maxims and modifications of old ones were broached: but, as these were all more or less connected with some physico-pathological system, their consideration may be delayed until these come under notice, and, in the mean time, M. Renouard briefly passes in review some of the ameliorations in the treatment of disease, as exhibited in the management of Small-pox, Syphilis, Intermittent Fevers, &c. which were achieved, and the new remedies, such as tartar-emetie, mercury, bark, ipecacuanha, belladonna, digitalis, &c., which were introduced.

"An important remark to be made is, that these great improvements were not made by virtue of, but in spite of dominant theories, these having, indeed, proved the greatest obstacles to their adoption. If mercurial medication was so long carried to the extent of a mischievous salivation, we must accuse the Galenic theory, according to which the virus of the disease circulated with the humours of the body, requiring evacuation for its expulsion. What was the reproach which the adversaries of Cinchona addressed to it? That it produced no sensible evacuation. As, in their opinion, founded on the authority of Hippocrates, Galen and others, the proximate cause of fever could only be vitiated bile or phlegm, no medicine which expelled neither of these humours could radically cure it. The Stahlians made a still more specious objection. They declared that fever, being a natural and salutary effort of nature to rid herself of a hurtful matter, the cutting short a paroxysm was to act controversive to the vital principle, and in the end to do more harm than good. If vaccination itself encountered opponents, is not this because the Arabs, who first described variola, propagated the opinion that the disease was innate in man, and concluded that the prevention of its spontaneous development was to oppose the endeavours of nature, and to imprison the enemy within our walls.

"From the avowal of all, therapeutics has owed the progress we have described to the purely experimental method, that is, to empiricism; not the ignorant and blind empiricism of charlatans, medicasters, and pharmacopoles, who, acquainted with the name of a disease, at once supply the drug required; but to enlightened and methodical empiricism, surrounded with all the positive indications derived from physiology, pathology, and the accessary sciences-to the empiricism of Sydenham, Morton, Torti, Van Swieten, Lieutaud, Stoll, Jenner, &c.—to that empiricism for which Sprengel so frequently apologises." (See Chap. 2 and 3 of his 16th Section especially).-Tom. II. p. 254.

5. Surgery.

Although the 16th century produced some names of note in Surgery, these were but exceptions, and this branch of medical science made little additional progress until towards the end of the 17th, from which period, through the whole of the 18th century, France, England, and Germany continued to produce names of imperishable celebrity. A great impulse was given to its study in France, by the foundation of the Royal Academy of Surgery, in 1731; but it is to our own JOHN HUNTER we are indebted for its elevation to the dignity of a science. Upon this point, we may quote the following passages from M. Malgaigne's Essay.

"If he suffered during his entire life from the absence of those preliminary studies, without which it is so difficult to impart to reasoning all its force and clearness of expression, we must at least do him the justice of testifying that he neglected no means of giving himself an education, and such a one as he deemed most suitable for the objects he had in view. Perhaps, too, strongly determined to consult only experience, he felt somewhat embarrassed in determining what part of our art he could most profitably apply his experience to. It is curious

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Progress of Surgery-John Hunter.

421

even to follow him in his efforts and hesitation. Anatomy had proved, in the hands of J. L. Petit, a powerful instrument of progress in surgery. John Hunter attached himself to its pursuit, consecrating to it ten years of his life; and, after having drawn from it some rich views, such as his theory of congenital hernia, perceived that he had mistaken his route and returned. What human anatomy could not furnish him with, perhaps he might find in the study of comparative anatomy. In this he engaged with renewed resolution, maintained a menagerie at his expense, stole hours from the night to expedite his dissections, and thus accumulated with his pen and pencil the anatomical history of three hundred and fifteen different species. But comparative anatomy not even serving his ends, a new ray of light broke in upon him. The subject is too often dumb, and he determined to interrogate the living. He instituted experiments upon animals, and thus created that fertile instrument of verification and progress, experimental surgery. Then, as he knew better than any other what differences separate man from the inferior beings, he recognised the necessity of controlling his experiments by direct observation on the living and dead man, and founded Surgical Pathological Anatomy. He resolutely approaches the fundamental question, from which J. L. Petit himself had shrunk, and enquires where are the bases and principles of surgery. Fear not that he will lose his time in merely examining the hypothetical theories of Boerhaave or of any one else. He does not even deign to mention them, and they are for him as if they had never existed. It is in the region of pure observation that he professes to delve, and it is there he hopes to lay foundations which shall prove indestructible.

"A curious comparison of dates may here be mentioned. The Royal Academy of Surgery, in 1774, published its last volume of Memoirs, and in 1775 Hunter commenced his celebrated course of lectures on the Principles of Surgery. Thus, during the whole period that the school of Petit was declining, the English surgeon was occupied in preparing the way for his own; and scarcely had the one lapsed into silence, before the other raised its voice and seized the noble inheritance. A memorable epoch, well worthy of celebration! Surgery, as the Middle Ages had left it, was little else than a handicraft: A. Paré and J. L. Petit made an art of it; and John Hunter constituted that art into a science.

"It is to Hunter, in fact, that we owe those general principles, which, regulating all portions of the art, and connecting them to each other, have made of it a magnificent whole, and which furnish, at the same time, so much strength to its doctrines and safety to its practice. It is Hunter who has made the surgeon, in the beautiful language of Bacon, the interpreter and minister of Nature. It is he who has revealed to us the procedures she follows in the cure of most surgical affections, and has taught us how to direct her operations. The union of simple wounds the nature of suppuration in the more complicated ones-the various phases of cicatrization-the varieties of inflammation, (that fortunate or redoubtable phenomenon according to whether we maintain it within due bounds or abandon it to its violence)—these are some of the subjects which Hunter has treated with an unrivalled superiority. All his views in these respects have so completely passed into the common domain, that the majority of surgeons put them into practice, in the idea that they have at all times been recognised, little dreaming of their recent origin. But take away from our classical treatises all that can legitimately be referred to Hunter, and you will see what an immense breach you have made, and how vast is the position he has created for himself in surgery." Bulletin, p. 186.

M. Renouard details at considerable length the histories of the various surgical operations; but our limits quite preclude our following him.

6. Obstetrics.

The obstetrical division of medical science long continued in arrear of

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 seet; but several sects borrowed from his ideas. The chemical school owes to him the idea of ferments, and from him the ani mists 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 ecsta cies when he saw his soul, or at his dreams, during which the solutions of the