CHAPTER XXVII. The Founders of Human Anatomy and Physiology

THE FOUNDERS OF HUMAN ANATOMY AND PHYSIOLOGY

Among the earliest physicians of this period to inculcate the importance of substituting a correct knowledge of anatomy for the frequently incorrect descriptions that had been prepared by Galen and handed down through the succeeding centuries, were the following: Jacques DuBois of Paris (1478–1555), who was perhaps better known by his latinized name of “Sylvius”; Guido Guidi (died in 1569), who was also known as “Vidus Vidius”; and Winther of Andernach, a small city on the Rhine. These three men, all of whom taught anatomy at Paris, were commonly considered the best anatomists of that early period. DuBois was further entitled to the credit of having been the first physician to inject blood-vessels with a material that renders them more easily visible, and also the first person in Paris to dissect a human corpse. It was from these men that Vesalius, who afterward became such a famous anatomist, received his first practical instruction in this branch of medical science. Nothing further need be said here of DuBois, but brief sketches of Guido Guidi and of Berengarius of Carpi, another contemporary anatomist of considerable distinction, deserve to find places in our history of this period. Vesalius’ facetious remark that “Winther of Andernach never used a knife except for the purpose of dissecting his food” absolves us from the duty of saying anything further about his career as an anatomist.

In 1542 Francis the First, King of France, gave a great impulse to the study of medicine by calling Guido Guidi from Florence, Italy, to teach that science in the Collége de France, an institution which he had founded at Paris in 1530. Guidi, upon his arrival in Paris, was at once most cordially received, both by those who were to be his colleagues and by the King. Francis bestowed upon him a suitable gift, appointed him to the position of First Physician (Archiater) at his Court, and assured him that he would receive an ample salary during his residence in the French metropolis. In 1547, after the death of Francis the First, Guidi returned to his home in Florence, where Cosimo dei Medici, at that time the head of the Florentine Republic and a little later Grand Duke of Tuscany (Cosimo III.), made him his First Physician and gave him the appointment of Professor of Philosophy in the University of Pisa. Not long afterward Guidi was transferred to the Chair of Medicine. He retained this position almost up to the time of his death (May 26, 1569), and during this long period Cosimo bestowed upon him various ecclesiastic honors, which not only increased his social rank but added materially to his financial resources.

Dezeimeris says that, while Guidi does not deserve to be placed, as an anatomist, in the same rank with Vesalius and Fallopius, he merits full credit for the very important service which he rendered the physicians of his day by placing within their reach translations of certain Greek treatises relating to surgical topics--such treatises, for example, as those of Hippocrates on ulcers, on wounds of the head, on the joints and on fractures (with Galen’s comments), Galen’s treatise on fasciae, and that of Oribasius on ligatures and other surgical contrivances.

Apart from his merits as a worker in the field of medical science, Guidi occupies a creditable place in the history of medicine as a fine type of the well-educated and kindly disposed physician, as the following testimony given by Benvenuto Cellini, the distinguished Florentine sculptor, shows:--

On the occasion of my visit to Paris I made the acquaintance of Messer Guidi, and I wish to state in what a very friendly manner I was received by that noble citizen of Florence and excellent physician, the most virtuous, the most lovable, and the most domestic man whom I have ever met.

Guidi’s treatise on anatomy was first published at Venice (under the editorship of his nephew) in 1611--i.e., forty-two years after his death. His translations from the Greek treatises of Hippocrates, Galen and Oribasius will be found in the work which bears the title “Collectio Chirurgica Parisina,” Paris, 1544.

Berengarius of Carpi (a small town in Northern Italy), who died in 1530, is pronounced by Kurt Sprengel a worthy predecessor of Vesalius. He was Professor of Anatomy, first at Pavia and then at Bologna (from 1502 to 1527), and he is reported to have dissected more than one hundred(!) cadavers during that period. Fallopius and Eustachius were among his pupils, and it was their opinion that he did more than anybody else to revive the interest in anatomical work. The famous sculptor, Benvenuto Cellini (1500–1571), is authority for the statement that Berengarius was not only an experienced anatomist and practicing physician, but also a very skilful draughtsman; the three works which he published being illustrated with a certain number of original woodcuts that are not without interest both to the anatomist and to the lover of art.

Andreas Vesalius (1514–1564) was born at Brussels, of German parents whose home was located at Wessels on the Rhine,--whence the name “Vesalius.” His father was the apothecary of the Princess Margaretha, Charles the Fifth’s aunt, and several of his ancestors had been physicians of considerable distinction. At Louvain he received, in early youth, a thorough training in the Latin, Greek and Arabic languages and also in mathematics. When he was about eighteen years of age, he visited Montpellier and afterward Paris, at which latter city he received practical instruction in anatomy from the three men whose names I have mentioned in the preceding paragraph--viz., Guido Guidi, Jacques DuBois and Winther of Andernach. The instruction in anatomy given in Paris at that period (about 1533) consisted in interpretations of Galen’s teachings, in dissections of a few animals, and in occasional demonstrations--which never lasted longer than three days--of the easily accessible parts of a human cadaver. Scanty as were these sources of information, Vesalius cultivated them with the greatest zest. From time to time his teacher, DuBois, noting the interest which his pupil took in anatomy, and recognizing his fitness for imparting instruction, assigned to him the special duty of rehearsing, in the auditorium, before his fellow students, the essential facts of the day’s lecture. After war had been declared between the Emperor Charles the Fifth and Francis the First, King of France, Vesalius left Paris and returned to Louvain, where he began lecturing on anatomy. These lectures constituted the very first attempt at anything like systematic instruction in anatomy that is known to have been made at that ancient university. It was while he was engaged in this work that Vesalius, in order to become the possessor of an entire human skeleton,--a thing of which he felt a very great need,--ventured to remove from the gallows, outside the city, the cadaver of a criminal. This, as Haeser declares, was an act of great boldness and full of peril.

The life of a military surgeon attached to the army of Charles the Fifth, which was the life that Vesalius led during the following year or two, was not sufficiently attractive to divert his mind seriously from his favorite study; and it is therefore not surprising that we find him, at the age of twenty-three, accepting from the Senate at Venice the appointment of the professorship of anatomy at the University of Padua. When he entered upon this new work Vesalius felt considerable uncertainty as to the correctness of the anatomy which he was then teaching, and it is therefore easy to understand why his first three lectures were based entirely upon the teachings of Galen; but, before he had finished the third one of the series, he made up his mind that he would cut loose from the anatomy of the ape and confine himself to that of the human subject, as was then being revealed to him more and more perfectly from his own dissections. The stock of knowledge which he had thus begun to accumulate, increased steadily until, after seven years of teaching at Padua, Bologna and Pisa, at each of which schools of medicine he gave courses in anatomy of seven weeks’ duration, and after conducting the most painstaking dissections of a number of human cadavers, he finally declared that he was ready to publish his great treatise on anatomy. Some of his friends, foreseeing clearly what a storm of protest the new book would arouse among the followers of Galen, urged him to postpone for a time its publication; but a few others agreed with him that it should be issued without further delay. Accordingly Vesalius sent the manuscript of his work at once to the printers at Basel, and the book was finally published in June, 1543, before its author had attained his twenty-ninth year. Its title was “De corporis humani fabrica,” and it was provided with exceptionally fine pictorial illustrations, most of which were drawn, as is generally believed, by John de Calcar, one of Titian’s pupils. A second edition, superior in every respect to the first, was published in 1555. In comparison with this great work the few treatises written by Vesalius in later years are of minor importance.

Vesalius may rightly be considered the founder of modern anatomy, for he was the first to furnish correct information, based on actual dissections of the human cadaver, respecting quite a large number of the more important anatomical relations; and by this very act he won the further credit of having dealt the first effective blow toward the dethronement of Galen, the man who, next to Hippocrates,--probably even more than Hippocrates,--had exercised, by his teachings in nearly every department of medical science, almost despotic sway over physicians for considerably more than one thousand years. At this distance of time, it is hard to realize what a startling effect was produced by the announcement of the discovery of so many errors in Galen’s scheme of anatomy. Albert von Haller, the great authority on medical literature, speaks of Vesalius’ book as an “immortal work”; and, although its title would lead one to suppose that it deals only with the construction of the human body, an examination of its contents reveals the fact that it contains in addition quite full information regarding physiology and pathological anatomy, as well as many details relating to comparative anatomy. Perhaps the most marvelous thing about this book is the fact that its author completed his work before he had reached his twenty-eighth year. It may also interest the reader to learn that, prior to 1914, the University of Louvain possessed a copy of Vesalius’ great work printed on vellum and illustrated with many drawings in colors; but I am unable to say whether this beautiful volume did or did not escape destruction at the hands of the ruthless men who invaded Belgium during the summer of that memorable year.

(After the portrait by Van Calcar in the Royal College of Surgeons, London.)

Copied from the reproduction published in the Nederlandsch Tijdschrift voor Geneeskunde, Jan. 2, 1915.]

When the human mind has adjusted itself, in the course of years, to consider certain beliefs and ideas as settled truths, it comes as a painful shock to be told that these beliefs are erroneous and that new ones must take their places. This is precisely what happened when Vesalius’ book was first published. From one end of Europe to the other there was a very great stir among the well-educated physicians; the more liberal-minded being ready to accept at once the genuineness of the new anatomy, whereas others,--and possibly they represented the larger number,--acting under the influence of personal jealousy or perhaps blinded by the belief that it was impious not to accept without questioning the descriptions made by Galen, were scandalized by the boldness of Vesalius in asserting that many of the statements made by this great medical authority were incorrect. Jacques DuBois, whose name has been mentioned by me on a previous page, was one of the most bitter of Vesalius’ assailants. In a pamphlet which he published in Paris in 1551 he even went so far as to speak of his late pupil as “a crazy fool who is poisoning the air of Europe with his vaporings.” On account of their former pleasant relations, and also because DuBois was at that time an old man, Vesalius made no reply to these attacks; but when Bartholomaeus Eustachius, Professor of Anatomy at Rome, one of the most celebrated anatomists of that period, and a man of his own age, entered the lists as the champion of Galen, Vesalius took up the challenge, left the work upon which he was then engaged, and began a tour of visits to the universities of Padua, Bologna and Pisa, for the express purpose of disproving, by the aid of numerous dissections, the statements made by his antagonists. Throughout this tour he was received everywhere with enthusiasm, the older men among the teachers of anatomy vying with the younger in manifesting the strength of their approval. The entire journey, says Haeser, was from beginning to end a series of the most brilliant triumphs. But, notwithstanding this vindication, which most men would have accepted with the greatest satisfaction, Vesalius returned to his home in Brussels only to find that the bitter attacks made by his enemies had not ceased. This depressed him greatly, for he was not philosophical enough to recognize the facts that jealousy was at the bottom of this ill feeling toward him, and also that sufficient time had not yet elapsed for the news of his triumphant vindication to travel from Italy to Belgium. While suffering from this fit of the blues he committed to the flames all his books and manuscripts. These latter, it appears, contained not only the fruits of many years of laborious anatomical and physiological research, but also a large number of memoranda relating to pathological anatomy.

In 1556, complaints having reached the ears of Charles the Fifth to the effect that the sin of dissecting human corpses was greatly on the increase, this monarch decided to refer the question to the Theological Faculty of the University of Salamanca, in the northwestern part of Spain, for an authoritative opinion. The reply which these broad-minded theologians sent to the Emperor was most satisfactory. It is reported to have been expressed in the following words: “The dissection of human cadavers serves a useful purpose and is therefore permissible to Christians of the Catholic Church.” This decision did not of course put an immediate end to the harsh criticisms and petty persecutions of the bigots; but, as the years went by, it was noted that the work of scientific research in human anatomy and physiology acquired greater freedom of action, and it is fair to assume that this result was largely due to the famous decision to which I have just referred.

Shortly after Vesalius had retired, as stated above, from active participation in anatomical research work, he was called by Charles the Fifth to serve him in the capacity of private physician. During this service, which lasted for several years, he visited, in company with the Emperor, many of the principal cities of Europe; and then, when the latter abdicated the throne of Spain,--for Charles was not only Emperor of the Holy Roman Empire but also King of Spain,--Vesalius became the private physician of Philip the Second, Charles’ son and successor on the Spanish throne. This long period is largely a blank in the history of Vesalius. Toward the end he got into trouble with the Inquisition and was obliged, as a means of escaping the punishment of death, to undertake a voyage to the Holy Sepulchre in Jerusalem. While he was in that city he received an official invitation from the Senate at Venice to fill the Chair of Anatomy at Padua. He then at once turned his steps toward Italy, doubtless very happy over the prospect of once more engaging in anatomical work; but he was shipwrecked on the coast of the Island of Zante, October 2, 1564. Thirteen days later, before he had completed his fiftieth year, he died from starvation and exposure. A memorial tablet was placed in one of the neighboring churches on the island, and in 1847 his Belgian compatriots erected a suitable monument to his memory in the city of Brussels.

Admirable as was Vesalius’ treatise on human anatomy, it was soon discovered that it was deficient in certain particulars. Not a few of the descriptions, for example, were incomplete, and there were also a number of parts or organs for which no descriptions whatever had been provided. Many of these deficiencies were supplied by contemporary anatomists, nearly all of whom were Italians. First and foremost among this secondary but yet very important group of laborers in the field of original research work, the names of Fallopius and Eustachius deserve to be mentioned.

Gabriele Fallopius, who was born in Modena in 1523, was appointed to the Chair of Anatomy at Ferrara when he was only twenty-four years of age. Subsequently he taught at the University of Pisa. At the time of his death in 1563 he was Professor of Anatomy, Surgery and Botany at Padua. He made many important discoveries in anatomy, more particularly in relation to foetal osteology and the distribution of the blood-vessels. His work in the latter department is all the more remarkable from the fact that it was accomplished at a time when the art of injecting blood-vessels with some opaque material was unknown in Italy. His name has been perpetuated in connection with the Fallopian tube. As a man Fallopius was much liked because of his kindly disposition and absence of conceit. The only treatise which he published was that entitled “Observationes anatomicae,” Venice, 1561.

Bartholomaeus Eustachius, born at San Severino, in the Marches of Ancona, in the early part of the sixteenth century, was one of the most distinguished physicians of his day. He taught anatomy at the famous University of Sapienza at Rome, and devoted a great deal of time and thought to the preparation of a large work which was to bear the title “On the Dissensions and Controversies Relating to Anatomy”; but death overtook him before he had completed this undertaking. It appears, however, that in 1564--that is, ten years before he died--he published a smaller work containing separate chapters on the kidneys, the organ of hearing, the movements of the head, the vena azygos, the vena profunda of the arm, and on certain questions relating to osteology; and he introduced, as illustrations for the text, eight plates of octavo size. These plates and thirty-eight others, which were to have served as illustrations for the great work, were all completed as early as during the year 1552. The artist Pini, who made the drawings that served as the originals from which the plates were made, was related in some degree to Eustachius, and upon the latter’s death the metal plates became his property by inheritance. But nothing further was heard of them until they were discovered, early in the eighteenth century, by Lancisi, the Pope’s attending physician, in the possession of Pini’s descendants. They were published for the first time in 1714. Haeser says that these pictures are true to nature, but that in artistic merit they are not equal to those which belong to the treatise published by Vesalius. The name Eustachius is permanently connected with the channel which leads from the tympanum to the nasal cavities--the Eustachian tube.

Only the briefest possible mention may here be made of those anatomists who, following immediately in the footsteps of the three great leaders mentioned above, played parts of greater or less importance in building up the science of anatomy. Each one of them did creditable work in correcting the errors made by their predecessors or in supplying descriptions of structures or structural relations which these pioneers had overlooked. Thus, long before the sixteenth century came to an end, the gross anatomy of the human being had attained a large measure of the completeness which it possesses to-day. The names of some of the more prominent men among those to whom I have just referred are the following: Giovanni Filippo Ingrassia, Matthaeus Realdus Columbus, Julius Caesar Arantius, Constantius Varolius, Volcher Koyter and Hieronymus Fabricius ab Acquapendente.

Ingrassia (1510–1580), a Sicilian physician, cultivated osteology assiduously, and is entitled to special credit for having first described the stapes, the third one of the ossicles of hearing, and for having made valuable contributions to our knowledge of epidemic diseases. He was a professor in the University of Naples, and, after the year 1563, held the position of Archiater in Palermo, Sicily. His descriptions of the different bones of the skeleton were made with such care and thoroughness that later anatomists found very little for them to discover or to alter.

Matthaeus Realdus Columbus (or simply Realdus Columbus), who died in 1559, was born in Cremona, Northern Italy. He served for some time as Prosector to Vesalius at Padua, and then succeeded him in the Chair of Anatomy, first at Padua and afterward at Pisa. The last teaching position which he held was that of Professor of Anatomy in Rome, in which city he counted Michael Angelo among his intimate friends. The discoveries which he made in anatomy were quite numerous and of considerable importance, and his descriptions were distinguished by an unusual degree of accuracy and clearness. Unfortunately, he did not hesitate, at the same time, to exalt the value of his own work by disparaging that of his famous teacher.

Arantius, who also was one of the pupils of Vesalius, occupied the Chair of Anatomy in his native city of Bologna during the latter half of the century. His death occurred in 1589. The particular department in which he gained considerable fame was that of the foetus, the placenta, the uterus, etc. His descriptions of these structures are written with very great care. Blumenbach gives him credit for having been the first anatomist to furnish a description of the pregnant uterus in its different stages. His earliest published work bears the title “De humano foetu opusculum” Rome, 1564.

Constantinus Varolius, whose name is imperishably connected with that part of the brain which is known as the “Pons Varolii,” was born in Bologna in 1543. He was appointed Professor of Anatomy in the Academy of his native city at an early age, and soon distinguished himself by the careful studies which he made of the human brain and nervous system in general. Before his untimely death at the age of thirty-two he was chosen the attending physician of Pope Gregory the Thirteenth. His earliest published work bears the title “De nervis opticis, etc., epistola,” Padua, 1573.

Volcher Koyter, who was born at Groningen, North Holland, in 1534, studied under Fallopius and Guillaume Rondelet (1507–1566), to whom the University of Montpellier was indebted for its anatomical theatre, and to whom (rather than to Gaspard Bauhin of Basel) is due the honor of discovering the ileo-caecal valve. Koyter was one of the earliest workers in the field of comparative anatomy--a department of knowledge to which Vesalius had already made some creditable additions; and his two most important published treatises bear these titles: “De ossibus et cartilaginibus corporis humani tabulae” (Bologna, 1566), and “Externarum et internarum principalium humani corporis partium tabulae” (Nuremberg, 1573). He died in 1600.

Hieronymus Fabricius was born in 1537 at Acquapendente, a small city of Etruria, about fifty miles northwest of Rome. He studied anatomy at Padua under Fallopius, and, after the latter’s death, was assigned to the duty of making the necessary dissections and anatomical demonstrations before the class. In 1565 he was appointed Professor of Surgery, with the understanding that he was to continue giving his demonstrations in anatomy. The salary which he received for this double work was 100 ducats, but it was increased from time to time until finally he was paid 1100 ducats yearly. At the end of thirty-six years he was retired upon a pension of 1000 ducats for the remainder of his life, and was allowed the privilege of appointing his successor in the Chair of Surgery. He gave the place to Julius Casserius in 1609. To distinguish him from another Fabricius, who gained great distinction in the field of surgery, it has always been customary for later historical writers to speak of him as “Fabricius ab Acquapendente.” His namesake is known as “Fabricius Hildanus.”

As a teacher of anatomy, especially in its relations to physiology, Fabricius was held in the highest esteem. Albert von Haller speaks of him as being one of the glories of the Italian school of medicine. Pupils came in flocks from all parts of Europe to attend his lectures, and among them were some who, like William Harvey of England, afterward attained great celebrity for the effective work which they did in advancing the science of medicine. One of the attractive features of Fabricius’ teaching was to be found in his practice--something quite new at that period--of showing to the students, not only the particular organ (human) upon which he happened then to be lecturing, but also the corresponding organ in one or several of the animals; thus enabling them to learn what were the features possessed in common by all the species, and what were those in respect of which the species differed. As time went on, the number of those who came to witness his anatomical demonstrations increased so greatly that he felt impelled to build, at his own expense, a new and larger amphitheatre. But even this, in a short time, proved to be too small, and then the Senate at Venice, which exercised a governing control over the University of Padua, erected (in 1593) a much larger and more complete amphitheatre, upon the walls of which there was placed an inscription stating that it had been built in honor of Fabricius. Among the other distinctions which were conferred upon him at this time he was raised to the rank of Knight of the Order of Saint Mark and made an honorary citizen of Padua.

Fabricius ab Acquapendente added to our stock of anatomical knowledge by his researches on the structure of the oesophagus, stomach and intestines, the eye, ear, larynx and foetus. One of his chief claims to distinction, however, rests upon the fact that he wrote an elaborate monograph on the valves of the veins. Although these structures had been seen and described at an earlier date by Charles Estienne, Berengarius, Vesalius, Cannani and others (Fra Paolo Sarpi, for example), nobody had yet offered a satisfactory explanation of their probable use or had traced them through the venous system at large. In 1574 Fabricius demonstrated their presence in all the veins of the extremities.

But Fabricius ab Acquapendente was not merely a good anatomist and physiologist; he was also a most distinguished surgeon and general practitioner. From far and from near patients came to consult him about their ailments, and he appears to have been immensely popular among all classes of the community. His home, situated on the River Brenta, just outside the city of Padua, was most attractive, and it was there that he dispensed hospitality in a princely fashion. One of his peculiarities was that in many cases he was unwilling to accept a fee for his services. As a natural result, gifts of all sorts, many of them of considerable value, were showered upon him. He devoted one of the rooms of his residence to the purposes of a cabinet or museum, in which all those gifts which were suited to such display might be properly exposed to view, and over the doorway of the room he placed this inscription, “Lucri neglecti lucrum,” which I venture to render into English by the following, “Costly gifts representing unproductive wealth.”

Fabricius remained a bachelor all his life, and at the time of his death (May 21, 1619, at the age of eighty-two) his fortune, which he bequeathed to his brother’s daughter, amounted to 200,000 ducats--a very large sum in those days.

The writings of Fabricius were published at Leipzig in a single volume in 1687, but Johann Bohn, who edited the collection, omitted the different prefaces which Fabricius had written. In the Leyden edition of 1737 this defect has been remedied.

To furnish here even a much abbreviated account of the important discoveries made in anatomy and physiology during the sixteenth century would call for a much larger amount of space than can possibly be given to these two branches of medical science. Our modern text books on the subject of anatomy alone are, in a certain sense, catalogues of these very discoveries, and every physician knows what a vast amount of space they occupy. I have already made mention of a few of these discoveries, and, when I come to consider the splendid work done by William Harvey in the early part of the seventeenth century, I shall have occasion to recapitulate briefly the more important discoveries made by his predecessors in this particular field. In this way I shall be able to supply information regarding several of the discoveries which I am now obliged to pass over in silence, but which, under other circumstances, would more properly receive consideration in the present chapter.