the division of those nerves which are connected with the thorax; and
shows particularly the effect of dividing the recurrent branch of his
sixth pair of cerebral nerves (the pneumogastric of modern anatomy). He
explains how it happens that after division of the spinal cord, provided
that division be _beneath_ the lower termination of the neck, the
diaphragm will still continue to act--in consequence, namely, of the
origin of the phrenic nerve being _above_ the lower termination of the
neck.
Before the time of Galen the medical profession was divided into several
sects, _e.g._ Dogmatici, Empirici, Eclectici, Pneumatici, and
Episynthetici, who were always disputing with one another. After his
time all sects seem to have merged in his followers. The subsequent
Greek and Roman biological writers were mere compilers from his works,
and as soon as his writings were translated into Arabic they were at
once adopted throughout the East to the exclusion of all others. He
remained paramount throughout the civilized world until within the last
three hundred years. In the records of the College of Physicians of
England we read that Dr. Geynes was cited before the college in 1559 for
impugning the infallibility of Galen, and was only admitted again into
the privileges of his fellowship on acknowledgment of his error, and
humble recantation signed with his own hand. Kurt Sprengel has well said
that "if the physicians who remained so faithfully attached to Galen's
system had inherited his penetrating mind, his observing glance, and his
depth, the art of healing would have approached the limit of perfection
before all the other sciences; but it was written in the book of
destiny that mind and reason were to bend under the yoke of superstition
and barbarism, and were only to emerge after centuries of lethargic
sleep."
FOOTNOTES:
[16] Hence the name {thêriakai}.
[17] "De Antidotis," i. 13, vol. xiv. p. 65, Kuhn.
[18] "Ex ipsius etiam Galeni verbis hanc veritatem confirmari posse,
scilicet: non solum posse sanguinem e vena arteriosa in arteriam venosam
et inde in sinistrum ventriculum cordis, et postea in arterias
transmitti."--"De Motu Cordis," cap. vii.
VESALIUS.
_VESALIUS._
The authority of Galen, at once a despotism and a religion, was scarcely
ever called in question until the sixteenth century. No attempt worth
recording was made during thirteen hundred years to extend the boundary
of scientific knowledge in anatomy and physiology. It is true that the
scholastic philosopher, Albertus Magnus, who was for a short time
(1260-1262) Bishop of Ratisbon, in the middle of the thirteenth century
wrote a "History of Animals," which was a remarkable production for the
age in which he lived; although Sir Thomas Browne, in his famous
"Enquiries into Common Errors," speaks of these "Tractates" as requiring
to be received with caution, adding as regards Albertus that "he was a
man who much advanced these opinions by the authoritie of his name, and
delivered most conceits, with strickt enquirie into few."
As regards human anatomy, it was considered, during the Middle Ages, to
be impiety to touch with a scalpel "the dead image of God," as man's
body was called. Mundinus, the professor of medicine at Bologna from
1315 to 1318, was the first to attempt any such thing. He exhibited the
public dissection of three bodies, but by this created so great a
scandal that he gave up the practice, and contented himself with
publishing a work, "De Anatome," which formed a sort of commentary on
Galen. This work, with additions, continued to be the text-book of the
schools until the time of Vesalius, who founded the study of anatomy as
nowadays pursued.
Andreas Vesalius was born at Brussels, on the last day of the year 1514,
of a family which for several generations had been eminent for medical
attainments. He was sent as a boy to Louvain, where he spent the greater
part of his leisure in researches into the mechanism of the lower
animals. He was a born dissector, who, after careful examination, in his
early days, of rats, moles, dogs, cats, monkeys, and the like, came, in
after-life, to be dissatisfied with any less knowledge of the anatomy of
man.
He acquired great proficiency in the scholarship of the day. Indeed the
Latin, in which he afterwards wrote his great work, is so singularly
pure that one of his detractors pretended that Vesalius must have got
some good scholar to write the Latin for him. Latin was not the only
language in which he was proficient; he added Greek and Arabic to his
other accomplishments, and this for the purpose of reading the great
biological works in the languages in which they were originally written.
From Louvain the youth went to Paris, where he studied anatomy under a
most distinguished physician, Sylvius. It was the practice of that
illustrious professor to read to his class Galen on the "Use of Parts,"
omitting nearly all the sections where exact knowledge of anatomical
detail was necessary. Sometimes an attempt was made to illustrate the
lecture by the dissection of a dog, but such illustration more often
exposed the professor's ignorance than it added to the student's
knowledge. Indirectly, however, it did good, for whenever Sylvius, after
having tried in vain to demonstrate some muscle, or nerve, or vein, left
the room, his pupil Vesalius slipped down to the table, dissected out
the part with great neatness, and triumphantly called the professor's
attention to it on his return.
Besides studying under Sylvius, Vesalius had for his teacher at Paris
the famous Winter, of Andernach, who was physician to Francis I. This
learned man, in a work published three years after this period, speaks
of Vesalius as a youth of great promise. At the age of nineteen Vesalius
returned to Louvain; and here for the first time he openly demonstrated
from the human subject. In this connection a somewhat ghastly story is
told, which serves to show the intensity of the enthusiasm with which
our anatomist was inspired. On a certain evening it chanced that
Vesalius, in company with a friend, had rambled out of the gates of
Louvain to a spot where the bodies of executed criminals were wont to
be exposed. A noted robber had been executed. His body had been chained
to a stake and slowly roasted; and the birds had so entirely stripped
the bones of every vestige of flesh, that a perfect skeleton, complete
and clean, was suspended 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. Mounting upon the shoulder of
his friend, Vesalius ascended the charred stake and forcibly tore away
the limbs, leaving only the trunk, which was securely bound by iron
chains. With these stolen bones under their clothes the two youths
returned to Louvain. In the night, however, and alone, the sturdy
Vesalius found his way again to the place--which to most men, at any
rate in those times, would have been associated with unspeakable
horrors--and there, by sheer force, wrenched away the trunk, and buried
it. Then leisurely and carefully, day after day, he smuggled through the
city gates bone after bone. Afterwards, when he had set up the perfect
skeleton in his own house, he did not hesitate to demonstrate from it.
But such an act of daring plunder could not escape detection, and he was
banished from Louvain for the offence. This story is here quoted only to
show the extraordinary physical and moral courage which the anatomist
possessed; which upheld him through toils, dangers, and disgusts; and by
which he was strengthened to carry on, even in a cruel and
superstitious age, and placed, as he was, on the very threshold of the
Inquisition, a work at all times repulsive to flesh and blood.
After serving for a short time as a surgeon in the army of the Emperor
Charles V., Vesalius went to Italy, where he at once attracted the
attention of the most learned men, and became, at the age of twenty-two,
Professor of Anatomy at the University of Padua. This was the first
purely anatomical professorship that had been established out of the
funds of any university. For seven years he held the office, and he was
at the same time professor at Bologna and at Pisa. During these years
his lectures were always well attended, for they were a striking
innovation on the tameness of conventional routine. In each university
the services of the professor were confined to a short course of
demonstrations, so that his duties were complete when he had spent,
during the winter, a few weeks at each of the three towns in succession.
He then returned to Venice, which he appears to have made his
head-quarters. At this city, as well as at Pisa, special facilities were
offered to the professor for obtaining bodies either of condemned
criminals or others. At Padua and Bologna the enthusiasm of the
students, who became resurrectionists on their teacher's behalf, kept
the lecture-table supplied with specimens. They were in the habit of
watching all the symptoms in men dying of a fatal malady, and noting
where, after death, such men were buried. The seclusion of the graveyard
was then invaded, and the corpse secretly conveyed by Andreas to his
chamber, and concealed sometimes in his own bed. A diligent search was
at once made to determine accurately the cause of death. This pitiless
zeal for correct details in anatomy, associated as it was with
indefatigable practice in physic, appeared to Vesalius, as it does to
his successors of to-day, to be the only satisfactory method of
acquiring that knowledge which is essential to a doctor. Thus it was
that he, who at the age of twenty-two was able to name, with his eyes
blindfolded, any human bone put into his hand, who was deeply versed in
comparative anatomy, and had more accurate knowledge of the human frame
than any graybeard of the time, enjoyed afterwards a reputation as a
physician which was unbounded. One illustration of his sagacity in
diagnosis will suffice. A patient of two famous court physicians at
Madrid had a big and wonderful tumour on the loins. It would have been
easily recognized in these days as an aneurismal tumour, but it greatly
puzzled the two doctors. Vesalius was therefore consulted, and said,
"There is a blood-vessel dilated; that tumour is full of blood." They
were surprised at such a strange opinion; but the man died, the tumour
was opened; blood was actually found in it, and we are told _in
admirationem rapti fuère omnes_.
It was not until after Vesalius had been three years professor that he
began to distrust the infallibility of Galen's anatomical teaching.
Constant practical experience in dissection, both human and comparative,
slowly convinced him that--great anatomist as the "divus homo" had
undoubtedly been--his statements were not only incomplete, but often
wrong; further, that Galen very rarely wrote from actual inspection of
the human subject, but based his teaching on a belief that the structure
of a monkey was exactly similar to that of a man. With this conviction
established, Vesalius proceeded to note with great care all the
discrepancies between the text of Galen and the actual parts which it
endeavoured to describe, and in this way a volume of considerable
thickness was soon formed, consisting entirely of annotations upon
Galen. The generally received authorities being thus found to be
unreliable, it became necessary in the next place to collect and arrange
the fundamental facts of anatomy upon a new and sounder basis. To this
task Vesalius, at the age of twenty-five, devoted himself, and began his
famous work on the "Fabric of the Human Body." Owing possibly to the
good fortune of his family, and to the income which he derived from his
professorships, Andreas was able to secure for his work the aid of some
of the best artists of the day. To Jean Calcar, one of the ablest of the
pupils of Titian, are due the splendid anatomical plates which
illustrate the "Corporis Humani Fabrica," and which are incomparably
better than those of any work which preceded it. To him most likely is
due also the woodcut which adorns the first page, and which represents
the young Vesalius, wearing professor's robes, standing at a
lecture-table and pointing out, from a robust subject that lies before
him, the inner secrets of the human body; while the tiers of benches
that surround the professor are completely crowded with grave doctors
struggling to see, even climbing upon the railings to do so.
But throughout the work the plates are used simply to illustrate and
elucidate the text, and the information furnished in the latter is
minute and accurate, and stated in well-polished Latin. As the author
proceeds, he finds it necessary to disagree with Galen, and the reasons
for this disagreement are given. The inevitable result follows that
Vesalius is placed at issue not only with "the divine man," but also
with all those who for thirteen centuries had unquestioningly followed
him. Such a result Vesalius must have foreseen. It was not, therefore, a
great surprise to him, perhaps, to receive, soon after the publication
of his work, a violent onslaught from his old master Sylvius. He simply
replied to it by a letter full of respect and friendly feeling,
inquiring wherein he had been guilty of error. The answer he got was
that he must show proper respect for Galen, if he wished to be regarded
as a friend of Sylvius.
In 1546, three years after the publication of his great work, Andreas
was summoned to Ratisbon to exercise his skill upon the emperor, and
from that date he was ranked among the court physicians. In the same
year, 1546, in a long letter, entitled "De usu Radicis Chinæ," he not
only treats of the medicine by which the emperor's health had been
restored, but he vindicates his teaching against his assailants, and
again gives cumulative proof of the fact that Galen had dissected only
brutes.
It was the practice of Vesalius, while he was professor in Italy, to
issue a public notice the day before each demonstration, stating the
time at which it would take place, and inviting all who decried his
errors to attend and make their own dissections from his subject, and
confound him openly. It does not appear that any one was rash enough
ever to accept the challenge; yet, although the majority of the young
men were on the side of Vesalius, the older teachers continued to regard
him as a heretic, and in 1551 Sylvius published a bitterly personal
attack. It was nothing to him that the results of actual dissection were
against him--he even went so far as to assert that the men of his time
were constructed somewhat differently to those of the time of Galen!
Thus, to the proof that Vesalius gave that the carpal bones were not
absolutely without marrow, as Galen had asserted, Sylvius replied that
the bones were harder and more solid among the ancients, and were, in
consequence, destitute of medullary substance. Again, when Vesalius
showed that Galen was wrong in describing the human femur and humerus as
greatly curved, Sylvius explained the discrepancy by saying that the
wearing of narrow garments by the moderns had straightened the limbs.
Through these attacks, however, the writings of Vesalius fell into
somewhat bad odour in the court; for in that very superstitious age
there was a kind of vague dread felt of reading the works of a man
against whom such serious charges of arrogance and impiety were brought.
And so it came about that when he received the summons to take up his
residence permanently at Madrid, and the orthodoxy of the day seemed for
the moment to triumph, in a fit of proud indignation, he burned all his
manuscripts; destroying a huge volume of annotations upon Galen; a whole
book of medical formulæ; many original notes on drugs; the copy of Galen
from which he lectured, and which was covered with marginal notes of new
observations that had occurred to him while demonstrating; and the
paraphrases of the books of Rhases, in which the knowledge of the
Arabian was collated with that of the Greeks and others. The produce of
the labour of many years was thus reduced to ashes in a short fit of
passion, and from this time Vesalius lived no more for controversy or
study. He gave himself up to pleasure and the pursuit of wealth, resting
on his reputation and degenerating into a mere courtier. As a
practitioner he was held in high esteem. When the life of Don Carlos,
Philip's son, was despaired of, it was Vesalius who was called in, and
who, seeing that the surgeons had bound up the wound in the head so
tightly that an abscess had formed, promptly brought relief to the
patient by cutting into the pericranium. The cure of the prince,
however, was attributed by the court to the intercession of St. Diego,
and it is possible that on the subject of this alleged miraculous
recovery Vesalius may have expressed his opinion rather more strongly
than it was safe for a Netherlander to do. At any rate, the priests
always looked upon him with dislike and suspicion, and at length they
and the other enemies of the great anatomist had their revenge.
A young Spanish nobleman had died, and Vesalius, who had attended him,
obtained permission to ascertain, if possible, by a post-mortem
examination, the cause of death. On opening the body, the heart was
said--by the bystanders--to beat; and a charge, not merely of murder,
but of impiety also, was brought against Vesalius. It was hoped by his
persecutors that the latter charge would be brought before the
Inquisition, and result in more rigorous punishment than any that would
be inflicted by the judges of the common law. The King of Spain,
however, interfered and saved him, on condition that he should make a
pilgrimage to the Holy Land. Accordingly he set out from Madrid for
Venice, and thence to Cyprus, from which place he went on to Jerusalem,
and was returning, not to Madrid, but to Padua, where the professorship
of physic had been offered him, when he suffered shipwreck on the island
of Zante, and there perished miserably of hunger and grief, on October
15, 1564, before he had reached the age of fifty. His body was found by
a travelling goldsmith, who recognized, notwithstanding their starved
outlines, the features of the renowned anatomist, and respectfully
buried his remains and raised a statue to his memory.
Two of the works of this great man have been already referred to,
namely: "De Corporis Humani Fabrica;" "De usu Radicis Chinæ." Besides
these the following have appeared: "Examen Observationum Gabrielis
Fallopii;" "Gabrielis Cunei Examen, Apologiæ Francisci Putei pro Galeno
in Anatome;" a great work on Surgery in seven books.
With respect to the last of these, it may be sufficient to remark that
there is every reason to believe that the name of the famous anatomist
was stolen after his death to give value to the production, which was
compiled and published by a Venetian named Bogarucci; and that Vesalius
is not responsible for the contents.
The other works are undoubtedly genuine. In 1562 Andreas seems to have
been roused for a short time from the lethargy into which he had sunk,
by an attack from Franciscus Puteus; for to this attack a reply
appeared--from a writer calling himself Gabriel Cuneus--which has always
been attributed by the most competent authorities to Vesalius himself.
In this rather long work, covering as it does more than fifty pages in
the folio edition, the views of Vesalius, which are at variance with
Galen, are gone through _seriatim_ and defended.
In 1561 Fallopius, who had studied under Vesalius, published his
"Anatomical Observations," containing several points in which he had
extended the knowledge of anatomy beyond the limits reached by his
master. He had taught publicly for thirteen years at Ferrara, and had
presided for eight years over an anatomical school, so that he was no
novice in the field of biology. Yet so completely had Vesalius lost the
philosophic temperament that he regarded this publication as an
infringement of his rights, and in this spirit wrote an "Examen
Observationum Fallopii," in which he decried the friend who had made
improvements on himself, as he had been decried for his improvements on
Galen. The manuscript of this work, finished at the end of December,
1561, was committed by the author to the care of Paulus Teupulus of
Venice, orator to the King of Spain, who was to give it to Fallopius.
The orator, however, did not reach Padua until after the death of
Fallopius, and he consequently retained the document until Vesalius, on
his way to Jerusalem, took possession of it, and caused it to be
published without delay. It appeared at Venice in 1564.[19]
The letter on the China root--a plant we know nowadays as
sarsaparilla--by the use of which the emperor's recovery was effected,
has been already referred to. It was addressed to the anatomist's
friend, Joachim Roelants. Very little space, however, is taken up with a
description of the medicine which gives title to the letter. Something
certainly is said of the history and nature of the plant, the
preparation of the decoction and its effects; but the writer soon
introduces the subject which was at that time of very vital importance
to him, namely, his position with regard to the statements of Galen and
his followers. He collects together various assertions of the Greek
anatomist, on the bones, the muscles and ligaments, the relations of
veins and arteries, the nerves, the character of the peritoneum, the
organs of the thorax, the skull and its contents, etc., and shows from
each and all of these that reference had not been made to the human
subject, and that therefore the statements were unreliable.
To the work on the "Fabric of the Human Body" we have already alluded,
as well as to the causes which led to its being written. More than half
of this great treatise is occupied with a minute description of the
build of the human body--its bones, cartilages, ligaments, and muscles.
It may have been owing to the thorough acquaintance which Vesalius
showed with these parts that his detractors pretended afterwards that he
only understood superficial injuries. But other branches of anatomy are
fully dealt with. The veins and arteries are described in the third
book, and the nerves in the fourth; the organs of nutrition and
reproduction are treated of in the next; while the remaining two books
are devoted to descriptions of the heart and brain.
Vesalius gives a good account of the sphenoid bone, with its large and
small wings and its pterygoid processes; and he accurately describes the
vestibule in the interior of the temporal bone. He shows the sternum to
consist, in the adult, of three parts and the sacrum of five or six. He
discovered the valve which guards the _foramen ovale_ in the f[oe]tus;
and he not only verified the observation of Etienne as to the valve-like
fold guarding the entrance of each hepatic vein into the inferior vena
cava, but he also fully described the _vena azygos_. He observed, too,
the canal which passes in the f[oe]tus between the umbilical vein and
vena cava, and which has since been known as the _ductus venosus_. He
was the first to study and describe the mediastinum, correcting the
error of the ancients, who believed that this duplicature of the pleura
contained a portion of the lungs. He described the omentum and its
connections with the stomach, the spleen, and the colon; and he
enunciated the first correct views of the structure of the pylorus,
noticing at the same time the small size of the cæcal appendix in man.
His account of the anatomy of the brain is fuller than that of any of
his predecessors, but he does not appear to have well understood the
inferior recesses, and his description of the nerves is confused by
regarding the optic as the first pair, the third as the fifth, and the
fifth as the seventh. The ancients believed the optic nerve to be hollow
for the conveyance of the visual spirit, but Vesalius showed that no
such tube existed. He observed the elevation and depression of the brain
during respiration, but being ignorant of the circulation of the blood,
he wrongly explained the phenomenon.