[Illustration: JEAN FERNEL]
The third bright star of the Paris constellation was Jean Fernel
(1485-1558), of Amiens, who was regarded as the ablest physiologist of
his time and was physician-in-ordinary to Henry the Second. Fernel
dipped deeply into philosophy, geometry and mathematics. Before entering
the medical profession he issued three books on mathematic and geometric
subjects. He received the medical degree in 1530, but continued his
study of mathematics with such ardor that he was almost ruined
financially. On the advice of his friends he entered upon the practice
of medicine in Paris and met with remarkable success. He was skilled in
anatomy and surgery and accompanied his sovereign upon numerous military
expeditions. His medical writings are contained in many volumes and
concern a variety of subjects, such as physiology, therapeutics,
surgery, pathology, the treatment of fevers and the venereal diseases.
Fernel’s medical views were powerfully influenced by the teachings of an
unfortunate French philosopher, Pierre de la Rameé, or Ramus, who, like
many other Protestants, lost his life on Saint Bartholomew’s Night.
Brutally assassinated, his body was dragged through the streets of Paris
and then was thrown into the Seine; but his system of philosophy
survived and exercised a potent influence until it was eclipsed by the
doctrines of Descartes.
Ramus, who was an uncompromising opponent of the Aristotelian
philosophy, pointed out the defects and suggested the reforms in the
system of University education. He compared the teaching of medicine
with that of theology, much to the disparagement of the latter:—“The
reason”, said he, “why medicine is better taught, and the lectures are
better attended than in theology is, that those who teach it know it,
and practice it, and their disputations are chiefly on the books of
Hippocrates and Galen; whilst the theologians observe a strict reticence
on questions of the Old Testament, which they read in Hebrew, as well as
of the New, which they read in Greek, but display their learning in
subtle questions respecting the pagan philosophy of Plato and
Aristotle”.[18] Ramus endeavored to withdraw the minds of both
physicians and medical students from the authoritative dogmas of the
ancient physicians and to substitute therefor the intelligent study of
Nature. The practical trend of his mind is shown in his suggestion that
institutions should be arranged for clinical teaching.
[Illustration: RAMUS]
Just as Ramus had become an Eclectic in philosophy, so Fernel sought the
best from various sources and different medical systems. Like Ramus, he
cast off the yoke which authority had placed upon him; and proposed
carefully planned principles which should lead to the discovery of
truth. Like Ramus, Fernel presented his views in a clear style and in
better order than was to be found in the writings of his predecessors.
Like Ramus, he adopted the good and rejected the bad, regardless of
whether it had been said by Aristotle, or by Galen, or by Hippocrates.
Fernel was a reformer who stood for freedom of thought, which, up to his
time, had suffered from the despotism of the scholastics. Although many
of Fernel’s physiologic and pathologic ideas seem ridiculous when viewed
in the light of modern knowledge, yet he deserves praise for daring to
oppose ancient dogmas, and for pointing the road to progress. In breadth
of view, Fernel was far superior to Sylvius and Guinterius.
The anatomical teaching in Paris in the early part of the sixteenth
century was far from satisfactory. There was too much lecturing and
theorizing from Galen’s texts, and too little of actual dissection.
Vesalius, who was not backward in his criticisms, says that the
dissections were made by ignorant barbers, and during the whole time
that he was in Paris he never saw Guinterius use a knife upon a cadaver.
Only at rare intervals was a human body brought into the amphitheatre,
and then the dissection lasted less than three days. It comprised only a
superficial study of the intestines and abdominal muscles; no other
muscles were studied. The bones, veins, arteries and nerves were almost
wholly ignored. The great lights of the Paris profession were totally
unfit to give to the young Belgian what was his heart’s desire. They
were ignorant and knew it not. It is not surprising that, on more than
one occasion, Vesalius brushed the ignorant prosectors aside, took the
knife into his own hands, and carried out the dissection in a systematic
manner. His zeal and learning won the admiration of Guinterius who spoke
of Vesalius and Servetus in loving terms;—“first Andreas Vesalius, a
young man, by Hercules! of singular zeal in the study of anatomy; and
second, Michael Villanovanus (Servetus), deeply imbued with learning of
every kind, and behind none in his knowledge of the Galenic doctrine.
With the aid of these two, I have examined the muscles, veins, arteries
and nerves of the whole body, and demonstrated them to the
students”.[19]
Vesalius must have had many blue days in Paris—days when he longed to
have a free hand in dissection. A weaker character than his would have
fitted peacefully into the established order of things, but not of such
stuff was Andreas made. The difficulties which beset his path only
stimulated him to work the harder; he firmly resolved to devote his
energy, his talents and his life to anatomical study and teaching. He
decided to secure the opportunity to dissect the human body and to rival
the ancient Alexandrian professors who taught the subject. “Never”, he
says, “would I have been able to accomplish my purpose in Paris, if I
had not taken the work into my own hands”. The Book of Nature which
Sylvius lauded, but kept his pupils from studying, was now opened by
Vesalius. He dissected numerous dogs and studied the only part of human
anatomy that was available, namely, the bones. In his search for
materials for a skeleton he haunted the Cemetery of the Innocents. On
one occasion, when he went to Montfauçon, the place where the bodies of
executed criminals were deposited and bones were plentiful, Vesalius and
his fellow-student were attacked by fierce dogs. For a time the young
anatomist was in danger of leaving his own bones to the hungry
scavengers. By such dangers he gained what the Paris professors could
not supply. He became a master of the osseous system, so much so that,
when blindfolded, he was able to name and describe any part of the
skeleton which was placed in his hands. His talents were recognized by
both professors and students; and at the third anatomy which he attended
in Paris he was requested to take charge of the dissection. To the
satisfaction of the students, as well as to the astonishment of the
barbers, he made an elaborate dissection of the abdominal organs and of
the muscles of the arm.
[Illustration: VIVISECTION OF A PIG
(From the “Fabrica”, 1543)]
CHAPTER SIXTH
Vesalius Returns to Louvain
[Illustration: Illuminated capital]
In the latter part of the year 1536, owing to the outbreak of the third
Franco-German war, Vesalius returned to the University of Louvain.
During this period he secured a human skeleton by secret means.
Accompanied by his faithful friend, Regnier Gemma, known as a
mathematician as well as a physician, Vesalius visited the gallows
outside the walls of Louvain in order to search for bones. Here he found
a skeleton which was held together simply by the ligaments and still
possessed the origins and insertions of the muscles. Morley states that
the body was that of “a noted robber, who, since he deserved more than
ordinary hanging, had been chained to the top of a high stake and
roasted alive. He had been roasted by a slow fire made of straw, that
was kept burning at some distance below his feet. In that way there had
been a dish cooked for the fowls of heaven, which was regarded by them
as a special dainty. The sweet flesh of the delicately roasted thief
they had preferred to any other; his bones, therefore, had been
elaborately picked and there was left suspended on the stake a skeleton
dissected out and cleaned by many beaks with rare precision. The
dazzling skeleton, complete and clean, was lifted up on high before the
eyes of the anatomist, who had been striving hitherto to piece together
such a thing out of the bones of many people, gathered as occasion
offered”.
Such a prize could not be lost. With Gemma’s assistance Vesalius climbed
the gallows and secured the skeleton which he secretly conveyed to his
home. The treasure, however, was not complete; one finger, a patella and
a foot were missing. To this extent was Vesalius the owner of a human
skeleton. In supplying the missing parts Vesalius was obliged to incur
new dangers. He stole out of the city in the nighttime, climbed the
gallows unaided, searched through the mass of decaying bodies, and,
having found the coveted bones, he stole into the city by another gate.
These secret expeditions, however, soon became unnecessary, for the
Burgomaster of Louvain generously furnished an abundance of material for
Vesalius’s students.
It was at this period—late in the year 1536 or early in 1537—that
Vesalius conducted the first public anatomy that had been held in
Louvain in eighteen years. He performed the dissection and lectured at
the same time, which was an innovation. Some remarks he made concerning
the seat of the soul caused him to be critised by the theologians. A
further cause for suspicion was his association with such firm
Protestants as Guinterius and Sturm of Paris; and his friendly relations
with the publisher Rescius, and the physician Velsius. Fortunately the
suspicion of heresy did not lead to any formal charges, but the affair
seems to have rankled in his memory and some years later, in his
_Fabrica_, he sought to clear his name of even the appearance of heresy.
Vesalius began his career as an author by issuing a paraphrase, or free
translation, of the ninth book of the _Almansor_ of the celebrated
Rhazes[20]. This book, _liber ad Almansorem_, or work dedicated to the
Caliph Al-Mansûr, was written by a learned Arab physician who lived
between the years 860-932. The _Almansor_ consists of ten books and was
designed by the author for a complete body or compendium of Physic. The
first book treats of anatomy and physiology; the second, of
temperaments; the third, of food and simple medicines; the fourth, of
means for preserving health; the fifth, of skin diseases and cosmetics;
the sixth, of diet; the seventh, of surgery; the eighth, of poisons; the
ninth, of treatment of all parts of the body; the tenth, or last book,
deals with the treatment of fevers. The ninth book, which Vesalius
translated from the barbarous version into a readable form, was so
highly prized in mediaeval times that it was read publicly in the
schools and was commentated by learned professors for more than a
hundred years. By this publication Vesalius furnished a valuable
contribution to medical literature. The numerous marginal and
interlinear notes, which he supplied, show his intimate acquaintance
with classical literature as well as with materia medica. Vesalius
emphasizes the fact that the book of Rhazes contains many remedies which
were unknown to the Greeks. The value of his edition was increased by
the presence of original drawings of the plants mentioned in the text.
CHAPTER SEVENTH
Professor of Anatomy in Padua
[Illustration: Illuminated capital]
Shortly after the publication of his _Paraphrasis in nonum librum
Rhazae_, Vesalius journeyed into Italy. It was in the year 1537 that he
entered the prosperous and enlightened city of Venice. Here the study of
anatomy not only was not tabooed, but was encouraged, particularly by
the Theatin monks who devoted themselves to the care of the sick. At the
head of this order stood two remarkable men: J. Peter Caraffa, who later
ascended the papal throne as Paul IV.; and Ignatius Loyola, the founder
of the Jesuits. It is a strange circumstance that two strong characters
so dissimilar as were Vesalius and Loyola should meet as co-workers in
the same field. The one was filled with a thirst for anatomical
knowledge, and was dreaming of the day when his _opus magnum_ should
revolutionize an important science; the other was enthused with visions
of the world-wide acceptance of the doctrines of Catholicism. They met
again, in 1543—the year which marks two important events, namely, the
publication of the _Fabrica_, and the full recognition of the Jesuits by
the Pope.
In Venice the young anatomist entered into various lines of activity. He
experimented with a new remedy, the China root, and besought his
acquaintances to observe its effects in cases of pleurisy. He solicited
anatomical material and possibly may have conducted a public
demonstration in anatomy, although this is uncertain. He practiced minor
surgery; he leeched and opened veins, particularly the popliteal vein
which the barbers of that day did not venture to touch. In Venice he
fortunately met his countryman, Jan Stephan van Calcar, who was soon to
furnish the drawings for Vesalius’s first anatomical plates.
[Illustration: INSTRUMENTS USED IN DISSECTION
(From the “Fabrica”, 1543)]
In order to gain all the rights and privileges of a full-fledged
physician, Vesalius settled in Padua. On the 6th day of December, 1537,
shortly after having received his degree as Doctor of Medicine, Andreas
Vesalius of Brussels was appointed Professor of Surgery with the right
to teach Anatomy in the famous University of Padua. This, says Fisher,
“was the first purely anatomical chair ever instituted”.
From his own writings and from the manuscript notes of his loyal
student, Vitus Tritonius, a fairly good idea of Vesalius’s teaching can
be given. The first act of the young Paduan professor was to improve the
course in anatomy. Here, as he had done previously at Louvain, Vesalius
discharged the entire duties of the professorship. He acted as lecturer,
demonstrator and dissector. Dissatisfied with the ignorant barbers, he
ignored them and employed his students as assistants. He resorted to all
possible means to obtain anatomical material, much of which was secured
by stealth.
The aula in which Vesalius conducted his course was built of wood and
was capable of holding five hundred persons. In the centre of the room
was a table under which was a receptacle containing bones and joints. An
articulated skeleton was placed in an upright position at one end of the
table. In this elegantly appointed room, before an audience of
distinguished laymen and students, the instruction in anatomy was given.
The course was a strenuous one, occupying practically the entire day for
a period of three weeks, and comprising not only human but also much
comparative anatomy. The vivisection of dogs, pigs, and rarely of cats,
was a regular part of the course. Drawings were used to elucidate the
relations between the skeleton and the soft parts; and frequently
Vesalius marked the outlines of the joints upon the skin of the subject.
He also marked the cranial sutures with ink. His anatomical charts were
the work of his own hand; at times he drew the pictures in the presence
of his audience. His dissections were made with extreme neatness and
dexterity. He used but few instruments and these were of the simplest
kind: knives of different shapes, hooks, cannula, catheter, sounds,
bristles, hammer, saw, needles, thread and a sponge. Forceps and
injection apparatus were not used; he rarely used scissors. Much of the
actual separation of tissues was done by the aid of the finger-nails. A
vivisection board completed the list _de instrumentis quae anatomes
studioso debent esse ad manum_.
Let us now follow one Vesalius’s public courses in anatomy. It is the
month of December, in the year 1537. The report has spread that the
young Belgian professor will begin his course. Long before the hour set
for the lecture, every available seat has been taken and many persons
are standing. An audience comprising the professors of the University,
the students of medicine, officials of the city of Padua, and learned
persons of all ranks, including members of the clergy, numbering more
than five hundred persons, has assembled to do honor to the professor of
anatomy.
Vesalius comes into the arena and walks to the table which is closely
surrounded by his auditors. He wastes no time; after a few preliminary
remarks on the importance of anatomy and the methods of acquiring a
knowledge of this science, he launches into the practical demonstration.
After rapidly pointing out the divisions of the body, and demonstrating
the skin, joints, cartilages, ligaments, glands, fat and muscles, he
passes to the more complex parts, all of which are shown upon the
skinned body of a dog or of a lamb, in order to conserve the human
material. Now the human cadaver is placed on the table; all eyes are
turned upon it, for such a demonstration occurs only at long intervals.
Vesalius speaks first of the difference in the structure of joints at
different ages and in different sexes, illustrating his remarks by means
of drawings and by an abundant supply of bones of man and of the lower
animals.
Now comes the dissection. This is made rapidly and in regular order. Its
course depends upon the amount of material at hand; if the professor
resorts to two bodies, as in the year 1538, the demonstration is handled
in grand style. Vesalius uses the first body for a comprehensive
examination of the muscles, ligaments and viscera; whilst the second
cadaver is devoted to the relations of the veins, arteries, nerves and
viscera. The text of the _Fabrica_ is written according to this plan of
public dissection.
At times Vesalius attempted to teach the whole of anatomy on one
cadaver. In this event, osteology was followed by the dissection of the
abdominal muscles layer by layer, the demonstration closing with an
examination of the entire contents of the abdomen. The pelvic organs
were reached by incision and separation of the symphysis pubis. If the
cadaver was that of a female, the dissection began with the mammary
glands and then passed to the inferior venter. In pregnancy the foetal
membranes were removed intact, and were placed in a vessel filled with
water. The foetus was opened and its anastomosing vessels were found.
For demonstrating the cotyledons, the uterus of a sheep or goat was
used. After the thorax had been raised by means of a log or brick,
Vesalius passed to the face and the anterior part of the neck, freely
exposing the muscles on one side and the vessels and nerves on the
other. Then followed the unilateral preparation of the muscles of the
shoulder and back, then those of the mouth, which were approached by
means of division of the lower jaw; and, finally, the pharynx and the
larynx were exposed. The rectus anticus muscle was next brought into
view, whereupon Vesalius detached the head from the vertebral column.
Decapitation was followed by an examination of the cranium; the
skull-cap was sawed and the brain was dissected in its natural position.
Then came the examination of the eye, which Vesalius dissected in two
ways: either by a complete section, or layer by layer from without
inwards.
The ear and the cavities of the frontal and sphenoidal bones were next
opened, provided these bones were not needed for the setting up of a
skeleton. Finally he took up the extremities, demonstrating the muscles
of an arm and a leg on one side, and the nerves and vessels on the
other. The anatomy lesson ended with the introduction of numerous
vivisections.
Vesalius could not entirely escape disputations, but he gave to them a
close anatomic basis. Theoretical physiology was repugnant to him; for
him physiology was not speculation but the sequel of anatomic research.
If he at times gave free reign to his views, he indicated them as mere
theories. He did not ignore pathologic conditions, but he handled them
as briefly as possible. Fearing to tire his audience with too much
variety, he confined his students closely to the structure of the human
body.
The merit of Vesalius’s public dissections, and the impression which
they made upon his auditors, can be appreciated only by comparison with
similar demonstrations made by his predecessors. The large and
enlightened audience remained day by day for a period of three or four
weeks. He says not a word about the physical and mental strain incident
to such a strenuous course, in which his entire time was employed. The
courses brought great financial profit to the professor.
On two occasions, probably in the years 1539 and 1540, Vesalius was
called from Padua to Bologna to conduct public dissections. This was a
great honor, for Bologna was the city in which Mondino had revived the
practical teaching of anatomy. These courses were conducted by Vesalius
in a wooden building erected for that particular purpose. Here, as in
Padua, the professor acted as demonstrator and lecturer, remaining in
this ancient city for a period of several weeks. On the first occasion
he was supplied with three human bodies and was enabled to handle the
subject in grand style. At the first séance he engaged with the
celebrated Professor Matthaeus Curtius, whose acquaintance he had made
in 1538 while on a vacation trip, in a deep study of the question of
venesection. Before a large and select assembly he demonstrated in all
three bodies that Galen’s description of the vena azygos was incorrect.
On the second convocation Vesalius seems to have disposed of more
bodies. He reviewed Galen’s work on the joints, and by numerous
specimens, which were prepared by the students, he demonstrated the
difference in the ancient knowledge of the skeleton. On this occasion he
undertook the complete dissection of an ape and presented its skeleton,
as well as that of a man, to Professor John Andreas Albius, who held the
chair of Hippocratic medicine in Bologna.
Little is known of the way in which Vesalius taught surgery. The first
year he was in Padua, he began with Avicenna’s treatise on tumors.
According to the fragmentary notes in the college book of his ardent
pupil, Vitus Tritonius, Vesalius compared Avicenna’s teachings with the
classical works of Hippocrates, Galen, Paul of Aegina, and Aetius,
explaining and correcting them.
[Illustration: INITIAL LETTER BY VESALIUS
(From the “Fabrica”, 1543)]
CHAPTER EIGHTH
First Contribution to Anatomy
[Illustration: Illuminated capital]
Like all great teachers, Vesalius was ever mindful of the interests of
his students. Soon after accepting the chair of Anatomy in Padua, he
articulated a human skeleton for use in his class room. His next work
was the preparation of a set of anatomical plates, _Tabulae Anatomicae_,
which were intended to pave the way to anatomy for beginners. For the
further benefit of his class, he edited an edition of Guinterius’s
_Institutionuin Anatomicarum_, which was issued in April, 1538.