Herman Boerhaave

In his time Herman Boerhaave was the teacher of Europe and a physician’s physician. He lived more than three hundred years ago, enough time to have had reams of paper written about him, including a monograph published one year after his death by Dr. Samuel Johnson, then a young journalist.

Boerhaave lived at a time when medicine was still poorly differentiated from witchcraft, and physicians dressed in black and wearing gold chains prescribed bleeding, cupping, vigorous emetics, enemas, purging in excess, and quaint diets of asses’ milk and extracts of mummy. Boerhaave did indeed practice bleeding and purging, but moderately so, and most of his remedies seem to have been more benign.1 Thus for the man who hurt the Nerves of the diaphragm by staying too long in cold water and developed an Asthma,  he recommended swallowing three pills every three hours followed immediately by drinking two ounces of a liquid mixture. Meticulous in his history taking, he carried out detailed physical examinations and inspections of the patients’ urine, feces, and sputum. He used a magnifying glass to look at the skin, and recommended measuring the body temperature with an instrument given to him by his friend Fahrenheit.

Born in 1668 some two miles out of Leiden in the Netherlands, he first intended to become a minister and received a thorough education in languages and the classics, in mathematics and chemistry. Dr. Johnson reports that as a teenager he had a painful non-healing ulcer on his left thigh that eventually he healed himself by “laying aside all the applications of his physicians” in favor of applying salt and urine—perhaps the source of his later therapeutic approach. At the university he studied all sciences and obtained his degree in philosophy in 1690, but then switched to medicine.

He spent ten years studying at the University of Leiden—six in philosophy and four in medicine. He never attended formal lectures but educated himself by reading the medical texts of Hippocrates, Galen, Vesalius, William Harvey, and Thomas Sydenham, and witnessing the occasional dissection. Graduating in 1693, he established a flourishing private practice that became so lucrative that he died a rich man. He also continued to read much and carry out experiments in chemistry.

In academia he worked his way up the ranks and ended up being triple professor—with separate chairs in botany, medicine, and chemistry. He worked hard, studying in the morning and evening, and allotting the middle of the day to his administrative duties and clinical work. Riding was his usual exercise, the violin his relaxation, and his greatest pleasure was to retire to his country house, enjoy the garden, and quietly pursue his studies.

Dr. Johnson describes him as always cheerful and desirous of promoting mirth by a humorous conversation, tall, of a robust and athletic constitution, remarkable for his extraordinary strength, and so “majestic and a great” that “no man ever looked upon him without veneration, and a kind of tacit submission to the superiority of his genius.”  Nobody could find a fault with him, wrote his pupil Albrecht von Haller, except for his undistinguished dress, indicative of a thriftiness not unusual in a Dutchman.

His contributions to science were legion. As professor of botany he enlarged the collection of the botanical garden of Leyden, doubling the number of plants, studying new species, and publishing many articles on the subject. He carried out many chemical experiments, and discovered a substance believed to have been urea. To his patients he prescribed massage, exercise and baths, and gave detailed dietary instructions. He made no discoveries to which his name would be attached, except for spontaneous rupture of the esophagus.

This he observed in the grand admiral of the Dutch fleet, a 51-year-old man who retched forcefully after a heavy meal, vomited, then felt a sudden excruciating pain in the chest as though something had ruptured, and died the next day.  At autopsy gas, fluid, and the contents of his last meal has spilled into the mediastinum, lungs, and pleural cavities, there was massive  subcutaneous emphysema and a large hole in the esophagus—a classical case of Boerhaave’s syndrome.

Boerhaave is remembered as a teacher and for his writings.  In his Institutes of medicine and Aphorisms, he offered clinical instruction in the spirit “that the great seal of truth is simplicity.” He was a superb lecturer, and his public lectures, given for two hours every afternoon, were attended by students from all over Europe, sometimes by as many as one hundred at one time. He spoke slowly, in simple Latin, lecturing on clinical medicine, chemistry, botany, and anatomy.  He paid great attention to symptoms and physical sign, and often would invite students to come down from the auditorium to discuss the patient and his treatment. Nearly two thousand students matriculated from the medical faculty during his professorship, and of these 178 were his.

Many of the rulers of Europe sent him pupils. He was visited by a succession of illustrious personages, by Peter the Great, Linnaeus, and Voltaire, and he received letters and salutations from many parts of the then known world. His influence throughout Europe was enormous. A succession of his pupils returned to their homes, propagating his message and adopting his methods. They were instrumental in developing the great medical schools, Edinburgh through John and Alexander Monro,  Gottingen in Sweden through Albrecht von Haller, and through his distinguished pupil Gerard van Swieten the first Vienna School of Medicine.

It has been suggested that he suffered from excessive adulation on one hand and severe criticism on the other, that he enjoyed great a fashion for little scientific merit or clinical insight. But these harsh words must be viewed in the context of his times, when medical practice was primitive, and the teaching of medicine in its broadest sense also embraced philosophy, botany, and chemistry. Viewed in this light, Herman Boerhaave was indeed the compleat physician.

Note

1. Boerhaave towards the end of his life was said to have lost his faith in the efficacy of most medicines and narrowed down his prescribing to sodium bicarbonate. But not being able to find the reference, I have desisted from the practice of  “Quote what you guess, and do not fight/ To trace the source or get it right.”

References

Booth, CC: Herman Boerhaave and the British. Journal of the Royal College of Physicians of London, 1997, 23:125.

Editorial: Herman Boerhaave. JAMA 206:2309

Hull, B: The influence of Herman Boerhaave. Journal of the Royal Society of Medicine, 1997, 512: 90.

Lindenboom, GA, Herman Boerhaave (1668-1738), JAMA, 206:2297.

Underwood, EA: Boerhaave after Three Hundred Years.  BMJ  28 December 1968, p 820.

Samuel Johnson: Herman Boerhaave. The Gentleman’s Magazine, January to March 1793, reprinted on the Internet.


 

GEORGE DUNEA, MD, Editor-in-Chief