Herman Boerhaave

Born 1668
Died 1738

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Dutch physician, anatomist, botanist, chemist and humanist, born December 31, 1668, Voorhout, near Leiden; died September 23, 1738, Leiden.

Biography of Herman Boerhaave

Praeceptor Europe – teacher of Europe

One of the most influential clinicians and teachers of the 18th century, Boerhaave spent almost his entire life in Leiden, which became a leading medical centre of Europe. Like Thomas Sydenham (1624-1689) he helped to revive the Hippocratic method of bedside instruction; he further insisted on post-mortem examination of patients whereby he demonstrated the relation of symptoms to lesions. Boerhaave's syndrome, the spontaneous oesophageal rupture, was named so because of his description of a Great Admiral of the Dutch Fleet who overate and experienced a spontaneous rupture of the oesophagus following vomiting. He thus instituted the clinico-pathological conference still in use today. Boerhaave's fame was enormous, extending far beyond Europe to China. Skilled as physician, botanist, chemist and anatomist, he adhered to no single tradition but combined the best features of the mechanistic and chemical schools in his own brand of eclecticism. His methods of instruction were spread throughout Europe by a host of students. Two of his writings, the Institutiones Medicinae (1708) and the Elementa Chemiae (1732) remained standard textbooks for decades.

Background
Hermann Boerhaave was the son of the Calvinistic Reverend Jacobus Boerhaave and his second wife, Hagar Daelder, the daughter of an Amsterdam tradesman. he was born at Voorhout, a village about three kilometers from Leiden. His mother died when he was five years old, and his father then married Eva Dubois, the daughter of a Leiden clergyman, who proved to be a devoted stepmother.

After attending school in Leiden, Boerhaave spent three years in the grammar school of that city, and as a young man he accumulated broad knowledge og classical languages, even learning Hebrew, Arabic, English, and German. At intervals, to recreate his mind and strengthen his constitution, his father used to send him into the fields and employ him in agriculture, rural occupations he loved throughout his life.

When he was twelve years of age his studies were interrupted by an illness, caused by an attack by a swarm of bees, so described by Samuel Johnson (1709-1784):
"In the twelfth year of his age, a stubborn, painful, and malignant ulcer, broke out upon his left thigh; which, for near five years, defeated all the art of the surgeons and physicians, and not only afflicted him with most excruciating pains, but exposed him to such sharp and tormenting applications, that the disease and remedies were equally insufferable. Then it was, that his own pain taught him to compassionate others, and his experience of the inefficacy of the methods then in use, incited him to attempt the discovery of others more certain.
He began to practise, at least, honestly, for he began upon himself; and his first essay was a prelude to his future success, for having laid aside all the prescriptions of his physicians, and all the applications of his surgeons, he at last, by tormenting the part with salt and urine, effected a cure.
That he might, on this occasion, obtain the assistance of surgeons with less inconvenience and expense, he was brought, by his father, at fourteen, to Leyden, and placed in the fourth class of the publick school, after being examined by the master; here his application and abilities were equally conspicuous. In six months, by gaining the first prize in the fourth class, he was raised to the fifth; and, in six months more, upon the same proof of the superiority of his genius, rewarded with another prize, and translated to the sixth; from whence it is usual, in six months more, to be removed to the university.
Thus did our young student advance in learning and reputation, when, as he was within view of the university, a sudden and unexpected blow threatened to defeat all his expectations."

The reluctant clergyman
His father, who died on November 12, 1682, had decided for him a career in the cleresy. Complying with his father's wish, Boerhaave in 1784 matriculated at the University of Leyden to study philosophy, mathematics, and theology. In 1687 he won a scholarship at the university. As his father had left behind very slender provisions for his widow and nine children, these years were very difficult. He lacked the means to bear the expenses of a learned education, but obtained the consent of his guardians to prosecute his studies, so long as his patrimony would support him.

As a student Boerhaave distinguished himself by a series of five disputations, three of which dealt with the human mind. In 1689, he gave a public oration with a disputation on the views of Cicero on the concept of Epicurus of the summum bonum, for which the governors of the university awarded him a gold medal. The following year he was conferred doctor of philosophy with a thesis on the distinction of mind from body. Upon graduation, Boerhaave continued to study theology, and later was also conferred doctor of theology.

Into medicine
In 1690 he took up the study of medicine, chemistry and botany. This year his scholarship ran out, and Boerhaave was forced to support himself teaching mathematics. His talents gave him many assignments at the university, and finally he found a benefactor, van Alphen, a generous friend of his father's, who facilitated his studies.

Because of his skills he was entrusted the preparation of the catalogue of the Vossius' library, which had been acquired by the university.

During his work on the library catalogue he made the acquaintance of the rich and influential van den Bergh, who strengthened his love of medicine. Thus Boerhaave concentrated his efforts in this science, besides theology, but in a peculiar way. At this time his ambition was to be "a doctor of both body and soul" and he commenced systematically reading every available medical work, from Hippokrates (ca 460–ca 377), to Andreas Vesalius (1514-1564), Gabriele Falloppio (1523-1562), Thomas Bartholin (1616-1680), and Thomas Sydenham. On the other hand, he hardly ever visited lectures in medicine, with the exception of a few in anatomy, in particular Charles Drélincourt (1633-1697), and Anton Nuck’s (1650-1692) yearly public dissections. He, who was to become the most famous physician of his time, was thus practically autodidact in the medical sciences. Even chemistry he studied at home, together with his younger brother Jakob. Jakob had originally entered the university to study medicine, but later changed to theology and became a minister - opposite of Herman, who began having serious doubts about the "purity" of his belief.

After three years of medical studies he obtained a degree in medicine at the provincial university in Harderwijk on July 15, 1693. His thesis was on the usefulness of examining the patient's excrements for diagnostical purpose.

On his return journey from Harderwijk Boerhaave came into dispute with a travel companion over Spinoza, whom he defended energetically against unjustifiable attacks. His opponent subsequently, in Leiden, spread the rumour that Boerhaave was a secret adherent of Spinoza - an atheist. As this was detrimental to a future career in theology, Boerhaave now devoted himself entirely to medicine.

Practitioner turned teacher
In 1793 he settled down as a general practitioner in Leiden, using his ample free time left from his small practice to continue his education and do Repetitorien in mathematics and medicine for students, and augmenting his sparse income teaching mathematics. He spent his entire professional life in Leyden, where his private practice grew slowly. As a therapist he was concerned about sparing his patients the hardships of all too radical treatments, something that puts him in a class of his own among physicians of his day.

He was appointed lecturer of theoretical medicine – Lector Institutionum Medicarum – at the University of Leyden May 18, 1701, succeeding his teacher Charles Drélincourt. He owed this lectureship to Jan van den Berg and van Alphen. In 1703 Jan Van den Berg became the mayor of Leiden.

His inaugural public address lecture was a recommendation to study the works of Hippocrates – "De commendando studio Hippocratico" – and there began a career as one of the most admired teachers who ever lived, attracting ever more students. At first they were of a more theoretical nature, on topics like the adaptation of mechanical calculations to the medical sciences. Besides his teaching duties at the university he also gave private medical and chemical lectures.

Boerhaave's success as an associate professor who attracted students even from abroad drew the attention of the faculty, which promised him the next appointment for professor - provided he did not accept an appointment somewhere else. In 1703 he thus declined a professorship at Groningen. This resulted in an increase of his fee, and he was authorized to give an academic oration. This address, his thank to the faculty, was De usu ratiocinii mechanici? in medicina. From now on Boerhaave did not limit his teaching to theoretical medicine, but also gave private courses on botany, chemistry, and practical medicine in his own home. These courses brought enthusiastic flocks of students to his home.

Boerhaave’s lecture room was crowded with students from several countries and all lectures were given in Latin, of which Boerhaave had an easy mastery. Often many students had to stand, and some young noblemen were known to hire men to get to the classroom early to reserve their seats. Albrecht von Haller called Boerhaave communis Europae praeceptor– teacher of Europe. In the years of his tenure, 1. 919 students were enrolled in the medical faculty, of whom 690 came from English-speaking countries, 600 from German speaking countries, and several from the Near orient and America.

In 1709, when Boerhaave had a busy medical practice, he was appointed to succeed Petrus Hotton (1648–1709), becoming professor medicinae et botanices. He thus entered into a new field of science. As professor of botany, he was ex officio supervisor of the university’s botanical garden and was given an official residence and an allowance for foreign correspondence and the exchange of seeds and plants.

It was at the St Caecilia Hospital in Leyden, wher he worked from 1714, he introduced the modern method of clinical instruction which has remained the basis of medical education until the present day.

On September 14, 1710, Boerhaave married Maria Drolenvaux, the daughter of the rich merchant, Alderman Abraham Drolenvaux. They had four children, of whom one daughter, Maria Joanna, lived to adulthood.

Over the years Boerhaave's medical practice became very lucrative. He was turning away rich and famous clients. His servant charged a guilder for admittance to his office and he once charged 30 guilders for a consultation by mail.

Rector Magnificus and triple professor
In the summer of 1714, upon the death of Govert Bidloo (1649-1713), he was appointed second professor of practical medicine, also taking upon himself the responsibility for the clinical teaching, which had been a proud tradition in Leyden since 1639. That year he was also made physician of St. Augustin's hospital in Leiden, into which the students were admitted twice a week, to learn the practice of physick.

Besides, in 1718 (the year Karl VII fell for a Norwegian bullet at Fredriksten, Halden), he succeeded Jacob Le Mort (1650-1718) as Ordinarius Professor Chymiae. Chemistry was his favourite science for many years, and he became a highly popular lecturer even in this field. For the next ten years he held simultaneously three of the five chairs that constituted the whole of Leiden’s Faculty of Medicine. His inaugural thesis in chemistry was Oratio de chemia suos errores expurgante. When Frederik Dekkers (born 1644) died in 1720, Boerhaave succeeded him as first professor of practical medicine.

Despite the fact that his medical system was mainly based on mechanics and he did not think that chemistry was yet an adult science - in which he was quite right, Boerhaave’s most important contributions to science were probably made in chemistry. He introduced exact, quantitative methods by measuring temperature and using the best available balances made by Fahrenheit.

He lectures were given with extraordinary zeal and energy, four or five hours a day, until he was halted by a severe, painful illness that confined him to bed for five months in 1722. Again we turn to Samuel Johnson's description:
"In 1722, his course, both of lectures and practice, was interrupted by the gout, which, as he relates it in his speech after his recovery, he brought upon himself, by an imprudent confidence in the strength of his own constitution, and by transgressing those rules which he had a thousand times inculcated in his pupils and acquaintance. Rising in the morning before day, he went immediately, hot and sweating, from his bed into the open air, and exposed himself to the cold dews.
The history of his illness can hardly be read without horrour: he was for five months confined to his bed, where he lay upon his back without daring to attempt the least motion, because any effort renewed his torments, which were so exquisite, that he was, at length, not only deprived of motion but of sense. Here art was at a stand; nothing could be attempted, because nothing could be proposed with the least prospect of success. At length, having, in the sixth month of his illness, obtained some remission, he took simple medicines in large quantities, and, at length, wonderfully recovered.
His recovery, so much desired, and so unexpected, was celebrated on Jan. 11, 1723, when he opened his school again, with general joy and publick illuminations."

Boerhaave’s influence spread throughout Europe. The medical faculties of the universities of Vienna, Göttingen and Edinburgh were begun or reformed after the system that Boerhaave instituted at Leiden. He was consulted about the curriculum of the Edinburgh Medical School and by some is regarded as a founding father. One of his students, Gerard van Swieten (1700-1772), was foundation professor of medicine in Vienna and so his influence stretched the breadth of Europe. And even further. Boerhaave's reputation was known in China and his works were translated into arabic. He undoubtedly was a fine scholar himself since he knew all the European languages including Latin. In 1770, half a century after his death, Frederick the Great of Prussia ordered all medical professors in his realm to teach in the style of Boerhaave.

From February 1714 to February 8, 1715 he was vice-chancellor of the University. He filled the same position again in 1730, and left his high office in 1731 with the speech "Oratio de honore medici servitute", in which he maintains that the greatest glory of this high office, is that of being a servant of nature.

One of those who followed his lectures was Carl von Linné (1707-1783), future professor of medicine at Uppsala and famous botanist. In 1735, when Linne had just graduated from the Univesity of Harderwijk, Boerhaave helped him get a patronage post.

Written works
He wrote several important and lasting books, but he was first and last a clinician and a faithful Hippocratist who put the care of the patients above all considerations of theory. In his works he strived to found the medical sciences on a sound basis of natural science.

Several of his textbooks were based on his lectures, many of them unauthorized editions. His student's notes were bought by booksellers who were not too particular and printed them. Angered by this, Boerhaave finally wrote a textbook of chemistry, Elementa Chemia (1732), which was later to be translated into several languages and appeared in many editions.

The death of an admiral
The case story on the disorder that bears his name, is found in his little book Atrocis, nec descripti prius, morbi historia (1724). His description of ruptured oesophagus resulted from his being called in consultation to see the Grand Admiral of the Dutch Fleet and Prefect of Rhineland, Baron Jan Gerrit van Wassenaer.

The patient was 51 years of age. It was at 23.30 on the evening of October 29, 1723, the admiral's son came to him personally, crying and asking Boerhaave to see his father as he was in death cramps or was even already dead. The patient was a man who suffered from gout, drinking and eating much. He was sitting on his bed, bent forward. Three days earlier the grand admiral had enjoyed a grand dinner in the company of good friends, thereafter riding home with his son.

The admiral had eaten a heavy meal. During the next hours he had taken small cups of a mild emetic, as was usual when he was feeling heavy. At four times he had about 28 grams of olive oil and later drank about 180 grams of beer. When this did not have the desired effect, he took another four cups. He tried to throw up, but suddenly screemed because of an excruciating pain in the chest. He felt as is something had been broken or ruptured there. He immediately declared himself dying and started praying. It was a very sick, patient, though free of fever, who met Boerhaave. The admiral spoke with a clear voice and did not cough, even though he had extreme pains in the chest.

The house physician, dr de Bye, had tried bleeding. There were no symptoms of any known disease or poisoning, and the two physicians ordered another bleeding, something non-alcoholic to drink and warm compresses. But, in vain, the baron succumbed the next day.

Boerhaave conducted an autopsy which revealed the rent in the oesophagus and the contents of a previous meal, gas, and fluid in the chest. In his presentation, he established the classic form for morbid history anamnesis, physical examination, diagnosis, history of the disease, and autopsy findings.

At the outside palpation of the body subcutaneous emphysema and much air was found in the abdominal cavity, but no other abnormities. When the abdominal cavity was opened, however, large quantities of gas escaped. This drew the attention to the smell of duck meat, and only then Boerhaave remembered that the admiral had eaten duck at the meal three days previously. The lungs had collapsed and floated on a liquid filling almost the entire thoracic cavity, equally much on each side. Altogether there was close to three litres of liquid.

During examination of the left pleural cavity a ruptured hole was discovered through which one could put the finger into oesophagus. Everybody present were allowed to do so. Boerhaave concluded that oesophagus had been healthy, but had been ruptured by the vomiting.

After Boerhaave's first case description, spontaneous rupture of the oesophagus was considered a rare but inexorably fatal incident. During the next 220 years thereafter only some 50 cases were reported in literature. It was not until the 1940's that the first patient could be saved back to life through speedy surgical operation at the thorax.

Health
After his serious illness in 1722, diagnosed by himself as lumbago rheumatica, Boerhaave realized he must take care of his health. In 1724 he bought an estate near Leiden, where he spent his leisure time arranging a great private botanical garden. The illness recurred rather serious in 1725 and forced him to give up his lectures in botany and chemistry, but he continued bedside teaching until his death. He resigned his professorships of botany and chemistry on April 28, 1729 and left his office of residence in 1730, but continued to teach Institutes, practical medicine, and clinical medicine until 1738.

He died on September 23, 1738, following months of sufferings from dropsy caused by a heart disturbance. He was buried in St. Peter’s Church, and the whole scholarly community of Europe mourned him. On November 4, 1738 his friend Albertus Schultens (1686-1750) delivered a eulogy based, in part, upon biographical notes left by Boerhaave.

One story is that he left a book in which he had set out all the secrets of medicine. After he died it was opened and all the pages were blank except one on which was written "keep the head cool, the feet warm and the bowels open."

Boerhaave turned down several invitations from monarchs, he thought he would be tempted to compromise himself at a court: "Exeat aula, qui vult esse pius." Royalty and members of the nobility sought his advice. During his Grand Embassy, 1797-1798, even Czar Peter the Great (1672-1725) of Russia honoured the doctor with a visit in Leiden, and in 1730, despite being told he could name his conditions, Boerhaave declined an offer from of the Russian Czarina to be her court physician. He also had a hand in selecting his successors for his various chairs.

He held memberships of several prestigious scientific societies. He was a member of the Medical College, in 1715 he was elected corresponding member of the Académie Royale des Sciences in Paris, and in 1730 he was unanimously elected Fellow of the Royal Society of London. He was chairman of the Surgeon's Guild at Leiden from 1714 to 1738.

The city of Leyden raised him a memorial with the inscription Salutifero Boerhaavii genio sacrum, and his slogan, Simplex sigillum veri – the great seal of truth is simplicity.

The Boerhaave Museum Rijksmuseum voor de geschiednis van der natuurwetenschaften en van de geneeskunde) in Leyden bears his name. «To offset all these inconveniences of the profession there remains the necessity of writing alle singularity of disease and indeed of each disease observable. For such a task it is required that the case history be so clear that when it is read the Reader will immediately see the evident correspondence, so that he will learn of the present disease from the previously described. Everything pertaining to the case must be listed; nor that least thing neglected which a critical Reader might rightly seek to understand the malady.»
Atrocis, nec descripti prius, morbi historia.

«What a hope that is, to have the philosopher’s stone! To hold to an unfailing bodily health, a constant vigour and tranquillity of mind, to preserve these into a green and rugged old age, until without a struggle or a sickness body and soul part company ... nay more, to regain lost youth - the old granddam to win back a merry suppleness, ... the wrinkles of her brow to fill and level, so that she straightens and she shines, ... even old moulted fowls to feather and lay eggs again. Yet alas for that fortunate hope: the nearer they win to it, so much the more does possession threaten present dangers to them that all but have it, and how these may be avoided I do not know.» Dissertatio academica de gaudiis alchemistarum.

«A good doctor can foresee the fatal outcome of an incurable illness: when he cannot help, the experienced Doctor will take care not to aggravate the sick person’s malady to tiring but injurious efforts; and in an impossible case he will not frustrate himself further with ineffective solicitude.»
Atrocis, nec descripti prius, morbi historia
(translated in Bulletin of the Medical Library Association, 1955, 43: 217.

«What doctor is there, who while he treats a disease unknown to him, might be at ease, until he had clearly perceived the nature of this disease and its hidden causes?»
Atrocis, nec Descripti Prius, Morbi Historia.
(translated in Bulletin of the Medical Library Association, 1955, 43: 217.

«My best patients are the poor because the Lord has taken it upon himself to pay me for them.» Quoted by Jean Cruveilhier in a letter.

«A disease which is new and obscure to you, Doctor, will be known only after death; and even then not without an autopsy will you examine it with exacting pains. But rare are those among the extremely busy Clinicians who are willing or capable of doing this correctly.»
Atrocis, nec descripti prius, morbi historia
Translated in Bulletin of the Medical Library Association, 1955, 43: 217.

Simpex veri sigillum.
The great seal of truth is simplicity.
We thank Zoran Bojanic, M.D., Serbia, for material used in this article.

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