Boerhaave and Eighteenth-Century Dutch Medicine

Synonyms

The Netherlands, Leiden University, Medical teaching, Boerhaave school, health, healing, body

Definition

Herman Boerhaave:

Leiden professor of chemistry, botany, and medicine

Hieronymus Gaubius:

Leiden professor of chemistry and medicine

Boerhaave school:

Pupils of Boerhaave and Gaubius who formulated a particular kind of medicine based on (1) physiology of the fluids and (2) vitalist principles.

Introduction

Herman Boerhaave was born in the Dutch village of Voorhout on 31 December 1668. His father was a pastor in the village and had destined his son to follow in his footsteps. To this end Boerhaave went to the Latin school in 1682 and Leiden University in 1685 where he studied philosophy, theology, and medicine. In 1690 Boerhaave finished his education with an oration on Cicero’s right interpretation of Epicurus’ maxim of the highest human good, which was awarded a gold medal. He obtained a medical degree from the University of Harderwijk in 1693. However, on a canalboat on the way back to Leiden, Boerhaave allegedly spoke up in favor of the controversial philosophy of Spinoza, after which he was accused of being a Spinozist. He had to give up his vocation, and he devoted himself wholly to a career in medicine.

The year 1701 marks the beginning of Boerhaave’s very successful teaching career at Leiden University. Boerhaave eventually filled the chairs of medicine, chemistry, and botany. Moreover, Boerhaave was twice awarded the office of Rector Magnificus of the University. Boerhaave’s fame spread abroad as he received royal visits from Czar Peter the Great and Prince Eugene de Savoy. Allegedly a letter from China addressed to Professor Boerhaave in Europe arrived on his doorstep. He was elected foreign corresponding member of the Académie Royale des Sciences in Paris in 1715 and Fellow of the Royal Society in London in 1730.

In 1727, weakened by a long illness and a “chronic complaint,” and tired from patients who kept knocking on his door, Boerhaave decided to resign the chairs of botany and chemistry. He kept teaching medicine, and in his spare time he was still devoted to his work in the botanical garden and the chemical laboratory. In May 1737 Boerhaave felt a tightness in his chest, followed by an abnormal pulsation at the right side of his neck. He never recovered and died in September 1738, leaving behind his wife Maria Drolenvaux and his daughter Joanna Maria, his only surviving child (Lindeboom 1968).

Communis Europae Praeceptor

Boerhaave’s pupil, the Swiss medical professor, Albrecht von Haller (1708–1777), named Boerhaave the Communis Europae praeceptor, the teacher of all of Europe. Historians have often pointed at Boerhaave’s excellence in bedside teaching as an important reason for Boerhaave’s popularity. However, this argument has no grounding in Boerhaave’s own reflections nor in the extensive notes of the students nor in the Leiden hospital records. Boerhaave’s attraction must rather be sought in his unique approach. Unlike other medical teachers, Boerhaave stimulated his students to think, observe, and experiment themselves, rather than apply ready-made and generally accepted courses of action. At the basis of his teaching method was a Hippocratic focus on observing and understanding the nature of the body and its diseases. Boerhaave always urged his students to follow nature as their own guide and never to rely on idle speculation and preconceived opinions. As a result, Boerhaave’s medical works do not list remedies for particular diseases, but they consist of Hippocratic statements of wisdom. This is particularly visible in the set-up of his Institutiones Medicae (1708), which follows the pattern of the Hippocratic Aphorisms (Knoeff 2002, 2010).

Boerhaave’s moving away from grand theory and his insistence on performing experiments and gathering materials greatly appealed to medical students, who also universally appreciated Boerhaave’s (religious) tranquility of mind, the fact that he never got angry and remained friendly under all circumstances (Cunningham 1990). Boerhaave hardly ever berated his students for criticizing their master’s anatomical and physiological ideas, which they did frequently. After all, this was a logical consequence of what Boerhaave taught his students, i.e., to think for themselves and never to adopt preconceived opinions and hypotheses. Henry Pemberton (1694–1771), for instance, remembers that Boerhaave never blamed him for pointing out mistakes in Boerhaave’s ideas on vision. Instead, in the introduction of Pemberton’s A Course of Chemistry (1771), it was stated that “the Professor [Boerhaave] far from taking this amiss, everywhere spoke of it with the highest commendation, boasting of his having so great a genius for his pupil.” Boerhaave’s calmness in taking criticism was truly exceptional in a time when criticism was often the beginning of a long and vile controversy. Boerhaave’s success in teaching is perhaps best summarized by Montpellier physician Louis de Lacaze (1703–1765), who wrote in his Idée de l’homme physique et moral (1755) that Boerhaave was “a schoolmaster, a physician whose reputation was based on the ease with which his students absorbed his teaching rather than the success he enjoyed in treating the sick.” Indeed, Boerhaave was so much liked by his students that in 1723, after a long period of illness, lanterns were lit in the city of Leiden as citizens, and students celebrated Boerhaave’s recovery and return to work.

From Strict Mechanical Medicine to a Chemico-medical Program

Boerhaave’s medical ideas show a remarkable shift from a radical mechanistic program to an emphasis on life-giving principles and the importance of chemistry for medicine. In 1703 Boerhaave gave an oration on the use of mechanistic reason in medicine (De usu ratiocinii mechanici in medicina). He argued that medicine paid too little attention to (Newtonian) mechanics, even though life and health depended on the mechanical motion of the humors through the tubes and vessels. Boerhaave compared the body to a clock; once the inner mechanisms are known, the physician can correct its structures and repair defects. The basic building block of the Boerhaavian body is the fiber, long threads of earthlike particles, which woven together turn into membranes. These membranes, when rolled up, form small vessels (vasa minora), which in turn are woven together into bigger vessels and organs. The fluids filter their way through the vessels, so that the big globules of blood fit the blood vessels and the much smaller lymphatic particles the lymphatic vessels. All the vessels are directly or indirectly relate to the left ventricle of the heart, so that all bodily fluids (except excretions) eventually return to the heart. As long as the fluids move regularly, the body is alive and healthy. When the movements of fluids are obstructed or cease altogether, the body falls ill and dies.

Eleven years later, Boerhaave was far less optimistic about the endless possibilities of medicine. He doubted that the working of the body could be deduced from mechanical principles alone, and he was much more skeptical about the promise to ever fully understand the nature of the body. In 1715, in his oration on the achievement of certainty in physics (De comparando certo in physicis, Fig. 1), Boerhaave turned his attention to the principles of life and motion and argued that the first principles of nature (such as atoms, the Cartesian principle of extension, the void, Newtonian gravity, motion, the working of seeds and even the growing of a single hair) are hidden: “only from the observation of our senses can knowledge of their properties be gained.” Boerhaave firmly stated that any claim to knowledge about the nature of the hidden principles of nature are false and illegitimately venture into the domain of the divine. As a result, instead of emphasizing the mechanical laws of bodies in motion (and the resulting claim that mechanics would lead to a full enclosure of the body’s working), Boerhaave devoted himself to the essentially incomprehensible vital powers of bodies. Although mechanics remained an important part of the Boerhaavian system, it was superseded by chemistry as the principal discipline important in uncovering the working of the “latent peculiar powers” of bodies.

Boerhaave and Eighteenth-Century Dutch Medicine, Fig. 1

Albinus’ depiction of a rhinoceros representing the muscular strength of enormôn, in Albinus anatomical atlas. (Credit: Tables of the skeleton and muscles of the human body … /Translated from the Latin. Courtesy of Wellcome Collection. CC BY 4.0)

In 1718 Boerhaave was appointed to the chair of chemistry. In his inaugural oration “on chemistry purging itself of its own errors” (De chemia suos errores expurgante), Boerhaave was critical about general mechanical notions and instead argued that medicine should devote more attention to the vital powers that cause the fluids to move through the vessels, thereby invigorating the body with life and motion. In doing so Boerhaave presented the body as an organic unit steered by vital forces inherent in the physical substance of the body. He argued that chemistry was best suited to uncover the working of these vital forces: “In physics we can be of good cheer with this guide, in medicine all possible good may be expected from it. It teaches most faithfully how the deepest secrets may be revealed, intricacies be disentangled, imitated, directed, changed, applied, and perfected” (Boerhaave in Luyendijk- Elshout and Kegel- Brinkgreve 1983, p. 211).

After numerous student publications of Boerhaave’s chemistry lectures, to Boerhaave’s great annoyance, Boerhaave published his Elementa chemiae in 1732. The work became an immediate success. It appeared in many languages and editions and remained a standard reference work throughout the eighteenth century. In it, Boerhaave reorganized various chemical traditions (including craft chemistry, Paracelsian and Helmontian iatrochemistry and alchemy) on the basis of pedagogical ideals and a rigorous philosophical foundation, thereby transforming chemistry into an academic discipline (Powers 2012). The title of Peter Shaw’s translation of Boerhaave’s work, A New Method of Chemistry, indicated the novel basis of Boerhaave’s textbook: It focused on the theoretical underpinning of chemistry on the basis of which students were stimulated to invent and reconfigure their own experiments and theories.

Boerhaave School

During the first decades of the eighteenth century, the medical faculty at Leiden University was an international hub of excellence. This had to do with Boerhaave’s anti-authoritarian and irenic teaching as well as with the fact that Leiden itself was an attractive place to study (tax-free beer for students; the allowance to carry swords in public; and the short duration of study programs more than compensated for high living costs). Returning home, Boerhaave’s pupils established medical faculties based on Boerhaave’s ideas and approaches across Europe. Best known are the Boerhaavian medical schools of Göttingen, Vienna, and Edinburgh. But Boerhaave’s influence was also felt in the French medical faculties of Paris and Montpellier, the Academy of Sciences in St. Petersburg and even in North America (Lindeboom 1968). So great was Boerhaave’s influence that his pupils referred to “the school of the great Boerhaave” and his name became a cultural marker and household name in the international medical field (Verwaal 2018).

The historical focus on Boerhaave’s international fame has moved attention away from Boerhaave’s fame in the Netherlands itself, where eventually his influence was felt in every Dutch medical faculty. Boerhaave’s most important Dutch pupil was Hieronymus Gaubius (1705–1780), who was appointed to the chair of chemistry after Boerhaave’s resignation in 1734 (Fig. 2). After Boerhaave’s death in 1738, Gaubius also became Leiden professor of theoretical medicine. Gaubius was well-known throughout Europe for his pathological textbook, the Institutiones Pathologiae medicinalis (1758) in which he proposed the chemical investigation of organic compounds as an important basis for medicine. The textbook appeared in three editions and was translated many times. Even Rudolph Virchow used it while being a medical student in Berlin in 1839. Late in his life Virchow called Gaub’s pathology the world’s first textbook of general pathology and the standard until far into the nineteenth century. Gaub’s work differed from other pathological textbooks (for instance, from Morgani) in that it was not a book on pathological anatomy, but on “general pathology” concerned with the noxious and healing powers of the body. Gaubius was also famous for his two essays on the management of the soul, the De regimine mentis (1747 and 1763). These have often been called the first works on psychosomatic medicine. They were well known in the eighteenth century but quickly forgotten afterwards.

Boerhaave and Eighteenth-Century Dutch Medicine, Fig. 2

Frontispiece of Boerhaave’s 1715 oration. (Credit: Boerhaave giving a lecture. Courtesy of Wellcome Collection. CC BY 4.0)

During the second half of the eighteenth century, students of Boerhaave and Gaubius were appointed to medical professorships in Leiden, Franeker, Groningen, Utrecht, and Harderwijk. Programmatically, the Dutch Boerhaave School distinguished itself in a communal focus on:

• 1. A chemical exploration of the bodily fluids, rather than a mechanical reconstruction of the organs, tubes, and vessels;

• 2. Speculations about the vital principles invigorating the body

Chemistry of the Fluids

The development of new chemical methods and measuring instruments such as the thermometer led to a renewed physiological attention for the humors, which had formerly been discarded by Paracelsian iatrochemistry (which focused on the tripartite principles of salt, sulfur, and mercury) and Cartesian mechanics (with its focus on sizes and shapes of solid particles). Moving beyond the image of the body machine, Boerhaave in his Elementa chemiae described many in vitro experiments on the nature of blood, urine, milk, and other bodily fluids, in order to explain the life and motion of the body. Undoubtedly, also the famous anatomical injection techniques of Boerhaave’s close friend Frederik Ruysch (1638–1731) contributed to a renewed interest into the fluids. Just like Ruysch’s injection fluids were of vital importance in the making of lifelike anatomical preparations, and just as the making of these fluids was Ruysch’s well-kept secret, just so the bodily fluids were considered a chemical composition whose peculiar powers were hidden, yet of vital importance to life and motion. Nevertheless, Boerhaave did not present the body as a kind of chemical laboratory like Franciscus de le Boë Sylvius (1614–1672) had done before him. Instead, he presented chemical experiments and methods as important means to show the effects of chemical reactions inside as well as outside the body. Boerhaave, in other words, transformed bodily humors into chemically defined and researchable objects.

The Boerhaavian turn to the bodily fluids is reminiscent of the Ancient stress on the body’s fluids. However, whereas the Ancient interest in blood, bile, and phlegm was mainly related to pathology (i.e., indicative of disease), Boerhaavian physicians took the normal and healthy state of the fluids as their focal point of research. Moreover, while the Ancients explained illness in terms of humoral disbalances, the Boerhaavians were more likely referring to a change in the (chemical) make-up of the bodily fluids themselves. And it was precisely the Boerhaavian emphasis on chemico-medical practices – an emphasis which fitted Enlightenment concerns with the flesh and bodily functions (“equally seen as a source of pleasure and a nuisance, in need of care, attention and apology,” (Porter 2003)) – which resulted in a focus on the bodily fluids.

Gaubius followed Boerhaave’s insistence on centralizing the humors. He stated in his inaugural oration: “I take as the theme of my public [chemistry] lectures that most noble and most copious part of the entire human body, the fluids of course” (Gaubius in Verwaal 2018, pp. 29–30). And a big part of his influential medical textbook, the Institutiones pathologiae medicinalis (1758), is on the nature and balance of the humors. Following the teaching of Boerhaave and Gaubius, many students devoted their dissertations to the bodily fluids. They grounded their ideas in chemical experiments and observation, thereby distancing themselves from dubious alchemical claims. Most notably the inaugural lecture of Gaubius (Oratio inauguralis qua ostenditur chemiam artibus academicis jure esse inserendam (1731) and Abraham Kaau Boerhaave’s satirical lecture on alchemy (De Gaudii Alchemistarum (1737)) contributed to institutionalizing chemistry as an academic discipline.

Vital Principles

A direct result of Boerhaave’s teaching on the chemistry and physiology of “latent peculiar powers” was a physiological focus on the vital powers of the fibrous body. Historians have often considered Dutch eighteenth-century vitalism a reaction against a prevailing Boerhaavian mechanism. Yet, since all Boerhaave’s influential pupils were involved in investigating vital principles, “the investigation of such properties in the Netherlands was therefore as much a development of Boerhaavian thought as it was a reaction against its more reductionist elements” (Steinke 2005, p. 35). In fact, the Boerhaave school shows that a strict dichotomy between mechanism and vitalism is problematic. The teaching of its most prominent doctors contains elements of both.

At first sight, Johannes de Gorter (1689–1762), professor of medicine in Harderwijk, presented a thoroughly mechanistic medicine, but at the same time he stated that a God-given life-giving principle, a motus vitalis, is present in muscle fibers, membranes, vessels, and even bones. This motus viventium particularis agitates the body and stimulates the organs. Frederick Winter (1712–1760) similarly posed a vital principle together with a principle of irritability, even before Albrecht von Haller famously posed the principle in 1752, in order to explain muscular motion.

Bernard Siegfried Albinus (1697–1770), Gaubius and Boerhaave’s nephew Abraham Kaau-Boerhaave (1715–1758) went along with Boerhaave’s introduction of the Hippocratic principle of enormôn (although the term enormôn cannot be found in the Hippocratic works!). However, where Boerhaave had used the principle mainly to explain psycho-somatic phenomena, his followers argued that enormôn pervades even the minutest parts of the body, giving it life and motion. Albinus argued that enormôn is immanent in all liquid and solid parts of the body, a vital principle inseparable from matter, which reacts to mechanical stimuli. In his anatomical atlas, the Tabulae sceleti et musculorum corporis humani (1747), a drawing of a rhinoceros in the background represents the muscular strength of enormôn (Punt 1983) (Fig. 1). Kaau-Boerhaave enthusiastically followed Albinus’s ideas, in describing the transport and infusion of enormôn within the body in his Impetus faciens dictum Hippocrati (1745). Gaubius likewise stated that enormôn is spread through the whole body. He stated in chemical terminology that enormôn mingles with every single particle of the body so that it functions as a man within man. However, contrary to Albinus’ “vitalistic mechanism,” Gaubius, after initially assuming that enormôn has a corporeal and an incorporeal element, later only spoke about an incorporeal vital force. This likely had to do with the continuous threat of being associated with materialism, which in the case of Gaubius was a close call. Julien Offray de la Mettrie used some of Gaubius’ ideas in his L’Homme Machine after which Gaubius hastily renounced “the repulsive offspring of the little Frenchman” in his second oration on the management of the mind (Rather 1965).

The Boerhaavian emphasis on vital principles importantly contributed to discussions on the nature and working of irritability, nervous spirits and sensibility, the relationship between body and mind, phlogiston, electricity, and other invisible powers, which eventually led to organic (rather than strictly mechanistic or materialistic) ways of thinking Fig. 3.

Boerhaave and Eighteenth-Century Dutch Medicine, Fig. 3

Portrait of Hieronymus Gaubius. (Credit: Hieronymus David Gaubius. Line engraving by J. Houbraken, 1744, after H. van der My, 1741. Courtesy of Wellcome Collection. CC BY 4.0)

Conclusion

For a long time, historians of science and medicine have considered the eighteenth century as a period of stagnation, an intermezzo between the establishment of new natural philosophies during the period known as the Scientific Revolution and the overturn of chemical ideas at the time of Lavoisier’s chemical revolution. However, nothing could be farther from the truth. The (Dutch) Boerhaave school was an important breeding ground for medical and chemical innovations that stood at the basis of later nineteenth-century biomedicine.

Cross-References

• Chemistry Teaching and Textbooks in the Seventeenth Century

• Life, Mechanization of

• Mechanical Philosophies

• Newtonianism and the Life Sciences