VAN HELMONT'S PATHOLOGY. 307 finally a blas alterativum, or fœtid sweat. The intermittencies are due to his taking breath for another effort, and the therapeutic indication is to assist him by giving support, especially by wine, and to imitate his action by the use of diaphoretics. Bleeding is Helmont's special abomination, for nothing is more calculated to weaken and irritate the Archeus. "I see a blood-stained Moloch presiding at the councils of physicians. Repent, repent, therefore, my brethren, for there cometh a terrible day upon the world at the sound of the trumpet, when every man shall give an account of his deeds." Catarrhs, according to the Humoralists, are caused by phlegm rising to the brain, where it is condensed as by a cold dish cover, and flows down into the nose, eyes, lungs, joints, and muscles, giving rise to coryza, bronchitis, and different kinds of rheumatism, diseases to be treated mainly by purgatives, demulcents, and "hot" medicines. Helmont calls these theories absurdities, catarrhi deliramenta. Phlegm is secreted by the local Archei, or "guardians," as he here terms them, to protect the tissue from irritants; but if the irritation continues the guardian gets reckless, he becomes a custos errans, and secretes mucus of bad quality and excessive quantity, so as to block up important passages, which the presiding Archeus has to reopen by setting up sneezing and coughing. The proper treatment is obvious. In slight cases nothing more is required than to remove the cause of irritation; in severe coryza he recommends a sternutatory or snuff of powdered hellebore and sugar, equal parts, and a reduction of diet, especially in fluids, so as to cut off the errant guardian's supplies. Sulphur is sometimes useful in bronchitis, and when the Archeus overdoes the coughing he may be restrained by the use of narcotics. Divested of its fantastic language, we must admit that there is much valuable truth in the above, and Van Helmont rendered additional services to medicine by his chemical researches, which resulted in the discovery of carbon dioxide, and in the proof that an acid takes part in gastric digestion. He was directed to chemistry by his early admiration for Paracelsus, but soon became dissatisfied with his master, and his refutation of the latter's most characteristic theories is not the least important part of his work. The doctrine of signatures, says Helmont, is false, and rests on the pagan delusion of the microcosm. "I believe that God reveals remedies to whom He will by special grace, not per signa Naturæ, for man is not the image of Nature, but of God." He similarly attacks the Paracelsic doctrine of "tartar" and of the mystic elements, salt, sulphur and mercury. But, on the other hand, he strongly upheld the virtue of the sympathetic ointment, and his works abound in absurdities surpassing even those of Paracelsus. We have only space for one example. Dropsy is, he says, not due to an organic lesion of the liver, but to the anger of the renal Archeus, who has lost his temper, and refuses to work. One way of reducing him to order is to terrify him, and this may be done by tying a snake round the patient's waist and applying live toads to the region of the kidneys. The rules of contraria contrariis and similia similibus are equally false, both being merely treatment of symptoms. The true principles of therapeutics are to remove the harmful products of disease, and above all to pacify the Archeus, and bring him back to his normal course of action by the use of specific remedies. For Van Helmont, like Paracelsus, holds that special medicines exist for the cure of every disease, and that each country produces its own, so that it is needless to bring new drugs from the ends of the earth. He would, therefore, probably have rejected quinine, which was introduced shortly before his death, for he declares that "it is inconceivable that the merciful Father of mankind should have been less merciful to his European children, before the discovery of the Indies than afterwards ". NOTES. Van Helmont's biography is derived chiefly from the preface to his chief work, Ortus Medicina, Opera Omnia, Frankfort, 1797. There is an THE CHEMICAL SCHOOL. 309 English translation of most of the treatises by J. C., London, 1664. Very complete criticisms of his work may be found in Spiess, J. van Helmont's System der Medicin etc., Frankfort, 1840, and the prize essays of Drs. Rommelære and Mandon (in the Mémoires de Concours de l'Académie Royale de Médecine Belgique, Brussels, 1868) to the former of which I am much indebted. LIII. THE CHEMICAL SCHOOL OF MEDICINE. THE origin of the so-called iatro-chemical school is often traced to Van Helmont, but its doctrines may be rather contrasted than compared with those of the Flemish physician, which are far more closely allied to the later vitalistic theories. The seventeenth century, like our own, was an age of physical science, a character due partly to a reaction from the mysticism of the preceding period, but especially to the influence of the discoveries of Harvey and Galileo, and the teaching of Bacon and Descartes. Bacon, by formulating the principles of inductive science, had pointed out the true path of progress between the barren desert of Aristotelean dialectics on the one side, and the mist-enveloped swamp of Neoplatonic theosophy on the other; but his influence on medicine is probably less important than that of Descartes. It seemed to the French philosopher that the universe contains two distinct things-matter, with the characteristic property of extension; and mind, with the characteristic property of thought, between which he held that there can be no conceivable connection; and he declared that the only proof of the existence of mind is conscious thought-Cogito, ergo sum. But all the processes of life may go on without conscious thought, therefore vital activity is of a purely material character; and Descartes boldly asserted that animals are merely self-acting machines or automata, while man is a similar machine with a mind behind it and sometimes acting upon it. This Cartesian dualism, as it may be called, dominates the medical theories of the seventeenth and part of the eighteenth centuries, as well as those of our own day, but it is the very reverse of the doctrine of Paracelsus and Van Helmont, who held that matter and mind are intimately connected, and that all the processes of nature are lower or higher, less or more self-conscious manifestations of one universal life. The physicians of the seventeenth century made two attempts to solve the problems of life and disease on purely materialistic principles, one by the aid of chemistry, the other by the aid of mechanics, and thus arose two schools or systems of medicine known respectively as the iatro-chemical and the iatro-mechanical. The foremost and most typical representative of the former school is Francis de la Boe (Sylvius) (1614-72), whose chemistry, however, is based not upon that of the Paracelsists with its arcana and quintessences, but upon the more sober observations and experiments of their great opponents, Libavius and Sennert. And he contrasts with his predecessors in his purpose as well as in his method. Paracelsus and Van Helmont had attempted to overthrow Galenism, and to replace it by new systems evolved largely from their own inner consciousness; Sylvius, on the contrary, strove to re-establish the humoral pathology on a firm basis of chemical facts, and he may not inappropriately be called "the last of the Galenists". Sylvius commences with principles worthy of a disciple of Harvey, Bacon and Descartes. Nothing, he says, is to be admitted as true in medicine or natural science unless experience has confirmed and shown it to be true. As regards medicine, this experience may be classed under three heads (1) anatomical, (2) chemical, (3) clinical; but he warns his pupils against falling into the error of the old Empirics, that of drawing conclusions too hastily, and proposes to divide his results into conjectures, suspicions, opinions, and conclusions, according to their relative scientific value. Medicine, he declares, still rests mainly upon evidence of the first kind, and, though a progressive art, does not yet deserve the name of science. Its firmest pillars are anatomy, SYLVIUS OF LEYDEN. 311 chemistry, and Harvey's doctrine of the circulation, which he vigorously defends against all remaining adversaries. From such a preface great results might have been expected, but unfortunately even men of scientific mind are apt to give the rank of opinions, if not of conclusions, to theories of their own, which, if put forward by others, they would justly class among conjectures; and contempt for authority, though frequently leading to new truth, may also give rise to error. So now it was with the Leyden professor. Among the matters in which most follow authority rather than reason is, says Sylvius, the doctrine that the bile is secreted by the liver, and passes thence into the gall-bladder. Careful anatomical observation has convinced him that this is absurd, and that the bile is secreted directly from the cystic artery into the gall-bladder, whence it passes partly into the intestine, and partly through the liver and vena cava into the heart. Here it meets with the acid lymph, brought by the thoracic duct and superior vena cava, and the combination of the acid and alkaline fluids produces a mild fermentation, the source at once of the bodily heat and the diastole of the heart. If either the acidity of the lymph, or the alkalinity of the bile be increased, the fermentation becomes more active, and we get increased heat and exaggerated action of the heart, or, in other words, "fever". Excessive increase or decrease of this cardiac fermentation causes death, and he explains the rapid collapse in "cholera" by the fact that all the bile is expelled by the intestine, and none left to go to the heart. The active parts of the body are the fluids or humours, the solids serving chiefly to contain them (partes continentes), and most diseases are due to an "acridity" of some humour, which may have become either too acid or too alkaline. Sylvius modestly admits that the above theories are only "opinions," but he nevertheless makes them the basis of his whole medical system. In his therapeutic doctrines we find equally admirable principles, followed by a far less satisfactory application. The indications for treatment are, according to Sylvius, |