the other branches, being for the most part in the hands of ignorant women. One of these female practitioners, however, more enlightened than her consœurs, set an example, which has been followed by some illustrious members of the sisterhood in our own times, of publishing, at the beginning of the 17th century, an account of her experience; but it was not until 1666, when the first edition of Mauriceau's work appeared, that the art of the accoucheur was placed upon any firm or rational basis. Many of his contemporaries likewise published upon this subject; "while the labours of the surgeons and physicians of the 18th century have raised several portions of the art to a degree of perfection well nigh approaching

that of the exact sciences."

The midwifery forceps were invented in 1721 by John Palfyn; for, although the Chamberlayne family had long before employed an instrument of this kind, they disgraced themselves by refusing to give it publicity, whereas Palfyn hastened to announce to the world the instrument he had contrived, and which was afterwards advantageously modified by Smellie and Levret, in England and France respectively.

7. Clinical Medicine.

Oral Clinical Instruction, after having prevailed in the Asclepiadean families until the period of the School of Alexandria, fell into disuse, only to be revived at an epoch not very remote from our own, viz. in 1578, when it is related that the professors, Bottoni and Oddo, taught clinically at Padua. However, the practice seems to have been interrupted, and not to have been formally re-introduced, until Otto de Hewin lectured at the bedside at Leyden, at the beginning of the 17th century. Leboe, commonly termed Sylvius, followed his example, and his lectures acquired an immense reputation from 1658 to 1672. Again the practice fell into disuse, when it was revived at Leyden by the illustrious Boerhaave (1714), whose talents and celebrity attracted auditors from every part of Europe.

"His renown, which was already great, for he had published his Institutions and Aphorisms, became immense. He was consulted from the most distant countries, and was in correspondence with several sovereigns, and the Pope himself, although a Protestant. In searching for the real titles which recommend this illustrious man to the admiration of posterity, we find them thus clearly laid down by M. Dezeimeris, in the Dictionnaire Historique de Medicine.

"Boerhaave exercised, during his life-time and long afterwards, an immense influence upon medicine. Inferior in genius to his cotemporaries, Stahl and Hoffman, he enjoyed a much more extended reputation, and his doctrines long prevailed over those of his rivals. He owed this to the success of his mode of teaching, and the brilliant qualities of his mind. Gifted with rare activity and facility, he acquired the most varied and extended knowledge. Upon this he constructed a system connected together in all its parts with infinite art. Developed in his lectures and in his works with method, clearness, and precision, and set off with a rare grace of eloquence, we can believe it secured all suffrages. This system, which may be considered as a true eclectism, was formed of some ideas taken from Themison and the ancient methodists, those of the chemiater Sylvius, and especially of those mechanical and iatro-mathematical theories, towards which his taste and mathematical studies naturally inclined him. These last predominated, and this is why Boerhaave is justly classed among the mechanical physicians. It is to be regretted that, with such happy powers of observation, he allowed himself to be estranged from even his own principles by the

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Clinical Medicine-Boerhaave and Sydenham.

423

spirit of system and hypothesis. He commenced by preaching the method of Hippocrates with enthusiasm, and finished by following the brilliant, but uncertain example of Galen."-Tom. II. p. 311.

After the death of Boerhaave, the Leyden school rapidly declined in reputation, which was transferred to Edinburgh, and especially to Vienna, where Van Swieten, De Haen, Stoll, and Frank taught in brilliant succession.

The number of written clinical observations continued to increase during the period, which is characterized by attempts at a more accurate classification of already acquired facts, and an especial study of the influence of climate, seasons, regimen, and epidemic constitutions. Towards the end of the 16th century, the Hippocratic methods of study beginning to prevail over the Galenic, these important subjects occupied much attention; the work of Baillou upon the Epidemic Constitutions of Paris during the years 1570-80, representing the period of almost insensible transition from the Galenism of Fernel to the Hippocratism of Sydenham and Stoll.

Sydenham, who flourished during the better half of the 17th century, has justly obtained the title of the "English Hippocrates," both on account of his medical doctrines, and his profound study of the Epidemic Constitutions. The friend and cotemporary of Locke, he first taught physicians to recur to the simple observation of morbid phenomena after the example of Hippocrates. So great, indeed, was his dislike to mere hypothesis, that Sprengel has not hesitated to place him among the votaries of Empiricism; but he too often departs from his own wise maxims, by adverting to the essential causes of fevers and other disease to render this allowable. Much as he admires the admirable patience and untiring zeal with which Sydenham observed the influence of the Epidemic Constitutions, during so many years, M. Renouard is disposed to regard the theory he broached concerning their stationary character, supported though it is by the subsequent opinions of Stoll and Pinel, as fanciful, and calculated to destroy all stability in therapeutics. This and other of the opinions and labours of our countryman we could have wished to have examined at some length, both on account of their intrinsic importance, and because we believe they are insufficiently appreciated by the practitioners of our times. We are therefore much pleased to find that Dr. Milroy is publishing a series of admirable papers in the pages of a cotemporary,* with the laudable intention of presenting a complete and faithful summary of the writings of this great observer.

8. Theories and Systems.

The rapid progress of the various branches of natural science had already much shaken the authority of the Scholastic Philosophy, when, at short intervals from each other, Bacon and Descartes appeared, who, however much they differed from each other in the characteristics of their genius, or the modes of their reasoning, agreed in demanding as the primary step the entire liberation of the mind from its trammels. The great innovation introduced by Bacon was the reasoning from individual ideas to general axioms, thus reversing the procedure of Aristotle. The Inductive System,

* Vide Lancet, for Aug. 15th and Nov. 14th, 1846, and Jan. 16th, 1847.

in his hands, was however disfigured by vague descriptions and departures from the lessons of experience, and met with little attention until it was completed and popularized by Locke, who, with lucid sagacity, demonstrated that which Bacon had only affirmed. All the leading philosophers of England and France now adopted it, and no one contributed more to its greater simplification and general reception than Condillac. M. Renouard contrasts at some length the Inductive with the Deductive system of Descartes, Leibnitz, and Kant; but we need not pursue the parallel, as it is now generally acknowledged that, however appropriate the latter may be for conducting the investigations of the metaphysician, the moralist, and the mathematician, it is to the former we can alone look for safe guidance in the pursuit of natural science.

The Origin of Animism and Chemical Medicine.

No one contributed more to the discredit of the ancient philosophy and the introduction of a taste for novelties than did John Baptist Van Helmont (1577-1644). Thoroughly versed in a knowledge of the ancient writers, attached to the mysticism of Thomas a Kempis and other divines, an able and eloquent disputant, a friend to independent observation, a discoverer in chemistry, and believer in alchemy, his writings constitute a transition period between the ravings of Paracelsus and the more learned theories of a later epoch. Yet, a keen exposer of the verbiage, the inconsistencies, and the visionary theories of Galen and Aristotle, he expounds in his turn a system so baseless and so confused, that M. Renouard, with all his patience, renounces the attempt of giving any connected view of it. Accord ing to it, the animal economy is influenced by three motor powers, consisting of certain ferments, the archæus, or great governing principle, and a third, which he terms blas, regulating the natural and voluntary movements. To the Stomach and Spleen, under the quaint title of the Duumvirate, he accords an omnipotence over the rest of the economy, the archæus, or sentient soul, always residing in one of these viscera, and especially at the pylorus. There are no less than six stages of digestion described, operated through the agency of various ferments, in the stomach, the duodenum, the mesentery, the heart, and the brain. The primary seat of all disease is the lining membrane of the stomach, the abode of the archæus and the various symptoms result from the efforts made by this principle to rid itself of the morbid conditions which injurious agencies may have induced. In therapeutics, substances only which are agreeable to this archæus must be prescribed. Bleeding was proscribed and purgatives used sparingly, opium, wine, and the new mineral preparations being the favourite remedies, not neglecting magical words, charms, and amulets.

"Van Helmont founded no sect; but several sects borrowed from his ideas. The chemical school owes to him the idea of ferments, and from him the animists and vitalists derived that of the vital principle, modelled upon his archæus. The miracle-mongers, magnetisers, &c., place him among the adepts, and never did the partisans of the scholastic philosophy meet with a ruder adversary. 'At an epoch,' says M. Littré, when the superstitious beliefs of the Middle Ages were still adhered to, and when the powers of Nature, timidly interrogated, seemed always to present themselves under a mysterious or supernatural form, we should not feel surprised at the mystical spirit of Van Helmont, at his ecstacies when he saw his soul, or at his dreams, during which the solutions of the

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Iatro-Chemistry and Iatro-Mechanics.

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most difficult problems were revealed to him. Nor is it astonishing that he often substituted hypothesis for hypothesis, error for error. The observers of that period were, in regard to many questions now well understood by us, in the same condition we find ourselves in with respect to other difficulties insoluble by our modes of investigation. What theory have we to offer in explanation of the cure of ague by bark, the origin of variola, or the destruction of its germ by vaccination? Who of us has not made his vain efforts to penetrate obscurity, and plunge beyond the horizon? Well! Let us then cast a glance back at that past which was then future, on our lights which were then darkness, and we can picture to ourselves the false glare and gropings of our predecessors-all the more ready to lose themselves, as unpossessed of that compass we have-the method of observation-inasmuch as, in the absence of facts, they could scarce abstain from hypotheses."-Tom. II. p. 378.

Iatro-Chemistry.-The Chemist-Physicians.

Francis Leboe, surnamed Sylvius (1614-1672), the first Clinical Professor at Leyden, and a great cultivator of anatomy and chemistry, first employed the laws of this last science for the exclusive explanation of the animal economy. Borrowing the idea of the agency of ferments from Van Helmont, he does not employ the intervention of his archæus or governing principle. The saliva, bile, and pancreatic fluid, from the active parts they play in the economy, are termed the triumvirate, and through their agency the various fermentary processes are gone through. Professing to found his views entirely upon observation, he is continually assuming what is not proved, and explaining what is not understood. Disease, according to his views, consists in a vitiated or acrimonious condition of these various fluids, and is best treated by purgatives, narcotics, and the abundant use of volatile alkalis for the correction of morbid acidity.

Thomas Willis, (1621-1625,) our countryman, and the author of so excellent a work upon the brain, basing his views upon the same chemical foundation as the Leyden professor, even surpassed him in gratuitous hypotheses. From the igneous analysis of bodies he concluded there were five elements, spirit, sulphur, salts, earth and water, and endowed these with qualities as fanciful as the ancients attributed to theirs. The various organic apparatus of the economy, by virtue of special ferments with which they are endowed, are enabled to produce the requisite proportions of these different elements; and it is through the faulty operation of such fermentations that disease is generated; so that the physician has little else to do than watch such operation and remove obstacles from its due performance. Remedies act upon the spirits or the humours, exciting or modifying their fermentory motions in a thousand manners, thus producing various effects upon the system, and secondarily modifying the condition of the solids.

Iatro-Mechanics.-The Mechanical Physicians.

As the progress of chemistry gave rise to the attempt at explaining the functions of organized beings by the same laws which regulate the elementary combinations of inanimate matter, so that of mechanical and mathematical science suggested the application of calculation to the elucidation

* Iarpos, Medicus.

of the same phenomena. Sanctorius, by his experiments upon transpiration, led the way in this new description of research; but Alphonso Borelli (1608-1679) was the true founder of the Iatro-mechanical Sect. He published several essays bearing upon the subject; but his great work De Motu Animalium, did not appear until the year after his death.

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*

"The fruit of patience and genius, this work created a new branch of medicine. Until then, very vague and erroneous ideas prevailed as to the amount of force expended by animals during their various movements, and the manner in which it was applied. Setting out from the principle that Nature attains her ends by the most simple means and the most direct road, it had always been believed that man and animals were so constituted as to be able to execute the greatest movements and bear the heaviest burthens whilst employing the least possible power. Borelli overcame this prejudice by reasoning founded upon anatomical research and the laws of statics. Comparing the bones brought into play by the muscles to cords set in motion by levers, he proved that man expends an enormous amount of force during his movements. * However much some of his calculations may be wanting in exactitude, and accepting them only approximatively, it is still demonstrated that man develops, during his movements, an incomparably greater amount of muscular energy than the obstacle he has to overcome-a truth which was far from being suspected prior to the time of Borelli. His book contains also a prodigious quantity of observations as minute as new, upon the various modes of progression and the postures of animals. To cite one example of a thousand, he furnished a very ingenious explanation of the manner in which a bird supports itself upon one foot while sleeping, and that upon a branch of a tree which every breath of wind puts into motion."-Tom. II. p. 393.

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Really possessed of as little foundation as iatro-chemistry, Borelli's mechanical explanations of all the healthy and diseased phenomena of the economy, seemingly supported by anatomical facts, minute hydraulic calculations, and the recent microscopic observations, obtained, by their apparent mathematical exactitude and simplicity, the suffrages of numerous enlightened observers. No such precision of ideas had been attempted since the porous tissues and various shaped atoms of the old Methodists. Bellini, Baglivi, Sauvages, Senac, Boerhaave, Bernovilli, Pitcairn, Keill, Freind, and Mead, were among those who accepted them with more or less modification. Of these, M. Renouard confines his attention to Baglivi and Boerhaave.

George Baglivi (1668-1706), surnamed the Roman Hippocrates, endeavoured to extend the application of Borelli's ideas to pathology and therapeutics. Believing that the prevailing sects paid too exclusive attention to the condition of the humours, he set himself the task of proving that in all conditions of the economy, whether of health or disease, the solids are of predominant importance. Like the Methodists under Themison, he admits of only two classes of affections of the primary fibril, viz. too great tension or constriction, and too great softness or relaxation-the strictum and laxum. But Baglivi's theories are not his only claim to our notice; for he produced an admirable work on practical medicine, in which he insists upon our taking observation as our guide, sacrificing theory to experience. We no longer see merely the great opponent of the old humoral pathology and parent of modern solidism; but the enlightened practitioner, admitting that in chronic disease there may be a cocochymia or vitiation of the humours.