Chapter III: Introduction (2)

Giacomo Berengario, Jacobus Berengarius Carpensis, also known as Carpus, was born in the small town of Carpi, in the Duchy of Modena, in the year 1470. His father, who was a surgeon, directed his studies, and for a time he was placed under the instruction of the learned Aldus Manutius. Graduating in medicine from the University of Bologna, Berengario became noted for his skill in surgery and anatomy. He taught these branches in Pavia, and was a member of the Bologna faculty from 1502 to 1527. Then he practiced for a time in Rome, where he amassed a fortune by the treatment of the victims of syphilis. The last twenty years of his life were spent in Ferrara, where he died in 1550. Berengario was one of the restorers of anatomy. His first dissection is said to have been made in the house of Albert Pion, Seigneur de Carpi. This demonstration was given publicly upon the body of a pig. Soon the anatomist turned his attention to human subjects, of which it is said that more than a hundred passed beneath his scalpel.

Berengario’s later years are said by Brambilla to have been made miserable by the machinations of the agents of the Inquisition, who objected to some of his opinions regarding the organs of generation. He was unjustly accused of dissecting living men—an accusation which arose from his statement that the surgeon should observe the anatomy of the living body whenever it was opened by wounds or accidents.

Berengario determined to improve Mondino’s book by making corrections in the text, and by adding suitable illustrations. No illustrations were to be found in the early editions of Mondino, and those which were added by later editors of the work were untrue to nature. To Berengario must be given the credit of furnishing some of the first anatomical illustrations that were published, and that were made from actual human dissections. These appeared in his “Commentaries of Carpus upon the Anatomy of Mundinus”, (_Carpi Commentaria super_ _Anatomia Mundini_), which was published at Bologna in 1521. The volume contains twenty-one plates which were cut in wood. They have been credited to the celebrated artist, Hugo da Carpi. While the drawing is somewhat coarse, the illustrations are true to nature and show a distinct advance over preceding pictures of this class. Berengario states that his plates will be of value not only to physicians and surgeons but also to artists (_et istae figurae etiam juvant pictores in lineandis membris_). Some of his figures are schematic; for example, those showing the abdominal muscles. So much better are his illustrations than those of his predecessors that it may fairly be claimed that Berengario was the first author to produce an illustrated anatomy.

Berengario also wrote a “Short Introduction to the Anatomy of the Human Body”, _Isagogae Breves in Anatomiam Humani Corporis_; and a work on Fracture of the Skull.

He was the first anatomist who described the basilar part of the occipital bone, the sphenoidal sinus and the tympanic membrane. Meryon[8] credits him with the “first correct description of the great omentum (gastrocolic) and transverse mesocolon; of the caecal appendix vermiformis, of the valvulae conniventes of the intestines; of the relative proportions of the thorax and pelvis in man and woman; of the flexor-brevis-pollicis; of the vesiculae seminales; of the separate cartilages of the larynx; of the membranous pellicle in front of the retina (attributed to Albinus); of the tricuspid valve, between the right auricle and ventricle of the heart; of the semilunar valves at the commencement of the pulmonary artery; of the inosculation between the epigastric and mammary arteries, and an imperfect account of the cochlea of the ear”. He was the first of the mediaeval anatomists to deviate from the Galenic teaching in regard to the structure of the heart. He diplomatically states that in the human subject the foramina in the cardiac septum are seen only with great difficulty (_sed in homine cum maxima difficultate videnter_).

John Dryander

John Dryander, a German physician, whose true name was Eichmann, called himself Dryander in accordance with the custom of adopting names derived from the Latin or Greek languages. He was born about the year 1500 in the Wetterau in Hesse. After obtaining proficiency in mathematics and astronomy, he went to Paris where he studied medicine for several years. Returning to Germany, he engaged in the study of practical anatomy and became a professor in Marburg, in which city he died in the year 1560. He is said to have conducted the first dissections that were made in Marburg, where he taught anatomy for twenty-four years, or from 1536 to 1560.

Dryander, although he was a partisan of Mondino and da Carpi, and was a fierce and sometimes an unfair opponent of Vesalius, deserves to be regarded as one of the restorers of anatomy. He made several observations upon the distinction between the cortical and the medullary portions of the brain; and was one of the earliest practical anatomists of the sixteenth century to furnish anatomical illustrations. He made important astronomical observations and was the inventor of several useful instruments. He was the author of three medical works of which two were upon anatomy. His _Anatomia Mundini_, which was published at Marburg in 1541, contains forty-six plates, many of which have been copied from Berengario’s work.

Charles Estienne

Charles Estienne, better known by the name of _Carolus Stephanus_, was a French anatomist whose work is worthy of remembrance. Born in the early part of the sixteenth century, he was given an excellent education. He belonged to a noted Huguenot family of scholars and printers who have made the Estienne name famous. Robert Estienne, the brother of Charles, became the victim of religious persecution; he was obliged to flee to save his life, and for a time the publishing business was conducted by Charles Estienne. The latter also suffered for his faith; he was thrown into a dungeon, where he died in the year 1564. Charles Estienne wrote numerous books on literature, history, forestry and botany. His anatomical treatise, _De Dissectione Partium Corporis Humani_, appeared at Paris in 1545 with sixty-two full page plates which combine anatomical clearness, beauty of form, and artistic representation. A French translation of Estienne’s Anatomy was published in 1546. This work was printed as far as the middle of the third book as early as the year 1539: some of the plates are dated as early as 1530. The illustrations have been excellently cut in wood; many of them show the entire body, with much ornamentation, so that the proper anatomical part seems small and irrelevant. Some of the plates show the subject in picturesque and even loathsome attitudes. The text of this work is especially valuable for the history of anatomical discovery. Although he was an ardent Galenist, Estienne made numerous original observations in anatomy. He described the synovial glands, a discovery which has been credited to Clopton Havers. Estienne was the first anatomist to discover the canal in the spinal cord; he described the capsule of the liver, a tissue which bears Glisson’s name; and differentiated the eight pair from the sympathetic nerves. He was the first anatomist to see and describe the valves in the veins, which he called _apophyses venarum_— discovery which has been claimed for Jacobus Sylvius, Cannanus, Amatus and Fabricius.

The question of priority in the discovery of the valves of the veins gave rise to much controversy. It is reasonable to assume that these structures were noticed independently by all of the anatomists whose names are mentioned above.

CHAPTER FOURTH
Vesalius’s Early Life

Andreas Vesalius, or Wesalius as the family name was inscribed prior to the year 1537, was born in Brussels on the last day of the year 1514. From astrological observations made by Jerome Cardan we learn that this event occurred about six o’clock in the morning, and under favorable stellar auspices. The placenta and caul, to which popular belief ascribed remarkable powers, were carefully preserved by the mother.

The Vesalius family originally was named Witing, (_Witting_, _Wytinck_, _Wytings_, according to various authorities) and adopted the name Wesalius from the town of Wesel, (_Wesele_, _Vesel_), in the Duchy of Cleves, which the family claimed as their native place. The three weasels (_Flemish_—“Wesel”), found in the Vesalian coat of arms, testify to this origin.

It may be said with truth that medical learning ran in the blood of the Vesalius family. Andreas’s great-great-grandfather, Peter Wesalius, wrote a treatise on some of the works of Avicenna and at great cost restored the manuscripts of several medical authors. Peter’s son, John Wesalius, held the responsible position of physician to Mary of Burgundy, the first wife of Maximilian the First; in his old age John taught medicine in the University of Louvain. From that time the Vesalius family was closely associated with the Austro-Burgundian dynasty. Eberhard, son of John Wesalius, served as physician to Mary of Burgundy; he died before attaining his thirty-sixth year, and was long survived by his father. Eberhard, who was the grandfather of Andreas, wrote commentaries upon the books of Rhazes and on the _Aphorisms_ of Hippocrates. He was also noted as a mathematician. Eberhard’s son Andreas, the father of the anatomist, was apothecary to Charles the Fifth and to Margaret of Austria. He accompanied the great Emperor upon his numerous journeys and military expeditions. In 1538 he presented Andreas’s first anatomical plates to the Emperor, and thus opened the way to the court to his son. The father remained in the imperial service until the day of his death, which occurred in 1546. Andreas’s mother, Isabella Crabbe, exercised a great influence upon the youth whom she believed to be destined to accomplish great things. She it was who preserved the manuscripts and books of the Vesalian ancestors. Isabella happily lived long enough to see the _Fabrica_, to witness the intellectual triumph of her son, and to know of his activity at the Spanish court.

Little is known of the youth of Vesalius. The traditions of his ancestors, their accomplishments in the field of letters and in medicine, and their loyalty to their sovereigns, were themes which his mother must have recounted with pleasure. At an early age Andreas was sent to the neighboring city of Louvain, whose University, founded in the year 1424, in the early part of the sixteenth century eclipsed many institutions of greater age, and in the number of its students ranked second only to the University of Paris. The theologians of Louvain were noted for their orthodox Catholicism; from the very first days of religious controversy they had battled strongly against the rising tide of the Reformation. Her professors of jurisprudence and of philosophy were men of eminent talents. Within the University were four literary schools which were named _Paedagogium Castri_, _Porci_, _Lilii_, and _Falconis_, from their insignia:—a fort, a pig, a lily, and a falcon. Here also was the _Collegium trilingue Buslidianum_, which was founded by Hieronymus Busleiden (+1517) for teaching the Greek, Hebrew and Latin languages. Vesalius selected the _Paedagogium Castri_ which he fondly mentions in laudatory terms in his _Fabrica_. Here, and in the Busleidinian College, he obtained that thorough knowledge of ancient languages which, in later years, astonished his hearers and served him well in numerous literary controversies. The names of Vesalius’s teachers are unknown, although Adam[9] states that John Winter of Andernach was his professor of Greek. Vesalius speaks scornfully of one of his teachers, a theologian, who, in trying to explain Aristotle’s _De Anima_, used a picture of the _Margarita Philosophica_ to show the structure of the brain. Among Vesalius’s school companions were Gisbertus Carbo, to whom the anatomist presented the first skeleton which he articulated (_Fabrica_, 1543, page 162); and the younger Granvella, who later was Chancellor to Charles the Fifth.

At an early age Vesalius possessed a desire to study the structure of the human body. His powers of observation were precociously developed. When a boy, learning to swim by the aid of bladders filled with air, he noted the elasticity of these organs, and he referred to the incident in his _Fabrica_ (1543, page 518). When little more than a child, he tired of dialectics and tried to learn anatomy from the scholastic writings of Albertus Magnus and of Michael Scotus. He soon discovered that the true road to anatomical science led, not through books but through the actual handling of the dead tissues. He began the practical study of anatomy by dissecting the bodies of mice, moles, rats, dogs and cats.[10]

CHAPTER FIFTH
Sojourn in Paris

One thought was uppermost in the mind of Vesalius, and that was to follow the profession of his ancestors, just as in ancient Greece the sons of the Asclepiadae naturally adopted the vocation of their fathers. Andreas possessed an excellent preliminary education and was especially proficient in the Greek and Latin languages; he also knew something of Hebrew and much of Arabic. It was in the year 1533 that the young Belgian travelled to Paris for the purpose of obtaining a medical education. At that time the French capital was the Mecca of the medical world—Paris, that city where classical medicine first secured support (_ubi primum medicinam prospere renasci vidimus_)[11]. In Paris, under the leadership of Budaeus, Humanism had enjoyed a rapid growth; and here Petrus Brissotus, after gaining the doctor’s cap in the year 1514, produced a revolution by delivering his lectures from the books of Galen in place of the treatises of Averröes and of Avicenna. At his own expense Brissotus published Leonicenus’s translation of Galen’s _Ars Curativa_, in order that his pupils might not be misled by the incorrect text of the Arab authors. It will be recalled that, long before this time, classical Greek and Latin medical literature had passed through the distorting crucible of Saracenic translations. At this period medical science, purified from Arabic dross, was taught in a splendid manner in Paris by such eminent professors as Jacobus Sylvius, Jean Fernel, and Winter of Andernach. At their feet sat young men from the remotest parts of Europe.

The most popular of the Paris teachers was Jacobus Sylvius, or Jacques Dubois, whose Latinized name is perpetuated in anatomical nomenclature. He was born at Louville, near Amiens, in 1478. In his early years he was noted for his scholarly attainments in the Greek, Latin and Hebrew languages and was the author of a French grammar. His anatomical knowledge was gained under Jean Tagault, a famous Parisian practitioner and surgical author.

Sylvius was noted for his industry, for his eloquence, and above all for his avarice. It was the inordinate desire for money which led him to abandon philology for medicine. While studying under Tagault he began a course of medical lectures, explanatory of the works of Hippocrates and Galen, with such success that the Faculty of the University of Paris protested on the score that Sylvius was not a graduate. He then went to Montpellier, whose medical professors had long held a high position, where, according to Astruc, he received the doctor’s cap at the end of November, 1529. He was then above fifty years of age. Armed with this degree, he returned to Paris and immediately entered the lists as an independent medical teacher, but was again halted by the Faculty who ruled that he must first receive the Bachelor’s degree. This he gained on June 28, 1531. Sylvius then resumed his lectures with such success that his classes in the Collége de Tréguier numbered from four to five hundred, while Fernel, who was a professor in the Collége de Cornouailles, lectured to almost empty benches. In 1550, Henry the Second named Sylvius Professor of Medicine, as the successor of Vidus Vidius, in the recently established Collége de France. Sylvius died January 13, 1555, and was interred in the paupers’ cemetery as he had wished.

Sylvius was not only an eloquent lecturer but he was also a demonstrative teacher. He was the first professor in France who taught anatomy from the human cadaver. In his lectures on botany he used a collection of plants to elucidate the subject. His chief fault was a blind reverence for ancient authors. He regarded Galen’s writings as gospel; if the cadaver presented structures unlike Galen’s description, the fault was not in the book but in the dead body, or, perchance, human structure had changed since Galen’s time! In one of his early books[12], Sylvius declared that Galen’s anatomy was infallible; that Galen’s treatise, _De Usu Partium_, was divine; and that further progress was impossible!

The character of Sylvius was contemptible. He was a man of vast learning and at the same time was rough, coarse and brutal. His avarice led him to endure the cold winters of Paris without the benefit of a fire; in severe weather he would play at football, or engage in other violent exercise in his room, to save the cost of fuel. Once, and once only, did his friends find him hilarious; they wondered and asked the cause. Sylvius said he was happy because he had dismissed his “three beasts, his mule, his cat and his maid”. He was notoriously rigid in exacting his fees from students, and on one occasion he threatened to stop his lectures until two delinquents should pay their dues. Although he was supposed to have amassed great wealth, little of it was found after his death, and these sums were secreted in secluded places. In 1616, when his former residence in the _rue Saint-Jacques_ was demolished, numerous gold pieces were found. His reputation for miserliness followed him beyond the grave, as witness his epitaph:

_Sylbius hic situs est, gratis qui nil dedit unquàm,_
_Mortuus et gratis quod legis ista dolet._

“Sylvius lies here, who never gave anything for nothing:
Being dead, he even grieves that you read these lines for nothing.”

In controversies he was violent and vindictive—a pastmaster in the use of bitter language. Jealous of the fame of other anatomists, he was particularly enraged when, in later years, he was opposed by Vesalius. Sylvius spoke of him not as Vesalius, but as _Vesanus_, a madman, who poisoned Europe by his impiety and clouded knowledge by his blunders. Such was the man who, in the mid-part of the sixteenth century, filled the position of highest honor in the Medical Faculty of the Collége de France[13].

Sylvius rendered valuable service in naming the muscles which, prior to his time, were designated by numbers. These, says Northcote[14] “were differently applied by almost every author; so that it was the description, and not the name, that must lead one to know what part was meant by such authors; and this required a previous thorough knowledge of anatomy”. He is the first writer who mentions colored injections and is supposed to have discovered this useful adjunct of anatomical study. He was the first anatomist who published satisfactory descriptions of the pterygoid and clinoid processes of the sphenoid bone, and of the os unguis. He gave a good account of the sphenoidal sinus in the adult but denied its existence in the child, as had been affirmed by Fallopius[15]. Sylvius also wrote intelligently concerning the vertebrae but incorrectly described the sternum. His observation concerning the valves in the veins gave rise to much discussion; the honor of priority in the discovery, however, belongs to other anatomists—Estienne and Cannanus. His discoveries in cerebral anatomy have caused his name to be attached to the _aqueduct_, the _fissure_ and the _artery of Sylvius_.

The manner in which Sylvius conducted his anatomical course is known to us by his own writings, by the testimony of Moreau[16], and by that of Vesalius[17]. Thus the course for the year 1535 began with the reading, by Sylvius, of Galen’s treatise _De Usu Partium_. When the middle of the first book was reached, Sylvius remarked that the subject was too difficult for his students to understand and that he would not plague his class with it. He then jumped to the fourth book, read all to the tenth book, discussed a part of the tenth and omitting the eleventh, twelfth and thirteenth, he took up the fourteenth and the remaining three books. Thus he omitted all that Galen had said concerning the extremities. A second Galenic work which Sylvius used was the anatomico-physiologic treatise, _De Musculorum Motu_. Not infrequently the professor was unable to demonstrate in dissection the parts on which he had lectured. Thus, on one occasion, the students succeeded in finding the pulmonary and aortic valves which Sylvius had failed to find on the preceding day.

Joannes Guinterius of Andernach

Another famous member of the Paris Faculty of this period, and a man whose life-story reads like a romance, was Joannes Guinterius, the beggar of Deventer. Guinterius (Gonthier, Guinther, Guinter, Winter, or Winther), who is often called John Winter of Andernach, from the name of the town in which he was born, lived between the years 1487-1574, and rose to eminence in both the literary and the medical worlds. Born of humble parents, he was sent at an early age to the University of Utrecht. Leaving this institution because of his poverty, he went to Deventer where he was reduced to the necessity of begging in the streets. He drifted to the University of Marburg, and here displayed such brilliant talents that he soon obtained employment as a teacher in the small town of Goslar, in Brunswick. His growing reputation for learning led to his appointment to the chair of Greek in the noted University of Louvain.

Desiring to study medicine, Guinterius went to Paris in 1525; he received the Bachelor’s degree in 1528, and the full medical title two years later. He passed a brilliant examination which won for him the commendation of the most eminent professors. Remaining in Paris, he engaged in practice and in teaching, and rapidly rose to eminence. In addition to conducting courses in anatomy, he translated into Latin the writings of the most noted Greek medical authors of antiquity—the books of Galen, of Oribasius, of Paul of Aegina, of Caelius Aurelianus, and of Alexander of Tralles—all of which were held in high esteem in the sixteenth century. His fame reached far beyond the boundaries of France. Christian III., the enlightened king of Denmark, who was noted for his love of literature, sought to attach him to the Danish court, but the honor was refused. Having become a convert to the religious views of Luther, Guinterius found that his life was in danger; he left Paris and resided for a time in Metz. He soon removed to Strassburg, where he was received with distinguished honors and was appointed to a professorship in the University. Owing to the activity of his enemies, his position became insecure; accordingly, he resigned his chair and spent a considerable time in travelling throughout Germany and Italy. In the year 1562, Ferdinand I., in appreciation of the great merits of Guinterius, raised him to the highest distinction by placing him among the nobles of the land; and thus the beggar of Deventer became a nobleman of Strassburg. His life ended October 4, 1574.

Like Sylvius, Guinterius was a teacher of men who became greater than himself—Vesalius, Servetus and Rondelet sat upon his benches. Like Sylvius, he placed his faith in Galen and failed to grasp the great truth that anatomical science is based, not on the writings of the Fathers but on dissection of the dead body.

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.

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.

CHAPTER SIXTH
Vesalius Returns to Louvain

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

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.

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.

CHAPTER EIGHTH
First Contribution to Anatomy

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.

Tabulae Anatomicae

The _Tabulae Anatomicae_ were in the form of _Fliegende Blätter_, or loose leaves, and consisted of six plates which are now among the rarest of medical works. They bore the following title:

_Tabulae Anatomicae. Imprimebat Venetiis B(ernardinus).
Vitalis Venetus sumptibus Joannis Stephani
Calcarensis Prostrant verò in officina
D. Bernardini. a. 1538._

In the preface Vesalius says that no one can learn either botany or anatomy from figures alone, but illustrations are a valuable means toward the imparting of knowledge. In publishing these plates he hopes to benefit those persons who had attended his public dissections. Not a line in these pictures is unnatural; all has been reproduced just as he had shown in his demonstrations. He gives due credit to van Calcar, the artist who made the drawings of the three skeletons. The other pictures were made by the author himself.

The _Tabulae Anatomicae_ were arranged in the following order:—

I.—The Portal System and the Organs of Generation;
II.—The Venae Cavae and Chief Veins;
III.—The Great Artery—Arteria Magna—and the Heart;
IV.—The Skeleton in its Anterior View;
V.—The Skeleton in its Side View;
VI.—The Skeleton in its Posterior View.

The plates are of large dimensions, measuring over sixteen inches in length, and were cut in wood. Like those in the _Fabrica_, they were made in Italy. Owing to their transient use by medical students, the _Tabulae_ were soon destroyed, although unauthorized editions were printed in several cities. The book was dedicated to Narcissus of Parthenope (Narciso Verdunno, or Vertuneo) who, in 1520, was first physician to the crown of Naples, and later, in 1524, was physician and councilor to Charles the Fifth. It is noteworthy that three of these plates deal with the skeleton, a subject to which Vesalius had given much attention. The absence of a plate showing the nervous system is also to be noted. Vesalius had such a plate prepared, and it appeared in a pirated edition of the _Tabulae_ which was published at Cologne in 1539. The large size of these plates, their fidelity to nature, and the skill with which they were cut in wood, were features which showed to the world that a real master of anatomy had been born. The original drawings were made by Jan Stephan van Calcar, who probably also was the engraver.

Only two copies of the _Tabulae Anatomicae_ are known. A fine edition of these plates, reproduced by photography, was privately issued in 1874 by Sir William Stirling-Maxwell, the talented author of the _Annals of the Artists of Spain_.

CHAPTER NINTH
Publication of the Fabrica

On the first day of August, 1542, after three years of strenuous labor, Vesalius completed the _Fabrica_, and twelve days later he wrote the last word of the _Epitome_. The blocks for the _Fabrica_, and also those for the _Epitome_, were made in Italy. In the summer of 1542 they were conveyed to Basel by a merchant named Danoni and were safely delivered to the printer, Oporinus. They were accompanied by a long Latin letter, written by Vesalius to his friend, “Joannes Oporinus, professor of Greek letters in Basel”. He begs Oporinus to take the greatest care that the printed illustrations shall correspond with the proofs which accompany the blocks. “Every detail must be distinctly visible, so that each cut shall have the effect of a picture”. Early in the following year Vesalius went to Basel to superintend the printing of his books. While there, he conducted a demonstration in anatomy—the first which had occurred in that city since 1531—and presented the articulated skeleton of the subject to the University. Part of this skeleton exists today. It is thought to be the oldest anatomical preparation in existence.

The Fabrica

The heart of Vesalius must have filled with joy when he saw the final page of his book turned from the press. The treatise which founded modern anatomy bears this title:—

_Andreae Desalii Brurellensis, Scholae medicorum
Patabinae professoris, de humani corporis
fabrica Libri septem. Basileae._
MDXLIII

A fortune was lavished upon the illustration and publication of this grand work. To use the words of Fisher, “it was and is a glorious book, a rare and precious monument of genius, industry and liberality”. It abounds with curious initial letters bearing quaint and interesting anatomical conceits, each one teaching its lesson. One of these, reduced in size, introduces the present chapter; and it was this letter that Vesalius used in his opening sentence: _Os caeterarum hominis partium est durissimum & ardissimum, maximaque terrestre & frigidum, & sensus denique praeter solos dentes expers._

The first edition of the _Fabrica_ is a folio volume with magnificent illustrations on wood, all carefully printed by Joannes Oporinus (1507-1568) of Basel.

The title-page is a beautiful engraving which represents Vesalius at work dissecting a female subject. He is surrounded by interested spectators who crowd the amphitheatre. The abdomen of the subject is opened. Vesalius has raised his left hand; his right hand grasps a small rod which rests on the viscera. The great teacher is talking to his pupils. Placed at the head of the dissecting table is an upright skeleton which grasps a long staff with its right hand. In the audience are many persons of different rank. To the left a naked man is climbing a pillar, while to the right, and below, a dog is being brought into the arena. To the left, and below, is a monkey which appears to enjoy the demonstration. Above, in the architecture, we see the monogram of the publisher, Oporinus; in the centre, on a shield, are the three weasels of the Vesalius family, and below, is a shield which bears the privilegium. This old engraving is one of the most spirited and elaborate to be found in the whole range of medical literature. In the 1725 edition, for which Jan Wandelaar made copperplate reproductions of the original figures, the title-page is altered:—the monogram of Oporinus is absent and the architecture is slightly changed.

Who was the unnamed artist? It is noteworthy that Vesalius does not state who drew the illustrations, or who cut them in wood, for his _Fabrica_. He only states that this book has cost him a monstrous amount of labor in the preparation of the dissections, and in the directing of the eye, the hand, and the intelligence of the artist. He complains bitterly of the obstinacy of the artist, who, at times so tormented him that he—Vesalius—considered himself more unfortunate than the criminal whose body had been dissected[21]. It was probably owing to this unpleasant experience that Vesalius omitted the artist’s name. The great anatomist speaks regretfully of the large sums which he was obliged to pay, in order to induce skilled artists to undertake this class of work. He states that they were much more interested in painting Venus and The Graces than in drawing pictures of skinned and foul smelling bodies. Moehsen[22] assumes that Vesalius had Titian in mind when he penned these thoughts, but this is questionable. It is not surprising that eminent artists should have disliked anatomical drawing, at a time when antiseptic injections and preserving fluids were not known. Foul odors had no terrors for the great Belgian, who haunted cemeteries for anatomical material and often kept parts of cadavers in his bedchamber for weeks at a time.