The Evolution of Modern Medicine

Corporis Fabrica." The worth of a book, as of a man, must be judged by results, and, so judged, the "Fabrica" is one of the great books of the world, and would come in any century of volumes which embraced the richest harvest of the human mind. In medicine, it represents the full flower of the Renaissance. As a book it is a sumptuous tome a worthy setting of his jewel—paper, type and illustration to match, as you may see for yourselves in this folio—the chef d'oeuvre of any medical library. In every section, Vesalius enlarged and corrected the work of Galen. Into the details we need not enter: they are all given in Roth's monograph, and it is a chapter of ancient history not specially illuminating. Never did a great piece of literary work have a better setting. Vesalius must have had a keen appreciation of the artistic side of the art of printing, and he must also have realized the fact that the masters of the art had by this time moved north of the Alps. While superintending the printing of the precious work in the winter of 1542-1543 in Basel, Vesalius prepared for the medical school a skeleton from the body of an executed man, which is probably the earliest preparation of the kind in Europe. How little anatomy had been studied at the period may be judged from that fact that there had been no dissection at Basel since 1531.(22) The specimen is now in the Vesalianum, Basel, of which I show you a picture taken by Dr. Harvey Cushing. From the typographical standpoint no more superb volume on anatomy has been issued from any press, except indeed the second edition, issued in 1555. The paper is, as Vesalius directed, strong and good, but it is not, as he asked, always of equal thickness; as a rule it is thick and heavy, but there are copies on a good paper of a much lighter quality. The illustrations drawn by his friend and fellow countryman, van Calcar, are very much in advance of anything previously seen, except those of Leonardo. The title-page, one of the most celebrated pictures in the history of medicine, shows Vesalius in a large amphitheatre (an imaginary one of the artist, I am afraid) dissecting a female subject. He is demonstrating the abdomen to a group of students about the table, but standing in the auditorium are elderly citizens and even women. One student is reading from an open book. There is a monkey on one side of the picture and a dog on the other. Above the picture on a shield are the three weasels, the arms of Vesal. The reproduction which I show you here is from the "Epitome"—a smaller work issued before (?) the "Fabrica," with rather larger plates, two of which represent nude human bodies and are not reproduced in the great work. The freshest and most beautiful copy is the one on vellum which formerly belonged to Dr. Mead, now in the British Museum, and from it this picture was taken. One of the most interesting features of the book are the full-page illustrations of the anatomy of the arteries, veins and nerves. They had not in those days the art of making corrosion preparations, but they could in some way dissect to their finest ramifications the arteries, veins and nerves, which were then spread on boards and dried. Several such preparations are now at the College of Physicians in London, brought from Padua by Harvey. The plates of the muscles are remarkably good, more correct, though not better perhaps, on the whole, than some of Leonardo's. (22) The next, in 1559, is recorded by Plater in his autobiography, who gave a public dissection during three days in the Church of St. Elizabeth. Vesalius had no idea of a general circulation. Though he had escaped from the domination of the great Pergamenian in anatomy, he was still his follower in physiology. The two figures annexed, taken from one of the two existing copies of the "Tabulae Anatomica," are unique in anatomical illustration, and are of special value as illustrating the notion of the vascular system that prevailed until Harvey's day. I have already called your attention to Galen's view of the two separate systems, one containing the coarse, venous blood for the general nutrition of the body, the other the arterial, full of a thinner, warmer blood with which were distributed the vital spirits and the vital heat. The veins had their origin in the liver; the superior vena cava communicated with the right heart, and, as Galen taught, some blood was distributed to the lungs; but the two systems were closed, though Galen believed there was a communication at the periphery between the arteries and veins. Vesalius accepted Galen's view that there is some communication between the venous and arterial systems through pores in the septum of the ventricles, though he had his doubts, and in the second edition of his book (1555) says that inspite of the authority of the Prince of Physicians he cannot see how the smallest quantity of blood could be transmitted through so dense a muscular septum. Two years before this (1553),(*) his old fellow student, Michael Servetus, had in his "Christianismi Restitutio" annatomical touch with one another! (*) See the Servetus Notes in the Osler Anniversary Volumes, New York, 1919, Vol. II.—Ed. The publication of the "Fabrica" shook the medical world to its foundations. Galen ruled supreme in the schools: to doubt him in the least particular roused the same kind of feeling as did doubts on the verbal inspiration of the Scriptures fifty years ago! His old teachers in Paris were up in arms: Sylvius, nostrae aetatis medicorum decus, as Vesalius calls him, wrote furious letters, and later spoke of him as a madman (vaesanus). The younger men were with him and he had many friends, but he had aroused a roaring tide of detraction against which he protested a few years later in his work on the "China-root," which is full of details about the "Fabrica." In a fit of temper he threw his notes on Galen and other MSS. in the fire. No sadder page exists in medical writings than the one in which Vesalius tells of the burning of his books and MSS. It is here reproduced and translated.(23) His life for a couple of years is not easy to follow, but we know that in 1546 he took service with Charles V as his body physician, and the greatest anatomist of his age was lost in the wanderings of court and campaigns. He became an active practitioner, a distinguished surgeon, much consulted by his colleagues, and there are references to many of his cases, the most important of which are to internal aneurysms, which he was one of the first to recognize. In 1555 he brought out the second edition of the "Fabrica," an even more sumptuous volume than the first. (23) Epistle on China-root, 1546, p. 196. Vesalius may be quoted in explanation—in palliation: "All these impediments I made light of; for I was too young to seek gain by my art, and I was sustained by my eager desire to learn and to promote the studies in which I shared. I say nothing of my diligence in anatomizing—those who attended my lectures in Italy know how I spent three whole weeks over a single public dissection. But consider that in one year I once taught in three different universities. If I had put off the task of writing till this time; if I were now just beginning to digest my materials; students would not have had the use of my anatomical labours, which posterity may or may not judge superior to the rechauffes formerly in use, whether of Mesua, of Gatinaria, of some Stephanus or other on the differences, causes and symptoms of diseases, or, lastly, of a part of Servitor's pharmacopoeia. As to my notes, which had grown into a huge volume, they were all destroyed by me; and on the same day there similarly perished the whole of my paraphrase on the ten books of Rhazes to King Almansor, which had been composed by me with far more care than the one which is prefaced to the ninth book. With these also went the books of some author or other on the formulae and preparation of medicines, to which I had added much matter of my own which I judged to be not without utility; and the same fate overtook all the books of Galen which I had used in learning anatomy, and which I had liberally disfigured in the usual fashion. I was on the point of leaving Italy and going to Court; those physicians you know of had made to the Emperor and to the nobles a most unfavourable report of my books and of all that is published nowadays for the promotion of study; I therefore burnt all these works that I have mentioned, thinking at the same time that it would be an easy matter to abstain from writing for the future. I must show that I have since repented more than once of my impatience, and regretted that I did not take the advice of the friends who were then with me." There is no such pathetic tragedy in the history of our profession. Before the age of thirty Vesalius had effected a revolution in anatomy; he became the valued physician of the greatest court of Europe; but call no man happy till he is dead! A mystery surrounds his last days. The story is that he had obtained permission to perform a post-mortem examination on the body of a young Spanish nobleman, whom he had attended. When the body was opened, the spectators to their horror saw the heart beating, and there were signs of life! Accused, so it is said, by the Inquisition of murder and also of general impiety he only escaped through the intervention of the King, with the condition that he make a pilgrimage to the Holy Land. In carrying this out in 1564 he was wrecked on the island of Zante, where he died of a fever or of exhaustion, in the fiftieth year of his age. To the North American Review, November, 1902, Edith Wharton contributed a poem on "Vesalius in Zante," in which she pictures his life, so full of accomplishment, so full of regrets—regrets accentuated by the receipt of an anatomical treatise by Fallopius, the successor to the chair in Padua! She makes him say: There are two ways of spreading light; to be The candle or the mirror that reflects it. I let my wick burn out—there yet remains To spread an answering surface to the flame That others kindle. But between Mundinus and Vesalius, anatomy had been studied by a group of men to whom I must, in passing, pay a tribute. The great artists Raphael, Michael Angelo and Albrecht Durer were keen students of the human form. There is an anatomical sketch by Michael Angelo in the Ashmolean Museum, Oxford, which I here reproduce.(*) Durer's famous work on "Human Proportion," published in 1528, contains excellent figures, but no sketches of dissections. But greater than any of these, and antedating them, is Leonardo da Vinci, the one universal genius in whom the new spirit was incarnate—the Moses who alone among his contemporaries saw the promised land. How far Leonardo was indebted to his friend and fellow student, della Torre, at Pavia we do not know, nor does it matter in face of the indubitable fact that in the many anatomical sketches from his hand we have the first accurate representation of the structure of the body. Glance at the three figures of the spine which I have had photographed side by side, one from Leonardo, one from Vesalius and the other from Vandyke Carter, who did the drawings in Gray's "Anatomy" (1st ed., 1856). They are all of the same type, scientific, anatomical drawings, and that of