PIETISM, MECHANISM, AND THE SENSORIAL POWERS OF THE BRAIN

At mid-century there were three important medical schools in continental Europe whose leaders held competing medical philosophies: the schools of Georg Ernst Stahl (1659—1734) and Friedrich Hoffmann (1660-1742), both in Halle, Germany, and a third school of Herman Boerhaave (1668-1738) in Leiden. In the schools of Hoffmann and Boerhaave, medicine was practiced on the basis of a mechanical model of the human body. Stahl's system, however, has been labeled animistic or vitalistic. In Stahl's concept the soul is the leading power of the organic structure and is directly involved in any behavior of the body.^[47] The impact of these schools upon existing medical education fostered order and structure in the teaching program and generated a rational basis for medicine. In the other European countries there was little impact for a complex number of reasons, much too complicated to be

[47] On the animistic and vitalistic doctrines of Stahl see L. J. Rather, "G. E. Stahl's Psychological Physiology," Bulletin of the History of Medicine 35 (1961: 37-49 and Lester S. King, The Philosophy of Medicine: The Early Eighteenth Century (Cambridge, Mass., and London: Harvard University Press, 1978), 143-151. See also G. S. Rousseau's important study of Enlightenment vitalism and Bakhtin in The Crisis of Modernism: Bergson and the Vitalist Tradition, ed. Frederick Burwick and Paul Douglas (Cambridge: Cambridge University Press, 1991).

treated at any length here. In France, mechanism as a leading principle was hardly accepted.

In Germany and Leiden the concepts of the mechanistic schools interacted quite peacefully with the animism of Stahl, especially on physiological grounds such as the circulation of the blood, and the idea of sanitas (health) as an equal, moderate, and continuous perfusion of the humors through the parts of the body. But there was a difference in therapy: Stahl paid more attention to uncommon drugs, which he used in a sophisticated therapy of the presumed cacochymia in the body. Cacochymia was a supposed putrefaction of the body fluids, and an important part of Stahl's concept of disease. The main part of the recommended drugs were herbal, mentioned in the Wurtemberg Pharmacopoeia (1741).^[48] Stahl also accepted more uncommon drugs as lapis manati and cornu cervi. Lapis manati is a part of an otic bone of Manatus Australis (sea cow) and was used in treating spasmodic diseases. Cornu cervi (Harts horn), discussed by Stahl in 1690, was a popular antispasmodic remedy in the chemiatric schools. Hoffmann prescribed alterantia to change the temper of the blood and the organs.^[49] These medicines were based on the corpuscular theories of Robert Boyle's chemistry, related to the Cartesian concept of the crucial ether as a spiritual fluid through the nerves. Boerhaave wanted to act upon the "spissity" (thickness) of the body fluids and to control the density and the laxity of the fibers. His drugs were mainly Galenic and he attached much value to diet and exercise, especially in cases involving the sufferings and passions of frightened patients.^[50]

The extraordinary convergence of Pietism in Halle and a concept of the persona (the soul inextricably linked with man's individual being) created a new school of medicine which the Germans called "Pastoralmedizin," pastoral medicine.^[51] In this concept medicine was the servant

[48] See Joachim Petrus Gaetke's dissertation on the general therapy of hypochondriasis, De Vena Portae Porta Malorum Hypochondriaco-splenetico-suffocativo-hysterico-colico-haemorrhoidariorum (Halle, 1698), 52-55 (on the portal vein as the gateway to the evils of hypochondria, of smothering of the spleen and the womb, and of hemorrhoids in the colon).

[49] On Hoffmann's therapy, see K. E. Rotschuh, Konzepte der Medizin in Vergangenheit und Gegenwart (Stuttgart: Hippokrates Verlag, 1978), 247-249.

[50] On Boerhaave's therapy, see B. P. M. Schulte, Hermanni Boerhaave Praelectiones de Morbis Nervorum 1730-1735, Analecta Boerhaaviana, 2, (Leiden: E. J. Brill, 1959).

[51] Wolfram Kaiser and Arina Volker, "Michael Alberti (1682-1757)," Wissenschaftliche Beiträge der Martin-Luther-Universit t (Halle-Wittenberg) 4 (1982): 9-11. See also Rothschuh, Konzepte, 67-70. Michael Alberti was the author of the Specimen Medicinae Theologicae (1726).

of faith and godliness. The conscientia medica, medical conscience, should always be aware of the agreement of a medical theory with theology. Students of pastoral medicine were to learn how to preserve the tranquilliras animi —the mental balance of the patient—a medical approach highly appreciated by evangelists and preachers. Stahl taught that there must be a direct interaction between mind and body and dictated his ideas to his students in the form of deontology: a list of duties including "musts" and "must nots." After digesting this material, students were required to dispute or defend it in dissertation.^[52] There are a large number of propemtica (introductions) by Stahl which accompany these student works. In these speeches Stahl emphasizes medical ethics; he discusses the role of the physician in medical practice and his responsibility to his patients. For instance, in 1706 when Henricus König presented a thesis De curatione aequivoca (On a well-balanced therapy), Stahl gave his propemticon De temeritate, timiditate, modestia et moderatione medici (On drastic and reticent, on modest and restrained medical behavior) as an example of variability in an administration of therapy by the physician. Various propemtica such as De Dissensu Medicorum (1703) (On the disagreeing doctors), De Visitatione Aegrorum (1703) (On the visit of patients), De Testimoniis Medici (1706) (On medical reports), De Constantia Medica (1707) (On medical steadfastness), De Auctoritate et Veritate Medica (1705) (On medical authority and integrity) deal with ethics. Hoffmann went even further and expressed the need for morality in some letters to young doctors. One such letter is on physical pietas, which he describes as a spiritual combination of mental and physical health. Thus mental health is only possible as the individual's complete union with, and devotion to, the source of life: God.^[53] As such, it may restore physical health in a patient. Stahl stressed this point too in every discussion of the animi pathemata : frightened patients might be bled to restore the temperies of the blood, but Stahl warned his students that if they wanted to treat

[52] A collection of medical dissertations presented to the Halle Faculty is present in the university library a Leiden, dating from 1696-1714. They have been bound in four volumes under the title G. E. Stahl ii... Dissertationes Medicae, turn epistolares turn academicae in unum voluraen congestae (Halle, 1707 ff. ). This collection also contains dissertations defended under the supervision of Hoffmann, A. O. Goelicke (1671-1744) at Magdenburg, Johann Gottfried Berger (1659-1756) at Wittenberg, and Michael Alberti (1682-1757), just mentioned. The volumes of the collection were more or less haphazardly gathered; there is no introduction and the pages are not indicated, except for the first volume.

[53] "Epistola gratularia ad Virum Magnificum, Excellentissimum atque Experientissimum Dn. Bernhardum Barnstorffium," Halle, 1 October 1696, in Stahl, Dissertationes, vol. 3. A congratulatory letter was reserved for important inaugurations "more majorum." In this case, it was Bernard Barnstorff, who was Dean of the Rostock University.

patients psychologically, they should be in tune with themselves and tread lightly,^[54] rather resorting to doctrina moralis.^[55] Needless to say, students were not permitted to vent their personal opinions in these dissertations, but their experience allowed some conjecture to avoid explanations of diseases by natural or materialistic causes alone.

The state of medical affairs differed profoundly in Leiden. There, students were free to speculate in their writing, albeit more or less in agreement with the current school philosophy. Calvinism and the hierarchical, mechanistic concept of the body guided by an immortal soul were compatible views on man. In Leiden the concept of medicine remained theoretical and scientific; unlike the students in the Halle school, they paid less attention to moral or spiritual issues, to the physician's duties, or to the noble task (officium nobile ) of the physician.

At least in part, the difference in medical thinking was due to the introduction of the concepts irritability and sensibility.^[56] The growing importance of the nervous system in physiology focused the attention of scholars on these phenomena. The human body summoned a new view. It became an organism with a mind, which was believed to be responsive to outside influences apart from the pathways of mechanical connections. The mind/body relation became crucial in a different way, as well; more attention was suddenly paid to psychology, education, physiognomy, and medical anthropology. In Leiden, Hieronymus Gaub took the chair after Boerhaave's death in 1738. Gaub's concept of the human body was mechanistic in Boerhaave's sense, but he was also deeply involved in the mind/body discussions then taking place within and without the university, and, especially, in the pathemata of the mind,^[57] which

[54] J. J. Reich, "De Passionibus Animi Corpus Humanum Varie Aherantibus" (Diss. Halle, 1695), in Stahl, Dissertationes 1:97. Temperies, "inter se mutua proportia," is meant by Stahl as a chemical balance in the blood; homeostasis in present medicine.

[55] Geyer-Kordesch, "Cultural Habits of Illness" (n. 10 above), 178-204. She considers Pietism an affair of the sentiments. The faithful "feel" themselves pietists. They "feel" God within their heart. (In Calvinism, God is outside, he is the Arbiter, a dialogue is possible.)

[56] Richard Toellner, "Albrecht yon Hailer: Ueber die Einheit im Denken des letzten Universalgelehrten," Sudhoffs Archiv 10 (1972): 17l-182. Albrecht von Hailer published in 1750 his famous study on these properties of the parts of the body, especially of the muscles. Since tissue could react to a stimulus, even when it was no longer in contact with the body, irritability and sensibility had a rather autonomous quality.

[57] L. J. Rather, Mind and Body in Eighteenth-Century Medicine (London: Wellcome Historical Medical Library, 1965). This is an excellent study on Gaub's addresses De Regimine Mentis, quod Medicorum est —a great help for any scholar who wants to be informed on the complex material of the mind/body problem in medicine at the time.

became his preeminent study. He inspired Robert Whytt (1714-1766), the Scots Professor of Medicine in Edinburgh, who used Gaub's textbook for teaching purposes.^[58] So there became a close teaching connection between Leiden and the Edinburgh school, founded in 1727 on Boerhaave's model, where the interest in psychological phenomena was growing. We may naturally expect to find concepts derived from both schools in Leiden publications, especially in the students' dissertations.

The growing interest in the sensorial powers of the brain was also responsible for a shift in the concept of disease accompanied by fear such as hypochondria and hysteria, and was especially apparent in the work of Robert Whytt, who declared these diseases to be neurogenic,^[59] by which he meant originating in the nervous system. Another important consequence was the popularization of the mind/body subject. S. A. Tissot's (1728-1797) influential book Traité des nerfs et leurs maladies (Lausanne, 1778) became especially popular, not least because he gave an extensive survey of case histories on the animi pathemata, which were cited by professors of medicine all over Europe. The medical schools at Paris and Montpellier, where mechanistic doctrines never took root, explained virtually all emotional disturbances as "crises nerveuses" and looked for chemical changes in the blood and for indigestion.^[60] Furthermore, the concept of sympathy gained ground again, especially in Montpellier. This "action on a distance," or external aspects of nerve endings acting in a type of vibrational or materialistic sympathy, was entirely condemned by the mechanists, but later in the eighteenth century it captured the interest of all the European physicians. Tissot paid great attention to the action on a distance upon several parts of the body by the distribution of the peripheral nerve. By this distant influence the brain had the sympathy of the stomach (consensus ), and the concept became very important in physiology and psychology, not only in

[58] R. K. French, Robert Whytt, the Soul, and Medicine, Publications of the Wellcome Institute of the History of Medicine, n.s., vol. 17 (London, 1969), 151. The textbook is H. D. Gaub, Institutiones Pathologiae Medicinalis (Leiden, 1758), which was quite popular. It was translated into English in 1778 by C. Erskine and published by C. Elliot and T. Cadell in London and Edinburgh.

[59] French, Robert Whytt, 31-45. See also Fischer-Homberger, Hypochondrie, 32.

[60] Jean Astruc (1684-1766) lectured in 1759 at the Collège Royal. In this lecture, he discussed the causes of hypochondria and hysteria, especially the primary cause of tension of the nerves. See the MS at the Municipal Archives in Middelburg, corr. David Henri Gallandat (1732-1782). On Gallandat, see G. A. Lindeboom, Dutch Medical Biography: A Biographical Dictionary of Dutch Physicians and Surgeons 1475-1975 (Amsterdam, 1984).

France,^[61] where Tissot's influence was considerable, but also in Scotland among Whytt's students.

The consequences for psychotherapy were not obvious. Galenic drugs were still dominant, and as we have seen, Gaub prescribed Peruvian bark and musk for attacks of hysteria or fearfulness.^[62] Gaub had a special preparation for his tranquilizing medicine: he combined valerian root with Peruvian bark in a single pill. For hysterical patients his formula was an odorous drink composed of musk, Peruvian bark, and several other herbs. All these herbal and chemical formulas were fine, but they only worked to subdue the hypochondriac's fear. Amelioration required psychological treatment, a subject about which even the young medical students then had suggestions.