ershr 1 he helped to call forth the fine mettle and unshakable courage of this virtuous and virile-minded woman. THE JOHNS HOPKINS HOSPITAL BULLETIN, JUNE, 1909. ^wnis^isi!r. Her native intelligence and force of character, goaded by [162] the necessities of impending danger, as much as by the suc- cessful example of her main adversary, the unprejudiced and progressive young King of Prussia, soon taught the young Queen to break through the iron trammels of ossified usage and tradition, to recognize antiquated and inefBcient con- ditions inherited from the supine administrators of preceding reigns, and to reach out for the aid of modem men fit to [163] repair the eifects of long-standing neglect and incapacity. When Maria Theresa ascended the throne, that part of the iSTetherlands which corresponds to present-day Belgium was still an Austrian possession. Many liens of a common history, of blood and interest, persisted between the Dutch Eepublic and its Catholic sister. In the latter, a respectable measure of modern progress in arts and sciences was irresistibly in- duced by mere propinquity to Holland. Louvain attracted Catholic students from Holland, while the Protestant subjects of Maria Theresa frequented Leyden, this exchange naturally leading to mutual assimilation of ideas, to emulation, and to salutary rivalry. Evidently the great difference between the energy manifested by the schools of the Netherlands, and the lethargy that dominated Vienna, did not escape the attention of Maria Theresa. Gerhardt Van Swieten was born at Leyden on May 7, in the year 1700, of Catholic parents. His father, Thomas, and his mother, Elizabeth Van Loo, were of old Dutch stock, and of noble quality. The history of the Van Swietens went hack to the XIV Century, they having multiform relations of blood with the best families of the Low Countries. In spite of persecution, and against their material interests, they had remained steadfast Catholics. They had furnished to their country statesmen, jurists, soldiers, and administrators of dis- tinction and merit. Gerhardt received his first training in the Latin school of his native town, where his alacrity and studiousness attracted attention. While at this school, he lost both parents. The care of the orphan devolved on certain guardians who, according to Father Wurz, shamefully neglected the boy's temporal and spiritual interests. The reverend Father's [1631 acerbity seems to indicate, that the boy frequenting a Pro- testant school, sufficient attention was not paid to church attendance, confession and communion, and also that his clothing and personal cleanliness were neglected. Whatever this may mean, his zeal and unguided energy overcame all obstacles. He graduated with honors, showing special pro- ficiency in Greek and Latin — in those days the " sine qua non " of eminence in the learned professions. At sixteen, he was sent to Catholic Louvain, to prepare himself for an administrative career, to which, following family tradition, his parents had destined him. The mastering of law and of administrative science was the proper purpose of his sojourn. He not only absorbed all that was offered, but found time to cultivate modern languages, mathematics, chemistry, physics, and the natural sciences — for all of which he had developed an earlj' and eager predilection. From the beginning, his teachers became aware of the good parts of the boj' — iatelligence, pene- tration, practical sagacity and good judgment, together with dogged industry and a prodigious memory being mentioned by them. The great diversity of his studies, notably useful notions of the law and of administration acquired at Louvain, were to him of the utmost utility in his later career as organizer and administrator. The study of a wide range of human knowledge w.'is in the air at the time, and this pas- sionate acquisition of manifold information led to the rise of the French encyclopedists. Boerhaave's fame undoubtedly made the young man, an omnivorous reader, to take curioiis cognizance of his writings, and the great teacher's spell, thus cast over Van Swieten, was strong enough to determine a change of career. Accordingly, we see him at eighteen retiirned to Leyden, and sitting at the feet of the Master, whose lectures he followed from this time on for twenty consecutive years. Boerhaave was then fifty years old and at the zenith of his European fame. Immedi- ately their relations became close and cordial, and remained unchanged until the Master's death. After seven years of medical study. Van Swieten was, in 1725, graduated Doctor of Medicine. The theme of his inaugairal thesis was "De arterise fabrica." On this occasion Boerhaave took pains pub- licly to designate him as an equal, and the worthiest of his [163] pupils to become his successor. Contemporary authors all dwell with sympathetic interest on the touching relations of friendship that subsisted between these two remarkable men. Sincere manifestations of Van Swieten's exemplary modesty crop out frequently on the pages of his life's work, " The Commentaries." This sentiment, the depth of which cannot be questioned, led to his steadfast self-effacement, to the very end, before his Master, Boerhaave. Throughout his long life the great physician, organizer, statesman, and favorite of the Empress Maria Theresa, consistently and proudly proclaimed himself a mere pupil of his teacher. All he Imew, all that he accomplished was attributed to the influence of Boerhaave. In the preface to the Commentaries, we read the often quoted sentence : " It has been my good fortune to have an opportu- nity of attending Boerhaave's lectures, both public and private, for the space of near twenty years. What I hold to be still more fortunate, during all that period, I have had the honor of being admitted to a large share of his friendship and con- versation, and have been allowed to consult him freely upon every difficulty which occurred. These advantages have been peculiar to myself." To nothing except these relations must be attributed Van Swieten's unwillingness to write down his medical knowledge, original in many respects, in the shape of an independent work. His avowed preference was to figure as a mere com- mentator of his teacher. To the individualism and egotistic trend of our days, this sentiment is almost incomprehensible. In 1739, Van Swieten married Maria Lambertine Theresa Beck Von Coesfeld, daughter of an ancient and noble family, issued from Cassel in Hessia, from whom he had two sons and two daughters. We find mention of a serious illness befalling him in the early years of his marriage. Excessive application to study, and the lack of recreation and exercise seem to have produced a profound mental and physical depression, easy to recognize as a form of grave neurasthenia. Father Wurz's funeral oration thus describes the condition : " To search for the fundamental principles of the sciences at their very sources; to renounce, for the sake of solid work, all society; [163] to enclose one's self in solitude, unbroken even by the hours of repast; to neglect taJjiing nourishment until forced by [164] necessity ; to rob the nights of required rest ; thus to continue until the overburdened spirits fall into a state of sombre and sad melancholy, and the exhausted body succumbs to the load ; until bodily strength disappear; sleep vanish, and food and recreation become a source of disgust — to this regime, main- tained for several years, led the immensity of the labors of Van Swieten," etc. Boerhaave, who had been mildly protesting against these ex- cesses, finally became seriously alarmed. Fortunately, earnest remonstrances, and the evident necessities of the ease, did not fail to bring about a radical change of habits, and a cure of the malady. In 1736, against much Protestant opposition, overborne, hovpever, by Boerhaave's influence. Van S^vieten was appointed Professor to .the Chair of Materia Medica. Immediately his lectures became very popular, especially among the English students. This very popularity, however, was the undoing of the young Professor's ambition. An old law, forbidding the occupancy by a Catholic of public oflBce in Holland, was invoked by envious Protestant rivals, and Van Swieten had to relinquish his chair. Thus we see, that in this instance. Catholic intolerance found a worthy counter- part in Protestant meanness. As soon as the issue became public, an outraged and generous student body arose in riotous protest. The instigators of the intrigue against Van Swieten were waylaid, mobbed, and but for the energetic personal in- tervention of Van Swieten himself, would have sustained serious bodily damage. On this occasion, as well as ever afterward, one of the leading traits of our man's character proclaimed itself. It was a pronounced aversion to strife and controversy. In all his writings you will search in vain for ' even a single sentence conceived in the polemic spirit so com- mon in those days. When conviction compelled divergence. Van Swieten always found a proper way of robbing dissent of its sting. Morel states, that the sharpest dart he ever fired into an opponent, was that used in reference to some erro- neous ideas on the bile, advanced by a Dr. Simson. The term, " candidus vir," that is, a naive, simple-minded man, or simpleton, is immediately toned down by the remainder of Li64i the phrase, which runs thus : " Ex cujus scriptis me plura et utilissima didicisse lastus recordar," anglice — " From whose writings I gladly acknowledge to have learned many and most useful things." May it not be inferred that the pacific attitude of Van Swieten was rooted in a lack of the sense of humor, a disposition to take things over seriously, and also in the instinct of the well-bred man, who loves above all good form and suavity? The difference between Van Swieten and his illustrious schoolmate and successor in the Chair of Medi- cine at Vienna, the pugnacious, witty, and aggressive De Haen is very pronounced. Shortly after his retreat from the Chair of Materia Medica, a tempting offer was extended to Van Swieten to settle in England, where an annual fixed income of 1000 pounds, to be derived from the interest of a capital deposited " ad lioc," was to secure him against care. He declined the offer, the main reason therefor, according to Father Wurz, being his disinclination to live in a country, where Catholic public worship was a crime, punishable under the laws of the realm. Thus we see him remaining very content at Leyden, at peace with himself and the world, enjoying the pleasures of a stu- dious life spent in the friendly atmosphere of his beloved master, Boerhaave. It would be extremely interesting to shed light upon the factors that determined the first contact of Maria Theresa with Van Swieten. In the absence of facts at our disposal, we may be permitted to bring forward a legend, that circulates to this day at the University of Vienna regarding the first service Van Swieten had rendered his mistress at the time following her nuptials to Francis of Lotharingia, in 1736. The young princess was a robust, tall, earnest, and unspoiled girl of nineteen, who, thoroughly impressed with the im- portance of her future position, had been spending the best of her time in the company of an array of male teachers of ripe age. In studies, the enthusiastic pupil needed restraint rather than encouragement; she was made to seek recreation in outdoor sports, especially horseback exercise, which suited her energetic and fearless disposition. Latin, according to [164] usage, was the language of her instruction, and she acquired such a mastery of the idiom, that she could not only maintain, with much adroitness her side of a learned dispute, but could " ex tempore," deliver a lengthy address, called for by any occasion, and undismayed by a numerous audience. Her Latinity was much praised by experts. Beside the ancient authors, her studies embraced the political and administrative sciences, law, and all the accomplishments that were indis- pensable to a person of her high destiny. She revelled in the company of men distinguished in learning and state-craft, and combined with the ingenuousness of a young girl a remarkable precocity with much force of character. Having thus been brought up like a young man rather than a girl, she entered wedlock in absolute innocence of mind and body. The geni- tive instincts of the young bride of nineteen were under the glacial burden of much learning, and her aversion to the inti- macies of the married state were such an obstacle to the hope of future progeny, that it became a subject of serious care and embarrassment to the court. The legend says, that acceptance . of the advice of Van Swieten, delivered in solemn consulta- tion, speedily overcame the difficulty, its application resulting in pregnancy, and the happy delivery of a princess. The bare facts, as known to us, say that the first volume of the Commentaries had appeared in 1741; in 1745 it was fol- lowed by the second; and immediately after this the Queen extended to him a flattering call to move to Vienna and to become her " Leibarzt." As motives that may have prompted her action, we may mention: First, the shameful state of all medical affairs in the realm, an absence of talent and capacity, compelling her to go abroad for a competent physician in ordi- nary; then, the urgent desire, prompted by her keen sense of a sovereign's duty, to remedy the scandal. As to the choice of the man, we may say that he was then the foremost pupil of the famous Boerhaave, was a man of well-known talent, of good breeding and unquestioned integrity; and last, but per- haps not least, that he had borne persecution for their com- tl65] mon Catholic faith and, though tempted with, gold, had, on account of conscientious scruples, declined to enter heretical England. She would thus do a noble deed by exalting one worthy and persecuted, would acquire the services and grati- [16S tude of a man of unquestioned eminence and utility, and would at the same time teach the Protestant Dutch a useful lesson. Not without hesitation, Van Swieten finally accepted the Queen's offer, and we see him arriving in Vienna on June 7, 1745. This migration marks the closure of the first epoch of his life, an epoch devoted to the acquisition of Imowledge for knowledge's sake, warmed by the glow of the friendship of Boerhaave, embellished by the aifections of family life and by the simple pleasures of a student's existence at a small uni- versity. He had acquired little practice, but a modest patri- mony afforded him all the liberty and comfort that were neces- sary to a scholar's contentment. The change from the happy but bourgeois mediocrity of Leyden to the pomp and circum- stance of the imperial court of Vienna, must have meant a veritable revolution to the habits of the student and recluse. The promptness with which middle-aged Van Swieten was able to adjust himself to the radical change, testifies to the elasticity and energy of his temper. Surely there could have been little in his makeup of the rigidity of the book-worm and pedant. The first sign of the Queen's satisfaction with her protege was his elevation to the barony. The motto selected by him- self for his arms was characteristic of the man : " Simplex veri sigillum."" Undoubtedly, the mutual understanding so quickly established between him and the Queen was based on many points of agreement in their characters. Both were serious in the conception of their duties; both religious with- out an excess of formalism and bigotry; both just as resolute and fearless in facing ugly facts as they were energetic in meeting them by action. The friendship and kindness of the sovereign, famous for her simplicity and almost bourgeois directness of manner, were reciprocated by the sincere and earnest devotion of Van Swieten. He felt no hesitation in suggesting improvement where there was need for it. Plain- spoken, but as to manner always polished, he evidently pos- ^ Originally this was Boerhaave's own motto; it was adopted without change by Van Swieten. [165J sessed the rare art of awakening and maintaining the Queen's interest in whatever he laid before her, for otherwise how could the curious fact be explained, that in the midst of the tremendous cares of her great wars she found time to institute, through his agency, all the incisive reforms that actually took effect shortly after his appearance at Vienna. The foremost of these innovations was the successful estab- lishment on a great scale of the clinical teaching of medicine. Teaching at the bedside was unknown then both in Germany and Austria. We find its first rudiments in Padua, where, about 1558, Bottoni and Oddo are mentioned as having occa- sionally demonstrated patients to their students. Their ex- ample was imitated for a while at Pavia and Genoa, but in the 17th Century all trace of the movement had disappeared ex- cept at Leyden, where, between 1602 and 1632, at the Col- legium Practicum, bedside demonstrations were given in a desultory manner. The official establishment of a public clinic at Leyden was determined by the marked falling away of the number of students, caused by the attraction of the great fame of Professor Straten, of the newly-founded Uni- versity of Utrecht. To meet this dangerous competition, Leyden, under the direction of Otto Heumius, organized a public clinic with twelve beds, to which students were to be admitted twice weekly. Autopsies were to supplement clinical teaching. At first the students did not take kindly to the in- novation, preferring the conventional didactic lecture ex cathe- dra, so that not rarely the professor had to make his rounds unaccompanied by even one student. The fate of the new way hung in the balance for a long time, but its advantages were so manifest to the successors of Heurnius, that after him Albert Kyper, and then about 1658, Francis Sylvius de Boe, then about 1715 Bildoo, courageously maintained the tradi- tion, until Boerhaave's great personality appearing, the matter became settled forever. The battle begun by Eoger Bacon against the chimseras of scholastic learning, continued by Francis Bacon, who emphasized the hollow worthlessness of preconceived theory compared with the evidence of well- observed fact — this battle was to be brought to a final issue in the modest clinic of Levden. Here it was that Van Swieten became thoroughly saturated bv Boerhaave's discipline, and [165] the happy combination of a great principle arming the hands of a great man, with a great opportunity properly seized, re- sulted in the establishment of modern medical teaching. Van Swieten, having been appointed professor to the Chair of Medicine in 1746, had, on account of the lack of a suitable lecture-room, to begin his teaching in the vestibule of the court library (Hofbibliothek). Immediate steps were taken, however, to supply what was wanting, and the adaptation of existing and the erection of new buildings were commenced. At this time he made a gift to the medical faculty of his large and valuable collection of anatomical preparations, which, according to Hyrtl, still fonns the kernel of the ana- tomical museum of Vienna. Maria Theresa, much impressed by the energy and success of her " Leibarzt," was easily in- duced to notice the shortcomings of all other branches of public instruction. The result was, that the whole matter of higher instruction was entrusted to Van Swieten. In quick suc- cession he became Director of the Army Medical Service and of the Imperial Library. Until this time, this, one of the richest collections of books then extant was inaccessible to the public. Van Swieten not only threw open the library to everybody, but his practical sense provided a well-lighted reading-room, properly furnished with writing materials and heated in cold weather, so that visitors could comfortably follow their studies and make notes and excerpts. This innovation met with resistance, but Van Swieten's determination overcame the opposition. In those times, except in Holland, the official censure of all printed matter was an accepted prerogative of government. This duty naturally devolved on the court librarian. Van [166J Swieten. As he, himself, had tasted the bitter fruits of re- ligious persecution, he exercised the functions of this office with moderation and good sense. It is difficult to determine how much his own convictions and how much pressure from above had to do with his forbidding the circulation of the works of the French encyclopedists. This repressive attitude brought down upon him the hatred and scorn of these icono- clasts, by one of whom, Voltaire, he was pleasantly apos- [166] trophized as " a tyrant of the mind, and (in his capacity of physician) an assassin of the body." All other branches of nniversity teaching beside medicine were vivified by liis influence, the philosophical faculty re- ceiving its share of attention. New chairs were established in mathematics, astronomy, physics, chemistry, and the several branches of natural history — even philology not escaping his interest. He, himself, began the study of Hungarian and Arabic. The multiplicity of his onerous duties finally compelled him to cease teaching, but he provided a worthy successor in the person of the fiery De Haen, who was installed in 1756. Gasser was called to the chair of anatomjr, Stoerck to that of pharmacolog)', and young talented men, sought out sedulously by himself, were dispatched abroad to absorb new knowledge, later to be utilized in teaching." In the selection of suitable personalities for the multipli- city of posts to be filled, Van Swieten showed remarkable tact and talent. In the Austria of those days, more even than to-day, court favor had everything to do with the filling of appointments. Van Swieten's good sense, integrity and firm- ness of character, backed by the unswerving trust of the • Queen, knew how to meet undue influence exercised on behalf of pushing mediocrity. ISTo blandishment or threat of aristo- cratic or clerical backers of unworthy candidates could ever make him deviate from a selection made after due delibera- tion. His kindness to talented young men issuing from the humbler walks of life, was proverbial, and was practically attested by the foundation of many scholarships. The care of the widows and orphans of medical men also engaged his solicitude, and led to the organization in Vienna of one of the greatest societies devoted to this purpose. In 1763, the new university building was inaugurated. At the order of their Imperial Majesties (Francis and Maria ' To those who wish to study the effects of the first Vienna school upon the development of medicine, the work of H. Lebert, " Ueber den Einfluss der Wiener Schule des 18ten Jahrhunderts auf den positiven Fortschritt in der Medicin, Berlin, 1865, can be warmly recommended. (14) Theresa having attained their new dignities), the oil portrait lioo] of Van Swieten was apposed to a conspicuous wall of the aula, with the following inscription : Franciscus I, et Maria Theresia Augg. Hanc effigiem Gerardi L. B. Van Swieten, Ob Studium medlcum ab ipso feliciter emendatum In auditorio hujus facultatis publice appendere jusserunt Die XXX. Decembris, MDCCLXIII. In another direction, Van Swieten's personal influence brought about gi-eat amelioration. Convinced that, to do their best, men of science must enjoy a certain material ease and a reasonable independence from sordid cares, he induced the Empress considerably to augment the perquisites and salaries of the University teachers. Though multiform and onerous duties, scrupulously and diligently fulfilled, much retarded, they did not interrupt his literary activity — notably, the finishing of the Commentaries, the fifth and last volume of which did not appear until 1772, that is, shortly before his death. Besides this, he found oppor- tunity to write an excellent manual on the diseases and inju- ries affecting the army,' then a Latin work on the London epidemics, and a number of other treatises of less extent. To illustrate the scientific significance of Van Swieten, we cannot wish for a better document than his famous Commen- taries. In them he adopted Eamsay's method. Each one of Boerhaave's aphorisms serves as the text for a monograph, embracing all that in those days was known of the subject. His temperamental soberness and reserve made him a pecu- liarly fit exponent of the transitional era in which he lived. The respect for authority, especially for the ancients as trans- mitted by clerical scholasticism, is still apparent in his text; but facts as facts are not distorted to fit the rigid frame of preconceived theory. The readiness of the scholastics to fur- nish a cut-and-dried explanation for every conceivable fact, and their alacrity to ascend through pure dialectics to the pri- ■ There is strong reason to assume that his authorship of this opuscle is apocryphal: WillibaUl MiiUer: Gerhard van Swieten. Vienna, 188.3. (1.5) [ifi6]mary cause of everything, are absent from Van Swieten'"s manner. His unbiased and sensible attitude of mind is well illustrated by the following anecdote. He once said : People are amused by the words of Mollere's candidate of medi- cine, who declares that opium produces sleep because its virtue is soporific; yet he said all that could at the present be said on the matter. His love of truth as he understood it, his freedom from controversial bias and preconception, are refreshing to observe at a time, when the bad manners and vicious acrimony of religious polemics had found their way into medical literature. Of this Von Haller and De Haen offered most reprehensible examples. Van Swieten's inclination to begin each inquiry by observation, and to argue and theorize therefrom, becomes more and more manifest as we progress from the first to the last volume of the work. Whenever the premises are insuffi- cient, he honestly admits the fact, and declines to draw con- clusions. To this attitride of mind is to be attributed Van Swieten's critical sifting and simplification of the prevailing and grotesque pharmaceutical notions of his time. He in- spired the first attempts at physiological experiment made by Stoerck, who studied the effects of certain poisonous plants, as, for instance, aconite and hemlock on the living body. Boerhaave's hostility to inoculation was reflected in Van Swieten by the milder attitude of simple evasion; but when [167] Maria Theresa, herself, contracted the small fox in 1167, the good sense of the Empress over-rode her physician's lack of faith. She ordered all her household inoculated, though not without first gaining A'an Swieten's formal assent. Up to Van Swieten's time the treatment of syphilis had remained in a barbarous state, excessive salivation being con- sidered indispensable. Observing the fact, that in many in- stances the malady had the tendency to run a self-limiting ■ course, he concluded that the immoderate use of mercury was unnecessary and harmful. Precursor of this view was the " eura per extinctionem," that is, the " expectant " method that had originated at the school of Montpellier. In 1754 he succeeded in securing for Maximilian Locher the appoint- ment of Director of St. Mark's Hospital, in which all cases of syphilis were then collected. Under his direction, Locher [I67i began the methodical use of small doses of the watery solution of corrosive sublimate, first in the strength of one-quarter of a grain to the pint of water. To test the tolerance of the patient, this was gradually increased. Eesults were very encouraging, many cures succeeding without any salivation whatever. At this time it happened that a Portuguese student named Eibeiro Sanchez, having recently returned from St. Petersburg, told Van Swieten of the employment of the same drug by an old Eussian surgeon, who dissolved one grain in two ounces of brandy, administering the solution in teaspoon- ful doses. Immediately the matter was put to the test, and having been found reliable, the new preparation was admitted to the pharmacopoea under the name of "liquor Swietenii." As to the literary character of the Commentaries, we may first note the concise, yet lucid Latinity of its text, to which, in a great measure, must be attributed the long popularity of the work. The author's immense erudition is attested by over five hundred references to ancient and modern authors. Six years after the arrival of Van Swieten at Vienna, that is, in 1751, a young man by the name of Leopold Auenbrugger was appointed to the vacant position of physician to the Spanish (military) Hospital. Ten years later, Auenbrugger published his " Inventum novum," the result of seven years' research, containing the first exposition of what we now call physical diagnosis by percussion. As Auenbrugger was the immediate pupil of Van Swieten at Vienna, and repeatedly refers to his master in the text of the " Inventum," it is not conceivable that the fact of the discovery of this new and valuable aid to diagnosis should have remained unknown to Van Swieten. The fact is, however, that no mention is made of Auenbrugger's epoch-making discovery in the last two volumes of the Commentaries, published in 1764 and 1773 respectively, though they contain two long treatises on pulmo- nary phthisis and on pleuritic effusions. De Haen, Van Swieten's successor in the Chair of Medicine, paid no more attention to the work of Auenbrugger than did his predecessor. Though mention was made of the new invention in two or three of the scientific periodicals of the time, the great con- [167J temporary authorities failed to leeognize its importance. Most of those who noticed the " Inventum " did not even grasp its meaning, confounding " percussion " with the " suc- cussion " of Hippocrates. Abstaining from a criticism of Van Swieten's attitude in the matter, we shall let it rest after having stated the facts. Auenbrugger's invention, failing to attract the notice of the leaders in medicine of his time, fell into oblivion until 1808, when Corvisart, Napoleon's physi- cian, recognizing its surpassing merit, translated the " In- ventum " into the French language. According to the ways of human nature, this meritorious invention, like others, was accepted by the countrymen of the inventor only after a for- eigner of distinction had put the seal of his approval to it. Corvisart's translation was followed by Laennec's and Skoda's labors, which, in turn, made the modest Styrian's discovery the universal possession of the world. Up to the year 1769, we see the great physician and admin- istrator indefatigably directing the arduous work of intel- lectual and practical regeneration, smoothing the ways for everything that seemed to him salutary and progi'essive, stead- fastly supported in everything b}'' the confidence and energy of the great Empress. In that year, however, his health began to suffer from an increasing disorder of assimilation. Aging rapidly, he tired quickly, complained of coldness in the limbs and of recurrent pains in one leg, symptoms suggesting to our mind intermittent claudication. Evidently, his arteries were degenerating, for in March, 1772, a bleb appeared on one of the toes, and after the detachment of the slough, the phalanx became exposed. Knowing that his end was approaching, he hastened the publication of the final volume of the Commen- taries, and had the pleasiire of seeing his life's work completed. When spring had set in, the Empress arranged for his removal from the city to the salubrious airs of Schonbrunn. His de- clining days were cheered by her frequent and familiar visits. She called on him the last time a week before his death. This ensued from gangrene of the leg on June 18, 1773. Sustained by a steadfast faith, he bore his affliction with exemplary cheer- fulness and resignation. At his death, the grief of the Empress manifested itself in (18) a long and passionate fit of crying. By her orders, his statue U67] was erected in the aula of the University. His body was in- terred in the crypt of the Augustins, where it reposes with the ashes of illustrious soldiers and statesmen. The memorial service held in his honor at the University of Vienna was mentioned at the beginning of this paper. A similar tribute was accorded to his memory by the Paris Academy of Sciences, where, on April 21, 1773, an oration was delivered by the Secretary, M. de Fouchy. However, the most perennial monu- ment, erected by himself to his own fame, was the firm estab- lishment of the clinical method of teaching medicine and surgery. Vienna's example led to its rapid and universal acceptance in Germany and abroad. It also laid the foiinda- tions for the development of the second school of Vienna, the exponents of which were Eokitansky, Hyrtl, Briicke, Skoda, Oppolzer, Hebra, and Billroth. To the traits of Van Swieten's personal character, hereto- fore mentioned, we may add one or two more, adduced by Father Wurz. His temperament was ardent and impetuous, and whenever amongst his subordinates he met with inexcus- [168] able negligence, but especially with a veiled passive opposition, he was apt to be carried away by just indignation. But the very hotness of such an explosion exercised vipon him a sober- ing efl^ect. Unqualified condemnation was first modified into friendly remonstrance, then turned to kindly advice, usually ending in apologies protifered to the culprit for the violence of the well-merited rebuke. His native love of honesty and truthfulness was so strong, that from the moment a fault was frankly confessed without subterfuge or tergiversation, his forgiveness was assured. Deception and lying, however, were invariably followed by merciless expulsion from office. It is needless to state, that the injection of such an energetic and aggressive character as Van Swieten's into the stagnant life of the Vienna court, stirred up many a hornet's nest, and must have been the cause of endless intrigue. His very ingenuousness and abstention from strife and underhanded plotting, won for him the unfailing confidence and support of the Empress. Their relations remained untroubled and cordial to Van Swieten's death. 116SJ A great consulting practice and the emoluments of office naturally permitted him to accumulate a modicum of wealth, a large proportion of which, however, was spent in aiding the indigence of less fortunate colleagues, their widows and orphans, both in Holland and Austria, and in furnishing means to needy but talented students, numbers of whom were regularly aided by him in pursuing their studies at home and abroad. ^ :^ :^ iii zi: :[; The foregoing sketch easily permits the conclusion that without the possession of a broad foundation of general knowledge, both theoretical and practical. Van Swieten's career could never have attained its epoch-making importance. To fulfil such a task, much more than mere professional emi- nence was required. The principal work of Van Swieten, his Commentaries to the aphorisms of Boerhaave, have seen a number of editions in Latin, and have been repeatedly translated into the English, German, French, Spanish, and Dutch languages. The " Kurze Beschreibung und Heilungsart der ICrankheiten, welche am oftesten in dem Peldlager beobachtet werden, Trattner, Wien, Prag, und Triest, 1758," was also translated into French, English, Dutch, and Spanish. A posthumous book was " Con- stitutiones epidemicse et morbi potissimum Lugduni Batav- orum observati, ex ejusdem adversariis edidit Maximilianus StoU." Vienna and Leipzig, 1783, 2 vols. His first publication was the inaugural dissertation, " De arterise fabriea," Leyden, 1725. I also find the title of an "oratio de senum valetudine tuenda," which was published in Vienna in 1778. R529.SW5 G32 Gerster The life and times of Gerhardt van f;wif»+.(»n