and is now, at the period of which we speak, in the 
seventy-third year of his age. He was educated in the school 
of the chemists, and early in life was appointed, through the in- 
fluence of Hoffman, to a medical professorship in the new uni- 
versity of Halle. To the interests of this institution he conse- 
crated his life; and now, in his old age, enjoys, with his col- 1839.J 
the State of Medicine. 
253 
leagues the satisfaction of seeing it contending for superiority 
with the most distinguished schools of the age. Applying him- 
self to the study of chemistry and pathology, his genius was 
soon displayed in new and enlarged views of these departments 
of science. Of him as a chemist, and especially as the chief 
author of the theory of phlogiston, we have already spoken. We 
are now to regard him as the expounder of the nature of 
diseases. 
From attentively examining the phenomena of the living hu- 
man body, and especially observing the changes which sub- 
stances undergo when received into it, he was led to reject the 
doctrines of the chemical and mechanical physicians, and to refer 
the various states of the system to the operations of an intelligent, 
spiritual power, superadded to the organization. He is accord- 
ingly regarded as a metaphysical pathologist. In fact he adopts 
substantially the leading tenet in the hypothesis of Yan Hcl- 
mont, the founder of the metaphysical school, who died in 
1644. 
To the power or agent in question, Yan Helmont had given 
the name of archeus, and Stahl, believing it to be the rational 
soul, calls it anima. All the functions of the body, he contends, 
are under its control; and that, when their healthy condition is 
disturbed, it is immediately exerted in restoring them to a sound 
state. The body in health, he says, is inclined to plethora, and 
that the dangers and evils of this state are obviated by the anima 
inducing regular and sufficient excretions. When, in disease, 
the discharges are excessive, or otherwise, it is active in 
diminishing, or increasing them ; and should its power be inade- 
quate to the purpose, it is then the province of the physician to 
aid its operation. Interference, however, he believes is seldom 
necessary, and, when necessary, he asserts that mild measures 
only are required. He accordingly condemns, in general, all 
heroic remedies. His practice, in a word, is entirely based on 
the hypothesis, that the morbid actions of the system, being 
induced by the superintending intelligent power, are always 
salutary in their tendencies, and, consequently, should not be 
roughly promoted or retarded, but carefully watched and 
regulated. 
In exhibiting the important truth that there is a principle in 254 
Smith’s Comparative View of 
[October, 
the body which occasions elementary combinations and func- 
tional phenomena that mere physical agencies are incapable of 
producing, Stahl forcibly invalidates the doctrines of the che- 
mists and mechanicians. In this respect his theory possesses 
superior merit. In another view, however, it is liable to objec- 
tion. By relying too much on the curative power of the anima, 
his practice is often extremely inefficient. Moreover, by making 
the metaphysical characters of disease the chief objects of me- 
dical study, he inclines his followers to consider healthy and 
morbid anatomy, and diagnosis, as of little importance. The 
work in which his hypothesis is elaborately stated, is entitled 
“ Theoria Medica Vera,” and was published in 1708. 
It is obvious that not until medicine shall assume the charac- 
ter of a demonstrative science, will physicians agree in any one 
system of theory and practice. The state of medicine in 1733 
possesses nothing of that character, and accordingly we are not 
surprised to find doctrines prevailing which differ essentially in 
their principles. The pathology of Stahl, though supported by 
all his ingenuity, leaves room for the display of other theories, 
equally or more attractive and popular. Such is the theory of 
Hoffmann. This distinguished physician was born in the same 
year as Stahl, viz. 1660, and what is remarkable, besides being 
of the same age, they have, during a great part of their lives, 
been associate professors of the same branches, in the same uni- 
versity, the latter being adjunct to the former. 
To a fertile genius, Hoffmann unites great learning and un- 
tiring industry. In his medical inquiries he exhibits a mind 
freed from the strong prejudices of education, and bold in ori- 
ginal research. Hitherto, as we have before stated, disease had, 
for the most part, been considered as depending on certain con- 
ditions of the blood. The solids had scarcely been adverted to 
as the primary seat of disease. Baglivi, professor of medicine 
and anatomy at Rome, in the course of his researches was led to 
the conclusion, that the primordial deviations from health take 
place in the moving fibres. Animated by the discovery, he 
abandoned the beaten tracks of the humoral theorists, and confi- 
dently asserted that disease consisted in certain alterations in the 
state of the solids, and that when the fluids are disordered they 
had become so consecutively. This novel doctrine was widely 1839.] 
the State of Medicine. 
255 
published; but made little impression on pathology during the 
life of its author. Baglivi was several years younger than Hoff- 
man, but died in 1706, at the early age of thirty-eight, leaving 
his name inseparably connected with a theory which is destined 
never to perish. 
Enlightened by the original inquiries of the Roman professor, 
Hoffmann embraced his fundamental principles, and founded 
upon them a system peculiarly his own. He not only contends 
that diseases commence in the solids, but he explains the nature 
of their morbid conditions. He supposes the moving fibres to 
possess, in health, a certain degree of tone or action, and that 
deviations from this state constitute disease. If, from any cir- 
cumstance, the action is morbidly increased, a spasm of the 
fibres is the consequence, and, if the action be diminished, a de- 
bility is induced which may extend to the point of atony. 
Spasm and atony of the moving fibres, therefore, are, in his sys- 
tem, elementary or primary states of most diseases. In explain- 
ing the manner in which these states of the solids are produced, 
he brings into view the functions of the nervous system; and 
thus gives to pathology a form essentially different from all pre- 
ceding hypotheses. But to these new doctrines are added, in his 
system, much of the humoral pathology, and many speculations 
purely chemical and mechanical. 
Leaving the great school at Halle, and its celebrated profes- 
sors, we come next to the University of Leyden, at the head of 
which, in the faculty of medicine, is Boerhaave. This illus- 
trious physician is now, at the period under notice, in the sixty- 
fifth year of his age, and has successively filled the chairs of se- 
veral branches of medicine. He is distinguished as a chemist, 
botanist, physiologist, and pathologist. 
As a pathologist, Boerhaave is an eclectic. In forming his sys- 
tem, he selects what he considers the most valuable from all the 
preceding systems, instead of adopting any one of them. Some 
of the materials which enter into his system, he derives from the 
the doctrines of the Galenists, some from the hypothesis of the 
mechanicians, and some from that of the chemists. In the in- 
troduction to his Institutes he says, “ at present physic may 
be learned without adhering to any particular sect, by rejecting 
every thing that is offered without demonstration, and by col- 256 
Smith’s Comparative View of 
[October, 
lecting and retaining what has been offered and approved to be 
real truth, both by the ancients and moderns.” 
To convey a general idea of the pathological opinions of 
Boerhaave, it is necessary first to observe, that he supposes that 
the solids are composed of elementary or earthy particles which 
are united together by a glutinous matter, and which, when thus 
united, form minute or simple fibres. Now, these simple fibres, 
he imagines, possess certain mechanical properties which are 
affected in disease. Thus, in some disorders they are too lax, 
and in others too rigid. This difference forms the basis of a 
division of their diseases into two great classes, viz. 1st. Those 
of a weak and lax fibre; and, 2dly, those of a stiff and elastic 
fibre. Having laid down these principles, he proceeds to treat 
of the disorders of the vessels and viscera; and as these are com- 
posed of simple fibres, he, without particularly considering their 
functions, divides their diseases into those of laxity and rigidity. 
This doctrine is specious and intelligible. Yan Swieten, the 
pupil of Boerhaave, observes in relation to it, that “ the diseases 
of the fibres being considered, and consequently of the solid parts 
of the body, so far as they consist of fibres, it appears to how 
great a simplicity the diseases which occur in all the solid parts 
of the body may be reduced.” After giving his pathology of the 
solids, Boerhaave enters upon that of the fluids. He first treats 
of those morbid alterations of the humours which take place in 
them spontaneously. These he divides into three kinds, 1st, 
those of an acid; 2dly, those of a glutinous; and, 3dly, those 
of an alkaline quality. The principal sources to which he 
traces these spontaneous changes, are the varieties of food, and 
certain circumstances of the body into which they are received. 
Having treated of the diseases of the solids and fluids severally, 
he next considers the phenomena which result from the union 
of the pathological conditions before described. The force of 
the circulation is here brought under examination, and this leads 
to a division of diseases into 1st, those that arise from an ex- 
cess of the circulatory motion ; and, 2dly, those from its defect. 
His reasoning upon these opposite forms of disease, is, for the 
most part, mechanical. Connected with his pathology of the 
vascular system is his doctrine of obstruction which forms an 
important part of his system. “ An obstruction,” he says, “ is a 1839.] 
the State of Medicine. 
257 
stoppage in a canal denying a passage to the liquid, whether 
vital, sound, or morbid, that ought to pass through it,” and 
among the causes which produce it he enumerates constriction 
and compression of the vessels, a lentor, viscidity, inspissation, 
or coagulation of the humours, and an error loci of the globules 
of the blood. Upon these views of the vessels and circulating 
fluids, he founded his practice of using diluents, attenuants, and 
deobstruents. 
These are the broad outlines of the theory of Boerhaave—a 
theory so felicitously constructed, so harmonious with the state 
of the various sciences at the time, and so captivating in its de- 
tails and illustrations, as to annually draw around its author a 
multitude of pupils from different and distant countries. The 
genius, erudition, and auspicious fortunes of Boerhaave, give him 
a renown which few physicians can ever hope to enjoy. His 
pupils admire him as a teacher, and the learned deem it an 
honour to know him; his fame is universal, and every where 
his character is revered by the great and good. 
In the sketch now given of the systems of the three great 
theorists, Stahl, Hoffmann, and Boerhaave, it will be remarked 
how slightly they rest upon the only true basis of medical science, 
experimental physiology, and pathological anatomy. Made up 
chiefly of assumptions and scholastic reasonings, they afford little 
evidence of laborious observation, and cautious induction. Still 
they possess some truths of great value, and which, from their 
fundamental character, will ever occasion frequent reference to 
the systems in which they first appeared. But though little at- 
tention is given by the systematics in question to the study 
of morbid anatomy, there are those, contemporary with them, 
who, laying aside theories and preconceived opinions, pursue it 
with spirit and success. In this number is the celebrated 
Morgagni. Indeed, the medical libraries of 1733, are not with- 
out works on this subject. Within a little more than half a cen- 
tury, anterior to this time, Bartholini, Bonetus, Yalsalva, and 
Chirac, not to mention others, had gathered from dissections 
valuable materials for the construction of a just system of pa- 
thology. These instances of toil, in a pursuit of all others con- 
nected with science the least inviting to most minds, are suf- 
ficient to redeem the age from the charge of exclusive indulgence 
in speculations. 258 
Smith’s Comparative View of 
[October, 
With regard to the modes of practice common at this epoch, 
there is less diversity than in the prevailing theoretical systems. 
In fact the therapia of the times is, with all parties, substantially 
the same. To this remark, however, there is, perhaps, one ex- 
ception. The Stahlian physicians condemn all active reme- 
dies ; whilst most other practitioners admit the advantage 
and frequent necessity of them. The writings of Sydenham, 
who died in 1689, when Stahl and his rival contemporaries 
were about commencing their brilliant career, containing many 
demonstrations of the benefits that result from studying the 
simple phenomena of disease, and fulfilling the indications they 
obviously furnish, could not otherwise than influence the prac- 
tice of all who read them with a view to instruction. Boerhaave 
speaks of him as the English Hippocrates. Destitute, for the 
most part, of the subtleties of learning, but rich in facts, and 
perspicuous in description, the works of Sydenham are, in an 
eminent degree, practical, and are consulted with a confidence 
which those of the mere theorist fail to inspire. His treatment 
of disease is that naturally suggested by a sound judgement 
acting with competent knowledge; it is, in fact, careful and ju- 
dicious empiricism, founded on extensive clinical observation. 
If he is drawn into error by the seductions of theory, he is sure 
to be reclaimed by the appeals of experience. But the thera- 
peutical improvements of Sydenham are limited to the more 
common acute diseases. There are many morbid affections, of 
the nature and seat of which he had not the slightest know- 
ledge ; and, for the removal of which, modes of practice are 
required, that empiricism could never reveal. In the treatment 
of such cases, he, in common with his contemporaries and im- 
mediate successors, resorted to whatever means accident might 
suggest as probably suited to their relief and cure. 
Much of the practice of physicians, in 1733, is of this des- 
cription ; and, in some instances, to a degree that is singularly 
fanciful and ridiculous. The truth of this remark is shown in 
their materia medica and officinal preparations. Not content with 
combining a few medicines that modify the action of one an- 
other, and thus more effectually fulfil certain indications of cure, 
they mingle together a multitude of articles, many of which 
are altogether inert, or so feeble in quality and inconsiderable 
in quantity, as to render them trivial in a pharmaceutical com- 1839.] 
the State of Medicine. 
259 
pound. The most celebrated instances of this kind are the 
Mithridatium, or Confectio Damocratis, and the Theriaca An- 
dromachi; the former consisting of forty-five, and the latter of 
upwards of sixty ingredients. The original formula of these 
compounds is said to have been found in the cabinet of Mithri- 
dates, king of Pontus. It was afterwards reformed by Andro- 
machus, physician to Nero. The Theriaca was held in the 
highest estimation as a preservative against every species of 
venom; and, in an age of superstition, when dread of assassi- 
nation by poison prevailed, it was frequently resorted to, espe- 
cially by those who moved in the higher circles of society. 
Though not regarded as possessing the antidotal power ascribed 
to it at a former period, it is employed by the physicians of the 
eighteenth century as serviceable in the cure of many diseases. 
But more striking illustrations of the therapeutical notions 
of the day are presented in the catalogue and classification of 
medicinal agents. Thus, among the detergents, are enume- 
rated snails, vipers, white dog’s dung, earth-worms, and fox- 
lungs. Among absorbents, are rubies, emeralds, and goat’s blood. 
Among diurectics, are hog’s lice and hog’s dung. Among 
diaphoretics, are unicorn’s horn, and bone of a stag’s heart. 
Among the hysteric remedies, are elk’s hoof, dung of the goose 
and peacock, and man’s skull. Among ripeners and drawers, 
are fat of a dog and fat of a man. Among repellents, are a 
dead man’s hand, and the royal touch. Numerous other ex- 
amples might be cited, equally remarkable and disgusting.* 
* Huxham, who had risen to eminence in 1733, and whose works possess the 
practical character and general merit of those of Sydenham, strongly inveighs 
against the polypharmacy of his contemporaries. “When a physician,’’ he says, 
“knows whether stimulants or anodynes, relaxants or astringents, attenuants or 
incrassants, are indicated, he can be at no great loss how to serve himself of proper 
drugs out of the vast materia medica which we at present abound with. He should 
select a few of the most effectual for his use, of each sort, and stick to them, and 
not run into the immense farrago which some are so fond of. By so doing, he will 
soon be acquainted with their virtues and effects, and readily distinguish between the 
symptoms of the disease, and those caused by the medicines; which is a thing 
many times of no small importance. I have seen in private practice, and some 
public writings, such a jumble of things thrown together in one prescription, that 
it would have puzzled Apollo himself to know what it was designed for; not but 
that there are frequently such complications (and contra-indications too sometimes) 
in diseases, as makes some degree of combination and contrast in a medicine neces- 
sary.”— Essay on Fevers, fyc.— Preface. 260 
Smith’s Comparative View of 
[October, 
But to the credit of the physicians of this period it must be 
said, that they have no faith in the catholicons which the al- 
chymists professed to have discovered, by which life could be 
extended beyond its natural limits. Of these life-preserving 
expedients, the most remarkable was the Tincture of Artephius, 
consisting of human spirits, extracted from a healthy young 
man, which taken in small doses, from time to time, would 
protract life beyond a thousand years. Boerhaave, in speaking 
of this tincture, but without any faith in its alleged power, 
says, nevertheless, that “it is certain that the strength of a 
healthy body may, in some measure, be communicated to one 
that is weak or diseased, since girls lying with old women waste 
away, whereas the old women improve and have better health 
and spirits.” 
Such is a circumspective review of the state of the world, 
and particularly of medicine, in 1733. And now, bearing in 
mind what has been noticed, let us return to our own time. 
And here, how wonderful is the change ! In whatever direction 
we turn, the scene presents a new aspect; its limits are ex- 
tended ; with a few exceptions, ancient structures have disap- 
peared, or been rebuilt from their foundations, enlarged, and 
embellished; objects, new, and in great variety, attract from 
every quarter; and, though impenetrable obscurities bound the 
view, every thing is disposed in a light that renders the contrast 
striking and impressive. In accomplishing these changes the 
human mind, during the last one hundred years, has been in 
constant and vigorous action. In some countries governments 
have been overthrown, and civil institutions reformed; in others, 
the ties of allegiance have been sundered, and free and inde- 
pendent states erected. Inquirers after truth have ceased to 
venerate speculative authorities, and broken down the idols of 
the schools. Besides transforming the political condition of 
nations, and producing numerous discoveries in science, and 
inventions in art, the revolution of a century has created new 
objects of ambition, and given new impulses to human enter- 
prise. The particulars, in a survey so extensive, are too nume- 
rous to be adverted to at this time. In noticing some of them, 
we shall select such as are most interesting:. 
o 
In no branch of knowledge have the changes been more im- 1839.] 
the State of Medicine. 
261 
portant and radical than in that of medicine. What now re- 
mains of the phlogistic doctrine of Stahl, and his psychological 
pathology, or of the hypothesis of Hoffmann, and the splendid 
system of Boerhaave? Resting on, comparatively, a small num- 
ber of acknowledged facts, their theories now appear like fictions 
of the imagination founded on a few realities. The age, how- 
ever, in which their doctrines were received, will ever be re- 
garded with interest. It was the point of time at which specu- 
lative medicine reached its height, and began to decline, and 
at which inductive inquiry commenced a course of rigorous 
observation, and careful inference. 
The chemistry of the present time bears few of the characters 
of that of 1733. Instead of the confusion of phenomena, and 
mystical postulates of that day, we have now analyses, gene- 
ralizations, and formulae, that give to every part of the science 
an exactness almost mathematical. Moreover, in description and 
detail, ambiguity is avoided and precision obtained, by a no 
menclature at once beautiful and expressive. Modern chemistry 
might not unaptly be said to have had its origin at the epoch 
on which our attention has been turned, since in 1733 was born 
one of its earliest and most successful cultivators, namely, Dr. 
Priestley. To the discoveries of this eminent man, and to those 
of Scheele, Lavoisier, Cavendish, Black, Rutherford, Davy, 
Berzelius, Dalton, Yauquelin, Bertholet, Gay Lussac, Magendie, 
Pelletier, and a few others, the science is indebted for the mate- 
rials that, at present, form its substantial ground-work. Through 
the powerful agency of the electrical principle, first recognised 
by Franklin, and brought under control by him, Galvani and 
Yolta, many of the more refractory compounds have yielded 
up their elements, and disclosed their hitherto recondite proper- 
ties and relations. 
In the departments of anatomy and physiology also, the im- 
provements are numerous and important. Besides perfecting 
the descriptive anatomy of Cheselden, Winslow, Heister, and 
their contemporaries, the human structure has been demonstrated 
in several new points of view. The anatomy of relation, or 
topographical anatomy, forms now an essential part of a sur- 
gical education. It exhibits the organs and tissues of the body 
as they are connected and relatively disposed to one another, 262 
Smith’s Comparative View of 
[October, 
in particular regions of the body. Though at every period in 
the history of operative surgery some attention must have been 
given to this mode of studying the human frame, it is chiefly 
within the last one hundred years, and particularly of late, that 
it has received the impress of a distinct department of anatomy. 
Among those to whom surgical anatomy owes its elevation, are 
found the distinguished names of Desault, Boyer, Roux, Colles, 
Burns, Hey, Gimbernat, Scarpa, Cooper, and Yelpeau. 
Another mode, equally modern, of examining the structure of 
the human body is that known by the title of General Anatomy. 
Under this head, all the elementary textures of the system are 
investigated and generalized; those being arranged together 
which are similar in organization and analogous in function. 
c o 
Thus collected and classified, their common characters are ex- 
amined, and their specific peculiarities, arising from their diver- 
sity of situation and connection, particularly determined. This 
division of anatomy, in its application to physiology and pa- 
thology, is of the first importance. It leads to the study of the 
uses of every tissue of the body separately, and consequently of 
the part each tissue performs, when acting with others, in pro- 
ducing the various functions of organic life. It displays, too, the 
structures which are the immediate seats of disease, and exhibits 
the barriers which, in certain affections, limit the extension of 
morbid action. The advantages of this mode of unravelling the 
human body are experienced in every inquiry concerning the 
nature of diseases. The origin of general anatomy cannot, per- 
haps, be dated earlier than the time of Bordeu, whose researches 
on the cellular tissue, were published in 1767. Subsequently, 
the inquiries of Dr. Carmichael Smyth contributed to draw at- 
tention to the subject. But is it to Bichat the world has decreed 
perpetual honour for his lucid exposition of the organization, 
properties, analogies, and relations of the various elementary 
tissues that make up the body. Led to the study of the organic 
textures by the striking distinctions, pointed out by Pinel, be- 
tween the mucous and serous membranes, his happy genius ac- 
complished a work that, in its results, established a new era in 
the history of medicine. Whatever modifications general ana- 
tomy has since received from the labours of Meckel, Gordon 
Mascagni, Meyer, Bedard, and others, and how considerable 1839.] 
the State of Medicine. 
263 
soever, the changes it may hereafter undergo, it must ever re- 
tain the characteristic features given it by the creative hand of 
Bichat. 
But there is yet another branch of anatomy which at present 
holds a high rank among liberal studies, and of which neither 
Cheselden nor his contemporaries of 1733, had scarcely any cor- 
rect knowledge, namely, philosophical anatomy; a department 
which elucidates the laws that governs the formation of the 
organs, the causes and varieties of abnormal structure, the opera- 
tions of moral and physical influences on the human constitu- 
tion, and the comparative organism of man and the inferior ani- 
mals. 
But though the modern improvements in anatomy are many 
and important, they are less so than those in physiology. Here, 
indeed, almost every thing is new. Of the physiological sys- 
tems of 1733, scarce a vestige remains. It was said, by the 
celebrated Dr. William Hunter, who died in 1783, that “ there 
never was a man more followed and admired than Dr. Boer- 
haave. I remember the veneration in which he was held. And 
now, in the space of forty years his physiology is — it shocks me 
to think in what a light it appears.” The physiological dis- 
coveries since the time of Dr. Hunter, far exceed, in number 
and value, those which had been made within the period he 
mentions; and consequently, the Boerhaavian system is, at pre- 
sent, deeply overlaid by accumulated truth. The improvements 
in physiology are too numerous to be even noticed on this oc- 
casion. We can but allude to those relating to the functions of 
the digestive and respiratory organs, and the vascular and 
nervous systems. 
Corresponding with the advances in physiology, are those in 
pathology. Instead of the hypothesis that diseases are, originally, 
certain alterations in the condition of the fluids, we have now 
the doctrine that they are, for the most part, primarily certain 
affections of the solids. The principles of pathology, therefore, 
have undergone a fundamental change. We have said that the 
age of Stahl, Hoffmann, and Boerhaave, will always be regarded 
with interest. It will be so, for the reason, that a limit was then 
put to the long and exclusive reign of the humoral pathology, 
and a commencement made in new modelling the frame of medi- 264 
Smith’s Comparative View of 
[October, 
cal philosophy. The first movement in this great revolution, as 
we have already hinted, was the bold annunciations of Baglivi, 
and certain theoretical opinions of Hoffmann. The idea, that ♦ 
diseases originated in the moving fibres, being authoritatively pro- , 
mulgated, especially by the last of these distinguished men, soon 
attracted general attention; and, eventually, was adopted as a 
primary fact in pathological science. The downfall of humoral- 
ism followed of course, leaving no memorials of its former do- 
minion, but the few solitary truths that had given it a precarious 
support. 
The theory of Stahl, though in a high degree fanciful, obvi- 
ously favoured, in its leading principle, the revolution in ques- 
tion. By contending that the anima, or rational soul, governed 
the physical movements in health and disease, he drew atten- 
tion, more particularly than had been done, to the common prin- 
ciple of vitality, the phenomena of which are chiefly manifested 
in the solids. So far, and without any design on his part, he 
contributed to the overthrow of the humoral pathology. Hoff- 
mann, too, in supporting his great proposition, that certain dis- 
eases primarily consist in a spasm or atony of the moving fibres, 
evidently had no conception of the turn he was giving to the 
course of medical inquiries; for, excepting the principles em- 
braced in that proposition, his doctrines are humoral and me- 
chanical. It is a fact sufficiently singular to be stated, that 
Boerhaave, whose theoretical system transcended in popularity 
every other, furnished nothing original promotive of the ad- 
vancement of medicine, whilst Stahl and Hoffmann wrought up 
into their hypotheses, elements, which though crude and un- 
shapen, were destined to explode the errors with which they 
were connected, and become, under improved forms, the basis 
on which medicine was afterwards to rest. 
The transition from humoralism to solidism being: thus com- 
menced, was rapidly carried forward by their immediate succes- 
sors. Among the abler and more distinguished of these, were 
Haller and Cullen, both of whom in L733, were just entering 
the profession, the former being, at that time, twenty-four and 
the latter twenty-one years of age. Haller was the pupil of Boer- 
haave ; but abandoned the system of his preceptor, and engaged 
as early as 1739, in a course of inquiries into the nature and 1839.] 
the State of Medicine. 
265 
laws of irritability and sensibility. The result of his inquiries 
were so original and satisfactory, that the humoral theories lost 
their attractions, and ceased, in a measure, to exert their former 
authority. At the same time Cullen, being appointed to the 
chair of medicine in the rising school of Edinburgh, and adopt- 
ing, with certain alterations and additions, the leading principles 
of Hoffmann with respect to the spasmodic and atonic affections 
of the moving fibres, entirely subverted, in a few years, the 
pathology of the fluids, and established that of the solids. But 
though solidism is every where received as the true basis of 
pathology, the medical philosophy of the present day does not 
exempt the fluids from disease. It regards them as often 
affected secondarily to the solids, and, perhaps, sometimes pri- 
marily. It contemplates the human body as a unit, the organic 
apparatus elaborating and distributing the fluids, and the fluids 
influencing and modifying the solids. It views the nervous, 
vascular, and secretory organs as the parts in which the vital 
principle is primarily and especially operative in preserving 
health; and hence it refers the origin of disease to functional 
derangements occurring in those parts. 
Now, if to these changes in chemistry, anatomy, physiology, 
and the general doctrines of pathology, be added the immense 
stores of facts accumulated, within a few years, from post mor- 
tem examinations, demonstrative of the precise seat and anatomi- 
cal characters of disease, the present state of medicine will ap- 
pear in forcible contrast with that a century ago. Compara- 
tively, every thing is now settled upon a permanent physiologi- 
cal basis. The history, symptomatology, etiology, and diagnosis 
of most disorders are, in a high degree, full and precise ; and 
their treatment, aided, in many instances, by new and powerful 
agents, greatly improved. Moreover, in the progress of medical 
discovery, many specific diseases have been disarmed of their 
terrors, while others, for the most part, are banished, or limited 
in their prevalence. 
Surgery has detached itself from its former degraded associa- 
tion, and by many and signal achievements, raised itself to the 
rank of medicine. The medical character amono; the well edu- 
cated, no longer imposes by a grave demeanour, aristocratic 
habiliments, and show of learning; but is cheerful, frank, un- 266 
Smith on the State of Medicine. 
[October, 
distinguishable in attire from the rest of the world, and intelligi- 
ble in communication. 
There are now no Stahls, or Hoffmanns, or Boerhaaves, whose 
doctrines give character to the age. No hypothetical systems, 
deserving of notice, that divide physicians into parties, and chal- 
lenge their adhesion and support. Medical fame is distributed 
among a multitude scattered in every enlightened country. 
Such are the divisions of medical pursuits, that eminence 
founded on merit, is widely equalized, through the attainment 
by many to the same degree of excellence in the different de- 
partments of study and practice. In no individual are found 
combined the qualities that distinguish the cultivators of the 
several branches of medicine. If a few, here and there, rise 
above others, by reason of superior industry or superior talent, 
their greater elevation is so inconsiderable as to be scarcely dis- 
cerned above the line that forms the high but extended level of 
professional eminence. 
Medical knowledge is too widely diffused to allow any me- 
dical school, however able its faculty, to exert a controlling 
influence over the medical world. Compared with its state a 
century ago, medicine is now a republic; and such it must 
remain, so long as the a posteriori method of research is pur- 
sued with zeal, as it has been of late, in various countries. 
Everywhere practical studies have taken the place of theoretical 
speculations; instruction is sought in hospitals, dispensaries, 
almshouses, lazarettos, prisons, and the private chambers of the 
sick; pestilence is fearlessly encountered, and its phenomena 
and ravages calmly observed: the dead of all diseases, are 
carefully and minutely dissected; and though the field of in- 
quiry is yet boundless and inviting, the three kingdoms of 
nature have been widely explored, their productions analyzed, 
and many of them applied to the great ends of all medical 
science, the prevention and cure of diseases, and the physical 
happiness of mankind. Finally, the knowledge derived from 
these sources in different countries, is carefully gathered up, 
and periodically circulated by the press; and thus a regular in- 
terchange of medical intelligence is established throughout the 
earth.