BELLINI—PITCAIRNE. 317 though so often employed, is contra-indicated, for the materies morbi is not in the blood but in the nervous system, and Borelli concludes: “If this theory of fever is not false and utterly out of the way, I doubt not that ingenious physicians will soon discover more certain remedies”. One of the most famous followers of Borelli was Lorenzo Bellini, for thirty years (1663-93) professor at Pisa, during which period he published numerous works expounding and defending the doctrines of the mechanical school of medicine. Perhaps the most interesting and original part of his teaching is his theory of local stimulus, or, as we now call it, counter-irritation. The iatro-mechanics held that the great causes of disease are alterations in the elasticity or “tone” of the solids, or in the density of the fluids, which hinder the free movement of the latter, and give rise to local congestions or stagnation. One way of dealing with such a state is by bleeding, especially from an artery, which, as Bellini is at great pains to prove, tends to increase the velocity of the circulation. But he considers that the same end may often be attained by local stimulus, by cautery, blisters, rubefacient lotions, flagellation, etc. These agents produce a local contraction of the fibres, whereby the fluids are expressed from one part to another, while at the same time the local blood flow is accelerated, and tends to wash out any morbid matter. How completely the minds of the mechanical physicians were dominated by Harvey's discovery may be seen in the works of the chief British representative of the school, Archibald Pitcairne, the friend of Bellini, and tutor of Boerhaave. The following are the fundamental definitions with which he commences his Elementa Medicina PhysicoMechanica. Life is the circulation of the blood. Health is its free and painless circulation. Disease is an abnormal motion of the blood, either general or local. Like the English school generally, he is far more exclusively mechanical than are the Italians, and will hear nothing of ferments or acids even in digestion. This, he declares, is a purely mechanical process due to heat and pressure, the wonderful effects of which may be seen in Papin's recently invented "digester". That the stomach is fully able to comminute the food may be proved by the following calculation. Borelli estimates the power of the flexors of the thumb at 3720 lb., their average weight being 122 grains. Now, the average weight of the stomach is 8 oz., therefore it can develop a force of 117,088 lb., and this may be further assisted by the diaphragm and abdominal muscles, the power of which, estimated in the same way, equals 461,219 lb. ! Well may Pitcairne add that this force is not inferior to that of any millstone. Indigestion is due either to paralysis of the stomach, which is very rare, or to the presence of a viscid substance on its surface and between its fibres, preventing their proper contraction. The treatment indicated is to give purgatives or drugs which will remove this viscosity, and he recommends, among other things, the Elixir Proprietatis of Sylvius. The calculations of the British iatro-mathematicians, however, were not always so wild as those of Borelli and Pitcairne. Thus Keill estimated the force of the heart beat at from five to nine ounces, while he also repeated and corrected some of the observations of Sanctorius. Another member of the school, Dr. Edward Barry, thought that the probable length of life might be calculated mathematically, on the supposition that the heart is a clock-like machine set to beat so many times. Suppose, for example, a person be endowed with an organ which will last seventy years, at an average rate of sixty beats per minute, then, if by excesses and excitements he increases the rate to seventy-five beats, he will live, excluding accidents, exactly fifty-six years. But, with all their love of calculation, the disciples of Borelli soon saw that it was absurd to apply the strict rules of mathematics to the varied and complicated phenomena of disease, and so began to separate their theory from their practice, following in the latter the principles of a rational empiricism; and so marked is this distinction in the works of the two greatest members of the school, Baglivi and Boerhaave, that they may fairly be classed with our own Sydenham among the clinical or Hippocratic physicians of the age. NOTES. Sanctorius, Ars de Staticâ Medicinâ, Venice, 1614; Commentaria in Primam Fen Avicenna, Venice, 1646; Borelli, De Motu Animalium, Rome, 1680; Bellini, Exercitationes Dua Physica, Leyden, 1711. The first of these contains the description of the tubules of the kidney, which has immortalised his name (ducts of Bellini). But the tubular structure of those organs had already been pointed out by Eustachius, 1565. Opuscula Aliquot ad Archibaldum Pitcarnium, Leyden, 1714. Pitcairne, Opera Omnia, Hague, 1722. LV. THE CLINICIANS. IN the preceding chapters we have seen how able physicians, led astray by love of system, attempted to replace the ruined fabric of Galenism by new edifices based upon the still but half-solidified foundations of physics and chemistry. We shall now see how others fell back upon an older and a better model, and how the banner of the Hippocratic medicine, unfurled in England by Thomas Sydenham, was carried to Italy and Holland by his admiring disciples, George Baglivi and Hermann Boerhaave. The praises of Sydenham (1624-89) have been recorded by so many able writers, and his works are so readily accessible, that he may be here discussed more briefly than his merits would otherwise demand. The first and greatest of these merits was that he not only repeated the Hippocratic dictum that medicine depends not on theory but on observation, as Sylvius and others had done before him, but that he also carried it out in practice. Thus, to take the example which most impressed his contemporaries, he substituted for the old treatment of fevers by purgatives and sweating, with the view of getting rid of a supposed morbid humour, the antiphlogistic method of cooling drinks, fresh air, and venesection as being most in accordance with Nature and experience. The progress of medicine may, he thinks, be furthered in three ways: (1) By accurate descriptions or natural histories of diseases, written without any pre-conceived idea, separating them into their various species, and distinguishing the essential from the accidental symptoms; (2) by establishing a fixed principle or method of treatment, founded upon experience; (3) by searching for specific remedies, which he believes must exist in considerable numbers, though he admits that the only one yet discovered is Peruvian bark. Sydenham holds that diseases are as typical and distinct from each other as the various species of plants and animals, which they resemble in appearing and disappearing with the seasons; and though he believes with Hippocrates that they are efforts of Nature towards a cure by the elimination of morbific matter, he compares them at the same time to parasites which develop in man owing to some change in his humours, just as, to use his own simile, mosses, mushrooms and mistletoe grow on trees, the juices of which have been corrupted by some internal or external agency. The progress of medical knowledge has shown that he exaggerated both the number of specific remedies and the specific nature of disease, and this is still more the case with his favourite doctrine of the "epidemic constitution," which he borrowed directly from Hippocrates. According to Sydenham, acute diseases, especially those of an epidemic character, while differing from one another in special properties, present a general type which varies from time to time, not through change of climate or season, but "because of certain secret and inexplicable alterations in the bowels of the earth," and a knowledge of the existing type is of fundamental importance in treatment. Thus in 1661-4 the "epidemic constitution" had ague as its basis. In 1665-6 came the plague, during which all febrile diseases, pleurisy, pneumonia, etc., assumed a plague-like character. The years 1666-9 were marked by a Constitutio variolosa when small-pox gave what we may call the key-note. This was followed by the Constitutio dysenterica, and so on. The above theory, though perhaps not entirely false, did great harm, for it became the fashion to ascribe excessive mortality of any kind to a "genius epidemicus," "cosmotelluric miasm," or mysterious influence, sometimes confined to a single hospital ward, at other times spreading itself over whole countries, a doctrine which not only saved the physician the trouble of further investigation, but also excused his want of success, for what can mere mortals do against cosmo-telluric influences and epidemic genii? But we need not dwell on the unavoidable errors of a great man, and the influence of Sydenham's teaching as a whole was as beneficial as it was extensive. Chief among his pupils, in spirit, if not in fact, were Baglivi (1668-1707) and Boerhaave (1668-1738). The former, who flashes like a bright meteor across the horizon of medical history, has been called an Italian Sydenham, and had he lived, would doubtless have merited the title; but he may be better compared with Bichat, whom he closely resembled in his wonderful activity and early death, as well as in the style and nature of his teaching. Having studied at Naples, and graduated, perhaps, at the ancient University of Salerno, Baglivi went round the schools and hospitals of Italy to observe the state of medical teaching and practice, lingering especially at Bologna, where he attended the lectures of Malpighi, then the greatest of living anatomists. He published the results of his observations and experience in his Praxis Medica, and was soon afterwards elected professor of anatomy at Rome, and, what he considered a still higher honour, foreign member of the Royal Society, in succession to Malpighi, 1697. His few remaining years were spent in the continuous labours of teaching, research, and practice. He lectured twice daily in anatomy, besides giving instruction in chemistry and medicine. He devoted much time to experimental physiology, which he declared was the source of all the chief discoveries of the age, and he |