Herman Boerhaave: The Nearly Forgotten Father of Modern Medicine - [TEST] The Objective Standard

Isaac Newton developed calculus, demonstrated the immense practicality of the scientific method, and discovered the laws of motion that govern the physical world. Charles Darwin developed the theory of evolution, discovered the mechanism of natural selection, and established the fundamental principles of biology. Michelangelo perfected the art of sculpture, depicted man as a heroic being, and inspired viewers and artists across centuries. Such men advanced their respective fields by orders of magnitude. Who is their equivalent in the field of medicine? His name, which few people today recognize, is Herman Boerhaave (1668–1738).

In his day, Boerhaave was a world-renowned physician and educator. He held three professorial chairs—in medicine, chemistry, and botany—at the University of Leiden and made the Dutch school the focal point of medical education in the Western world. During the Age of Reason, Boerhaave was the undisputed standard-bearer of Enlightenment medicine:1 When he began his work in medicine, the field was still mired in the mystical methodologies and superstitions of the Middle Ages; by the time he was through, the field was a science concerned with the natural causes and treatments of illnesses. And although his name has since faded into near obscurity, his influence remains.

To acquaint you with this heroic man, let us briefly survey the highlights of his life, and then consider his seminal contributions to medicine.

Boerhaave was born on December 31, 1668, in Voorhout, Netherlands. At age twelve he contracted a large, painful ulceration on his leg that required months of medical treatment, an experience that some biographers believe sparked his interest in medicine.2 At fourteen, having already learned Greek and Latin from his father, Boerhaave began formal grammar school in Leiden.3 At fifteen he matriculated at the University of Leiden, where his studies included mathematics and experimental physics. In 1690, following his completion of a dissertation on the nature of body and soul in which he covered the philosophical thought of Epicurus, Thomas Hobbes, and Baruch Spinoza, Boerhaave was awarded a doctorate of philosophy.

At this point, by every indication, Boerhaave was preparing to follow in the footsteps of his father, a Calvinist minister. But an event in the late summer of 1693 would cause him to alter his course.4 Boerhaave was traveling on a Dutch canal boat when he overheard several passengers discussing Spinoza, with whom Boerhaave was quite familiar, but whose writings, at the time, were considered heretical by both Catholic and Protestant authorities. What followed is well described by biographers Richardson and Martin:

One [passenger] more loudly than the rest condemned the great Jew [Spinoza] in no measured terms, whereupon Boerhaave put in the pointed question, whether the declaimer had ever read the works he so outrageously criticized? “The orator”, it is said, “was at once struck dumb and fired with silent resentment.” Then, some other passenger, having learned Boerhaave’s name, wrote it in a book, and when the would-be minister of religion arrived at Leyden, he found himself [widely regarded as] a Spinozist. He had now two goals before him, the pulpit or the medical professor’s chair. If he tried for the pulpit, such was the clamour against him, that he, son of the honoured orthodox divine, might be refused the licence. That goal was, therefore, clouded; the other was clear before him.5

Boerhaave set his theological ambitions aside and wholeheartedly pursued his other interest, medicine.

In pursuing medicine, Boerhaave attended very few formal lectures. Instead, he took a job as supervisor of the library at the University of Leiden and there engaged in a regimen of self-study, reading the works of Hippocrates and his followers; those of Roman philosopher-physician Galen (129–ca. 199/217 CE); those of the contemporary British physician Thomas Sydenham (1624–1689);6 and those of the Renaissance anatomists, in particular Andreas Vesalius of Padua (1516–1564) and Caspar Bartholin (1585–1629).7 Of the few formal medical lectures Boerhaave did attend, he profited most from those of professor Anton Nuck (1650–1692), in whose laboratory Boerhaave learned techniques for properly preserving cadavers for later study. On July 15, 1693, after a few years of intensive, largely independent studies, Boerhaave took and passed the medical exam at the University of Hardewijk (which, unlike the University of Leiden, did not require of its graduates formal attendance at lectures).

After passing the exam, Boerhaave established a private medical practice in Leiden, meanwhile continuing his independent studies of the medical writers of antiquity.8 During this period, his reputation as an outstanding clinician grew considerably, to the point that he was offered numerous prestigious and lucrative positions outside of Leiden—including a position as court physician to King William at the Hague. But Boerhaave turned down all of these, for he was holding out for an offer to teach at the University of Leiden.9 He did not have to wait long: In 1701, the university offered him a position as lecturer of physik (medicine), which he happily accepted.

Boerhaave proved to be such a popular lecturer that the university offered him the professorial chair in botany when it became available in 1709. He accepted, and quickly established himself as an outstanding botanist, cataloging some six thousand species of plants in the university’s botanical gardens and personally cultivating an additional two thousand plant species. In 1714 he assumed the professorial chair of medicine as well, and with it the responsibilities of clinical bedside training at St. Caecilia Hospital in Leiden. In this twelve-bed hospital, Boerhaave established an institution that would soon become the model for clinical teaching throughout Europe.10

In 1718 Boerhaave assumed a third professorial chair at Leiden, this one in chemistry. His responsibilities now included lecturing, research, experimentation, clinical teaching, and publishing across three scientific disciplines. He maintained this schedule until 1729, when, due to a prolonged and painful infectious illness, he had to resign his chairs in botany and chemistry. Even so, he retained his chair in medicine and continued most of his clinical responsibilities until he died in 1738.11

Although Boerhaave wrote many influential articles and books, his contributions to medical thought were perhaps best transmitted via his students. Boerhaave’s ability to integrate, advance, and teach a vast body of knowledge across three academic disciplines earned him widespread fame during his career, and because of this fame he attracted the best and brightest students of medicine to Leiden. These students, in turn, transmitted his teachings throughout the world. Historian Richard Toellner writes:

From all of Europe the students streamed to Leiden, 690 alone from English speaking countries, 600 from German speaking countries, and even from the Orient and distant America they came, in order to learn from Boerhaave. . . . At the pinnacle of his fame, two thousand students would hear his medical, botanical and chemistry lectures. . . . At many Courts and Universities of Europe, from Uppsala to Palermo, from Moscow to Edinburgh, Boerhaave’s students held leading medical positions, by virtue of being students of the great Boerhaave.12

And, as historian Kathleen Wellman notes:

These students [of Boerhaave] returned to their own countries and effected changes in the medical curriculum in accord with Boerhaave’s model. For example, it is generally conceded that Boerhaave was almost single-handedly responsible for the school of medicine at the University of Edinburgh; all of its outstanding teachers were at one time his pupils. And the University of Edinburgh was responsible for the training of physicians from the American colonies, making Boerhaave’s influence as far-flung as the New World.13

What was the content of Boerhaave’s contribution to medicine and medical education? Among other things, he restored and elaborated on the Hippocratic conception of disease processes as natural occurrences; he endorsed and adopted Newton’s inductive approach and experimental method, which had important implications for the development of chemistry, biochemistry, and physiology; he established the study of human anatomy as an indispensable component of medical teaching and practice; and he established the modern medical curriculum that is still, in its essential form, used today. Let us consider these contributions in turn.

Grounding Medicine in the Ideas of the Hippocratic Writers

Prior to Boerhaave, despite significant advances made during the Renaissance, the practice of medicine suffered from a crippling reliance on authority and mysticism. During the Middle Ages and early Renaissance, the accepted principles and practices of medicine were taught not by engaging students in observation, experiment, or hands-on experience, but by having students read and memorize the texts of ancient authorities. Consequently, the errors of these authorities were often transmitted through the ages.

One such authority was the Roman philosopher-physician Galen. Due to strict prohibitions against dissecting humans during much of his lifetime, Galen had no choice but to base many of his ideas about human anatomy and physiology on studies of animals,14 which, as we now know, have significantly different anatomies and physiologies from those of humans. Thus, despite Galen’s many exceptional achievements in advancing medicine (including differentiating between tissues and organs and their pathological syndromes and better systematizing disease processes within a general theoretical framework),15 he drew many substantially erroneous conclusions. And these errors would go uncorrected for more than a millennium: During the Dark and Middle Ages that followed the decline of Rome, challenging established authority—whether scriptural or scholastic—was a sure way to draw the attention of the Inquisition.

Galen’s work, having been passed down virtually unaltered by medieval scholastics, was extremely influential until the start of the Renaissance. By this time, the writings of the physician Paracelsus (1493–1541) had become influential as well. Although Paracelsus was critical of scholastic reliance on authority, his own conception of medicine was based upon fanciful deductions and contained numerous mystical elements. For instance, Paracelsus held that the human body was a microcosm of the universe, and that disease was thus caused and determined in large part by the arrangement of stars and planets at the time of the patient’s birth. Another component of Paracelsus’s system was alchemy, the idea that material elements “strive” to transmutate into gold, the most “perfect” of all elements. In his conception of man and medicine, the physician had to be a quasi-philosopher and mystic (in order to glean a partly rational, partly mystical understanding of the universe), a quasi-astrologer (in order to discern the course of disease as revealed by the heavens), and an alchemist (in order to discern the strivings of the elements and thus determine which chemicals are useful for treating maladies). In fact, Paracelsus derisively called any physician who did not fit this quasi-philosopher-astrologer-alchemist description a mere “experimentator.”16

Renaissance medicine suffered from other mystical premises as well. Among these was the belief that disease could be caused and affected by angels, demons, and miracles. And physiognomy, the “science” of divining various psychological and physical ailments on the basis of one’s facial features, was widely practiced during the Renaissance and taught at several universities.17 Medical historian Fielding Garrison provides a poignant summary of the state of Renaissance medicine:

Medical practice during the Renaissance period was bound up with superstition, herb-doctoring and quackery . . . He [the physician] usually believed in astrology, and [determined] the proper time for purging and blood-letting by the conjunction of the planets. Even a court physician was often an “astronomer royal,” that is, a deviser of fortune-tellers’ almanacs. The followers of Paracelsus believed in “the doctrine of signatures,” in virtue of which a drug is indicated by some fanciful associative resemblance to the disease, as trefoil for heart disease, walnut shells for head injuries, topaz and the yellow celandine [flower] for jaundice, and so forth.18

Against this pseudo-scientific backdrop, Boerhaave studied the medical writers of antiquity. In the Hippocratic corpus in particular, Boerhaave found, in contrast to the reliance on authority and mysticism that plagued medicine for hundreds of years, “systems of medicine for the most part free from magical and religious elements and based upon natural causes. . . . a strikingly rational attitude which resulted in a radically new conception of disease whose causes and symptoms were now accounted for in purely natural terms.”19 These ancient writings had a profound effect on Boerhaave, who saw himself as starting with a Hippocratic clean slate, bypassing the irrational elements of medieval and Renaissance medicine, and returning to Western medicine’s rational roots. The ancients’ naturalistic view of disease progression thus became his own, and grounded the conception of medicine he would practice and teach.

One important way in which Boerhaave disseminated the naturalistic Hippocratic approach was via his Aphorisms, a series of essays that had begun as lecture notes. Modeled directly on a part of the Hippocratic treatises that bear the same name, this work presents Boerhaave’s definition of disease and medicine and provides a systematization of illness, based on his own observations and experience, using both the form and perception-based methodology of the Hippocratic writers. Although his Aphorisms were originally intended only as a supplement for his students, they were so well regarded that unauthorized publications began appearing throughout Europe, where they soon became highly valued sources of information for European physicians. When Boerhaave recognized the demand for this material, he began publishing authorized editions of these works, including five editions of the Aphorisms and more than eighty related commentaries and abridgements. Thus,
historian and biographer G. A. Lindeboom notes, “the teaching of Boerhaave spread over Europe, as a flood of his books, which continued nearly to the end of the eighteenth century.”20

In this way, Boerhaave caught the attention of one of his most influential students, the Portuguese physician Ribeiro de Sanchez (1699–1783). After receiving his medical degree from Spain’s University at Salamanca in 1724, Sanchez traveled extensively, including in France. While there in 1728, a trusted medical colleague introduced Sanchez to Boerhaave’s Aphorisms. Deeply impressed, Sanchez immediately enrolled in medical school again—this time at the University of Leiden, to study Boerhaave’s Hippocratic methods first-hand. After studying under Boerhaave for three years, Sanchez became court physician to the Russian czarina (1731–1747), and held several additional medical positions in the military during his long career in Russia.

Another of Boerhaave’s most influential students was Gerard van Swieten (1700–1772), who attended Boerhaave’s lectures for more than twenty years. Van Swieten saw it as his task to pass to a younger generation of physicians Boerhaave’s clinical ideas, particularly the interpretation of Hippocratic methods contained in the Aphorisms. Van Swieten focused his life’s work on Commentaries on Boerhaave’s Aphorisms, five volumes of which were published between 1742 and 1772. In 1745, Van Swieten was called by the Austrian Empress Maria Theresa to serve as a professor of medicine at the Old Vienna Medical School; in 1749, he was appointed director of its medical faculty, with full powers. This institution, due in part to van Swieten’s influence, became the model of medical education for most of German-speaking Europe.21

Embracing and Applying Newton’s Ideas

In addition to infusing medicine with the rational approach to disease progression provided by the ancients, Boerhaave reinvigorated the field with what was in his day cutting-edge scientific methodology.

A major influence in medicine when Boerhaave began his study of the field was Cartesianism, the philosophy of Rene Descartes (1596–1650). Descartes lived some twenty years in Holland and wrote and published several of his works there. His ideas profoundly influenced philosophical and scientific thought in Holland and penetrated many intellectual, scientific, and medical circles in Leiden.22 But Boerhaave was unimpressed, for Descartes held that knowledge was gained by deduction from a priori (preconceived) ideas. Contra Descartes, Boerhaave held that one should explain natural phenomena by means of observation, not by reflecting upon “preconceived” ideas. In Boerhaave’s own words: “by observation with the senses only those qualities become known that are recognizable by experience.”23 Although Boerhaave praised Descartes’s achievements in mathematics, he was unequivocally opposed to Descartes’s philosophic and scientific views. In one of his orations, Boerhaave states:

As soon as you pass from the mathematical to the physical works of that distinguished writer [Descartes] you would scarcely believe that such different ideas could originate from the same man. Indeed, if you had time to consider earnestly what Descartes wrote on the impenetrable infinite, which was at first at rest and afterwards began to move, on the laws of motion, on the origin of the world, on elasticity, on the nature of the magnet, on the “grooved corpuscles [Descartes fancied that grooves on particles explained their behavior],” on the ways which attract or repel them, on the origin, structure and functions of the human body, you will be astonished that such things had emanated from a writer who had enlightened everyone by his mathematical ingenuity.24

Although the followers of Descartes claimed that his deductive methods represented a new approach to philosophy and science, Boerhaave recognized that Cartesian science was not science at all.

The ideas of Isaac Newton (1643–1727) were another matter. Newton’s approach stood in stark contrast to Descartes’s rationalistic a priori conception of science. As Lindeboom recounts:

Newton, some twenty-five years older than Boerhaave, strongly opposed the deductive method in natural science, as favoured by Descartes. At any rate he took his starting point in experience and he would return to it again. He warned emphatically against accepting more explanatory principles than were really necessary. Did he himself not explain the motion of the planets and the fall of objects on earth from one and the same principle? . . . Through the influence of Newton, Boerhaave soon became an enthusiastic adherent of the method of experiment in natural science, that is, of the so-called ‘experimental philosophy’. At Leyden he behaved as its faithful and persistent champion.25

In 1714, Boerhaave gave a rectorial address on the issue of certainty in physics, proposing that doctors use the same inductive method in their field as Newton did in his. In applying Newton’s ideas himself, Boerhaave laid the groundwork for two new sciences: biochemistry and physiology.

Boerhaave recognized that Newtonian mechanics applied not only to the behavior of solids, but also to the behavior of liquids, including the liquid parts of the body. Newton had observed that when a heavier solid is dissolved in a lighter liquid, the heavier solid does not settle to the bottom of the liquid-containing vessel, but rather distributes itself throughout the entire volume of the solvent. He therefore concluded that the dissolved solid particles, once in solution, exhibit a repulsive force toward one another and simultaneously exhibit greater attraction to the particles of the liquid solvent.

Boerhaave recognized the applicability of Newton’s observations to organic solutions. Rather than speculate about the unknown shapes and surfaces of organic atomic particles—as Descartes, the alchemists, and, earlier, the atomists would have done—Boerhaave considered the directly observable phenomena of solids dissolving in organic solutions, and, with Newton’s newly discovered laws, looked for the causes of solutions in the forces that gave solid solutes greater affinity for liquid solvents than they had for themselves. Boerhaave’s integration of Newtonian concepts with medicine and chemistry extended Newton’s revolutionary inductive and experimental methods—and had enormous implications for the future development of biochemistry.

In his widely distributed and influential masterwork Elementa Chemia (1732), Boerhaave argued that biochemical interactions should properly be “modeled as changes in the relative positions, and hence the configurations of particles; that is, as changes in molecular structure”26 and that “changes produced in bodies by chemistry must be mechanical [in the Newtonian sense], that all the operations of chemistry produce ‘alterations in bodies which are owing entirely to motion.’”27 Chemistry can thus be distinguished from ordinary mechanics, Boerhaave observed, in that the latter concerns the motion of a body from one place to another, whereas the former deals with the motions of the different kinds of molecules that make up bodies. As such, a biochemical interaction involves either the compounding of a new molecule out of previously discrete molecules, the breakup of a molecule into two or more parts, or the reconfiguration of the internal structure of the molecule itself.28

In the conception of science and medicine that Boerhaave taught and practiced, biological chemical processes are strictly causal in nature, verifiable by observation and experimentation, and subject to the same physical laws Newton elucidated.

In addition to using Newtonian mechanics to explain biochemical behavior, Boerhaave applied Newton’s experimental method to studies of cardiac function, which would lay the foundations for modern physiology. Through repeated experiments that he often performed for his students, Boerhaave observed that the small sections of a heart that had been dissected from an animal could be made to beat in the usual rhythm of systole and diastole. In his Institutiones Medicae Boerhaave noted, “There is an amazing and occult tendency in the heart to repeat the systoles and diastoles, alternatively, also after death and even in the excised heart, and actually in single parts of the dissected heart.”29 The implication of these experiments was clear: The contractile properties of the heart are functions of the organ’s structure and tissues, not imposed on the organ by the creature’s living soul.

One of Boerhaave’s most famous and influential pupils, the Swiss physician and scholar Albrecht von Haller (1708–1777), expanded upon these experiments. After studying at Leiden under Boerhaave, Haller was appointed professor of anatomy, surgery, and botany at Gottingen in Germany in 1736, where he remained until 1753. Through his lectures, experiments, and publications von Haller considered it his task to transmit the teachings of Boerhaave, whom he called the “Communis Europae Praeceptor”—the teacher of all of Europe. In particular, Haller sought to teach material from the Institutes Medicae and Elementa Chemia, in which Boerhaave integrated Newton’s mechanics and experimental method with medicine. Haller’s expansion of Boerhaave’s experiments in physiology gave rise to his own treatise, Elements of Physiology (1757–1766), a landmark in the development of physiology as an independent modern science. As one historian writes, “Although Haller considered this textbook a concise summary of the field, the range of this work was so extensive that the great French physiologist Francois Magendie (1783–1855) complained that whenever he thought he had performed a new experiment, he found it had already been attempted or described by Haller.30

Thus Boerhaave’s integration of Newton’s ideas had two important and lasting effects on medicine: First, his applications of Newton’s mechanical concept of solutions to organic solvents laid the foundation for modern biochemistry; and, second, his adoption of Newton’s observation-based experimental methods and his transmission of them to “legions of devoted students and disciples” enabled and inspired von Haller to develop physiology, one of the most important basic sciences in the medical curriculum.31

Integrating Human Anatomy and Clinical Autopsy

Prior to Boerhaave, neither human anatomy nor clinical autopsy was universally accepted as an important component of the medical curriculum or clinical practice. Nevertheless, by the 16th century, anatomy had progressed as an independent science thanks to the great Renaissance anatomists, in particular Andreas Vesalius. In the less-restrictive intellectual climate of their day, these men were able to reestablish observation as the accepted means of gaining knowledge about human anatomy. In De humani corporis fabrica (originally published in 1543), Vesalius disputed Galen’s anatomical ideas and corrected Galen’s mistakes with detailed observations made during his own dissections of human cadavers. Boerhaave studied the works of Vesalius and Caspar Bartholin and saw that integrating their achievements with Enlightenment medicine was crucial to uncovering and treating the causes of various ailments.

Boerhaave applied his knowledge of anatomy to uncover a patient’s cause of death in one of the earliest examples of modern pathological anatomy.32 Hours after eating a large meal of duck, Baron Jan Gerrit (1672–1723) took an emetic to induce vomiting and suddenly screamed, feeling as though his chest had torn. Suspecting the pain to be indigestion, Gerrit took a treatment of several ounces of olive oil and beer. But this did not help and, after three days of continued pain, Gerrit called upon Boerhaave for a diagnosis. Unfortunately, the baron died just hours after Boerhaave’s initial evaluation. The next day Boerhaave and another physician performed an autopsy, noting such peculiarities as air bubbles beneath the skin of Gerrit’s chest and abdomen; air escaping from his abdomen; the smell of duck meat emanating from his chest cavity; and a beer-colored fluid in the chest cavity, covered with a thin film of oil. Finally, in the lower esophagus, Boerhaave observed a tear through which he surmised the fluid had leaked from the abdomen into the chest cavity. From this he concluded that the esophagus had ruptured from the baron’s violent vomiting—a diagnosis later named “Boerhaave’s syndrome.”

Recognizing the tremendous practical applications that anatomy and autopsy had for the practice of medicine, Boerhaave was eager to spread the word to other physicians. He thus copublished a second edition of Vesalius’s De humani corporis fabrica, the standard from which later editions would be made, and taught his students to value anatomy and autopsy as means to better understanding and treating disease.33 One of Boerhaave’s students, the Scottish surgeon Alexander Monro, assumed the chair of anatomy at Edinburgh in 1719, a facility responsible for teaching many physicians from the American colonies.34 Another student, the famed botanist and physician Carl Linnaeus (1707–1778, best known for developing the “genus and species” classification system for plants and animals), reformed medicine at Sweden’s University of Uppsala, remodeling it in the form of Boerhaave’s Leiden prototype. Under Linnaeus’s direction, an anatomical theater was erected in 1762–1763, and, for the first time in Sweden, medical students began to study human anatomy.

Establishing the Modern Medical Curriculum

Among Boerhaave’s seminal contributions to modern medicine, one of the most significant was his reintroduction of bedside teaching into the medical educational curriculum. Lindeboom recounts the history of bedside training leading up to Boerhaave’s time:

Although the ancient Greek and Roman physicians seem to have taught their pupils at the bedside, the universities of Europe did not follow this classical example when they initiated medical teaching. The medicine at the universities remained for centuries entirely theoretical. . . . It was during the Renaissance that medical teachers began to see the irreplaceable value of personal examination and observations. The anatomists were the first to descend from their rostrum to take the knife into their own hands. This method was introduced by Andreas Vesalius. . . . His colleague at Padua, Giovanni Battista da Monte (Montanus, 1498–1561), was the first to deliver clinical lectures to his pupils at the bedside.35

But although the anatomists at Padua saw value in bedside teaching, educators in Holland and elsewhere in Europe had little regard for it.36 Boerhaave would change this situation permanently, establishing bedside training—including observation, diagnostics, treatment, prognostics, and taking the patient’s medical history—as a cornerstone of the modern medical curriculum.

After assuming the chair of practical medicine at Leiden in 1714, Boerhaave, having recognized the value of bedside training during his study of the ancients, began giving his students hands-on instruction at nearby St. Caecilia Hospital.37 (Although bedside teaching had begun several decades earlier at Leiden, it was held in such little regard that student attendance dropped over the years to almost none.)38 As Lindeboom recounts:

There is no doubt that Boerhaave was at his best at the bedside. Here he showed himself a real Hippocratic physician. Here he did not discuss doctrines and systems, but he devoted all his attention to [the patient’s] signs and symptoms. . . . He drew attention to the general appearance, the state of nutrition, the constitution, the position assumed by the patient in bed, the pulse and respiration, the presence of swellings, and the sounds that the patient made on breathing.39

Under Boerhaave’s careful tutelage, students began to see hands-on clinical instruction as the vital source of learning it is widely recognized to be today.

Further, using the experimental and inductive approach of Newton as his model, Boerhaave developed an entire curriculum for his students. He taught the basic sciences—physics, chemistry, anatomy, botany, and theoretical medicine—followed by clinical instruction at the bedside. Today, medical students follow essentially the same course: studying biology, physics, and chemistry as undergraduates; studying human anatomy, pharmacology (botany in Boerhaave’s time), biochemistry, physiology, pathology, and pathophysiology (chemistry and theoretical medicine in Boerhaave’s time) in their first two years of medical school; and studying clinical medicine during their last two years of medical school. As Lindeboom summarizes: “Nowhere else in Europe was such a medical curriculum available at such a level.”40 Students elsewhere might receive one or two aspects of this curriculum where such existed, but at the time, such a complete and modern medical school curriculum was available only at Leiden under Boerhaave.

Just as they did with his Hippocratic influences, his experimental physiology, and his emphasis on human anatomy, Boerhaave’s students took his prototype of the modern clinical curriculum with them to their respective institutions and thereby improved medical education far and wide. Boerhaave’s student Johannes Theodorus Eller (1689–1760) became one of the leading professors of Berlin’s medical Collegium and head of Berlin’s premier hospital (Charite), where he initiated and taught at those facilities the clinical curriculum and methods he learned from his master.41 In addition to Alexander Monro, nine more of Boerhaave’s students became professors of medicine and allied disciplines at the Scottish school, where several of them held important academic chairs. William Cullen (1710–1790), an esteemed medical theorist and clinical instructor who was instrumental in founding the medical school at Glasgow, recalled his years as a student at Edinburgh:

I learned the system of Boerhaave; and for the names of some ancient writers, of Sydenham, and a few other practical authors, I heard of no other names of writers on physic [medicine]; and I was taught to think the system of Boerhaave to be very perfect, complete and sufficient.42

Benjamin Rush (1745–1813), a signer of the Declaration of Independence, received his medical degree from Edinburgh along with more than one hundred other American physicians.43 Commenting on Boerhaave’s influence in his sector of the New World, Rush said that “the system of Dr. Boerhaave then governed the practice of every physician in Philadelphia.”44 In 1765, John Morgan, another Edinburgh graduate, established the first medical school in North America, the Medical School of the College of Philadelphia. Writes medical historian Henry E. Sigerist:

If the faculty of Edinburgh could be called a daughter of Leiden then the faculty of Philadelphia can with equal right be a daughter of Edinburgh and therefore, a grand–daughter of Leiden. No wonder that the spirit of the new clinical medicine was fully alive [in Philadelphia] and that Boerhaave’s influence was strongly felt.45

Thus, primarily by way of his many well-trained students, Boerhaave’s modern medical curriculum was transmitted throughout the world.

* * *

Standing on the shoulders of the medical and scientific giants that preceded him, Herman Boerhaave’s contributions—grounding medicine in the direct observation of disease processes, integrating Newton’s mechanics and experimental approach, integrating the achievements of the Renaissance anatomists, and developing a curriculum based on hands-on experience and study of the fundamental sciences—gave medicine its modern, rational form.

Even recent medical advances, such as organ transplantation, brain surgery, and antibiotics, ultimately rest upon his accomplishments. Indeed, the rapid development of medical knowledge from the late 18th century until today would not have been possible without Boerhaave’s influence. Boerhaave helped the field of medicine abandon the mystical and irrational ideas it acquired during the Middle Ages and early Renaissance; he discerned the magnitude of Newton’s achievements and brought them to bear upon the field; he ensured that the study of human anatomy found its proper place in medical teaching and practice; and he taught these groundbreaking ideas to a host of eager students via the modern curriculum he developed. Although there were certainly other accomplished physicians and professors in his day, none did more than Boerhaave to modernize medicine. In short, we can credit Herman Boerhaave in large part for the life-serving achievements of modern medicine: Having established the intellectual foundations for these enormous advances, he was truly their fountainhead.


1 Richard Toellner, “Herman Boerhaave (1668–1738),” in Klassiker Der Medizin, edited by Dietrich v. Engelhardt and Fritz Hartmann (Munich: Verlag C. H. Beck, 1991), p. 215 (translations mine).

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2 Rina Knoeff, Herman Boerhaave (1668–1738): Calvinist Chemist and Physician, (Amsterdam: Koninklijke Nederlandse Akad. van Wetenschappen, 2002), p. 22.

3 D. A. K. Black, “Johnson on Boerhaave,” Medical History, vol. 3, no. 4, October 1959, p. 325.

4 Toellner, “Herman Boerhaave,” p. 223.

5 Benjamin Ward Richardson and George Martin, “Disciples of Aesculapius,” vol. 1 (New York: E. P. Dutton & Co., 1901), p. 99.

6 Frits G. Nelis, “Hermannus Boerhaave: simplex very sigillum,” Folia Gastroentologica et Hepatologica, vol. 2, no. 1, 2004, p. 5.

7 G. A. Lindeboom, Herman Boerhaave: The Man and His Work (London: Methuen & Co., 1968), p. 34.

8 William Burton, An Account of the Life and Times of Herman Boerhaave (London: Henry Lintot, 1746), pp. 21–23.

9 Burton, Account of the Life and Times (London: Henry Lintot, 1746), pp. 21–23.

10 Toellner, “Herman Boerhaave,” p. 225.

11 Lindeboom, The Man and His Work,pp. 163–216.

12 Toellner, “Herman Boerhaave,” p. 215.

13 Kathleen Wellman, La Mettrie: Medicine, Philosophy, and Enlightenment (Durham, N.C.: Duke University Press, 1992), pp. 62–63, www.questia.com, accessed January 31, 2010.

14 Ursula Weisser, “Galen (129–ca. 200 oder nach 210 n. Chr.),” in Klassiker Der Medizin, edited by Dietrich v. Engelhardt and Fritz Hartmann (Munich: Verlag C. H. Beck, 1991), p. 23 (translations mine).

15 Weisser, “Galen,” pp. 22–27.

16 Heinrich Schipperges, “Paracelsus (1493–1541),” in Klassiker Der Medizin, edited by Dietrich v. Engelhardt and Fritz Hartmann (Munich: Verlag C. H. Beck, 1991), pp. 101–12 (translations mine).

17 Nancy G. Siraisi, “Medicine and the Renaissance World of Learning,” Bulletin of the History of Medicine, vol. 78, no. 1, Spring 2004, pp. 1–36.

18 Fielding H. Garrison, An Introduction to the History of Medicine (Philadelphia: W. B. Saunders, 1913), p. 169.

19 James Longrigg, Greek Rational Medicine: Philosophy and Medicine from Alcmaeon to the Alexandrians (New York: Routledge, 1993), p. 1.

20 Lindeboom, The Man and His Work,p. 358.

21 Lindeboom, The Man and His Work, pp. 363–64.

22 Lindeboom, The Man and His Work, p. 266.

23 Lindeboom, The Man and His Work, p. 101.

24 Lindeboom, The Man and His Work, p. 101.

25 Lindeboom, The Man and His Work, p. 269.

26 Wellman, La Mettrie, p. 67, www.questia.com, accessed February 1, 2010.

27 Wellman, La Mettrie, p. 67.

28 Richard Allen, “David Hartley On Human Nature,” in SUNY Series in the Philosophy of Psychology (Albany: State University of New York Press, 1999), p. 105.

29 Hubert Steinke, Irritating Experiments: Haller’s Concept and the European Controversy on Irritability and Sensibility, 1750–90 (Amsterdam: Rodopi, 2005), p. 33, www.questia.com, accessed February 15, 2010.

30 Lois N. Magner, A History of the Life Sciences,3rd ed., (New York: Marcel Dekker, Inc., 2002), p. 216.

31 Magner, A History of the Life Sciences, p. 216.

32 Lindeboom, The Man and His Work, pp. 154–57.

33 Lindeboom, The Man and His Work, pp. 137–41.

34 Lindeboom, The Man and His Work, p. 369.

35 Lindeboom, The Man and His Work, pp. 283–84.

36 Lindeboom, The Man and His Work, pp. 283–86.

37 Wellman, La Mettrie, p.63, www.questia.com, accessed January 31, 2010.

38 Lindeboom, The Man and His Work, pp. 285–86.

39 Lindeboom, The Man and His Work, p. 291.

40 Lindeboom, The Man and His Work, p. 292.

41 Lindeboom, The Man and His Work, p. 365.

42 Kim Ock-Joo, Lee Myung, and Hwang Sang-Ik, “Hermann Boerhaave: A Historiographical Survey,” Korean Journal of Medical History, vol. 6, 1997, p. 121.

43 John Sanderson Robert Taylor Conrad, Sanderson’s Biography of the Signers of the Declaration of Independence (Philadelphia: Thomas, Cowperthwait and Co., for James A. Bill, 1848), pp. 378–90.

44 Gillian Hull, “The Influence of Herman Boerhaave,” Journal of the Royal Society of Medicine, vol. 90, September 1997, p. 513.

45 Lindeboom, The Man and His Work, p. 364.


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