The Evolution of Modern Medicine

THE same year, 1542, saw a very different picture in the far-famed city of Padua, "nursery of the arts." The central figure was a man not yet in the prime of life, and justly full of its pride, as you may see from his portrait. Like Aristotle and Hippocrates cradled and nurtured in an AEsculapian family, Vesalius was from his childhood a student of nature, and was now a wandering scholar, far from his Belgian home. But in Italy he had found what neither Louvain nor Paris could give, freedom in his studies and golden opportunities for research in anatomy. What an impression he must have made on the student body at Padua may be judged from the fact that shortly after his graduation in December, 1537, at the age of twenty-four, he was elected to the chair of anatomy and surgery. Two things favored him—an insatiate desire to see and handle for himself the parts of the human frame, and an opportunity, such as had never before been offered to the teacher, to obtain material for the study of human anatomy. Learned with all the learning of the Grecians and of the Arabians, Vesalius grasped, as no modern before him had done, the cardinal fact that to know the human machine and its working, it is necessary first to know its parts—its fabric. To appreciate the work of this great man we must go back in a brief review of the growth of the study of anatomy. Among the Greeks only the Alexandrians knew human anatomy. What their knowledge was we know at second hand, but the evidence is plain that they knew a great deal. Galen's anatomy was first-class and was based on the Alexandrians and on his studies of the ape and the pig. We have already noted how much superior was his osteology to that of Mundinus. Between the Alexandrians and the early days of the School of Salernum we have no record of systematic dissections of the human body. It is even doubtful if these were permitted at Salernum. Neuburger states that the instructions of Frederick II as to dissections were merely nominal. How atrocious was the anatomy of the early Middle Ages may be gathered from the cuts in the works of Henri de Mondeville. In the Bodleian Library is a remarkable Latin anatomical treatise of the late thirteenth century, of English provenance, one illustration from which will suffice to show the ignorance of the author. Mundinus of Bologna, one of the first men in the Middle Ages to study anatomy from the subject, was under the strong domination of the Arabians, from whom he appears to have received a very imperfect Galenic anatomy. From this date we meet with occasional dissections at various schools, but we have seen that in the elaborate curriculum of the University of Padua in the middle of the fifteenth century there was no provision for the study of the subject. Even well into the sixteenth century dissections were not common, and the old practice was followed of holding a professorial discourse, while the butcher, or barber surgeon, opened the cavities of the body. A member of a famous Basel family of physicians, Felix Plater, has left us in his autobiography(19) details of the dissections he witnessed at Montpellier between November 14, 1552, and January 10, 1557, only eleven in number. How difficult it was at that time to get subjects is shown by the risks they ran in "body-snatching" expeditions, of which he records three. (19) There is no work from which we can get a better idea of the life of the sixteenth-century medical student and of the style of education and of the degree ceremonies, etc. Cumston has given an excellent summary of it (Johns Hopkins Hospital Bulletin, 1912, XXIII, 105-113). And now came the real maker of modern anatomy. Andreas Vesalius had a good start in life. Of a family long associated with the profession, his father occupied the position of apothecary to Charles V, whom he accompanied on his journeys and campaigns. Trained at Louvain, he had, from his earliest youth, an ardent desire to dissect, and cut up mice and rats, and even cats and dogs. To Paris, the strong school of the period, he went in 1533, and studied under two men of great renown, Jacob Sylvius and Guinterius. Both were strong Galenists and regarded the Master as an infallible authority. He had as a fellow prosector, under the latter, the unfortunate Servetus. The story of his troubles and trials in getting bones and subjects you may read in Roth's "Life."(20) Many interesting biographical details are also to be found in his own writings. He returned for a time to Louvain, and here he published his first book, a commentary on the "Almansor" of Rhazes, in 1537. (20) M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1892. An excellent account of Vesalius and his contemporaries is given by James Moores Ball in his superbly printed Andreas Vesalius, the Reformer of Anatomy, St. Louis, 1910. Finding it difficult, either in Paris or Louvain, to pursue his anatomical studies, he decided to go to Italy where, at Venice and Padua, the opportunities were greater. At Venice, he attended the practice of a hospital (now a barracks) which was in charge of the Theatiner Order. I show you a photograph of the building taken last year. And here a strange destiny brought two men together. In 1537, another pilgrim was working in Venice waiting to be joined by his six disciples. After long years of probation, Ignatius Loyola was ready to start on the conquest of a very different world. Devoted to the sick and to the poor, he attached himself to the Theatiner Order, and in the wards of the hospital and the quadrangle, the fiery, dark-eyed, little Basque must frequently have come into contact with the sturdy young Belgian, busy with his clinical studies and his anatomy. Both were to achieve phenomenal success—the one in a few years to revolutionize anatomy, the other within twenty years to be the controller of universities, the counsellor of kings, and the founder of the most famous order in the Roman Catholic Church. It was in this hospital that Vesalius made observations on the China-root, on which he published a monograph in 1546. The Paduan School was close to Venice and associated with it, so that the young student had probably many opportunities of going to and fro. On the sixth of December, 1537, before he had reached his twenty-fourth year and shortly after taking his degree, he was elected to the chair of surgery and anatomy at Padua. The task Vesalius set himself to accomplish was to give an accurate description of all the parts of the human body, with proper illustrations. He must have had abundant material, more, probably, than any teacher before him had ever had at his disposal. We do not know where he conducted his dissections, as the old amphitheatre has disappeared, but it must have been very different from the tiny one put up by his successor, Fabricius, in 1594. Possibly it was only a temporary building, for he says in the second edition of the "Fabrica" that he had a splendid lecture theatre which accommodated more than five hundred spectators (p. 681). With Vesalius disappeared the old didactic method of teaching anatomy. He did his own dissections, made his own preparations, and, when human subjects were scarce, employed dogs, pigs or cats, and occasionally a monkey. For five years he taught and worked at Padua. He is known to have given public demonstrations in Bologna and elsewhere. In the "China-root" he remarks that he once taught in three universities in one year. The first fruit of his work is of great importance in connection with the evolution of his knowledge. In 1538, he published six anatomical tables issued apparently in single leaves. Of the famous "Tabulae Anatomicae" only two copies are known, one in the San Marco Library, Venice, and the other in the possession of Sir John Stirling-Maxwell, whose father had it reproduced in facsimile (thirty copies only) in 1874. Some of the figures were drawn by Vesalius himself, and some are from the pencil of his friend and countryman, Stephan van Calcar. Those plates were extensively pirated. About this time he also edited for the Giunti some of the anatomical works of Galen.(21) (21) De anatomicis administrationibus, De venarum arterinrumque dissectione, included in the various Juntine editions of Galen. We know very little of his private life at Padua. His most important colleague in the faculty was the famous Montanus, professor of medicine. Among his students and associates was the Englishman Caius, who lived in the same house with him. When the output is considered, he cannot have had much spare time at Padua. He did not create human anatomy—that had been done by the Alexandrians—but he studied it in so orderly and thorough a manner that for the first time in history it could be presented in a way that explained the entire structure of the human body. Early in 1542 the MS. was ready; the drawings had been made with infinite care, the blocks for the figures had been cut, and in September, he wrote to Oporinus urging that the greatest pains should be taken with the book, that the paper should be strong and of equal thickness, the workmen chosen for their skill, and that every detail of the pictures must be distinctly visible. He writes with the confidence of a man who realized the significance of the work he had done. It is difficult to speak in terms of moderation of the "Fabrica." To appreciate its relative value one must compare it with the other anatomical works of the period, and for this purpose I put before you two figures from a text-book on the subject that was available for students during the first half of the sixteenth century. In the figures and text of the "Fabrica" we have anatomy as we know it; and let us be honest and say, too, largely as Galen knew it. Time will not allow me to go into the question of the relations of these two great anatomists, but we must remember that at this period Galen ruled supreme, and was regarded in the schools as infallible. And now, after five years of incessant labor, Vesalius was prepared to leave his much loved Padua and his devoted students. He had accomplished an extraordinary work. He knew, I feel sure, what he had done. He knew that the MSS. contained something that the world had not seen since the great Pergamenian sent the rolls of his "Manual of Anatomy" among his friends. Too precious to entrust to any printer but the best—and the best in the middle of the sixteenth century was Transalpine—he was preparing to go north with the precious burden. We can picture the youthful teacher—he was but twenty-eight—among students in a university which they themselves controlled—some of them perhaps the very men who five years before had elected him—at the last meeting with his class, perhaps giving a final demonstration of the woodcuts, which were of an accuracy and beauty never seen before by students' eyes, and reading his introduction. There would be sad hearts at the parting, for never had anyone taught anatomy as he had taught it—no one had ever known anatomy as he knew it. But the strong, confident look was on his face and with the courage of youth and sure of the future, he would picture a happy return to attack new and untried problems. Little did he dream that his happy days as student and teacher were finished, that his work as an anatomist was over, that the most brilliant and epoch-making part of his career as a professor was a thing of the past. A year or more was spent at Basel with his friend Oporinus supervising the printing of the great work, which appeared in 1543 with the title "De Humani