1800: Albrecht von Haller studies respiration

Albrecht von Haller (1708-1777)

Albrecht von Haller was not an asthmatic, although he was a sickly in his youth, and this would force him to focus on his studies.  He would become among the most brilliant minds of his era, and what he accomplished had a great impact on the evolution of many diseases, including asthma.

He was born in Bern, Switzerland, in 1708.  His biographer, Charles Bert Reed, said:

"Like many other men of genius, his infancy was sickly and feeble. He had rickets, which retarded his physical, even as it accentuated his mental, development. Driven in upon himself for entertainment, he studied, read, and drew designs at the precocious age of four." (6, page 17)

It was observed from a very young age that he was a genius. Reed said:

As with Mozart, Macaulay, Goethe, Leibnitz, and others, the most extraordinary things are told of Haller's ability and greed for knowledge. During his childhood he outstripped all his companions. By the end of his ninth year he was thoroughly familiar with the Greek Testament. He made a lexicon of the Greek and Hebrew words in the Old and New Testaments, with their different roots and meanings. He made a grammar of Chaldee. He assembled the lives of 2000 celebrated people, on the model of Bayle and Moreri, whom he had read. Unlike most boys he preferred long and exhaustive treatises with interminable sentences and no paragraphs. His unusual industry, his fiery zeal to educate himself, and his unlimited patience seemed to make nothing impossible. He, also, "took all knowledge for his province.'' (6, page 17-18)

He early began to exhibit the exceptional understanding, the unfailing memory, the tireless industry and the impulses thereto, that characterized his entire life. He entered upon his emotional period at the age of twelve. At this time, while sick with smallpox, he was inspired with love toward the young lady who read aloud to him, and to her he dedicated his first poem. It was written in French, and appropriately named "The Resolution to Love." (6, page 18)

After the death of his father, Haller moved nearer the city and entered the gymnasium. His thesis for admission was in Greek, although Latin was sufficient. He wrote much and after the manner of all aspirants to eminence he aped sedulously the form of some admired exemplar. Homer, Horace, Ovid, and Virgil were his familiars. Homer for romance and Virgil as the model for his verses. Being chained to his room often and long by reason of his feeble constitution, he took refuge in poetry, which he read and practiced in all the tongues he knew. He wrote poems of occasion, tragedies, translations of Ovid, Horace, and two books of Virgil, together with an epic of 4000 lines on the'' Origin of the Swiss Union of States." (6, page 18)

His father had wanted him to go into the ministry. However, when he was fourteen, and after his father died, he moved in with a friend of the family at Biel who happened to be a physician. This man had an impression on a young Haler, and inspired him to go into the medical profession. (6, page e18)

After a year at Biel, he went to Bern to start his medical education, then to Tubingen, and then to Holland where he studied at Leyden.  There he became a student of Herman Boerhaave, the leading medical professor of the era.  It was probably from Boerhaave that Haller would have learned as much about the respiratory tract and respiratory medicine as was available at that time. (6, page 18-19) (2, page 143)

Medical historian Thomas Bradford said he had such a zeal for anatomy that, while at Tubingen, he dissected dogs, and, at Leyden, he purchased half a body for dissection.  He also "engaged in grave robbing, and betrayed by the stench that arose, was obliged to flee." (2, page 143)

When he was 19 he showed senior Professor Coschwitz, who had dissected a new salivary duct.  Haller proved that it wasn't a salivary duct, it was a vein.  (1, page 322)(6, page 20)

In 1727, when he was only 19, he earned his medical degree.

So his gift of intelligence was evident at a very early age; he was a prodigy.  He would go on to become the greatest systematist (of medicine) since Galen, and one of the most imposing figures in all medical history," said Garrison.  He was "the master physiologist of his time." (1, pages 321-322)

He then traveled as part of his studies, and wrote poetry about nature along the way.  One of his poems, Die Alpen, was about his journey through the Swiss Alps in 1728, and it was finished in 1729, the same year he started his medical practice in Bern. The poem, along with several other poems he wrote, was published in his Gedichte in 1732. Die Alpen would end up being his most famous poem. (5)(6, page 21-23)

His book of poetry went through several editions, and, although some say it was quite popular, others contend that he wasn't the best poet.

In 1731 he gave lectures and demonstration at Basel, in place of his teacher. He then returned to Bern, "where his thorough knowledge, broad scholarship, and influential connections assured to him an immediate success," said Reed.  (6, page 27)

He added:

His practice increased, but he kept up his botanical enthusiasm. Ten miles a day he averaged over hill and valley in search of specimens, which he identified and wrote up in the evenings or during meals. Meanwhile his vast and various powers were fed with the most extensive, the most accurate, and the most elaborate study of botany, anatomy, and medicine. Not a moment was wasted. He reread the Greek and Latin writers wherever he happened to be—at the table, on promenade, and on horseback, and the major portion of his wedding day was spent upon an abstruse problem in Differential Calculus. (6, page 27)

He tried to get in as directing doctor at the University at Bern, and later as professor of history (he probably knew more history than anyone in Bern at the time), but he failed in attempts.    (6, pages 30-31)

At 26 he became professor of anatomy and director of the hospital at Bern. He became especially famous for his botanical and anatomical research, of which he earned the attention of King George II.  (2, page 143)(5)

King George II created Goettingin "in the hope it would surpass the universities of Halle, Leipzig, Wittenberg, and Helmstedt."  In 1736 King George II called Haller to the chair of professor of anatomy, surgery, chemistry and botany at this new university.  (2, page 143)(6, page 32-33)

His wife and his four children moved with him from Bern to his new home, and four weeks later his wife died.  The emotional stress of this even caused him to write another poem.

"Thy death, beloved, shall I sing? Ah, Mariane, what a theme! When sighs my words are mastering, And thought is but a troubled stream, That longing which for thee I feel, My constant needs intensify; The wounds within refuse to heal — Again I seem to see thee die. "My love too eager was, I know; But thou deservedst it and well; Thy form is mirrored in me so That all thy beauty I must tell. Each telling of this love for thee Some former joy recalls to mind; In part thou livest still in me, A tender pledge Love left behind."

In the meantime, Haller wrote many books, and some say he was so busy that he slept in a library, said Bradford. (2, page 143)

Bradford said he is often given credit as the physician to revive experimental physiology, or the study of the functions of living organism. This, according to Garrison, was a subject that was lacking since the great Galen studied medicine in the first century. (2, page 143)(1, page 322)

Garrison said Haller believed "the specific imminent property of all muscular tissue, and that sensibility is an exclusive property of nervous tissue or of tissues supplied with nerve. This classic research, based on 567 experiments, of which he himself performed 190, was made at Gottingen in 1757.  (1, page 323-324)

He believed that "the normal act of expiration hindered the flow of blood through the lungs," and "demonstrated that the lungs contracted when concentrated acid was applied to it."  (3, page 27)

He also performed experiments that would verify the spasmotic theoery of asthma, or at least that the muscular fibres that wrap around the air passages may spasm under certain circumstances. (4, page 4)

Haller was an avid athlete as a youth, and was burdened by sports injuries the rest of his life.  He was inflicted with a disease the Germans called Heimweh at the age of 45 in 1753, and retired to Bern for the remainder of his days, "leading a life of most varied activity as pubic health officer and savant, with a touch of 'Lord High Everything Else'." (1, page 323)

In the short time he spent as a physician, botanist, physioloist and anatomist, he earned the respect of his peers.  While most people simply forgot the man by the time the 20th century rolled around, his biographer Charles Bert Reed said that in his own time he was simply "surnamed the great." (6, page 14)

References: see "1870-1900: What asthma theory won the era?"

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 
2. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
4. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
5. "Albrecht von Haller," http://www.nndb.com/people/677/000096389/, accessed 1/10/14
6. Reed, Charles, Bert, "Albrecht von Haller: A Physician -- Not Without Honor," 1915, Chicago, Chicago Literary Club

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1800-1900: The scientific revolution and the age of progress

Charles Darwin's "Origin of Species" may have helped
to spark the scientific revolution 

Perhaps among the most important centuries in the evolution of medicine wisdom was the 19th century. The great historian Fielding Hudson Garrison explained that this was the century that put an end to old dogmatic theories, thus opening the door for medicine and science to move forward. (1, page 424)

Respiratory diseases, particularly those looped under the umbrella term asthma, benefited greatly as pathology (the study of disease) and internal medicine (diagnosis and treatment of disease) were advanced during the course of the 18th century.  This brought us a greater understanding of the physiology of respiration,  setting the stage for what would transpire in the 19th century.

For instance, Mark Jackson, in his book "Asthma: A Biography, explained the following:

Eager to reject older irrational, mystical models of health and sickness, prominent Enlightenment physicians, such as Thomas Sydenham 1624-1689), George Stahl (1660-1734), Friedrish Hoffmann (1660-1742), and Herman Boerhaave (1668-1738), not only increasingly emphasized the importance of careful observation of the patterns and presentations of disease, but also strove to develop 'a simple and logical synthesis of medical knowledge designed to replace increasingly obsolete humoral conceptions inherited from antiquity' and to alleviate and conquer ill health.  (2, page 70)

Investigations of the human body, and new ideas such as "careful observation of patters and presentations of disease" brought about a better understanding not just regarding diseases, but the treatments to remedy them.  However, old theories persisted, thus acting as fetters to the furthering of wisdom.

Such theoretic fetters holding back great minds did not exist in the 19th century, wrote Fielding Hudson Garrison in his book "An Introduction to the history of medicine,"  mainly due to such works as: (1, page 424, 426)

• Friedrich Schelling's "Natural Philosophy" in 1797, "which aimed at establishing a subjective and objective identity of all things." (1, page 425)
• Hermann von Hemholtz,'s "Conservation of Energy" in 1847, which established the idea that no energy was lost in muscle movement, and that there was no vital force that causes muscle movement (wikepedia)
• Charles Darwin's "Origin of Species" in 1859, which established the idea that living creatures, including humans, evolve over time as changes in their environments occur. 

These works were met with much reservation and controversy by a dogmatic society, although they had a significant impact on both science and medicine, helping to open up the doors for scientific progress. As the ideas put forth by these works were accepted, great minds were no longer limited by theories made by famous men of the past, thus opening up a whole new world for them. (1, page 424)

Hermann Hemholtz shot down the age old theory that
'there was a vital force responsible for muscle movement.
His scientifically proven idea helped spark a revolution.

As noted by Garrison:

"It took a long time to demonstrate that the advancement of internal medicine as a science can never be accomplished by hugging some pet theory out of a regard for it's author's personality, but only through the performance of a vast amount of chemical, physical, and biological research by thousands of willing workers." (1, page 426)

Yet even though medical theories were no longer existent, "the modern scientific movement did not attain its full stride until well after the middle of the century. The medicine of the early half was, with a few noble exceptions, only part and parcel of the stationary theorizing of the preceding age," wrote Garrison.  (1, page 425)

A good example of this we can find in our own asthma history.  Dr. Robert Bree, who was the preeminent asthma expert in the first half of the 19th century, continued to believe in old humoral theories.  On the other hand, Dr. Henry Hyde Salter, who was the preeminent asthma expert in the second half of the 19th century, devised modern conclusions regarding asthma based on scientific investigations. 

Friedrish Schelling encouraged the subjective and the objective
review of patients. His ideas helped spark the scientific revolution.

We have to under stand, however, that the fact Bree did not use science and Salter did does not mean that Salter's conclusions were flawless, because they weren't.  The fact that pure asthma left behind no scarring in the lungs caused him to deduce, as experts before him had, that asthma must be nervous in origin.  Surely he was wrong, but he also didn't know about the immune system. 

The term asthma went through an amazing transformation during the course of the 19th century, with many physicians hunting for answers, and each coming to his own conclusion.  Some were right, thus leading investigators in the right direction.  Some were wrong, thus leading investigators in the wrong direction.  Regardless, all such investigations benefited our disease, thus setting the stage for what would transpire in the 20th century. 

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1913, 1st edition, Philadelphia and London, W.B. Saunders and Company
2. Jackson, Mark, "Asthma: A biography," 2009, New York, Oxford University Press; reference quoted by Jackson: Guenter B. Risse, "Medicine in the age of Enlightenment," in Andrew Wear, editor, Medicine in Society: Historical Essays, (Cambridge, 1992), pages 149-95

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1757: Boerhaave lectures about asthma

By reading the lectures of Dr. Herman Boerhaave we gather he had a very impressive understanding of the causes of difficult respiration, although his understanding of asthma is no better than that of the ancients. While he did have a better grasp on the anatomical changes that cause disease, he continued to believe in the humoral theory of medicine.

Yet, while he adds nothing new to our disease, he does give us a great view of what the medical community was taught about our disease.

It must be understood before we delve into the lectures of Boerhaave, is that he tailored them to his medical student, who were well educated in the medical terminology of the time. His sentences are often long winded, and he makes little effort to simplify complicated thoughts.  Two-hundred seventy six years after his death, that became my job.  Below you will find Boerhave's thoughts on asthma made easy.  

He wrote the following about symptoms attending on injured respiration:

1.  Apnoea:  "In which respiration is entirely suppressed... diminished or suppressed pulse..a state of the body approaching nearer to Death, and absolutely terminates in Death if it continues for Two minutes together."  (5, page 47)

2.  Dyspnoea:  "A dyspnoea is when the respiration is performed with Pain, Difficulty, and Fatigue.

3.  Asthma:  "An Asthma, which is a quick,  difficult and noisy or wheezing Respiration, arising generally from stronger causes than a Dyspnoea, but more especially as it would seem, from a spasmotic Constriction of the muscular Fibres in the lungs." (5, page 48)

He also said:

In this Disorder then the Patients erect their Body, raise the Shoulders, and draw them nearer to each other, and fixing their Elbows in some Window, they draw in their Breath with great Violence and Wheesing, by dilating the Thorax as much as lies in their Power. When the Fit is run to 'such a Height' that the Patient seems to be near to Suffocation, as the Blood now cannot pass thro' the Lungs, the jugular Veins appear turgid and ready to burst; neither the left Ventricle of the Heart nor the Aorta, and consequently the Encephalon and Lungs themselves receive no Supplies (5, page 49)

As was typical of the day he described asthma as either moist (with secretions) or dry (without secretions)

4.  Orthopnoea:  "Short, difficult, and wheezing Respiration, that can only be performed when the Patient's Neck and Thorax is in the erect posture. An orthopneoa is a Respiration with a kind of stertor, performed with the action of the Neck and Shoulders; Hippocrates calls it an exalted or high Respiration... more especially an empyema, a Dropsy of the Paricardium, and other Disorders of the like kind, from which an exalted respiration may follow; and it may also arise from the Lungs being over charged with Moisture or with Water." (5, page 50)

5.  Suffocating Catarrh:  "Which seems to be a sudden and fatal apneoa, or total suppression of the Breath

The causes of all the above are: (5, page 47)

• Vitiated air
• Poisonous vapours
• Air that is caustic, acid, or austere (5, page 47)

Suffocating Catarrh may also be caused by "sudden Distillation of the fluid Matter into the Fauces and Lungs, or great Disorders of the Nerves, as in hysteric cases; or lastly, a large polypus in the heart suddenly protruded into the lungs."   A violent effort to take in a breath often causes a "Vomica" to suddenly burst, and this causes "a bloody, purulent, or phlegmatic Matter" to be discharged from the mouth and nose. The patient does not have an opportunity to speak one word, and death quickly ensues. (5, page 50-51)

The inhalation of these cause "palsy or spasm of the organs subservient to respiration, as also other diseases which are capable of totally destroying the Functions of these parts." (4, page 47-48)

Surely there is no cure to suffocating catarrh, although the other ailments (apnoea, dyspnoea, asthma, and orthopnoea) may be cured by "discharge of the offending Matter.  (5, page 52)

The offending matter may result in the following, which causes difficult respiration:

(Caused) chiefly (by) a filling of the Thorax with extravasated Lymph, Matter, or Blood, an Inflammation of the Larynx, Wind-pipe, Bronchia, Lungs, Pleura, Mediastinum, Diaphragm, Pericardium, and Muscles of the Thorax and Abdomen subservient to Respiration; as also offending matter of various kinds, whether polypose, chalky, phlegmatic, stony, or purulent; and likewise a tumor formed about or within the Larynx; or in the Lungs themselves, or in the Thorax, whether the Tumor be Inflammatory, Supperating... cancerous: finally, we may add to these a very bad Adhesion of the Lungs to the Pleura. " (5, page 52-53)

He said he has seen cases of asthma whereby the patient was "tortured incessant coughing without intermission, till after some Weeks they brought up Calculi from the Wind-pipe, and then the Respiration has been free for some time, till the Calculi were again formed. I have seen other Patients who have kept by them large Cups full of these Stones, which had been brought up from the Lungs. Such People as these generally die with a spitting of Blood ; for the tender Fabric of the Lungs is destroyed by the violent Coughing used to bring up these Stones." (5, page 5)

Asthma may be so severe that the circulation of the blood becomes obstructed in the lungs, and this affects the constitution of the whole body.  A sign of this occurring is a short respiration.  This is a sign that "the Lungs are stuffed up with Blood or some other Matter to which they are not previous but rigid; or else or else that the Wind-pipe, or its Branches, being compressed or obstructed with some Sort of Homour or Matter, are scarce capable of admitting the Air; whence it is a very bad sign."  (5, pages 205- 206)

Regarding shallow breaths that occur with difficult respiration, he said:

The Lungs transmit a greater Quantity of Blood by acting in Respiration, than if they were at rest. lf now a greater Quantity of Blood is to be moved through the Lungs in a given time, the Respiration must necessarily become quicker, in order to transmit such a greater Quantity, and on the other hand, if the quantity of Blood 'remains the same, and the Respiration becomes twice as small, it must also become twice as quick, since without that, one half of the Blood will stagnate in the Lungs, and by degrees more compress the Air-Vessels, till they are at length wholly oppressed  the Consequence of which, if not timely removed, must be Death. (5, page 208)

He adds:

A suffocative Respiration, in which the Patient perceives a Sense of choaking, bespeaks that the Lungs are inflamed, obstructed, owrzsilled' or disordered by Stiffness'and Driness, also that the Blood is impervious ; hence it proves fatal in a little time, unless when it proceeds from aflightconvulsive Cause in hysterical 1 and hypochondriacal People, or in those who have been accustomed to an Asthma. (5, pages 208-209)

He also observed that "This is a kind of Death which generally terminates acute Diseases; namely, the arteries of the lungs are so distended with Blood, that they can transmit none to the Veins and left Ventricle of the Heart; whence the Pulse intermits, cold Sweats break out, and after Death the Lungs are found heavy and full of black Blood in their arterial system, while their venal system is empty, and whereas the Lungs of a healthy person are usually light and spongy." (5, page 209)

As typical for the day, he also describes nervous asthma:

It is true, that hysterical Women, hypochondriacal Men, and especially those who are troubled with an Asthma, are sometimes invaded with a suffocating Respiration, perfectly like that of adying Person : but these When they seem to be about expiring, are commonly relieved of a sudden -, for the Convulsive Spasm, which suppressed the Respiration, is removed when the Patient is thereby render'd extremely weak. Such a strangling arises from' the Fumes of burning Sulphur, which by excitinga Convulsion of the Musculi Mesachondriaci suppresIZ-s the Inspiration. (5, page 209)

As for his antidotes particular to asthma he noted but a few.  He said dry asthma was "cured by riding on horseback, with a mild diet."  He said that a lady who presented with "Disorders of the Nerves, with Anxiety, Pains, Asthma, etc. I ordered her Acids with a plentiful Use of Vinegar, by which the pulverized Lead was dissolved and her Maladies relieved (5, page 49-15, 348)

Other than the remedies mentioned in this post, he mentions few that were specific to asthma or other respiratory ailments.  He did prescribe the use of inhalers, such as inhaling fumes vinegar in a sponge, or fumigations, although there is no evidence he recommended these for breathing disorders.

If he thought though it was indicated, there were a variety of other things he might recommend to improve your asthma, such as an improved diet, bleeding, cupping, various herbal remedies prepared as draughts, baths, or the application of warm blankets or sitting by a warm fire.

Although there is no evidence by reading his complicated lectures that any of these remedies were specific to any one disease.  They were mor or less prescribed based on the signs presented by the patient and his surroundings, and prescribed in order to remove the poisons that entered the body to cause disease, and somehow disturbed the flow of humours through the body.

So as you can see, there was not much added to the definition of asthma by Boerhaave.  His definition here, however, is typical of the view of asthma during his generation. What is impressive is that he does seem to be quite aware of the anatomical changes that occur withing the body that cause difficult respiration.

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
2. Johnson, Samuel, "Herman Boerhaave," 1739, as printed in the book" "The Works of Samuel Johnson, with an essay on his life and genius," by Arthur Murphy, volume II, 1837, New York, George Dearborn Publisher, pages 307-314; (This biography of Boerhaave by Johnson was first published in January, February, March, and April of 1739 in subsequent issues of The Gentleman's Magazine. To view a version with section titles added for simplicity, you can click here. 
3. "Hermann Boerhaave", Encyclopedia Britannica, http://www.britannica.com/EBchecked/topic/71313/Hermann-Boerhaave, accessed 11/12/13
4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, 
5. Boerhaave, Herman, "Academical Lectures on the theoryof physic being a genuine translation of his institutes and explanatory comment, collated and adjusted to each other, as they were dictated to his students at the University of Leyden, 1757, Volume II, London, 

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1757: Boerhaave improves image of medicine

Herman Boerhaave's impact on medicine was to improve respect
and dignity for the medical profession by returning to the gentle
practices taught by Hippocrates, and treating patients by assessing
them and making observations about their surroundings. 

Herman Boerhaave was among the well established physicians of the 17th century who helped sway the profession away from the humoral theory of medicine and toward science. He "sought to fix the sciences of medicine on the basis of observation, experiment, and the consequent inferences, "said medical historian Thomas Bradford.  (1, page 127)

Samuel Johnson was the first person to write a biography of Boerhaave, and this was published in subsequent editions of Gentleman's Magazine from January to April in 1739. Johnson said Boerhaave was born in 1668 at Voorhout, a village two miles from Leyden, in the Netherlands. (2, page 307)

His mother was Hagar Daelder, a tradesman's daughter from Amsterdam, and so she had knowledge of medicine. She was unable to share this wisdom with her son because she died at a young age. His father, James, then married Eve du Bois, daughter of a minister in Leyden, in order so she could help James raise his seven children.

Meanwhile, James Boerhaave was preparing his son Herman for the ministry, although at the age of 12 an accident occurred that left such an impression upon the boy that he developed an interest in medicine. Johnson said: (2, page 307)

In the twelfth year of his age, a stubborn, painful, and malignant ulcer, broke out upon his left thigh; which, for near five years, defeated all the art of the surgeons and physicians, and not only afflicted him with most excruciating pains, but exposed him to such sharp and tormenting applications, that the disease and remedies were equally insufferable. Then it was, that his own pain taught him to compassionate others, and his experience of the inefficacy of the methods then in use, incited him to attempt the dscovery of others more certain. (2, page 307)

He began to practise, at least, honestly, for he began upon himself; and his first essay was a prelude to his future success, for having laid aside all the prescriptions of his physicians, and all the applications of his surgeons, he at last, by tormenting the part with salt and urine, effected a cure. (2, page 307)

Until he was fourteen he was educated by his father, and then his father started him in school at Leyden.  He was such an impressive student that he graduated from each class at a time, completing his studies in only six months.  He was then ready for a university education.  It was here, however, that his father died in November of 1692, leaving a 17 year old Boerhaave to tend to his step mother and siblings. (2, pages 307-308)

Eventually he was able to start school at the University of Leyden, the same university where Francois de la Boe (Sylvius) started a medical clinic in 1658. He started studying mathematics in 1687, although in 1690 he obtained a degree in philosophy. Up to this point the objective of all his studies was the ministry. Through his studies he became discontent with the ministry, and decided to study physick (medicine) and chemistry.  (2, page 308)(6, page 68)

It was here where he studied with great interest great anatomists like Vesalius, Fallopius and Bartholin.  He also observed public dissections in the theater.  He also visited slaughter houses "to observe the different structures of animals," said Bradford  All of this gave the young genius an impressive understanding of the inner workings of the human body, at least what was known up to that time.  (1, page 126-127)(2, page 308)

He then delved deep into medical theory, studying the works of ancient physicians such as Hippocrates and Galen.  Then he studied the works of modern physicians, with, said Johnson, none impressing him more than Thomas Sydenham (1624-1689).

He yearned to become a physician just like Sydenham, who believed in the humoral theories of medicine.  Sydenham was said to be the first physician of his era to return to the Hippocratic idea of using the art and skill of the physician to cure patients, as opposed to relying on science and theory.  (2, page 308)

He then went to Hardenwhich, where he obtained his degree in physick in July of 1693.  He then set up his practice in Leyden, and spent the majority of his career as professor of botany and medicine at the University of Leyden.  He soon became very popular both as a physician and professor.  (3) (2, page 309)

He actually returned to Leyten to pursue the ministry, but he was accused of being a practiced atheist, and so he was unable to do this.  Even though the accusations were untrue, he decided not to fight them, and to pursue his other passion, of which was physick. He continued his studies of medicine, started visiting patients, performing chemical experiments, teaching mathematics, and reading scripture.  (2, page 309)

Johnson said this was how Boerhaave lived until 1701 when he was recommended to fill a vacancy as professor of physick at the University of Leyden.  The first thing he observed as professor was that students were not well read in Hippocrates, and so he made sure his students were well read in Hippocrates.  He also read his lectures in public, and also encouraged his students to learn chemistry.  (2, page 310

It wasn't so much the theories of Hippocrates that he was concerned with, but his method of taking care of the sick.  He loved the gentle approach Hippocrates had with his patients, and his gentle remedies.  No more did he want patient's to fear a doctor's poor approach and his painful remedies.

He set up a practice in Leyden and began to visit patients.  Bradford said he soon became extremely popular,  "and all the distinguished persons who passed through Leyden visited him." (1, pages 128)

He said Boerhaave treated all his patients, rich and poor, famous and not so famous, as equals.  So even when Peter the Great sought out his services, he was made to wait all day to see the great physician.  (1, pages 128)

Britannica.com said that he was among the first to, instead of doing all his teachings in the classroom, to take his students to the patient's bedside. In this way, he is said to have given birth to the modern system of medical instruction. He was so famous that students traveled from all over Europe to learn from him. (2)

In this way he was among the first physicians to teach by experience and observation as opposed to science and theory. This, coupled with his gentle approach, established Boerhaave as among the various physicians of the 18th century to increase the respect and dignity of the medical profession. Of this, Johnson said:

Yet I cannot but implore, with the greatest earnestness, such as have been conversant with this great man, that they will not so far neglect the common interest of mankind, as to suffer any of these circumstances to be lost to posterity. Men are generally idle, and ready to satisfy themselves, and intimidate the industry of others, by calling that impossible which is only difficult. The skill to which Boerhaave attained, by a long and unwearied observation of nature, ought, therefore, to be transmitted, in all its particulars, to future ages, that his successors may be ashamed to fall below him, and that none may hereafter excuse his ignorance, by pleading the impossibility of clearer knowledge. (2, page 311)

Yet so far was this great master from presumptuous confidence in his abilities, that, in his examinations of the sick, he was remarkably circumstantial and particular. He well knew that the originals of distempers are often at a distance from their visible effects; that to conjecture, where certainty may be obtained, is either vanity or negligence; and that life is not to be sacrificed, either to an affectation of quick discernment, or of crowded practice, but may be required, if trifled away, at the hand of the physician. (2, page 311)

Encyclopedia.com said that "Boerhaave’s reputation as one of the greatest physicians of the 18th century lay partly in his attempts to collect, arrange, and systematize the mass of medical information that had accumulated up to that time." (2)

Medical historian Fielding Hudson Garrison said his writings had "an enormous impact in their day.  (4, page 321)

Future generations would then become acquainted with the teachings of Boerhaave through his writings, as his books were used as texts for medical instruction for several generations after his death.

He is not, however, remembered for his medicine. He was not even popular for his medical treatments. Plus he added nothing new about any particular diseases. His ideas were mainly his own adaptations of the views of Hippocrates and Sydenham.

Through his lectures he explained the curative part of physick generally attempts to do one of four things: (5, page 277)

1. Preserve life
2. Remove the cause of disease
3. Take away the disease itself
4. Expel the present effects or symptoms of the disease (5, page 277)

In order to accomplish these, he said that...

...artificial Change is to be produced in the Body of the Patient, for which Purpose Instruments or Remedies are required; by the Efficacy and Application of which, the Changes necessary for the attainment of the proposed Ends may be excited, whether under the Denomination of Remedies, Medicines, or help of any kind. (5, page 277)

He said the physician must have all the remedies memorized, and know which one to use for which signs. He likewise explained that...

...these Signs are to be taken from the Patient himself, and not from the general Principles of Physic, which when applied to particular Cases are often found deceitful: As for instance, suppose a Case which indicates a Vomit, if the physician does not attend to the particular Habit or Antipathy of the Patient, it may kill him, for there are some who are always thrown into Convulsions by an Emetic." (5, page 279)

Whatever is discovered in the Patient so as to instruct the Mind of the Physician is called Indicans, or the Things that indicates, and the knowledge of the arising in the Mind of the Physician, is called the Indication, as that which is by this knowledge indicated to be done is called Indicatum.  

He specified that the indicans and indications should not be derived from the patient alone, as the Methodists say, but from the patient and his surroundings, or anything which is known to have an influence on the patient. If, for example, the patient presents as having asthma, and it is known to be very hot the next day, great care must be taken to prepare the patient for this.  Or, if a patient has "drank plentifully of Brandy or other Spirituous Liqours, I thence know what is best to be done for his Recovery." (5, page 281)

All of this is done to determine the Methodus Medendi, or the Method of Healing.

Boerhaave said Hippocrates observed that:

"Disease always cures itself, since it is that imperfect life which still remains from Health; that is what Hippocrates calls Nature, and what others call strength; namely the powers of generating motion. (5, page 282)

Which powers being carefully examined, will be found to depend upon the Remaining motion, of the Humours through the vessels, however conditioned that motion may be." (5, page 282)

And though these powers are reduced to the least degree, they yet continue the circulating Motion of the Humours thro' the heart, lungs, and Cerebellum, in which therefore consists every the least Force of Life, which may be increased in various degrees." (5, page 282)

Boerhaave preached basically two rules for what to do once the indicans is discovered.  If it agrees with nature, it should be preserved in the body.  If it disagrees with nature, it should be removed. As far as the homours are concerned, contraries are removed by their contraries, which is the same belief held by Galen. Another belief he held in common with Galen was his belief that mild maladies required mild remedies, and greater maladies required powerful remedies.  (5, page 287)

Boerhaave notes diseases were caused by poisonous vapours entering the body, and that once poisons enter the body they are spread by the veins and not by the arteries.  The arteries resist the entry of poisons because the "Humours resist the Entrance of any kind of Particles." (5, page 332)

So life is the maintained by quality humours being continuously circulated through the vessels, and the remedies are meant to maintain this function within the body, and expectorate the poisons. When the poison enters the body there are a variety of effects that it can have on the body, such as increasing the viscosity of fluids or humours, thus making it so they become occluded.  In this case, the remedy would be thin or loosen the humours and juices to allow them to flow once more in a natural state.

Some examples of indicatum (remedies) he might use to accomplish this were: 

• Bleeding: to prevent suffocation (such as in peripneumonia)
• Cardiacs (or Cordials): Increase force of the heart to preserve life.  Some increase the quantity of healthy humours, some increase power and strength into the fibres (increase elasticity), some increase power and quantity and motion of nervous juice, and some stimulate the moving fibres (or agitate sluggish vessels to move forward the stagnant humours).  Examples are liquors, kiln, antimony, etc. (5, pages 293-4)
• Antidotes:  These are the remedies meant to remove the poisons that are causing disease.  An example is spirit of sal ammoniacum to treat and remove poisons inhaled from chemical fumes, and thus prevent suffocation by contraction of the vessels.  Another example is Hippocrates burning the bodies of the dead to remove the poisons, or making a wall of fire so that the poisonous air must pass through the fire wall and become purified before being inhaled by citizens.   (5, pages 314-319)

Other examples of antidotes may be: (5, page 329, 331, 332)

• Fumigations of the air
• Dry or moist vapours conveyed to the lungs
• Draughts
• Baths
• Formentations (poultice)
• Injections (5, page 282)
• Cupping glasses frequently renewed
• Bleeding with a lancet
• Leaches
• Scarification
• Friction (rubbing the skin to provide warmth)
• External warmth (warm blankets, fire, etc.) (5, page 331)
• Cautery (5, page 332)
• Vegetable poisons (such as hellebore, hyacinthi, etc.) 
• Opium
• Many other

The antidote should be taken in by the same means as the poisonous vapours entered the body.  For instance, if a poison entered into the brain, the remedy should be inhaled through the nose.  If the disease entered the mouth to the stomach, the remedy should be swallowed the same way.  (5, page 330)

Antidotes may also be used to prevent disease or, "armed and defended against any poison," as Boerhaave said.  One method of doing this is to "anoint the Part of the Body where the Poison is feared with remedies mild and oily."  (5, page 334-335)

Boerhaave said of antidotes used as preventatives:

But there is not yet any universal Antidote known, which can be safely relied upon... though a great many have boasted of such. (5, page 335)

He does, however, offer the some other options as preventative measures:

1. When you are to enter any Place which you suspect poisonous or infected, it is adviseable to drink first as much Hydromel or Mead, as will almost make one dropsical. (5, page 335)
2. One who is to visit Patients in the time of a Plague, cannot secure himself better, than by anointing his Body naked with Oil before a Fire, and then breathing the Air through a Sponge which has been dipped in the best Wine Vinegar by which means the Pores will be closed or filled up, and the Ingress of a put-rid or contagious Air prevented from taking up its Seat in the Lungs, Saliva and Stomach. (5, page 335)
3. But as to a preventative Diet in this Distemper, I hardly know any; but am apt to believe, that keeping the Stomach empty will give a better opportunity of discharging the Pestilential Virus at times by a gentle Vomit, as it is chiefly swallowed with the-Air and salival Humours of the Mouth. (5, page 335)
4. Bathing the body over with salt, vinegar and water and keeping up a copious perspiration. 
5. Sylvius avoided getting sick during a plague by rinsing his mouth with vinegar in the morning, and by keeping a sponge dipped with vinegar under the nose

Rather than description of disease, and his medicine, he is mostly remembered for his approach to medicine, and reintroducing the gentle approach of Hippocrates to the medical profession.  His approach was not soon forgotten, as they were shared through his students as they set up their practices throughout Europe, thus practicing in his image.  Later in our history we will meet William Cullen, who was one of these students, and who would become one of the more significant contributors to our asthma history.

He retired from his work due to failing health in 1729, and in 1737 he became very short of breath and died of hydrothorax.  He was 70 years old. (1, page 128)

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
2. Johnson, Samuel, "Herman Boerhaave," 1739, as printed in the book" "The Works of Samuel Johnson, with an essay on his life and genius," by Arthur Murphy, volume II, 1837, New York, George Dearborn Publisher, pages 307-314; (This biography of Boerhaave by Johnson was first published in January, February, March, and April of 1739 in subsequent issues of The Gentleman's Magazine. To view a version with section titles added for simplicity, you can click here. 
3. "Hermann Boerhaave", Encyclopedia Britannica, http://www.britannica.com/EBchecked/topic/71313/Hermann-Boerhaave, accessed 11/12/13
4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, 
5. Boerhaave, Herman, "Academical Lectures on the theoryof physic being a genuine translation of his institutes and explanatory comment, collated and adjusted to each other, as they were dictated to his students at the University of Leyden, 1757, Volume II, London, 
6. Foucault, Michael, "The Birth of the Clinic," 2003, Great Britain, Routledge Classics 

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1658: Swammerdam discovers RBCs

Jan Swammerdam (1637-1680)

His father, Jan Jacobzoon Swammerdam (1606-1678) worked as a Dutch pharmacist and had an apothecary shop and a fine collection of naturalia including both animals and insects. This created the perfect environment for his son, Jan Swammerdam, to develop an interest in insects and animals, enough to dissect them and inspect them, and their internals, with the compound microscope.

After he graduated, he apparently had a quarrel with his father, as he wanted to practice medicine.  His father, on the other hand, believed he was too skilled as a scientist, and in the end he won out.  The young Swammerdam "never killed or cure a patient. (21, page 71)

He became a skillful anatomist, zoologist and entomologist, and he would end up describing over 3,000 species of insects, many of which can be read about in the book "Natural History of Insects." (18, page 77) (20)(21, page 71)

He would end up giving up his interest in anatomy for religious purposes after being convinced of its sinfulness after reading the works of Antoinette Bourgnon (1616-1680).  Bourgnon traveled through France, Belgium and Holland trying to sell her brand of Christianity, and many were convinced by her words, including Swammerdam. (17, page 71)(18)(21, page 71)

The young Swammerdam was so into his new religion that he refused to participate in science, even to the point that he did nothing, not even publish, the material he had been working on. (21, page 710)

He ended up selling his collection for a low price before he died of malaria in 1680.  After he did so, the works of Bourgnon were viewed as being so radical that they were forbidden by both the Protestant and Catholic Church by 1699.  (17, page 71)(18)(21, page 71)

However, before he gave up the science, he studied insects and animals in implicit detail, describing them and their anatomy. He was the first to describe the anatomy and life cycle of bees and other insects. (11, page 251) (12, page 366) (18, page 77)

In 1658 he discovered red blood cells in the blood of frogs. In 1664 He discovered valves in the lymphatics. He also studied the heart, lungs, and muscles. (11, page 251)

He postulated that an element (later found to be oxygen) could be carried by blood to the various muscles of the body.  (11, page 251)(12, page 366)

In 1667 he discovered that fetal lungs of mammals sink before a breath has been taken, and float after respiration has taken place.  (11, page 251)(12, page 366)

He also demonstrated that a frog leg could be made to contract, and this proved useful by later investigators, or at least investigators who were privy to his work once it was published posthumously as Bybel der Natuur (Book of Nature) by Herman Boerhaave in 1737. (11, page 251)(12, page 366)

The book contained, said Garrison, "some 53 plates with accurate life histories, giving the finer anatomy of bees, the mayflies, the snail, the clam, the squid and the frog. The drawings in this collection surpass all other contemporary work in exquisite delicacy and accuracy of detail." (11, page 251)(12, page 366)

References:

1. Tissier
2. Lagerkvist, Ulf, "The Enigma of Ferment," 2005, Singapore, World Scientific Publishing
3. Potter, Elizabeth, "Gender and Boyle's Law of Gases," 2001, Indiana University Press
4. Newman, William R, et al, "Alchemy Tried in the Fire," 2002, University of Chicago
5. Lehrs, Ernst, "Man or Matter," 1958, Great Britain, Whistable Litho Ltd.
6. Jindel, S.K., "Oxygen Therapy," 2008, pages 5-8
7. Hill, Leonard, Benjamin Moore, Arthur Phillip Beddard, John James Rickard, etc., editors, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
8. Hamilton, William, "A History of Medicine, Surgery and Anatomy," 1831, Vol. I, London, New Burlington
9. Osler, William Henry, "The evolution of Modern Medicine: A series of lectures delivered at Yale University on the Sillman Foundation in April, 1913," 1921, New Haven, Yale University Press
10. Osler, ibid, pages 170, reference referring to William Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, Francofurti, 1628, G. Moreton's facsimile reprint and translation, Canterbury, 1894, p. 48. 20 Ibid., p. 49.
11. Garrison, Fielding Hudson, "Introduction to the history of medicine," 1921, London, 
12. Baker, Christopher, editor, "The Great Cultural Eras of the Western World: Absolutism and the Scientific Revolution 1600-1720: A biographical dictionary," 2002, CT, Greenwood Publishing; Herman Boerhavve published Biblia Naturae (Bible of Nature) in 1737, which was a two volume compilation of the works of Jan Swammerdam. Can you read Latin?
13. Garrison, op cit, 266; (Samuel) Pepy's Diary, Mynors Bright's ed., London, 1900, v, 191
14. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
15. Brock, Arthur John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
16. "History of Chemistry," historyworld.net, http://www.historyworld.net/wrldhis/PlainTextHistories.asp?ParagraphID=kpt, accessed 7/6/14
17. Affray, Charles, Denis Noble, "Origins of Systems Biology in William Harvey's masterpiece on the Movement of the Heart and the Blood in Animals," April 17, 2009, International Journal of Molecular Sciences, 10(2), pages 1658-1669, found online at ncbi.nlm.hih.gov, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680639/, accessed 7/8/14
18. Thomsen, Elsebeth, "Niels Stensen--Steno, in the world of collections and museums," from the book "The Revolution in Geology from the Renaissance to the Enlightenment," edited by Gary D. Rosenberg, 2009, U.S.A., The Geological Society of America
19. "Antoinette Bourignon (1616-1680)," distinguishedwomen.com, http://www.distinguishedwomen.com/biographies/bourigno.html, accessed 7/10/14
20. Swammerdam, Jan, "Natural History of Insects," 1892, Edinburgh, Printed By R. Morrison Junior
21. Robinson, William J, "The Medical Critic and Guide," volume 19, January-December, 1916, New York, "Jan Swammerdam (1637-1680), pages 71-72

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1664: Sylvius improves medical image

Sylvius started a medical clinic at Leyden in 1658.
A future successor of his was Herman Boerhaave,
who re-established respect for the profession by
having his students learn at the bedside, and focusing
on studying the patient before regarding theories.
Methods used at the clinic were so popular that
they quickly spread to other clinics in Britain, and
then throughout the whole of Europe. 

Francois de la Boe, also known as Sylvius, was among the first physicians who helped transform alchemy into chemistry, and improve the image of the medical profession.  

He was born in Hanau in the Netherlands in 1614, was educated at Paris, Sedan, Leyden and Basle, and earned his medical degree from Basle at the age of 23. He opened a practice at Hanua, and later moved it to Leyden and then Amsterdam.  He quickly became a very successful physician.  (1, page 115)

In 1660 he was hired as professor at Leyden, and in 1664 he opened the first medical clinic at Leyden. He also started what is believed to be the first university chemical laboratory.  (1, page 115)(2, page 68)

Bradford said: 

Here he had many pupils on account of the clinical method of instruction and his convenient system with its therapeutics. 

He was, therefore, among the first to take the student to the bedside of the patient in order to get the best medical education. This was an idea adapted and perfected by a future student and professor at Leyden by the name of Herman Boerhaave. This model of educating medical students would be later adapted by medical schools throughout Britain, all of Europe, and eventually the United States. (2, page 68)(3)

Bradford said Sylvius was a firm user of chemistry, and in this way transitioned the profession from alchemy to chemistry. His main ideas about medicine mainly follow the Hippocratic model, that diseases are caused by an imbalance of the humours. Although, like most physicians, he ads his own elements to the theory. Of this, Bradford said: (1, page 116)

There were three cardinal fluids—the saliva, the pancreatic fluid and the bile. The majority of diseases are caused by excess of acidity in the system or alkalinity. Health consisted in the undisturbed performance in the body of the process of fermentation; the saliva was thought to give rise to hectic fevers because there was some fever after eating. (1, page 116)

Bradford said the diagnostics of Sylvius can be summed up by the following passage by Sylvius:

As often as the whole blood appears black, it indicates that the acidity predominates; if the blood is redder, it shows that the bile in it is overabundant. In the first case the acid in the body and in the blood must be diminished; in the second, the bile must be lessened and its power broken. If the blood which is normally free from odor and of a sweetish taste, tastes salty, the alkali in the body is too pure, and when brought into contact with the acid spiritus engenders a humor of a saline taste which is prejudicial to the body. Fever is diagnosed by the pulse and not by the heat of the body. (1, page 116) 

In blending chemistry and medicine, britannica.com says that he "held that all phenomena of life and disease are based on chemical action."  Britannica also says that he blended William Harvey's proof that blood circulated through the body with the Hippocratic and Galen humoral theory. (3)

Regarding the view of Sylvius on the respiratory system, late 18th and early 19th century asthma expert Robert Bree said the following about Sylvius:

According to Sylvius, the parenchyma of the lungs is sometimes dense and corrugated, occasioning dyspnoea. He attributes this state to the restringent quality of the blood, but it may be assigned perhaps, with more reason, to preceding inflammation. (4, page 32)

Bradford said "his therapeutics were simple. We must get rid of the acids or the alkalies. When the acid is in excess give an alkali, when the alkali is in excess give an acid.  (1, page 116)

Bradford continued "(the) general object of therapeutics was to keep up the strength of the patient, remove diseases, mitigate symptoms, and remove their causes."  He listed the following as the remedies of Sylvius:

• Heating methods
• Absorbants
• Emetics
• Etc. 

Unlike most physicians of his era, he did not recommend bleeding.

Bradford said his ideas regarding medicine earned him many followers, although of his remedies, on the other hand, "it has been said that his therapeutics cost as many lives as the thirty years' war." (1, page 116)

Overall, like various other physicians from the 18th century (such as Boerhaave), and even while he was an ardent supporter of older theories, his contributions helped transform medicine away from "mythical speculation to a rational application of universal laws of physics and chemistry." (3)

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
2. Foucault, Michael, "The Birth of the Clinic," 2003, Great Britain, Routledge Classics 
3. Franciscus Sylvius, britannica.com, http://www.britannica.com/EBchecked/topic/577670/Franciscus-Sylvius, accessed 11/12/13
4. Bree, Robert, "A practical Inquiry into Disordered Respiration," 1810, London,  

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