the year 1405 furnish many sources of information. There is a
special division which is concerned with the _annual anatomy or
dissection_ that had to be made and the selection of the persons to
be present, the payment of the expenses and other details. An
addition to the statutes, made in the year 1442, determines the
arrangement of the delivery of the body from the city to the
university authorities. Every year two bodies, one male and one
female, must be provided for the {77} medical school dissections. In
default of a female body, a second male body was to be provided. In
the presence of such detailed regulations, the absence almost
entirely of details as to the actual performance of dissections can
mean very little. Bologna reached its highest development as a
medical school at the beginning of the sixteenth century when
Alexander Achillinus and Jacob Berengarius had charge of the public
dissections there. Of these I shall speak later." (All this is at
the University of Bologna, where ecclesiastical influence was
supreme and where the Popes exercised their jurisdiction as the
ultimate authority to be appealed to in all disputed educational
questions.)
Roth continues: "Padua had, like Bologna, dissection in the
fourteenth century. There is the record of a dissection made in the
year 1341, in which Gentilis made the discovery of a gall-stone."
(It is evidently not because the dissection was unusual, but because
the discovery was unusual, that this incident is mentioned. The
dissections were such ordinary occurrences as not to deserve special
mention except for some particular reason.)
"Much more is known about dissection at Padua in the fifteenth
century, when the city had become Venetian." [Footnote 11] (It is
significant to note that the previous occurrence was in pre-Venetian
days, for Professor White insists that it was the Venetian
authorities, in opposition to the Pope, who allowed dissection at
Padua. Here is the rebuttal of any such theory.) "Bertapaglia, in
his Surgery, has the record of the dissection of a criminal made
under the direction of Master Hugo De Senis, on {78} the 8th of
February, 1429. On the 4th of April, 1430, the dissection of a woman
was made. In 1444 Professor Montagnana speaks of fourteen
dissections at which he had been present." (This would seem to
indicate that dissections were quite common and that the occasional
records of them give no proper idea of their actual number.)
[Footnote 11: Note that this is a full century before Vesalius's time,
who, Professor White insists, reintroduced dissection.]
I would not wish to produce the impression, however, that Italy was
the only place in Europe in which dissections were freely done during
the fourteenth and fifteenth centuries. There is no doubt that anatomy
and surgery and every branch of medicine was cultivated much more
assiduously and with much better opportunities provided for students
down in Italy, than anywhere else in the world. This of itself alone
shows the utter absurdity of the declarations that the Church was
opposed to medical progress in any way, since the nearer the center of
Christendom, the more ardor there was for investigation and the more
liberty to pursue original researches. Other countries also began to
wake up to the spirit of progress in medical education that was
abroad. In France there were two centers of interest in anatomy. One
of these was at Montpelier, the other at Paris. It is interesting to
note, however, that the men to whom anatomical progress is due at
these universities obtained their training, or at least had taken
advantage of the special opportunities provided for anatomical
investigation to be had, in the Italian cities. Guy de Chauliac I have
already mentioned. He is spoken of as the Father of Modern Surgery,
and there is no doubt that he did much to set surgery on a very
practical basis and to make anatomy a fundamental feature of the
training for it. He declared that it was absurd to think that surgeons
could do good work unless they knew their anatomy.
{79}
Under his fostering care the study of anatomy flourished to a
remarkable degree at the University of Montpelier. The difficulty
hitherto had been that it was very hard to procure bodies for
dissecting purposes. It is easy to understand that friends of the dead
would always prevent dissections as far as they could. They do so even
at the present moment, and there are not many of us who find it in our
hearts to blame them over much for it. Few of us are ready to make the
sacrifice of our own dead. Even the poor in those days had friends who
prevented the cutting up of their remains; for large alms-houses were
not presided over by paid officials, but by religious, to whom their
poor in their friendlessness appealed as kindred. There were not many
prisons, and they were not needed because all felonies were punished
by death. Guy de Chauliac realized that here was the best opportunity
to procure bodies. Accordingly it was mainly through his
instrumentality that a regulation was made handing over the dead
bodies of malefactors to the medical school for dissecting purposes.
It must be recalled that when he did this the Papal court was at
Avignon, in the South of France, and exerted great influence over the
University of Montpelier, situate not far away.
The reputation of the University of Paris is such that we should not
expect her to be backward in this important department of education.
As a matter of fact, there is abundant evidence of dissection having
been carried on here at the end of the thirteenth century, and the
practice was not interrupted at the beginning of the fourteenth
century. Lanfranc, the famous surgeon who had studied with William of
Salicet in Italy (we have already mentioned both of them and we shall
have much {80} to say of them hereafter), taught surgery from a very
practical standpoint in Paris, and illustrated his teachings by means
of dissections. Lanfranc was succeeded in Paris by Mondeville, whose
name is also associated with the practice of dissection by most
historians of medicine, and whose teaching was of such a practical
character that there can be no doubt that he must have employed this
valuable adjunct in his surgical training of students. In general,
however, the records of dissecting work and of anatomical development
are not near so satisfactory at Paris as in the Italian universities.
As is the case in our own day and has always been true, universities
were inclined to specialties in the Middle Ages, and the specialty of
Paris was Philosophy and Theology. This was choice, however, not
compulsion, any more than similar conditions in our own time. The
medical school continued to be in spite of this one of the best in the
world, though it was not famous for its original work, except in
surgery, which is, however, the subject most nearly related to anatomy
and the one whose development would seem necessarily to demand
attention to anatomy.
With the Renaissance, which is usually said to begin after the fall of
Constantinople in 1453, and the consequent dispersion of Greek
scholars throughout Italy, a new spirit entered into anatomy as into
every other department of intellectual life at this time. The reason
for it is not easy to explain. Perhaps the spread of Greek texts with
regard to medicine inspired students and teachers to try out their
problems for themselves, and so a new impetus was given to anatomical
investigation. Whatever it was that caused it, the new movement came
unhampered by the Church, and Italy {81} continued to be even to a
greater degree than before the Mecca for medical students who wished
to do original work in anatomy. During the last fifty years of the
fifteenth century anatomy began its modern phase, and original work of
a very high order was accomplished. There are five names that deserve
to be mentioned in this period. They are Gabriele Zerbi, Achillini,
Berengar of Carpi, Matthew of Gradi and Benivieni. Each of these men
did work that was epoch-making in anatomy, and each has a place in the
history of the science that will never be lost.
Zerbi, who did his work at Verona, traced the olfactory nerves and
describes the nerve supply of the special senses more completely than
it had ever been done before. After his time it was only a question of
filling in the details of this subject. Achillini added much to our
knowledge of the anatomy of the head, being the first to describe the
small bones of the ear and also to recognize the orifices of Wharton's
ducts. Besides this, which would have been quite enough to have given
him a place in the history of anatomy, he added important details to
what had been previously known with regard to the intestines, and
described very clearly the ileocecal valve and suggested its function.
Matthew of Gradi, or De Gradibus, was the first, according to
Professor Turner in his article on Anatomy in the Encyclopaedia
Britannica, who represented the ovaries in the correct light as
regards their anatomical relations and their function.
The most important of these fifteenth century investigators in pure
anatomy, however, is Berengarius or Berengar of Carpi, who did his
work at Bologna at the end of the fifteenth and the beginning of the
sixteenth {82} century. His commentaries on Mondino's work show how
much he added to that great teacher's instruction. If he had no other
distinction than that of having been the first to undertake a
systematic view of the several textures of which the body is composed,
it would have been sufficient to stamp him as a great original worker
in anatomy. He treats successively of the anatomical characters and
properties of fat, of membrane in general, of flesh, of nerve, of
villus or fibre, of ligament, of sinew or tendon, and of muscle in
general. Almost needless to say, he must have made many dissections to
obtain such clear details of information, and, as we shall see, he
probably did make many hundreds. If he had done nothing else but be
the first to mention the vermiform appendix, it would have been quite
sufficient to give him a distinction in our day. Everything that he
touched, however, he illuminated. His anatomy of the fetus was
excellent. He was the first to note that the chest of the male was
larger than in the female, while the capacity of the female pelvis was
in the opposite ratio. In the larynx he discovered the two arytenoid
cartilages. He recognized the opening of the common biliary duct, and
was the first to give a good description of the thymus gland. All
this, it must be remembered, before the end of the second decade of
the sixteenth century, that is, almost before Vesalius was born.
Berengar's work was done at Bologna. Some five years before his death
Bologna became a Papal city. There is no sign, however, that this
change in the political fortunes of the city made any difference in
Berengar's application to his favorite studies in anatomy. As we shall
see in the chapter on The Papal Medical School, already the Popes were
laying the foundations {83} of their own great medical school in Rome,
in which anatomy was to be cultivated above all the other sciences, so
that there would be no reason to expect from other sources of
historical knowledge any interruption of Berengar's work, and it did
not come.
A fifth great student of anatomy during the fifteenth century was
Benivieni, who has been neglected in the ordinary histories of anatomy
because his work concerned itself almost exclusively with
pathological, not with normal anatomy. In our increasing interest in
pathology during the nineteenth century, he has very properly come in
for his due share of attention. Professor Allbutt, in his address on
the Historical Relations of Medicine and Surgery down to the Sixteenth
Century, declares that Benivieni should be revered as the forerunner
of Morgagni and as one of the greatest physicians of the late Middle
Ages. Benivieni's life occupies almost exactly the second half of the
fifteenth century, as he was born probably in 1448, and died in 1502.
Allbutt says:--
"He was not a professor, but an eminent practitioner in Florence, at
a period when, in spite of its Platonism, Florence on the whole was
doing most for science; for as Bologna turned to law, Padua turned
to humanism and philosophy. He was one of those fresh and
independent observers who, like Mondeville, was oppressed by the
authority neither of Arab nor Greek."
We are not interested, however, at the present time in what he
accomplished for surgery, though there are a number of features of his
work, including the crushing of stone in the bladder and his puncture
of the hymen for retained menses, as well as his methods of division
and slow extension of the cicatricial contractions {84} resulting from
burns near the elbow, which place him among the most ingenious and
original of surgical thinkers. It is his interest in dissection that
commends him to us here. He must have done a very great number of
autopsies.
His interest in the causes of disease was so great that he seems to
have taken every possible opportunity to search out changes in organs
which would account for symptoms that he had observed. His place in
anatomy and the history of pathology has not been properly appreciated
in this matter, and Professor Allbutt claims for him the title of
Father of Pathology, rather than for those to whom it has been given,
and demands for his work done in Florence during the second half of
the fifteenth century the credit of laying the real foundation-stones
of the great science of pathological anatomy. Unfortunately, he died
comparatively young and without having had time properly to publish
his own contributions to medical science. Professor Allbutt says:--
"The little book _De abditis causis morborum_ (brief title), was not
published in any form by Antony Benivieni himself, but posthumously
by his brother Jerome, who found these precious notes in Antony's
desk after his death, and with the hearty cooperation of a friend
competent in the subject, published them in 1506 in a form which no
doubt justly merits our admiration. Benivieni's chief fame for us is
far more than all this; it is that he was the founder of
pathological anatomy. So far as I know, he was the first to make the
custom and to declare the need of necropsy to reveal what he called
not exactly "the secret causes," but the hidden causes of diseases.
Before Vesalius, before Eustachius, he opened the bodies of the dead
as {85} deliberately and clear-sightedly as any pathologist in the
spacious time of Baillie, Bright and Addison. Virchow, in his
address at Rome, said Morgagni was the first pathological anatomist
who, instead of asking What is disease? asked Where is it?"
But Benivieni asked this question plainly before Morgagni: "Not
only," says he, "must we observe the disease, but also with more
diligence search out the seat of it." The precept is so important, I
will quote the original words: "Oportet igitur medicum non solum
morbum cognoscere, sed et locum in quo fit, diligentius
perscrutari."
Among the pathological reports are morbus coxae (two cases); biliary
calculus (two cases); abscess of the mesentery, thrombosis of the
mesenteric vessels; stenosis of the intestine; some remarkable cardiac
cases, several of "polypus" (clot, which was a will-of-the-wisp to the
elder pathologists); scirrhus of the pylorus, and probably another
case in the colon; ruptured bowel (two cases); caries of ribs with
exposure of the heart. He gives a good description of senile gangrene
which even Pare did not discriminate. He seems to have had remarkable
success in obtaining necropsies; concerning one fatal case he says
plaintively, "Sed nescio qua superstitione versi negantibus cognatis,"
etc. Of another he says, "cadavere publicae utilitatis gratia inciso"
(the case of cancer of the stomach). With this admirable and original
leader, Italian medicine of the fifteenth century closes gloriously,
to slumber for some fifty years, till the dayspring of the new
learning. Of his work Malpighi says, and apparently with truth, "up to
now it is the only work in pathology which owes nothing to anyone."
{86}
This should be enough, it seems to me, to settle the question that
anatomy was permitted very freely before Versalius's time. I have said
it in other places, but it may be well to recall here, that Berengar
did his dissection at Bologna just before and after the time it became
a Papal city and when Papal influence was very strong. In spite of the
fact that in 1512 Bologna passed under the dominion of the Popes,
there is no question of any interruption or hampering of Berengar's
work in anatomy, and as a matter of fact, this great anatomist did not
succeed to the professorship of anatomy, which had been held up to
this time by Achillini, until in the very year when Bologna came under
Papal sway, and had his opportunity to do his independent work only
after this. Professor Turner can scarcely find words strong enough to
set down his admiration for Berengar and his work. Besides what we
have already quoted he says that, "the science of anatomy boasts in
Berengar of one of its most distinguished founders."
The distinguished Edinburgh anatomist harbors no illusions with regard
to any supposed opposition of the Church to dissection or to the
development of anatomy. As a life-long student of anatomy who knew the
history of his favorite science, he appreciated very well just who had
been the great workers in it and where their work had been done. He
says that "Italy long retained the distinction of giving birth to the
first eminent anatomists in Europe, and the glory she acquired in the
names of Mondino, Achillini, Berengar of Carpi, and Massa was destined
to become more conspicuous in the labors of Columbus, Fallopius and
Eustachius." These are the greatest names in the history of anatomy
down to the beginning of the seventeenth century, with the single
exception of Vesalius.
{87}
All this of anatomical development in Italy at universities that were
directly under the ecclesiastical authorities would seem to settle all
question of interference by the Popes or the Church with any phase of
anatomical development. It does not seem sufficient for Dr. White,
however. When I called attention to all these details of the history
of anatomy, long before the reformation and before Vesalius, Dr.
White's response was the following paragraph in which he explains how
dissection came to be practiced at all, and reiterates not only his
belief that Pope Boniface's bull prevented dissection, but even
insists on what cannot but seem utterly absurd to any one who has read
even the brief account I have given here, that except at one or two
places, and then only to a very limited degree, dissection was not
practiced at all. Here is how the history of dissection must be viewed
according to Dr. White:--
"But Dr. Walsh elsewhere falls back on the fact that shortly after
the decree of Pope Boniface VIII., which struck so severe a blow at
dissection, the Venetian Senate passed a decree ordaining that a
dissection of the human body should be made every year in the city
of Venice, and he leaves his readers to conclude that this
effectually proves that dissection had not really been discouraged
by the Pope. The very opposite conclusion would be deduced by anyone
familiar with the relations between the Republic of Venice and the
Papacy. These two powers were always struggling against each other;
again and again the Venetian Republic, in maintaining its rights,
braved the Papal interdicts. The fact that it allowed dissections,
so far from proving that the Pope allowed them, would seem to prove
that in this case, and in so many other cases, and especially that
of {88} Vesalius of Padua, the Venetian Senate sought to show the
Vatican that it would yield none of its rights to clerical control.
This very fact--that Venice refused to be bound with regard to
anatomical investigation by an order from the Vatican--seems to be
entirely in the line with all the other facts in the case, which
show that the Roman court had committed itself, most unfortunately,
against the main means of progress in anatomy and medicine."
Here then is the answer that a modern historian and educator makes to
all the representations with regard to the development of anatomy and
the practice of dissection during the Middle Ages. If the practice of
dissection was permitted it was in spite of the Popes. The fact that
there were a dozen of medical schools in Italy at which dissection was
carried on is ignored. The great anatomists of the fourteenth and
fifteenth centuries simply did not exist--Dr. White knows nothing
about them. There must be no admission that the Popes permitted
dissection or any other form of science. Dr. White makes his last
stand by a really marvelous tour d'esprit. It was Venice defying the
Vatican that permitted dissection. This, he supposes, may help him,
for anatomy did develop very wonderfully at Padua when it was Venetian
territory. But, as pointed out by Roth, dissection was practiced very
successfully, and the anatomical tradition established at Padua,
before it came under the dominion of Venice. At all the other
important cities of Italy dissection was carried on. We have given
some of the evidence for Verona, for Pisa, for Naples, for Bologna,
for Florence, and, be it remembered, even for Rome. Padua was the
rival of Bologna in anatomy only for a comparatively short time.
Bologna {89} always maintained a primacy in the field of anatomy, and
never more so than after she became a Papal city at the beginning of
the sixteenth century. Vesalius taught and demonstrated not at Padua
alone, but also at Bologna and at Pisa. For two centuries Rome was the
most successful rival of Bologna, _and hundreds of dissections were
done in the Papal Medical School_.
Of course, the appeal to Venetian opposition to the Papacy as an
explanation for dissection being carried on in Italy in spite of
ecclesiastical regulations to the contrary is only a subterfuge. It
can only be found in histories written by those who refuse to see
facts as they were, because those facts do not accord with pet
theories as to Papal Opposition to Science, and the Warfare Between
Theology and Science, which must be maintained at all costs, though
with an air of apology always for having to tell such unpleasant
truths of these old-time religious authorities.
{90}
THE GOLDEN AGE OF ANATOMY
VESALIUS.
The Golden Age of discovery in anatomy culminated during the first
half of the sixteenth century. This will not be surprising if it is
but recalled that this period represents the culmination also of that
larger golden age of achievement in art and letters, which has been
called the Renaissance. Columbus and Copernicus were giving men a new
world and a new universe. Raphael, Michael Angelo, Lionardo da Vinci,
the Bellinis and Titian were creating a new world of art. Most of
these artists were deeply interested in anatomy. Every phase of human
thought was being born anew. Unfortunately, this word Renaissance has
given rise to many misunderstandings. Many people have taken its
significance of re-birth to mean that art and letters, and with them
education and thinking, were born again into the modern world at this
time with the coming in of the New Learning, just as if there had been
nothing worth while talking about in these lines of human
accomplishment in the preceding centuries. Taken in this sense, the
word Renaissance is entirely a misnomer. Magnificent achievements in
art and letters and every form of education preceded the Renaissance
by at least three or four centuries. The Gothic cathedrals and the
enduring artistic development that took place in their making, the
magnificent organization of technical education in the training of
artist artisans by the guilds of the time (we would be glad if our
technical schools could accomplish {91} anything like the same
results, for evidently, though the name technical education is our
invention, these medieval peoples had the reality to a high degree),
and finally the universities, which have remained essentially the same
down to our own day--all these serve to show how much was done for
every form of education many centuries before the beginning of the
Renaissance so-called.
It is not surprising that with this much of education abroad in the
land men succeeded in making enduring literature in every form and in
every country in Europe, and in setting examples of style in prose and
verse that succeeding generations have nearly always gone back to
admire lovingly. Such an amount of education and development of
thinking could not have come without profound attention to science,
and, as a matter of fact, there was much more anticipation of even
what is most modern in our scientific thinking than most scholars seem
to have any idea of. Personally, I have found, in writing the history
of The Thirteenth the Greatest of Centuries, more that interested me
in the science of this century than in almost any other department of
its wonderful educational development.