house, and from her ninth year has laboured under many infirmities, accompanied by great swelling of the abdomen. About her fifteenth year, when youthful wildness is most rampant, she frightened another girl with a cat, and the latter in revenge got a spider, of which animal she had a peculiar horror, and so terrified her therewith that she fell down in a fit, lasting nine days. Liberal venesection was employed, and forty-five cupping glasses applied to her spine and legs, thirty-six with scarification, according to the Hippocratic rule" extreme diseases demand extreme remedies". On the advice of an old woman, skilled in disorders of females, her feet were also scarified. So she recovered, but has ever since been liable to a hysteric affection, which takes her suddenly, even when eating or singing, and leaves her with equal rapidity. To preserve her health, and cure these fits, she has been bled during her life more than 700 times, not to 3 oz. or 4 oz. only, but to 12 oz., 16 oz., or more, and that daily, though now on account of her age it is done less frequently. The cause of such a plethora of blood is probably hypertrophy of the liver, but we may be able to investigate it more deeply post mortem.”

The figure of Nicholas Tulp (1593-1678) is widely known from Rembrandt's famous picture "The Anatomists"; he holds an honourable place in general history as the aged burgomaster whose intrepid patriotism prevented the surrender of Amsterdam to the French, 1672, and he deserves mention here as a skilful surgeon, whose small volume of Medical Observations has been called by Haller a “golden work" (aureum opus). The following are extracts therefrom :

"A distinguished painter, troubled by melancholia, thought that all his bones were soft like wax, and that his body would roll up in a ball if he moved, so he stayed in bed for a whole winter. I determined not to contradict his delusion, but to use a stratagem, and told him the disease was well known to physicians, and could readily be cured, so that, if he took the medicines prescribed, his bones would

become hard in three days, and he would walk in a week. Then I gave him some simple purgative, and on the third day allowed him to sit up, but by no means to walk, doing it gradually so that he might not suspect the stratagem. By the sixth day he was perfectly well; he overwhelmed me with gratitude, and ever after had the greatest confidence in medicine. For he never discovered the trick, though no fool in other matters and hardly second to any in his art." On another page he tells the story of a blacksmith who performed the operation of perinæal lithotomy on himself, and successfully extracted a stone weighing 4 oz. and larger than a hen's egg, with no other instruments than a common knife and his fingers; a deed which, says Tulp, may compare with the most valiant acts recorded in history. Tulp strongly disapproves of the increasing habit of writing medical books. in the vulgar tongue instead of in Latin. It will, he thinks, cause a marked increase both of real and imaginary diseases, and as an example of this he relates how a patient of his own; who had fractured and dislocated his fibula, got hold of the works of Ambrose Paré, and applied his description of the various disasters which may follow a fracture of the thigh bone to his own case. By perpetual anxiety and brooding thereupon he became sleepless, and finally went out of his. mind.

NOTE.

Wiseman, Eight chirurgical treatises, London, 1734; Longmore, Sir T., R. Wiseman, London, 1891; Richardson, Sir B., Wiseman and the Surgery of the Commonwealth, Asclepiad, 1886. Marchettis, Observationes Medico-Chirurgical, Padua, 1664. Severinus, De Abscessuum Naturâ, Frankfort, 1643; Severinus, De Efficaci Medicinâ, Frankfort, 1671. Scultetus, Armamentarium Chirurgicum, Leyden, 1693; Tulp, Observationes Medica, Amsterdam, 1685.

LVII. THE ANIMISTS.

THE eighteenth or philosophic century, as it has been called, is marked in medical history by the rise and fall of a number

of philosophic theories and systems, and by a revival of that Platonic mysticism which we have more than once noticed as the evil genius of the healing art. We find abstract expressions treated as though they were real existences, and attempts made to solve the problems of life and disease by such terms as "vital principle," "excitability,” and "polarity," explanations no more scientific and much less. poetical than that of thunder as the voice of Jove, or diseases as the arrows of Apollo.

The chief exponents of the so-called vitalistic systems of medicine may be divided into two classes, a metaphysical and a scientific. The former held that the body is composed of passive or "dead" matter, and is inhabited by a mysterious immaterial being called "life," which acts upon the body as it were from without, and separates from it at death. And they may be sub-divided into two sections: (1) the animists, who identified this life with the soul, and (2) the pure vitalists, who maintained the existence of a second mysterious entity, the "vital principle". In contrast to both of these, the organicists (as they may be called) taught that vital activity is the result of the intimate structure of organic matter-that life, in short, is the effect not the cause of organisation; but they differed from the materialists of the preceding age in holding that vital forces are entirely separate from, and in a sense superior to, those of physics and chemistry. Space only permits us to consider, in the present chapter, the typical representatative of the first subdivision of the former class, George Ernest Stahl, professor at Halle, a name equally famous in the history of medicine and of chemistry.

Stahl (1660-1734) whose deep piety and considerable genius were clouded by an unfortunate temper and an obscure style, tells us that when he began to teach there were no doctors, "for medicine is the science of life, and we have now only mechanics and chemists". "I deny (he says) that chemistry has anything to do with medicine". "Where the physicist ends, the physician begins," and he even

declares that anatomy, except in its broad outlines, is useless to the healing art. The animal body consists of highly putrescent substances, but does not putrefy while alive. Life, therefore, is something which resists putrefaction; and it does this, according to Stahl, by keeping the blood, the most putrescent part, in continual motion, and by expelling whatever is beginning to corrupt by the secretions and excretions. Motion in itself is immaterial, and presupposes an immaterial agent, and Stahl declares that the source of all vital movement is nothing else than the soul, which builds up the machine of the body, and maintains it for a time against external influences. The hypothesis of a special force called nature, pneuma, archeus, etc., is an old wives' fable (antiqua nania), for if unintelligent, how is it superior to mere mechanism, if intelligent, why distinguish it from the rational soul? The objection that spirit cannot act upon matter without some intermediary refutes itself, for this intermediary must be spiritual or material: in the first case it cannot act upon the body, in the second it cannot be acted on by the soul. He then supports his own theory by a great array of facts showing the close connection of mind and body, some of which will readily occur to the reader, and which might now-a-days be considerably extended, for the "anima" of Stahl closely resembles the sub-conscious personality of modern hypnotism.

One of the difficulties of animism is the explanation of natural death. The substance of the body is continually renewed; if the force behind it is an immortal soul, why should it not go on for ever? Stahl faces the problem boldly; he declares that the immediate cause of death is not disease, but the direct action of the soul, and he quotes with approval the curious expression of Seneca: "You die not because you are ill, but because you are alive". The soul leaves the bodily machine either because it has become unworkable through some serious lesion, or because it does not choose to work it any longer; but he attempts to justify this suicide by asserting that the tendency to

putrefaction increases with age, and may finally become irresistible.

As a rule, the soul tries to preserve the body as long as possible, and most so-called diseases are merely manifestations of its efforts in this direction. Such is the case, for instance, with the whole class of fevers. The natural tendency of the blood to putrefy has somehow become increased; the soul perceiving this, at once counteracts it by more rapid circulation and excretion; and Stahl observes that man is more liable to febrile diseases than are animals, because his more intelligent soul sees and guards against approaching dangers, which the stupid animæ of brutes do not perceive; therefore they have fewer illnesses but shorter lives. The most fertile cause of disease is plethora, which the soul relieves by natural losses of blood, by the nose in childhood, by the lungs in youth, and by the hæmorrhoidal or uterine veins in adults. The suppression of this natural loss causes headache, impetigo, and other head affections in children, pulmonary diseases in the young, and hysteria, hypochondria, renal and vesical affections in older persons. The chief source of chronic disease is the portal system, where the circulation is most sluggish, and therefore the natural tendency to putrefaction least counteracted, and Stahl wrote a special treatise, De vena porta porta malorum, on the multifarious evils of "portal congestion," long afterwards a favourite phrase with physicians at a loss for a diagnosis. But the soul is liable to error in its sub-conscious as well as in its conscious activities, and some diseases are due to a false idea or irregular motion (motus ataxia) on its part. It may, for instance, send an excess of blood to the lungs, and so produce congestion, stagnation, and their infallible results, putrefaction, and destruction of tissue, in short, pulmonary phthisis; a doctrine which reminds us of the "custos errans of Van Helmont.

Stahl's therapeutics, as might be expected, were of the simplest character. The soul, in spite of its mistakes, knows much more about the body it has built up than does