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Herman Boerhaave – Master Clinician and Humanist

      Herman Boerhaave was born on December 31, 1668, in Voorhout, a small village in the Dutch Republic (later the Netherlands), near the city of Leiden. In 1682, Boerhaave suffered from a non-healing ulcer on his left thigh and moved to Leiden to get better medical treatment than he could obtain in his home village, but after that treatment had failed and he had suffered from chronic pain in his leg for months, he finally successfully treated himself with a mixture of his own urine and various salts. His father, a Protestant clergyman who died in 1683, played a major role in his upbringing and formation of his moral values.
      Young Boerhaave entered the University of Leiden in 1684 on a scholarship, where he studied philosophy and theology in preparation for the clergy. He was an apt student who greatly admired the work of Isaac Newton and received a gold medal for an oration on Cicero. He received a theology degree in 1689, based on his thesis on the difference between the mind and body. He continued studying theology, but he became involved in an argument on a canal boat, which led to a false accusation of being a follower of Baruch Spinoza, who was considered a heretic by both the Protestant and Catholic churches. Although Boerhaave was a devout Christian, the accusations of heresy and atheism prevented a career as a clergyman.
      During his University studies, perhaps due to his experience treating his own leg wound, Boerhaave became interested in medicine and had attended public dissections by Anton Nuck, an anatomist working in Leiden until his death in 1692. Boerhaave also independently studied the writings of Hippocrates and Bartholin as well as the famous English physician, Thomas Sydenham. Therefore, he entered the University of Harderwijk – a university that had a poor reputation but offered low tuition. Following a dissertation on the examination of excrement, he received his medical degree in 1693.
      The University of Leiden appointed him as a lecturer in 1701. In addition, he gave private lectures on the theory and practice of medicine for which he was paid by the students. He was subsequently offered a professorship at the University of Groningen in the Netherlands but rejected it despite his poor financial situation. The University of Leiden promised him he would receive a professorship when it became available.
      Boerhaave continued to teach, and his outstanding lectures attracted physicians from all of Europe. These lectures resulted in the publication of his “Institutiones Medicae” in 1708, and in the following year his aphorisms on the recognition and treatment of various diseases. That same year the chairs of medicine and botany became available at the University of Leiden and he was appointed to both. Although he had had no formal training in botany, he established one of the finest botanical gardens in Europe at the university.
      His lectures in medicine soon attracted many students from all over Europe. He was able to communicate with most of these visitors, as it was said that he spoke a dozen languages. When the professor of chemistry at the University of Leiden died, Boerhaave was appointed to succeed him. For the following decade he held three (medicine, botany, chemistry) of the five chairs at the University of Leiden, Faculty of Medicine. He lectured on chemistry to the medical students and then published an influential textbook in the field. He was an outstanding teacher because he stressed that students should understand medicine, chemistry, and botany rather than engage in simple rote memorization, and he often lectured for 4-5 hours each day. The lectures were so large and popular that some students hired others to get to the classroom early and reserve their seats.
      One of his best known students was Albrecht von Haller from Bern, who became one of the most prolific medical writers of all time. von Haller wrote more than 10,000 descriptions of plants and their uses during his lifetime, which were collected into a 61-volume herbarium. Another talented student, Gerard van Swieten, a native of Leiden, was appointed personal physician to Queen Mary Theresa of Austria. In this position, van Swieten reorganized the teaching of medicine at the Allgemeines Krankenhaus and the University of Vienna. He also established medical care for Austria, emphasizing a need for proper sanitation.
      Boerhaave revitalized bedside teaching when he developed two 6-bed wards at the St. Caecilia Gasthuis – 6 beds for men and 6 for women. He emphasized the use of the medical history and physical examination followed by the diagnosis, prognosis, and treatment plan similar to today's medical practice.
      He introduced the use of the thermometer in clinical medicine. His student, Anton DeHaen, correlated the temperature readings of patients with a thermometer designed by Fahrenheit. Although he made few original discoveries in medicine, he did describe Boerhaave syndrome, which is a spontaneous perforation of the esophagus, usually due to severe vomiting. In 1714 he subsequently became rector of the University of Leiden, in addition to his continued teaching.
      He married Maria Drolenvaux, the daughter of a wealthy merchant, in 1710. Although they had four children, only one daughter survived to adulthood.
      He was tall and had a very calm disposition. In fact, he was asked one time if he ever became angry? He answered that by nature he was passionate, but that “by prayer and meditation” he had been able to master his temper. It is said that Boerhaave received letters that were sent to “The greatest physician in the world,” and they were promptly delivered to him. In the book Institutiones Medicae, he said the ideal physician was one who was knowledgeable about the basic sciences, and was able to carry out diagnostic tests as well as investigations in clinical research.
      His success was based upon the simplicity, clarity, and wisdom exhibited in his lectures. His personal warmth and his clinical skills at the bedside were considered outstanding. It was said that he kept Peter the Great, the Russian Czar, waiting as he continued to see patients who had arrived earlier.
      He developed severe gout as he aged and was bedridden because of it at one time for 6 months. When he returned to the University, church bells in the city of Leiden were rung in celebration.
      He developed a lung abscess and died September 23, 1738. He was honored twice by the Netherlands philatelically: In 1928 (Scott #B34), and in 1938 by a stamp (Scott #B107) on the 200th anniversary of his death.