Part 19

But if descriptive anatomy developed slowly in the hands of the physicians, the art of graphic representation of anatomical structures was still more backward. Several groups of anatomical drawings of mediaeval date have come down to our time, but examination of them shows that they have been drawn without direct reference to the human frame. Some of these figures are of the crude type known as the ‘five-figure series’ (Plate XXXIII), mere traditional diagrammatic sketches. Hardly better or more instructive are the series of dissections which illustrate certain MS. works of Henri de Mondeville (Plate XXVIII a) and Guido de Vigevano (Plates XXXI and XXXII), 1345. A few sketches representing the separate organs have also survived (Fig. 6), but these never suggest that the draughtsman had before him the structure which he seeks to depict, and the drawings appear to have been made in order to illustrate contemporary physiological theory rather than observed anatomical fact. Even the magnificent illuminated Dresden Codex of Galen, prepared in France or Flanders as late as the second half of the fifteenth century, betrays not the slightest first-hand knowledge of anatomy. Although the illustrations of this MS. are prepared with the utmost technical skill, they yet show us a teacher exhibiting to his pupils a heart of the form found on playing-cards, and other anatomical figures scarcely more faithful to the facts (Plate XXXIV).

After Bodleian Library MS. Ashmole 399 of about 1298, fos. 23 recto–24 recto.]

The spirit of investigation of the artist who perforce went direct to nature, dissecting with his own hands and observing with his own eyes (Plate XXXVI), showed itself indeed far more fruitful than the tedious ex cathedra methodization of the professor. Yet the system of the schools needed to be combined with the freedom of the artist for the production of an effective anatomical work. What the projected treatise of Marcantonio della Torre (1473–1506) might have been we may guess from the anatomical sketches of Leonardo da Vinci (Plate XXXV), who was to have been associated with him in the work. In the event, however, the medical schools had to wait yet another generation before the subject was placed on a sound basis by André Vesale.

The Mondino pamphlet--for it is little more--used since its author’s death in 1327 as a text-book in the schools of northern Italy, was first printed in 1478. Not until the last decade of the fifteenth century did there appear another work bearing evidence of the hand of a practical anatomist. This was an Italian translation of Ketham’s Fasciculus medicinae, impressed at Venice in the year 1493. The volume comprises Mondino’s pamphlet and a collection of other medical tracts that were probably put together by Giorgio di Monteferrato from the work of a writer of the previous century, for their contents are traceable to a fourteenth-century MS. The text is neither original nor remarkable, but the Venice volume derives its importance from certain figures which appear in it for the first time.

Two of these plates are of great interest both intrinsically and also in relation to the history of anatomy. One of them is the magnificent representation of a dissection scene, which is regarded as perhaps the finest example of book illustration produced during the first century of typography (Plate XXVII). This work of the ‘maître aux dauphins’, as the unknown artist is called by critics, is doubly interesting, for it is the subject of an experiment in colour printing, no less than four pigments being laid on by means of stencils. As early as 1457 the method of stencilling was employed for colouring the initials of a Psalter, and in 1485 Erhard Ratdolt in an astronomical work added yellow to the earlier red and black. The figure from which our plate is taken represents, however, the first attempt at a complex colour scheme and leads up to the work of Hugo da Carpi.

In this picture the professor, a youthful figure perhaps intended to represent Mondino himself, is shown standing at a desk which hides his book. Around a corpse, laid on a trestle table before him, there cluster a number of men in doctor’s robes. Their valid faces are sufficient to convince us that the artist is here presenting us with portraits. One of the listeners has removed his robe and stands with upturned sleeves and knife in hand, ready to make the first incision on the direction of the doctor, who points to the part with a wand held in the left hand. In the impression of 1495 and in those of later date, the book appears above the desk, the attitudes of the students are somewhat changed, and many other details are altered. In all these, however, the blocks have been recut and the result is artistically inferior (Fig. 3).

From the 1493 Venice edition of ‘Ketham’ translated into Italian. This is the first printed anatomical figure drawn from the object.]

The second plate from the 1493 Ketham with which we are here concerned is the outline of a female body, in a traditional pose, laid open to exhibit some of the internal organs (Fig. 7). These had clearly been sketched from the object, and therefore this drawing, the first printed figure of its kind, may be said to introduce the new era for the investigation of the human frame. The anatomical renaissance had begun. Into a discussion of the full development of that age we cannot now enter. But the MS. of Manfredi, with which we have here to deal, was written at the very dawn of the new era and is itself one of its earliest documents.

II. BOLOGNESE WORKS ON ANATOMY

An organized Medical Faculty existed at Bologna at least as early as 1156, though the first record of dissection there is of considerably later date. In February 1302 a certain Azzolino died under suspicious circumstances. Poison was suspected, an inquest was held and a post-mortem examination ordered. The investigation was conducted by two physicians and three surgeons, who unanimously agreed ‘that the said Azzolino assuredly met his death by no poison, but on the contrary, we assert that the quantity of blood collected in the great vein known as the vena chilis [vena cava] and in the veins of the liver adjacent thereunto, has prevented the due movement of the spiritus throughout the body, and has thus produced the diminution or rather extinction of the innate heat and thereby induced a rapid post-mortem discoloration. Of this condition we have assured ourselves by the evidence of our own senses and by the anatomization of the parts.’

The first anatomical document emanating from the University of Bologna is, however, of still earlier date, and is the work of William of Saliceto (1210?–80). This writer was educated at Bologna, and it is claimed that he was the first to dissect the human body there. His Cyrurgia, which was completed in 1275 (editio princeps, Piacenza, 1476), is divided into five books, of which the fourth and shortest is devoted to anatomy. Its descriptions are brief and concise. They are often clearly the result of actual observation, and they show hardly any trace of the absurd and irritating teleology that the influence of the Arabians and of Galen made customary in early anatomical literature. The anatomy of Saliceto appears to us very sensible and so far as it goes practical. It betrays the method rather of the Salernitan than of the Arabian anatomical writings, and is on the whole the best European work of the kind before the Renaissance. It was, however, soon replaced by the text-book of Mondino di Luzzi (1285–1327), which, though inferior to that of Saliceto, held the field until the subject was revolutionized by Vesalius.

VEINS, &c. ARTERIES NERVES BONES MUSCLES]

Plate XXXIV. DEMONSTRATIONS OF ANATOMY

Second half of XVth Century]

Mondino was professor at Bologna till his death in 1327. His work, easily accessible in one of its many editions, ‘is corrupted by the barbarous leaven of the Arabian schools, and his Latin defaced by the exotic nomenclature of Avicenna and Rhazes’. But it is not the language alone that has suffered. The schoolman’s attitude, well fitted for the classification of ideas, is an ill instrument for the investigation of Nature, and in the scholastic Mondino the very basis of scientific judgement is undermined, so that he readily accepts the views of the ancients against what must often have been the evidence of his own senses. The work, however useful to the contemporary student, was thus essentially reactionary as against the efforts of the earlier Salernitan anatomists and of William of Saliceto. This is the more remarkable because it is quite clear that he was accustomed to demonstrate on the actual body--a privilege denied to the early Salernitan school,--and he was, moreover, a popular and successful teacher. His work is a manual of dissection rather than a treatise on anatomy. This, added to its conciseness and brevity, strengthened its appeal to the ‘practical’ man--an epithet claimed then, as now, by the majority of stupid and unpractical people. The personal influence and enthusiasm of its author no doubt helped also towards the phenomenal success of this work, which for two hundred years held a position without rival as the text-book of the medical schools of Italy, where even as late as the sixteenth century Mondino ‘was still worshipped by all the students as a very god’.

Mondino was succeeded in the chair of Surgery at Bologna by his pupil, the Lombard Bertuccio, who died in the Black Death of 1347. Bertuccio’s surviving work is unnoteworthy, but he was the anatomical teacher of Guy de Chauliac, whose Surgery is of great value and was very influential in standardizing practice, especially in the north and west of Europe. Nevertheless it appears to us that the anatomical section is the weakest part of Guy’s great work. The teleology that is a blot in Mondino has here become a perfect plague, and Guy’s anatomy consists of one-third description and two-thirds wearisomely reiterated reasons for the existence of imperfectly described structures. Through Guy de Chauliac the anatomical tradition of Mondino passed over into the University of Montpellier.

A later fourteenth-century Bolognese writer was Tommaso di Garbo (died 1370), who did little but comment on Avicenna. A surgeon of the next generation, however, Pietro d’Argellata, deserves to be remembered for his description of the examination of the body of Pope Alexander V, who died suddenly at Bologna on May 4, 1410. His account throws light on the customary procedure and may be rendered here.

‘I ordered the attendants’, he says, ‘first to cut the abdomen from the pomegranate [i.e. the Adam’s apple or laryngeal cartilage] to the os pectinis [i.e. the symphysis pubis]. Then, so that they should not rupture the intestines, I myself sought the rectum and ligatured it in two places and then cut it between. Next I removed all the intestines as far as the duodenum and dealt with them as with the rectum, and so I had the intestines clean and without fetor. After this I extracted the liver, seizing its ligaments; then the spleen and then the kidneys, and these were all placed together in a jar. I now passed to the spiritual members [i.e. the thorax] and removed lung and heart and all their ligaments. Then I ligatured the meri [the Arabian term for oesophagus] and removed the stomach. When this had been done there were some who wished to remove the tongue but knew not how. I however cut under the chin and extracted the tongue through that hole, together with trachea arteria [trachea] and meri. Then I passed to the arteria adorti [aorta] and vena chilis [vena cava]. Lastly I removed the ligatured remnant of the intestines as far as the anal margin.’

Giovanni da Concoreggio (died 1438), who was lector in Surgery at Bologna in the early part of the fifteenth century, left a few anatomical observations of little note, and not very much more can be said for his successors and Manfredi’s contemporaries Gabriele Gerbi (de Zerbis, died 1505) and Alessandro Achillini (1463-1512). Gerbi does little but repeat in the most verbose fashion the work of Mondino and of Avicenna, some of whose errors, however--e.g. the three ventricles of the heart--he omits. He wrote also an anatomy of the infant, or rather of the foetus, and a treatise taken mainly from Avicenna’s De generatione embryonis. Like all his work, these are in the full scholastic style of a professor of Logic, a position to which, in fact, he ultimately attained.

Achillini’s work is but a slight advance on that of Gerbi. It is really little else than a note-book for students, and gives the baldest directions for dissection, accompanied by a few comments taken from Avicenna. Achillini occasionally ventures to criticize Mondino, and his work has at least the advantage of brevity. He has a claim to be remembered in that he was the first to describe the duct of Wharton and is said to have been the first to describe the ear ossicles, malleus and incus. Achillini, like Gerbi, was a windy and very ‘scholastic’ disputator. He was best known to his contemporaries as a supporter of the philosophy of Averroes. In 1506, when driven from Bologna with the other supporters of Bentivoglio, he became professor of Philosophy at Padua.

From Berengar of Carpi’s Commentary on Mondino, Bologna, 1521.]

With Giacomo Berengario da Carpi we come at length to one who definitely advanced the science, and who may be regarded as the first modern anatomist, so far as printed works are concerned. He was professor of Surgery from 1502 to 1527, and during that period published his great anatomical work. This volume, though modestly put forward as a commentary on Mondino, is in reality an original contribution of great value. It is the earliest anatomical treatise that can properly be described as having figures illustrating the text (Fig. 8). Carpi does not hesitate to criticize the work on which he comments--as for instance when he denies the existence of the ‘rete mirabile’ below the brain, though descriptions of the ‘rete mirabile’ had been based on the statement of no less an authority than Galen. Furthermore he was the first to describe the vermiform appendix, and he gave the earliest correct account of several other organs, e.g. the choroid plexus and the olfactory nerves. He was an industrious dissector, and he tells us that he had examined more than a hundred bodies.

With Carpi we close our series of Bolognese anatomists. Into that group we now proceed to fit the writer with whom we are here specially concerned, Hieronymo Manfredi.

Plate XXXV. VIEW OF THE INTERNAL ORGANS LEONARDO DA VINCI]

Plate XXXVI. THE TWO FIGURES DISSECTING ARE TRADITIONALLY SAID TO REPRESENT MICHELANGELO AND ANTONIO DELLA TORRE]

III. HIERONYMO MANFREDI

Hieronymo Manfredi was a member of a family that had already for more than two centuries provided distinguished citizens, and especially physicians, to the city of Bologna. He was born about the year 1430 and was educated at the University of Bologna. Here in 1455 he was laureatus in Philosophy and Medicine, and here he became professor of the latter subject in 1463.

During the second half of the fifteenth century, a perfect mania for the study of astrology infected Italy and penetrated equally into the Court, the Church, and the Academy. The profession of Medicine was far from immune, and at the University of Bologna, where a chair of Astrology had long been established, the study was pursued with ardour and enthusiasm. Here Manfredi early devoted himself to that will-o’-the-wisp, the pursuit of which absorbed and sterilized many of the best intellects of his day. By the year 1469 he was already regarded as an authority on the vainest of studies, and as the years went on he seems to have devoted himself to it ever more and more. The generally credulous character of Manfredi’s astrological ideas may be gathered from the page of his Prognosticon ad annum 1479 which we here reproduce (Fig. 10).