I have lived myself to see the disciples of Hoffman, Boerhaave, Stalh, Cullen, Brown, succeed one another like the shifting figures of a magic lantern, and their fancies, like the dresses of the annual doll-babies from Paris, becoming from their novelty, the vogue of the day, and yielding to the next novelty their ephemeral favor.
Thomas Jefferson to Dr. Caspar Wistar, 21 June 1807
Jefferson had little faith in medical practice. To restore health, he preferred for himself and his friends the “salutary efforts of nature”over what he called the “conjectural experiments”of physicians.
This is not to say that Jefferson despised medicine and all its practitioners. His library housed many books on anatomy, surgery, and medicine, including the works of Boerhaave, Hunter, Fontana, and Linnaeus. His circle of friends included at least four doctors: Benjamin Rush, Caspar Wistar, Pierre Cabanis, and Robley Dunglison. He simply believed that most doctors did more harm than good because they relied on guesswork rather than on clinical observation.
It is undoubtedly true that many charlatans practiced medicine during Jefferson’s lifetime. It is equally true, however, that serious medical scientists were at work laying the foundation for modern medicine. The superstition and wild speculation that Jefferson condemned were giving way to clinical concepts and careful experimentation. This exhibit features twenty medical classics that were part of this transition in medical practice. All were published during the years of Jefferson’s life, 1743-1826.
Matthew Baillie, nephew of John and William Hunter, was educated at the University of Glasgow and Balliol College, Oxford. Following an apprenticeship with his Uncle William in London, Baillie was appointed physician to St. George’s Hospital. At age 36, he left St. George’s, ceased writing and lecturing, and spent the rest of his life in private medical practice. Baillie served as physician extraordinary to King George III, but he accepted rich and poor alike as patients. He was the last and most famous owner of the gold-headed cane, the coveted symbol of excellence among London physicians.
Baillie’s most significant work, The Morbid Anatomy of Some of the Most Important Parts of the Human Body, was published in 1793. It established morbid anatomy as an independent science. Baillie gave the first clinical descriptions of gastric ulcer and chronic obstructive pulmonary emphysema and presented one of the clearest descriptions ever written on the pulmonary lesions of tuberculosis.
Born in Scotland, Charles Bell studied anatomy and medicine at the University of Edinburgh. Bell left Edinburgh for London after he and his brother John were rejected by the Edinburgh Royal Infirmary. He lived and worked in London for thirty years before returning to Scotland, where he ended his career as professor of surgery at the University of Edinburgh.
Bell was an expert surgeon: he served as a surgeon with the British army at the famous Battle of Waterloo in 1815. His fame, however, rests on medical illustration and neurology. His Essays on the anatomy of expression in painting (1806) is a classic of art history. His most notable achievements are his description of the exterior respiratory nerve (“Bell’s nerve”), his discovery that lesion of the seventh facial nerve causes facial paralysis (“Bell’s palsy”), and his demonstration of the motor function of anterior roots and the sensory function of dorsal roots in spinal nerves (the “Bell-Magendie law”).
An Exposition of the Natural System of the Nerves of the Human Body is a collection of Bell’s observations on the nerves.
Marie Francois Xavier Bichat studied medicine and surgery at the University of Montpellier and at the Hôtel-Dieu in Paris. Bichat conducted an enormous amount of physiological research during his time as student, demonstrator, and lecturer at the Hôtel-Dieu. In the five years between his graduation and his death at age 31, he amassed enough positive results to publish three monumental works: A Treatise on the Membranes (1800), Physiological Researches on Life and Death (1800), and General Anatomy (1802).
Bichat is the father of modern histology and tissue pathology. He argued that anatomy and pathology should be based not on the study of organs, as Morgagni had proposed, but on the classification and examination of tissue. He examined over six hundred bodies and identified twenty-one kinds of tissue--without using a microscope.*
Bichat introduced his ideas in Traité des membranes en général, et diverse membranes en particulier in 1800. The work was translated into English as A Treatise on the Membranes in 1813.
(*Microscopes were available to Bichat, but apparently he considered the microscope unnecessary in the identification of tissues.)
Jacob Bigelow studied medicine in Philadelphia under Benjamin Smith Barton, author of the first American textbook on botany. Bigelow was professor of materia medica at Harvard from 1815 to 1855 and practiced medicine in Boston for sixty years. He was the first to argue convincingly against treating a disease that ran its course regardless of physician intervention. This was a significant step away from the widely-accepted methods of Benjamin Rush, who claimed that all diseases were treatable.
Bigelow’s first love was botany. From 1817 to 1821, he compiled a three-volume survey of the medicinal plants of the United States, American Medical Botany. The work included sixty color plates printed in color by a process that Bigelow invented. It was one of the first two books in America to include plates printed in color (the other was a botanical work written and printed in 1817 in Philadelphia by William Barton, nephew of his former professor). During the publication of American Medical Botany, Bigelow also co-authored the first national pharmacopoeia (1820).
Astley Cooper studied anatomy and surgery at St. Thomas’and Guy’s Hospitals in London and at the University of Edinburgh. After returning to London he attended the anatomy lectures of John Hunter.
Cooper was the most popular surgeon in London during the early nineteenth-century. In 1821, he was made a baronet for removing a sebaceous cyst from the scalp of King George IV. He is best known for his studies of hernia, including his identification of the superior pubic ligament (“Cooper’s ligament”) and his description of hernia femoralis fasciae superficialis (“Cooper’s hernia”). He was also among the first to attempt, with some success, ligatures of the iliac and carotid arteries (1805-08). His treatise on dislocations and fractures (1820) remained the final word on the subject in England and America for thirty years.
Cooper’s Surgical Essays, first published in London in 1818, includes his work on dislocations as well as chapters on ligatures of veins and encysted tumors.
Born in Ruvo, Italy, Domenico Cotugno studied medicine at the University of Naples. Poverty and illness plagued Cotugno during his training. After barely surviving a critical illness that he contracted while resident physician at the Neapolitan Hospital for Incurables, he received his doctorate degrees in philosophy and physic and remained at the university as lecturer in surgery and anatomy.
Cotugno published his most important works at the beginning of his career. The first was De aquaeductibus auris humanae internae (1761), in which he identified the aqueduct of the inner ear (“the canal of Cotunnius”), the columns in the osseous spiral lamina of the cochlea (“Cotunnius’columns”), and the naso-palatine nerve. He also confirmed the presence of labyrinthine fluid in the semicircular canals. His second great work, De ischiade nervosa commentarius, appeared three years later. Cotugno distinguished arthritic and nervous sciatica (”Cotugno’s disease“), identified albumin in urine from a patient with acute nephritis, and described in detail the cerebrospinal fluid.
Cotugno wrote De sedibus variolarum, a treatise on fevers and smallpox, in 1771.
Born in Lanarkshire, Scotland, William Cullen studied medicine at the University of Edinburgh under Alexander Monro, one of the foremost anatomists of the time. Cullen co-founded the Glasgow Medical School in 1744. He left Glasgow in 1755 and finished his career at the University of Edinburgh. He attracted students from all over the western world, including the American Benjamin Rush. His fame as a teacher helped make Edinburgh the leading medical school in Europe.
In 1777, Cullen published the essential parts of his Edinburgh lectures in First Lines of the Practice of Physic. He suggested that disease was the result of disturbances in the nervous system. Thus he condemned the use of laxatives and purgatives and prescribed only tonics: medicines such as quinine, camphor, or wine that would either stimulate or sedate the nervous system. The book became Europe’s principal text on the classification and treatment of disease. Though Cullen’s reputation as a nosologist and physician has faded considerably, his ideas survive in the terms “nervous energy”and “neuroses”(a word that Cullen coined).
Erasmus Darwin was born in Nottinghamshire, England, and educated at the universities of Cambridge and Edinburgh. His medical practice in Lichfield was so successful that King George III invited him to be his personal physician, a post that Darwin politely refused.
Darwin’s interests extended well beyond the practice of medicine. He was dissatisfied with Linnaeus’s theory of the immutability of species and instead proposed the gradual evolution of animals and plants. He published his ideas in Zoonomia; or the Laws of Organic Life in 1794. This work has been called “the first consistent all-embracing hypothesis of evolution.”The publications of his French contemporaries, Cuvier and Lamarck, strengthened Darwin’s position and provided the foundation for later studies in the field, most notably for that of Charles Darwin, grandson of Erasmus. It should be noted, however, that Charles Darwin rejected his grandfather’s strict mechanistic, semi-experimental approach and even claimed that Zoonomia had no effect on his famous work, On the Origin of Species (1859).
Franz Joseph Gall was born in Tiefenbronn, Germany, and was a pupil of Van Swieten at the University of Vienna. As a student and later as a professor at Vienna, Gall concentrated on the study of the brain, particularly on the function and relation of the gray and white matter.
Gall is famous for introducing the theory of localization of cerebral function, and notorious for inventing the pseudo-science of phrenology, the assessment of intellect and personality based on the shape of the skull. He and his associate J. C. Spurzheim lectured throughout Europe in an attempt to popularize their theories, which they accomplished with some success. The Austrian civil and religious authorities, however, condemned Gall’s views and forced him to leave the country in 1805.
Resettled in Paris, Gall published his theory in Recherches sur le système nerveux en général, et sur celui du cerveau en particulier (Studies on the nervous system, with particular attention to the brain).
Born in Bern, Switzerland, Albrecht von Haller was educated at the University of Tübingen and at the University of Leyden, where he studied under Boerhaave and Albinus. In 1735, after practicing medicine for eight years in Bern, Haller accepted the position as chair of medicine, anatomy, surgery, and botany at the University of Göttingen. He remained at Göttingen for seventeen years, then returned to Switzerland to spend the rest of his life in research and writing.
Haller, called “the Great”even in his lifetime, was an illustrious scholar and prolific writer whose interests included poetry, botany, ancient languages, biography, and philosophy, as well as medicine. His primary claims to fame are in medical bibliography and physiology. Haller compiled twenty volumes of bibliographies on anatomy, botany, surgery, and medicine. As physiologist, he proved the concept of “irritability”of tissue, distinguishing between nerve impulse (sensibility) and muscular contraction (irritability). In 1747, he published his observations in Primae Lineae Physiologiae (First Lines of Physiology).
William Heberden was educated at St. John’s College, Cambridge. He lectured on materia medica at Cambridge for ten years then moved to London, where he established a successful medical practice. In 1748, he was elected to the Royal Society. With William Cullen, Heberden was one of the two most admired British physicians of the mid-eighteenth-century.
Heberden’s publication on renal calculi prompted Benjamin Franklin to seek Heberden’s advice on his bladder stone. Heberden and Franklin later collaborated on a pamphlet promoting smallpox vaccination in America (1759).
Heberden was a respected classical scholar as well as a physician. The renowned English lexicographer Samuel Johnson called Heberden “the last of our learned physicians.”
Commentarii de morborum historia et curatione, a compilation of Heberden’s most famous medical treatises, was published in 1802 shortly after his death. He was the first to distinguish chickenpox from smallpox, to describe in detail nyctalopia (night-blindness), and, most importantly, to give an accurate description of angina pectoris.
Born near Glasgow, John Hunter studied anatomy and surgery in London, first at St. Bartholomew’s Hospital under the direction of Percivall Pott, then at St. George’s, where he spent twenty-five years as an instructor of anatomy and surgery. He also served as a surgeon with the British army during the Seven Years’War (1756-63).
Hunter is considered, with Ambroise Paré and Joseph Lister, one of the three greatest surgeons of all time. He is credited with having raised English surgery from a mere “technical trade”to its position as equal to other medical specialties. He rejected academic speculation and insisted on experimentation and direct observation. Hunter expressed this basic tenet in an often-quoted remark to his most famous student, Edward Jenner: “Don’t think, try.”
Aside from his research and teaching in anatomy and surgery, Hunter wrote important works on teeth (he coined the terms cuspids, bicuspids, molars, and incisors), sexually transmitted disease, and inflammation. A Treatise on the Blood, Inflammation, and Gun-shot Wounds, a compilation of Hunter’s observations during the Seven Years’ War, was published posthumously in 1794.
Englishman John Huxham was a student of Dutch physician Herman Boerhaave, the creator of the modern method of clinical teaching, at the University of Leyden. He established a moderately successful practice in Plymouth, where, as a religious dissenter, he was invited to provide medical care only to fellow non-conformists. When his exclusion from the established medical community became unendurable, he converted to the Church of England. His practice and reputation grew as a result, and he was admitted to the Royal Society.
Huxham is known for his description of the “Devonshire colic,”his preparation of cinchona bark (“Huxham’s tincture”), and his promotion of citrus fruits as a defense against scurvy. His best single work, An Essay on Fevers, was published in 1739. He described in unprecedented detail diphtheritic throat and suggested a distinction between typhoid and typhus fevers, conditions that most physicians regarded as one. Huxham’s Essay on Fevers also included the first use of the word “influenza”by an English physician.
René Théophile Hyacinthe Laennec studied medicine in Paris under Jean-Nicolas Corvisart, personal physician to Napoleon. He served as visiting physician to Necker Hospital, then succeeded his mentor as chair of medicine at the Collège de France in 1822. Just four years later, he died of tuberculosis.
Laennec is considered one of the greatest clinicians of his time. Like his teacher Corvisart, who popularized Leopold Auenbrugger’s method of percussion to diagnose thoracic disorders, he specialized in the study of chest disease by auscultation. Laennec’s contribution to the field was De l’auscultation mediate (1819), in which he introduced auscultation by means of an instrument he invented and named the stethoscope (“chest examiner”). His first stethoscope was simply a cylinder of paper. By 1819, it had evolved into a hollow wooden tube. In De l’auscultation mediate, Laennec described in unprecedented detail the audible symptoms of thoracic diseases. He also included diagrams of his new invention and made the stethoscope available for purchase from the publishers.
Born in Bordeaux, François Magendie studied anatomy and medicine at the Collège de France in Paris. He passed his clinical examinations for the M. D. in 1808 and devoted the rest of his life to experimenting and lecturing as professor of anatomy, physiology, and semeiology with the Faculty of Medicine in Paris.
Magendie is the father of experimental physiology. He proved Charles Bell’s theory on the motor function of anterior roots and the sensory function of dorsal roots of spinal nerves (“the Bell-Magendie law”). He also introduced the effects and uses of morphine, emetine, quinine, strychnine, and other alkaloids, for which he is sometimes called the founder of experimental pharmacology.
In 1817, Magendie published Précis élémentaire de physiologie (A Summary of Physiology), the first modern physiology textbook, in which he demonstrated the importance of nitrogenous foods (protein) in the diet of mammals. He also challenged Haller’s view of regurgitation by noting the action of the diaphragm and the passivity of the stomach during vomiting.
Giovanni Battista Morgagni studied medicine at the University of Bologna under Antonio Maria Valsalva, a great pioneer in otology. In 1711, Morgagni left his position as lecturer in anatomy at Bologna for the University of Padua, where, four years later, he accepted the chair of anatomy. He remained active as an instructor until he died at age 89.
A teacher, philosopher, medical historian, and pathologist, Morgagni was one of the most respected scholar-physicians of his time. In 1761, he compiled a lifetime of clinical and anatomical research in De sedibus et causis morborum per anatomen indagatis (On the Seats and Causes of Diseases, Investigated by Anatomy). The book consists of seventy letters that describe about 700 cases. As the first work to establish the organ concept of disease, it is the foundation of modern pathological anatomy.
The first English translation of Morgagni’s work appeared in 1769.
Born in Scotland, John Pringle received a business education at the University of St. Andrew’s and at the University of Edinburgh. He traveled to Amsterdam for further training in business, but he switched to medicine after meeting the famous Herman Boerhaave. He was granted the M.D. degree at the University of Leyden in 1730.
Pringle served as Physician-General of the British Army during the War of the Austrian Succession (1740-48). He was shocked by the wretched conditions of military hospitals and by the lack of good food and supplies issued to the common soldier. Pringle recorded his experiences in Observations on the Diseases of the Army in 1752. He proposed revolutionary changes in military medicine, namely the ventilation of barracks and field hospitals, the sanitation of camp sites, and the standard issue of blankets for infantrymen. Pringle also co-invented the Red Cross concept when he helped establish a neutral field hospital to provide the wounded with a safe haven within easy-carrying distance from the battlefield.
Benjamin Rush, a signer of the Declaration of Independence and a close friend of Jefferson, Franklin, and Adams, studied medicine as an apprentice to John Redman, the most prominent physician in Philadelphia. Under Redman’s direction, Rush performed his duties as physician and pharmacist by day and studied Boerhaave and Sydenham by night. He also attended the lectures of William Shippen and John Morgan at the new medical school of the College of Philadelphia (University of Pennsylvania). Rush completed his medical education in Europe at Edinburgh, London, and Paris. He returned to America in 1769 and accepted the professorship of chemistry at the medical school of the College of Philadelphia.
Rush is considered one of the greatest physicians of American history. He called for the restriction of alcohol and tobacco use, proposed the study of veterinary medicine, and wrote the first American textbook on psychiatry. One of his primary interests was yellow fever, a disease he battled in Philadelphia during the epidemic of 1793-94. He published his observations and his suggestions for the prevention of the disease in 1794.
Antonio Scarpa studied at the University of Padua, where he served as assistant and personal secretary to Morgagni, the master of pathological anatomy. After ten years as professor of anatomy and clinical surgery at the University of Modena, Scarpa joined the medical faculty at Pavia and served as chair of anatomy for the rest of his professional life.
Scarpa wrote important works in otolaryngology, orthopedics, ophthalmology, neuroanatomy, and general surgery. He was the first to demonstrate cardiac innervation and to accurately describe the pathological anatomy of congenital club-foot. He also introduced the concept of arteriosclerosis, identified “Scarpa’s triangle”of the thigh, and provided the first detailed description of sliding hernia of the large bowel.
Scarpa’s Saggio di mallatie degli occhi was the first ophthalmology text published in Italian. The book earned Scarpa the title of “father of Italian ophthalmology.”Scarpa described the treatment of cataract by depression rather than extraction, noted his procedure for making artificial pupils, and suggested a surgical treatment of dropsy of the eyeball.
Like John Huxham, Dutch physician Gerhard Van Swieten was a student of Boerhaave at the University of Leyden. Boerhaave considered Van Swieten his star pupil and invited him to practice medicine in Leyden and assist at the University. Van Swieten accepted. His abilities quickly earned him the right to succeed his master as chair of medical faculty.
Van Swieten was a Catholic, however, in a predominantly Protestant country. His religion was probably a factor in 1745 when he accepted Empress Maria Theresa’s invitation to be court physician and university professor in Catholic-friendly Vienna. His popularity with the Empress won him a baronetcy and an appointment as director of the Army Medical Service.
Van Swieten popularized Boerhaave’s methods in Vienna and helped build the reputation of the medical school. For thirty years, he published and republished his famous Commentaries Upon the Aphorisms of Herman Boerhaave, originally in Latin, then in Dutch, Spanish, French, German, and English.