earnestly advise the use of tonics, friction of the body, suitable exercise, nutritious and easily digested food, etc., and I add these few medicines. Let her take three of the pills A every three hours, and then one ounce of the medicated wine B, if possible on an empty stomach. I would suggest that this treatment, if it commends itself to your judgment, be continued for two months; but use your own authority, excellent and learned sir, for correcting this, for you are fully competent. Condescend to inscribe me on your list of friends. Farewell". A.-Assafoetida, half a drachm; catechu, mastich, frankincense, balsam of Peru, extract of liquorice, each one drachm; divide into pills of three grains each. B.—Iron filings, sandalwood and various aromatics, in French or Portuguese wine. The doctrines loosely combined by Boerhaave were condensed into a definite system by Frederick Hoffmann of Halle (1660-1742) who forms a link between the mechanical and vitalistic physicians. He supposed that the universe is pervaded by an etherlike "vital fluid," which exists in a specially active form in the nervous system of animals, and through it acts upon their muscles both voluntary and involuntary, keeping them in a state of partial contraction or "tonus". The same fluid exists also in the blood; "the cause of life is the circulation of the blood; the body lives so long as the blood and humours are in motion, if they stop there is death". Disease is "a marked disturbance in the movements of the solids and fluids". In these disturbances the solids are the active and the fluids the passive agents. Excessive movement produces "spasm" and defective "atony," either of which may be general or local, and most acute diseases are due to spasm, most chronic diseases to atony. This theory reminds us of the ancient Methodism; but Hoffmann also admits that disease may be due to alterations in the humours, and especially to a gradual thickening of the vessels which tends at once to hinder their free circulation and to prevent the excretion of waste products. This, indeed, is the direct cause of old age and natural death. We thus get four main sources of disease, spasm, atony, altered humours and deficient excretion, to be met respectively by four kinds of medicines, sedatives, tonics, alteratives and evacuants. Pure water is an excellent medicine, it relieves spasm and favours the motion of the humours; but the great antispasmodic is camphor, though not without danger, as evidenced by the following case. A person took two scruples of camphor by accident. He was seized with extreme and continued vertigo, coldness of the limbs and delirium. Hoffmann administered aromatics and ammonia; but the patient got worse with rigor of the limbs and spasm of the œsophagus. Finally he recovered by the use of enemata, alcohol and "spirits of ether," which last formed the famous "Hoffmann's anodyne," still in use. His favourite tonics were wine, quinine and preparations of iron, while among alteratives and evacuants prominent place was held by mineral waters, the composition of which he made laudable efforts to analyse and imitate. The simplicity and plausibility of these doctrines made them very popular, and they formed the basis of most of the more practical "systems" of the eighteenth century. NOTES. Sydenham's works were published in Latin and English by the Sydenham Society, 1844 and 1849 respectively. The latter contains a biography by Dr. Latham. Among the very numerous estimates of his services to medicine, the late Dr. John Brown's Locke and Sydenham (in his Hora Subseciva) is especially noticeable. Baglivi, Opera Omnia Medico-Practica (by Pinel), Paris, 1788; Dr. Max Salomon, Giorgio Baglivi und Seine Zeit, Berlin, 1889. Boerhaave, Institutiones Medica, Leyden, 1713; Aphorisms, Leyden, 1715; Prælectiones Academica, Göttingen, 1739; Consultationes Medica, Göttingen, 1752. There are numerous English biographies, from that by Dr. Johnson to the one by Sir B. W. Richardson, Asclepiad, 1885. Hoffmann, Opera Omnia, Geneva, 1748, especially the "Commentary on the difference between his own system and that of Stahl” (Commentaria de Differentia, etc., Frankfort, 1746), which contains a very clear and impartial outline of the rival doctrines. LVI.-SEVENTEENTH CENTURY SURGERY. THE surgery of the seventeenth century is much less important than that which came before or after it, for the wonderful progress of physiology seems to have attracted the ablest minds to the study of medical problems, just as the anatomical discoveries of the preceding age gave birth to the great surgeons whose work has already been considered. Still there are some names which cannot be entirely omitted. 66 Richard Wiseman, though scarcely an Ambrose Paré, is in some sense the father of English surgery. After gaining much experience in the naval service, he joined the Royalist army in the West about 1645, and found the soldiers much troubled by an epidemic of scabies. commonly let them blood which fell under my care, and advised them to drink for their morning draughts brimstone and milk, and to anoint themselves with brimstone and butter. But in warm weather frequent bathing in the rivers was their cure." He afterwards became sergeant-surgeon to Charles II. But Wiseman's life and works have been so recently and fully discussed by two distinguished members of our profession that we may here dismiss him with Haller's estimate: "A man of much experience, sincere and not ashamed to confess his mistakes, not careful about the subtleties of the art, rather too fond of medicaments, and too sparing of operations". The chief Italian surgeons of the century were Peter Marchettis (1589-1675), professor at Padua, and Marcus Aurelius Severinus of Naples (1580-1656). The following case, taken from the Observations of the former, shows the exaggerated ideas as to the danger of suturing divided tendons, a dread which was finally removed by Haller's experiments on animals in the following century. "Nerves and tendons must never be sutured, for this practice is often followed by fatal tetanus. The ingenious surgeon should rather remedy deformities by appropriate splints, as I did in the case of a distinguished marshal of France, of the family of Montmorency. He received a sword cut on the right wrist, dividing the extensor tendons of the thumb. When the wound healed the thumb was drawn across the palm of the hand, so that he could not hold sword, dagger or lance, and was entirely incapacitated for the profession of arms, apart from which he declared life was not worth living. So he consulted me about amputating his hand, to which I could in no wise consent, but devised an iron case to hold the thumb out, fixed by two cords to bracelets round the wrist, and so he was able to hold and use all kinds of weapons. "Traumatic epilepsy cured by trephining: I was once called in consultation with Dr. Julius Sala, professor at Padua, to a patient who had been struck on the head with a dagger, with lesion of the skull, membranes, and brain. itself. The wound healed externally, but was followed in three or four months by recurrent epileptic attacks. On introducing a probe I found the above-mentioned penetrating wound. I therefore enlarged the opening with a trephine, letting out much yellow ichor, and in thirty days both the wound and the epilepsy were completely cured. M. A. Severinus is especially interesting as the last important representative of the school of Salerno. He became superintendent of the hospital for incurables at Naples, and achieved such popularity that when obliged to flee from the town, owing to some dispute with the Holy Inquisition, he was recalled by the unanimous voice of the citizens. In his work on surgery, or, as he calls it, "efficacious medicine," he blames his colleagues for their timidity, and for substituting drugs and balsams for operations, a degeneration which (he says) is largely due to the influence of the Paracelsists. Even mediæval surgeons were bolder than they; Peter of Argellata, for instance, resected the whole of the radius for necrosis, a feat which few would attempt in his time. Another interesting treatise deals with "the nature of abscesses". Cold or chronic abscesses which are sometimes. connected with the spine should, like all others, be opened as early as possible, but in their case there is a special liability to putrefaction, and to guard against this the operation should be performed with a red hot knife (scalpro candente). The name of Scultetus of Ulm (1595-1645), who distinguished himself by his ingenuity in devising artificial limbs, eyes, noses, and surgical instruments, is still remembered by a bandage which he invented, and he has left us many observations" which throw light upon the practice of his time. He was a bold operator even in his younger days. "While I was studying medicine in Padua, a noble undergraduate suffered for some months from a swelling of his left hand, which was not benefited by general or local treatment, and began to ulcerate in the palm. So we consulted the illustrious Spigelius (1578-1625) who, putting a probe in the ulcer reached carious bone, and said it was spina ventosa, an incurable disease, which attacks bones first and corrodes them without affecting the periosteum, or causing pain; then it forms a slightly painful swelling, and after some months the part ulcerates. I obtained permission of the patient and amputated his hand below the carpus. The metacarpals were corroded, but still covered with periosteum, except where the ulcer was." Scultetus was as fond of his lancet as of his amputating knife. The blood, which that new Atlas of Nature, Harvey, has shown to be the chief principle of the microcosm, is so precious a fluid that the Creator has revealed to man that the souls of animals are in their blood. Wherefore the Paracelsists, Helmontists, and other hæmophobes, banish phlebotomy from the medical republic as useless and noxious, and upbraid the practisers of venesection as sellers of souls. (animarum negotiatores). Which error, though long ago exploded by the universal experience of mankind, may be still further refuted by the venesection history of Guinanda Andrews (Andreæ filia). This virgin, now aged sixty-two, has passed all her life in the female orphanage and alms 66 |