decree that no surgeon will be allowed to practice, in case he has
not a written testimonial, which he must present to the teachers in
the medical faculty, that he has for at least a year applied himself
to that department of medicine which is concerned with the teaching
and practice of surgery, and that he has, above all, learned the
anatomy of the human body in this manner, and that he is fully
competent in this department {64} of medicine, without which neither
surgery can be undertaken with success nor sufferers cured."
[Footnote 6]
[Footnote 6: The complete text of this law, which is a marvelous
anticipation of all our efforts for the regulation of the practice of
medicine down even to the present day, will be found in the appendix.]
Such a regulation, as pointed out by Professor Pilcher in an article
on the early history of dissection, [Footnote 7] and as we know by
modern experience, does not come into force as a rule before the
actual practice of what is prescribed, has been for some time the
custom and its usefulness proved by the results attained. It seems
very probable, then, that even at this early day the Emperor Frederick
was only making into a law what had been at least a custom before this
time. Lest anyone should think that this is a far-fetched assumption,
certain other paragraphs of this law, which show very definitely the
high degree to which the development of medical teaching had reached,
must be recalled. Frederick declared that medicine could only be
learned if there was a proper groundwork of logic. Only after three
years devoted to logic, then, under which term is included the grammar
and philosophy of an ordinary undergraduate course, could a man take
up the study of medicine. After three years devoted to medicine, to
which it is again specifically declared another year must be added if
surgery were to be practiced, a man might be given his degree in
medicine, but must spend a subsequent full year in the practical study
of medicine under the supervision of an experienced physician.
[Footnote 7: The Mondino Myth, Medical Library and Historical Journal,
1906]
The law further decreed definite punishments for the practice of
medicine without due warrant and violation of its regulations, and
also regulated the practice of apothecaries. It is rather interesting
to find that these {65} were forbidden to share their profits with
physicians, and the physicians themselves were not allowed to
distribute their own medicines. In a word, practically every one of
the problems in the practice of medicine which medical societies are
trying to solve at the present moment, were also occupying the
attention of the civil authorities about seven centuries ago. Anyone
who reads this law will not be loath to believe that it represents the
culmination of a series of efforts to regulate medical practice, and
especially medical education, and that it was not merely a chance
legal utterance that happened to touch a single important question for
the first time. One of the paragraphs of the law even contains some
clauses that would prevent fake medical schools and that establishes a
board of medical examiners. This consisted of certain state officials
and some professors of the art of medicine. In a word, medical
education had reached a high grade of development, and medical
practice was legally established on a high plane of professional
dignity.
Salerno had already enjoyed a high reputation as a medical school for
more than two centuries when Frederick's law was promulgated. It is
true that we have no definite records of dissections done in the
school. If these were not an uncommon occurrence, however, but came as
did dissections later on, quite as a matter of course, the absence of
such records, when we recall how liable to destruction were the meagre
accounts of the university transactions of the time during the long
period that has intervened and because of the many vicissitudes they
were liable to, is not surprising. During the century following this
decree there seems to be no doubt that dissections were done
regularly, though {66} perhaps not very frequently from our modern
standpoint, at Salerno. Salerno, as we shall see in the chapter on The
Papal Medical School, was always closely in touch with the
ecclesiastical authorities, and especially with the Papacy. There was
no hint of friction of any kind, either before or after this law of
Frederick's. The question of ecclesiastical interference with
dissection does not seem to have arisen at all, much less to have
proved an obstacle to the development of medical science.
At the beginning of the fourteenth century the center of interest in
anatomy and the matter of dissections shifts to Bologna. We have
already discussed the question whether Mondino was the first to do
public anatomies, and as to whether he performed only the few that by
a narrow misunderstanding of certain of his own words have sometimes
been ascribed to him. Professor Pilcher, in the article The Mondino
Myth, already cited, is of the opinion, and gives excellent reasons
for it, that Taddeo, the great Bolognese physician of the thirteenth
century, who was Mondino's master, had done at least some dissections
in Bologna. Personally I have long felt sure that Taddeo or Thaddeus,
as he is sometimes called in the Latin form of his name, did not a
few, but a number of dissections.
Professor Pilcher's account of him does not exaggerate his merits. I
may say that he was one of the great Papal physicians of whom we shall
have more to tell hereafter.
"Any comprehensive attempt to trace the real influences to which was
due so great a step as a return to the practice of dissections of
the human body, seems to me must be very defective if it failed to
take into consideration the influence of such a man as Thaddeus
(Italian Taddeo).{67} That he was able to impress himself in the way
in which history records that he did, both upon the general public
and upon the scholastic foundations of Bologna, shows a strength of
character and a mastery of the peculiar conditions of the moment in
the fields of science and philosophy which made him a master and an
inspirer. If he is to be considered in his proper historical light,
as one who declares that the knowledge of the structure of the human
body to a most minute degree is the foundation upon which all
rational medicine and surgery must be built, then it is impossible
to exaggerate the importance of the pivotal moment when, in the
development of science, the human body began to be anatomized. Nor
is any fault to be found with the custom which has crowned with the
laurels of universal appreciation the names of those men who began
and who continued anatomical study, who vulgarized the practice of
dissection.
"In my own investigations and reflections upon the conditions which
led up to this happy renewal of scientific search into the
composition of the body of man, it has seemed to me that writers
have hitherto fallen short of tracing through to its ultimate
source, the earlier spirit of enthusiasm for knowledge, of insight
into the problems of disease, and of contempt for traditionary
shackles, to the influence of which, as shown by the master, Taddeo,
the latter work of the pupil, Mondino, was in great measure due."
Medici, in his History of the School of Anatomy at Bologna, [Footnote
8] quotes Sarti on The Distinguished Professors of the University of
Bologna for proof of Taddeo's familiarity with dissection. Von Toeply
does not think that {68} this quotation is enough absolutely to prove
that Taddeo had done dissections, yet it would be hard to understand
it unless some such interpretation is made. Taddeo was asked to decide
a medico-legal question with regard to a pregnant woman. He refused,
however, with a modesty that might well be commended to medico-legal
experts of more modern times, to answer the question decisively,
because he had never made a dissection of a pregnant woman. Sarti
argues that it is evident from this that he had dissected other bodies
more easy to obtain than those of pregnant women, or else that he had
had the opportunity to make observations on them when dissected by
others.
[Footnote 8: Medici Compendio Storico Della Scuola Anatomica de
Bologna, Bologna, 1857. ]
Certain of Taddeo's contemporaries must have had the incentive of his
example to help them to a knowledge of human anatomy, for they surely
could not have accomplished all that they did in surgery without
experience in dissection, yet Taddeo was looked up to as a master by
all of them.
Anyone who has read the contributions to surgery of William of Salicet
and his great pupil Lanfranc, even if only what we give with regard to
them in our chapter on Surgery during the Middle Ages, cannot but be
impressed with the idea that they must have done human dissections.
They do not mention this fact explicitly, but portions of their
surgical works are taken up with the consideration of applied anatomy.
They discuss the relations of various structures to one another,
especially with reference to the surgery of them. Von Toeply, in his
Studies on the History of Anatomy in the Middle Ages, says that the
anatomies written before William's chapters on applied anatomy, were
most of them purely theoretic discussions meant to be guides for
internal {69} medicine, or else they were very short directions for
those who undertook the practical work of the dismemberment of bodies,
usually, however, with reference to animals rather than to human
bodies. In William of Salicet we encounter, he says, for the first
time a treatise on anatomy made with the deliberate purpose of its
application to practical surgery. Everywhere William gives hints for
surgical operations with special reference to the anatomical
relations.
Puccinotti quotes from William of Salicet's surgery, written about
1270, a passage that shows how familiar this surgeon must have been
with dissection. The nephew of Count Pallavicini received an arrow
wound in the jugular vein and died within an hour. During his death
agony he suffered from a peculiar form of rattle in his throat. It was
thought that this might be due to the fact that the arrow had been
poisoned. William was called in to decide this question, and found
that there was nothing responsible for his death except the wound
itself. He describes how he found the blood in the lungs and in the
heart, and considers that the conditions that were present were due to
the wound. Von Toeply has suggested that William would have given more
details had he actually examined these organs, but when the autopsy
report is negative, such descriptive details are not usual even at the
present time. If he had found reason for thinking that there was
poison in the case, a careful description of the other organs would be
necessary. The fact, however, that he was asked to decide such a
question, would seem to indicate that he was supposed to have a
knowledge of the normal appearances of human tissues when examined by
dissection.
In everything else Lanfranc went farther than his {70} master William,
and he did so also in anatomy. Some of the details of his work will be
found in our chapter on Surgery in the Middle Ages. He could not have
been able to give the detailed instructions that he has for the
treatment of every portion of the body only that he knew them by
actual contact in the cadaver as well as the patient. His outlook upon
scientific medicine and surgery would satisfy even the most exacting
of modern experimental scientists. The famous aphorism of his runs as
follows: "Every science which depends on operation is greatly
strengthened by experience." More than anything else, however, surgery
owes to Lanfranc the distinct advantage that he carried into the West
as far as Paris, the methods which had come into existence in Italy,
and were ever after to prove a precious heritage in the great French
University. As Salicet's work was carried on by Lanfranc, at least as
well was Lanfranc's work further advanced by his pupil and successor
in the chair of surgery, Henri de Mondeville. This subject of surgical
development will be treated in the chapter on Surgery in the Middle
Ages. Here it is introduced only to emphasize the opportunity there
must have been for anatomical study through dissection in the
thirteenth century, or these men would not have made the marvelous
progress they actually accomplished in this department.
With regard to Mondino, Taddeo's successor at Bologna, enough has been
said already in the preceding chapter. About this time, however, very
definite evidence begins to accumulate of the frequent practice of
dissection. Roth, whose life of Vesalius is a standard work in the
history of anatomy, has summed up most of what we know with regard to
dissections in the early {71} part of the fourteenth century, in his
chapter on Dissection Before Vesalius's Time. Roth's work is well
known and is frequently referred to in Dr. White's History of the
Warfare of Science with Theology. There can be no question, then, but
that in taking what Roth has to say I shall be quoting from a work
with regard to which there can be no hint even of partiality. Roth
himself was a Swiss, with no leaning toward the Church. There are
certain portions of his book, indeed, in which he is inclined not to
allow that the Church did as much for education in these times as she
actually did. His study of the rise of anatomy can be accepted with
absolute assurance, that it is at least not written from the
standpoint of one who wants to make the situation with regard to
anatomy more favorable than it actually was during the fourteenth
century, for the sake of showing any lack of opposition on the part of
ecclesiastics.
Some of the material that Roth has made use of has already been
referred to in the preceding chapter, but it has seemed proper to
repeat it here because this gives a connected account from a definite
authority in the history of medicine, and especially of anatomy, with
regard to the century immediately following the promulgation of
Boniface's bull. Besides, it gives an opportunity for such comments on
various features of the history of anatomy, as he details it, as will
bring out the significance of his remarks. His account will make it
very clear that, far from the Papal bull in question having been
universally construed as prohibiting dissections, as Dr. White says it
was, it never entered into the minds of medieval anatomists to
consider it as having any such signification. The bull was never
thought of in that sense at all. It does not refer to anatomy or
dissection and it never had {72} any place in the history of anatomy
until dragged into it without warrant by Daunou and other nineteenth
century writers. Roth says:
"In the pre-Vesalian period the dissection of the human body was
practiced, according to the terms of Frederick's law, for the
instruction of those about to become physicians and surgeons. The
natural place for this school anatomy--for a dissection was called
anatomia, or, erroneously, anatomia publica--was at the universities
and the medical schools. Apart from teaching institutions, however,
public anatomies were held in Strasburg and in Venice. Their purpose
was the instruction of the practicing medical personnel of these
towns. Dissections which were not made for general instruction were
called private anatomies. They were performed for the benefit of a
few physicians, or students, or magistrates, or artists. Private
anatomies began to have special importance only toward the end of
the pre-Vesalian period (this would be about the end of the
fifteenth and the first quarter of the sixteenth century). It is a
play of chance that the first historical reference to a dissection
concerns a private anatomy, one undertaken for the purpose of making
a legal autopsy. This was made in Bologna in the year 1302 (two
years after the decretal supposed to forbid dissection). A certain
Azzelino died with unexpected suddenness, after his physicians had
visited him once. A magistrate suspected poison and commissioned two
physicians and three surgeons to determine the cause of death. It
was found that death resulted from natural causes. (As I have said,
it would appear that this was not an unusual procedure, for unless
medical autopsies had been done before, it does not seem probable
that this method of {73} determining the cause of death would have
been so readily taken up.)
"Thirteen years later there is an account of the dissection of two
female bodies, in January and March of the year 1315, performed by
Mundinus." (We have already seen that the fact that the two female
bodies should be especially mentioned, though taken by some
historians of medicine to indicate that Mundinus had done but few
dissections, will not stand such an interpretation, in the light of
the evidence that he had dissected many male bodies at least, as his
text-book of anatomy indeed makes very clear. These two dissections
of females happened only to have special features that made them
noteworthy.) "A few years later (1319) there is a remarkable
document which tells the story of body-snatching for dissecting
purposes." (This would seem to be sufficient of itself to show that
a number of dissections were being done, and, indeed, as I have
already said, Rashdall, in his History of the Universities, states
that, according to the University statutes teachers were bound to
dissect such bodies as students brought to them.) Roth concludes
with the words (italics are mine): "_These are a few, but weighty
testimonies for the zeal with which Bologna pursued anatomy in the
fourteenth century._" (I may add that all of these concern the
twenty years immediately following Pope Boniface's supposed
prohibition.)
Nor was the custom of making dissections any less active during the
rest of the half century after the time when, if we are to believe
Professor White, the decree of Boniface had been universally
interpreted to forbid it. In a note to his history of dissection
during this period in Bologna, Roth says: "Without doubt the passage
in {74} Guy de Chauliac which tells of having very often (multitoties,
many times, is the exact word) seen dissections must be considered as
referring to Bologna." This passage runs as follows: "My master,
Bertruccius, conducted the dissection very often after the following
manner: The dead body having been placed upon a bench, he used to make
four lessons on it. First, the nutritional portions were treated,
because they are so likely to become putrified. In the second, he
demonstrated the spiritual members; in the third, the animate members;
in the fourth, the extremities." (Guy de Chauliac was at Bologna
studying under Bertruccius just before the middle of the fourteenth
century. It is evident beyond all doubt, from what he says, that
dissections were quite common. This is during the first fifty years
after the decree. I shall show a little later that there are records
of dissections during the second half of this century. Roth, however,
goes on to tell next of the fifteenth century.)
Roth says nothing about the decree of Boniface VIII., nor of any
possible effect that it had upon anatomy. The real historian, of
course, does not mention things that have not happened. Roth
confesses, as I have said, that he takes the material for his sketch
of anatomy before Vesalius's time from Corradi. [Footnote 9] Corradi
being an Italian, and knowing of the slander with regard to the Papal
decree, explicitly denies it. Surely, here is material enough to
convince anyone that all that Professor White has said with regard to
the supposed effect of the misinterpretation of Boniface's decree is
without foundation in the history of anatomy. Within twenty years {75}
after the bull was issued dissection was practiced to such an extent,
that body-snatching became so common that there were prosecutions for
it, and public dissections seem to have been held every year in the
universities of Italy during most of the fourteenth century.
[Footnote 9: Corradi Dello Studio e dell' Insegnamento dell' Anatomia
in Italia nel Medio Evo ed in parte del Cinquecento, Padova, 1873.]
De Renzi [Footnote 10] gives an interesting account of the methods by
which material was obtained for dissection purposes before governments
made any special provision for this purpose. Naturally, the rifling of
graves was resorted to by students intensely interested in the subject
of anatomy. The first criminal prosecution for body-snatching on
record is in 1319, when some students brought a body to one Master
Albert, a lecturer in medicine at the University at Bologna, and he
dissected it for them. At this time, according to the statutes of the
university, teachers of anatomy were bound to make a dissection if the
students supplied the body. The whole party were brought to trial for
this offence, though they do not seem to have suffered any severe
penalty for their violation of the laws. At this time, according to De
Renzi, there was a rage for dissection and many bodies were yearly
obtained surreptitiously for the purpose.
[Footnote 10: De Renzi Storia della Medicina in Italia, Napoli.
1845-49, Vol. II., p. 247.]
With regard to the bodies of condemned criminals, people began to
countenance the procedure, and while unwilling as yet to give them
freely, allowed the bodies to be taken. Corradi, quoted by Puschmann,
says "that laws against the desecration of graves, without being
abolished, became a dead letter. The authorities interfered only if
decided violence had been used or a great scandal raised. Such
consequences were likely to follow only if, in the ardor of their
enthusiasm for anatomical knowledge, students rifled the graves of
well-known {76} persons or took the bodies of those whose relatives
discovered the desecration and proceeded against the marauders by
legal measures."
At the Italian universities after the middle of the fourteenth century
there is abundant evidence for perfect freedom with regard to
dissection. We have already shown by our quotation from Roth that
Bertrucci was very active in dissection work and did many public
dissections. He was followed by Pietro di Argelata, who died toward
the end of the fourteenth century. These men followed Mondino in the
chair of anatomy at Bologna, and Julius Pagel, in his chapter on
Anatomy and Physiology in Puschmann's Handbuch der Geschichte der
Medizin (Vol. I., p. 707), says that "the successors of Mondino were
in a position, owing to the gradual enlightenment of the spirit of the
time and the general realization of the importance of anatomy as well
as the fostering liberality of the authorities, _to make regular,
systematic dissections of the human body._" This would bring us down,
then, to the end of the fourteenth century.
To return now to Roth, who takes up the next century. He says: