Part 4

Early in the sixteenth century a Holland physician, Laurentius Phryesen (_Phries_, _Friesen_), residing in the German city of Colmar and later at Metz, wrote a popular book on medicine, _Spiegel der Artzny_, which was published at Strassburg in 1518. It contains two anatomical illustrations cut in wood, dated 1517, and supposedly made after the drawings of Waechtlin, a pupil of the Elder Holbein. These pictures tell their own story; they show a marked improvement over the figures which Hundt published in 1501. The other anatomical plate in Phryesen’s book is devoted to the skeleton.

Alexander Achillinus

The Italian physician Alexander Achillinus (1463-1525), professor of philosophy and medicine in Bologna, is deserving of mention for his anatomical knowledge. Zealously devoted to the Arab medical authors, Achillinus made numerous discoveries which are set forth in his general anatomy, _De Humani Corporis Anatomica_, Venice, 1516; and in a commentary upon Mondino’s book, _In Mundini Anatomiam Annotationes_, Venice, 1522. He discovered the duct of the sublingual gland, usually credited to Wharton; two of the auditory ossicles, the malleus and incus; the labyrinth; the vermiform appendix; the caecum and ileo-caecal valve; and the patheticus nerve. Portal credits him with a better knowledge of the bones and of the brain than was possessed by his predecessors.

Berengario da Carpi

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