Part 5

Another famous member of the Paris Faculty of this period, and a man whose life-story reads like a romance, was Joannes Guinterius, the beggar of Deventer. Guinterius (Gonthier, Guinther, Guinter, Winter, or Winther), who is often called John Winter of Andernach, from the name of the town in which he was born, lived between the years 1487-1574, and rose to eminence in both the literary and the medical worlds. Born of humble parents, he was sent at an early age to the University of Utrecht. Leaving this institution because of his poverty, he went to Deventer where he was reduced to the necessity of begging in the streets. He drifted to the University of Marburg, and here displayed such brilliant talents that he soon obtained employment as a teacher in the small town of Goslar, in Brunswick. His growing reputation for learning led to his appointment to the chair of Greek in the noted University of Louvain.

Desiring to study medicine, Guinterius went to Paris in 1525; he received the Bachelor’s degree in 1528, and the full medical title two years later. He passed a brilliant examination which won for him the commendation of the most eminent professors. Remaining in Paris, he engaged in practice and in teaching, and rapidly rose to eminence. In addition to conducting courses in anatomy, he translated into Latin the writings of the most noted Greek medical authors of antiquity—the books of Galen, of Oribasius, of Paul of Aegina, of Caelius Aurelianus, and of Alexander of Tralles—all of which were held in high esteem in the sixteenth century. His fame reached far beyond the boundaries of France. Christian III., the enlightened king of Denmark, who was noted for his love of literature, sought to attach him to the Danish court, but the honor was refused. Having become a convert to the religious views of Luther, Guinterius found that his life was in danger; he left Paris and resided for a time in Metz. He soon removed to Strassburg, where he was received with distinguished honors and was appointed to a professorship in the University. Owing to the activity of his enemies, his position became insecure; accordingly, he resigned his chair and spent a considerable time in travelling throughout Germany and Italy. In the year 1562, Ferdinand I., in appreciation of the great merits of Guinterius, raised him to the highest distinction by placing him among the nobles of the land; and thus the beggar of Deventer became a nobleman of Strassburg. His life ended October 4, 1574.

Like Sylvius, Guinterius was a teacher of men who became greater than himself—Vesalius, Servetus and Rondelet sat upon his benches. Like Sylvius, he placed his faith in Galen and failed to grasp the great truth that anatomical science is based, not on the writings of the Fathers but on dissection of the dead body.

Jean Fernel

The third bright star of the Paris constellation was Jean Fernel (1485-1558), of Amiens, who was regarded as the ablest physiologist of his time and was physician-in-ordinary to Henry the Second. Fernel dipped deeply into philosophy, geometry and mathematics. Before entering the medical profession he issued three books on mathematic and geometric subjects. He received the medical degree in 1530, but continued his study of mathematics with such ardor that he was almost ruined financially. On the advice of his friends he entered upon the practice of medicine in Paris and met with remarkable success. He was skilled in anatomy and surgery and accompanied his sovereign upon numerous military expeditions. His medical writings are contained in many volumes and concern a variety of subjects, such as physiology, therapeutics, surgery, pathology, the treatment of fevers and the venereal diseases.

Fernel’s medical views were powerfully influenced by the teachings of an unfortunate French philosopher, Pierre de la Rameé, or Ramus, who, like many other Protestants, lost his life on Saint Bartholomew’s Night. Brutally assassinated, his body was dragged through the streets of Paris and then was thrown into the Seine; but his system of philosophy survived and exercised a potent influence until it was eclipsed by the doctrines of Descartes.

Ramus, who was an uncompromising opponent of the Aristotelian philosophy, pointed out the defects and suggested the reforms in the system of University education. He compared the teaching of medicine with that of theology, much to the disparagement of the latter:—“The reason”, said he, “why medicine is better taught, and the lectures are better attended than in theology is, that those who teach it know it, and practice it, and their disputations are chiefly on the books of Hippocrates and Galen; whilst the theologians observe a strict reticence on questions of the Old Testament, which they read in Hebrew, as well as of the New, which they read in Greek, but display their learning in subtle questions respecting the pagan philosophy of Plato and Aristotle”.[18] Ramus endeavored to withdraw the minds of both physicians and medical students from the authoritative dogmas of the ancient physicians and to substitute therefor the intelligent study of Nature. The practical trend of his mind is shown in his suggestion that institutions should be arranged for clinical teaching.

Just as Ramus had become an Eclectic in philosophy, so Fernel sought the best from various sources and different medical systems. Like Ramus, he cast off the yoke which authority had placed upon him; and proposed carefully planned principles which should lead to the discovery of truth. Like Ramus, Fernel presented his views in a clear style and in better order than was to be found in the writings of his predecessors. Like Ramus, he adopted the good and rejected the bad, regardless of whether it had been said by Aristotle, or by Galen, or by Hippocrates. Fernel was a reformer who stood for freedom of thought, which, up to his time, had suffered from the despotism of the scholastics. Although many of Fernel’s physiologic and pathologic ideas seem ridiculous when viewed in the light of modern knowledge, yet he deserves praise for daring to oppose ancient dogmas, and for pointing the road to progress. In breadth of view, Fernel was far superior to Sylvius and Guinterius.

The anatomical teaching in Paris in the early part of the sixteenth century was far from satisfactory. There was too much lecturing and theorizing from Galen’s texts, and too little of actual dissection. Vesalius, who was not backward in his criticisms, says that the dissections were made by ignorant barbers, and during the whole time that he was in Paris he never saw Guinterius use a knife upon a cadaver. Only at rare intervals was a human body brought into the amphitheatre, and then the dissection lasted less than three days. It comprised only a superficial study of the intestines and abdominal muscles; no other muscles were studied. The bones, veins, arteries and nerves were almost wholly ignored. The great lights of the Paris profession were totally unfit to give to the young Belgian what was his heart’s desire. They were ignorant and knew it not. It is not surprising that, on more than one occasion, Vesalius brushed the ignorant prosectors aside, took the knife into his own hands, and carried out the dissection in a systematic manner. His zeal and learning won the admiration of Guinterius who spoke of Vesalius and Servetus in loving terms;—“first Andreas Vesalius, a young man, by Hercules! of singular zeal in the study of anatomy; and second, Michael Villanovanus (Servetus), deeply imbued with learning of every kind, and behind none in his knowledge of the Galenic doctrine. With the aid of these two, I have examined the muscles, veins, arteries and nerves of the whole body, and demonstrated them to the students”.[19]

Vesalius must have had many blue days in Paris—days when he longed to have a free hand in dissection. A weaker character than his would have fitted peacefully into the established order of things, but not of such stuff was Andreas made. The difficulties which beset his path only stimulated him to work the harder; he firmly resolved to devote his energy, his talents and his life to anatomical study and teaching. He decided to secure the opportunity to dissect the human body and to rival the ancient Alexandrian professors who taught the subject. “Never”, he says, “would I have been able to accomplish my purpose in Paris, if I had not taken the work into my own hands”. The Book of Nature which Sylvius lauded, but kept his pupils from studying, was now opened by Vesalius. He dissected numerous dogs and studied the only part of human anatomy that was available, namely, the bones. In his search for materials for a skeleton he haunted the Cemetery of the Innocents. On one occasion, when he went to Montfauçon, the place where the bodies of executed criminals were deposited and bones were plentiful, Vesalius and his fellow-student were attacked by fierce dogs. For a time the young anatomist was in danger of leaving his own bones to the hungry scavengers. By such dangers he gained what the Paris professors could not supply. He became a master of the osseous system, so much so that, when blindfolded, he was able to name and describe any part of the skeleton which was placed in his hands. His talents were recognized by both professors and students; and at the third anatomy which he attended in Paris he was requested to take charge of the dissection. To the satisfaction of the students, as well as to the astonishment of the barbers, he made an elaborate dissection of the abdominal organs and of the muscles of the arm.

CHAPTER SIXTH Vesalius Returns to Louvain

In the latter part of the year 1536, owing to the outbreak of the third Franco-German war, Vesalius returned to the University of Louvain. During this period he secured a human skeleton by secret means. Accompanied by his faithful friend, Regnier Gemma, known as a mathematician as well as a physician, Vesalius visited the gallows outside the walls of Louvain in order to search for bones. Here he found a skeleton which was held together simply by the ligaments and still possessed the origins and insertions of the muscles. Morley states that the body was that of “a noted robber, who, since he deserved more than ordinary hanging, had been chained to the top of a high stake and roasted alive. He had been roasted by a slow fire made of straw, that was kept burning at some distance below his feet. In that way there had been a dish cooked for the fowls of heaven, which was regarded by them as a special dainty. The sweet flesh of the delicately roasted thief they had preferred to any other; his bones, therefore, had been elaborately picked and there was left suspended on the stake a skeleton dissected out and cleaned by many beaks with rare precision. The dazzling skeleton, complete and clean, was lifted up on high before the eyes of the anatomist, who had been striving hitherto to piece together such a thing out of the bones of many people, gathered as occasion offered”.

Such a prize could not be lost. With Gemma’s assistance Vesalius climbed the gallows and secured the skeleton which he secretly conveyed to his home. The treasure, however, was not complete; one finger, a patella and a foot were missing. To this extent was Vesalius the owner of a human skeleton. In supplying the missing parts Vesalius was obliged to incur new dangers. He stole out of the city in the nighttime, climbed the gallows unaided, searched through the mass of decaying bodies, and, having found the coveted bones, he stole into the city by another gate. These secret expeditions, however, soon became unnecessary, for the Burgomaster of Louvain generously furnished an abundance of material for Vesalius’s students.

It was at this period—late in the year 1536 or early in 1537—that Vesalius conducted the first public anatomy that had been held in Louvain in eighteen years. He performed the dissection and lectured at the same time, which was an innovation. Some remarks he made concerning the seat of the soul caused him to be critised by the theologians. A further cause for suspicion was his association with such firm Protestants as Guinterius and Sturm of Paris; and his friendly relations with the publisher Rescius, and the physician Velsius. Fortunately the suspicion of heresy did not lead to any formal charges, but the affair seems to have rankled in his memory and some years later, in his _Fabrica_, he sought to clear his name of even the appearance of heresy.

Vesalius began his career as an author by issuing a paraphrase, or free translation, of the ninth book of the _Almansor_ of the celebrated Rhazes[20]. This book, _liber ad Almansorem_, or work dedicated to the Caliph Al-Mansûr, was written by a learned Arab physician who lived between the years 860-932. The _Almansor_ consists of ten books and was designed by the author for a complete body or compendium of Physic. The first book treats of anatomy and physiology; the second, of temperaments; the third, of food and simple medicines; the fourth, of means for preserving health; the fifth, of skin diseases and cosmetics; the sixth, of diet; the seventh, of surgery; the eighth, of poisons; the ninth, of treatment of all parts of the body; the tenth, or last book, deals with the treatment of fevers. The ninth book, which Vesalius translated from the barbarous version into a readable form, was so highly prized in mediaeval times that it was read publicly in the schools and was commentated by learned professors for more than a hundred years. By this publication Vesalius furnished a valuable contribution to medical literature. The numerous marginal and interlinear notes, which he supplied, show his intimate acquaintance with classical literature as well as with materia medica. Vesalius emphasizes the fact that the book of Rhazes contains many remedies which were unknown to the Greeks. The value of his edition was increased by the presence of original drawings of the plants mentioned in the text.

CHAPTER SEVENTH Professor of Anatomy in Padua

Shortly after the publication of his _Paraphrasis in nonum librum Rhazae_, Vesalius journeyed into Italy. It was in the year 1537 that he entered the prosperous and enlightened city of Venice. Here the study of anatomy not only was not tabooed, but was encouraged, particularly by the Theatin monks who devoted themselves to the care of the sick. At the head of this order stood two remarkable men: J. Peter Caraffa, who later ascended the papal throne as Paul IV.; and Ignatius Loyola, the founder of the Jesuits. It is a strange circumstance that two strong characters so dissimilar as were Vesalius and Loyola should meet as co-workers in the same field. The one was filled with a thirst for anatomical knowledge, and was dreaming of the day when his _opus magnum_ should revolutionize an important science; the other was enthused with visions of the world-wide acceptance of the doctrines of Catholicism. They met again, in 1543—the year which marks two important events, namely, the publication of the _Fabrica_, and the full recognition of the Jesuits by the Pope.

In Venice the young anatomist entered into various lines of activity. He experimented with a new remedy, the China root, and besought his acquaintances to observe its effects in cases of pleurisy. He solicited anatomical material and possibly may have conducted a public demonstration in anatomy, although this is uncertain. He practiced minor surgery; he leeched and opened veins, particularly the popliteal vein which the barbers of that day did not venture to touch. In Venice he fortunately met his countryman, Jan Stephan van Calcar, who was soon to furnish the drawings for Vesalius’s first anatomical plates.

In order to gain all the rights and privileges of a full-fledged physician, Vesalius settled in Padua. On the 6th day of December, 1537, shortly after having received his degree as Doctor of Medicine, Andreas Vesalius of Brussels was appointed Professor of Surgery with the right to teach Anatomy in the famous University of Padua. This, says Fisher, “was the first purely anatomical chair ever instituted”.

From his own writings and from the manuscript notes of his loyal student, Vitus Tritonius, a fairly good idea of Vesalius’s teaching can be given. The first act of the young Paduan professor was to improve the course in anatomy. Here, as he had done previously at Louvain, Vesalius discharged the entire duties of the professorship. He acted as lecturer, demonstrator and dissector. Dissatisfied with the ignorant barbers, he ignored them and employed his students as assistants. He resorted to all possible means to obtain anatomical material, much of which was secured by stealth.

The aula in which Vesalius conducted his course was built of wood and was capable of holding five hundred persons. In the centre of the room was a table under which was a receptacle containing bones and joints. An articulated skeleton was placed in an upright position at one end of the table. In this elegantly appointed room, before an audience of distinguished laymen and students, the instruction in anatomy was given. The course was a strenuous one, occupying practically the entire day for a period of three weeks, and comprising not only human but also much comparative anatomy. The vivisection of dogs, pigs, and rarely of cats, was a regular part of the course. Drawings were used to elucidate the relations between the skeleton and the soft parts; and frequently Vesalius marked the outlines of the joints upon the skin of the subject. He also marked the cranial sutures with ink. His anatomical charts were the work of his own hand; at times he drew the pictures in the presence of his audience. His dissections were made with extreme neatness and dexterity. He used but few instruments and these were of the simplest kind: knives of different shapes, hooks, cannula, catheter, sounds, bristles, hammer, saw, needles, thread and a sponge. Forceps and injection apparatus were not used; he rarely used scissors. Much of the actual separation of tissues was done by the aid of the finger-nails. A vivisection board completed the list _de instrumentis quae anatomes studioso debent esse ad manum_.

Let us now follow one Vesalius’s public courses in anatomy. It is the month of December, in the year 1537. The report has spread that the young Belgian professor will begin his course. Long before the hour set for the lecture, every available seat has been taken and many persons are standing. An audience comprising the professors of the University, the students of medicine, officials of the city of Padua, and learned persons of all ranks, including members of the clergy, numbering more than five hundred persons, has assembled to do honor to the professor of anatomy.

Vesalius comes into the arena and walks to the table which is closely surrounded by his auditors. He wastes no time; after a few preliminary remarks on the importance of anatomy and the methods of acquiring a knowledge of this science, he launches into the practical demonstration. After rapidly pointing out the divisions of the body, and demonstrating the skin, joints, cartilages, ligaments, glands, fat and muscles, he passes to the more complex parts, all of which are shown upon the skinned body of a dog or of a lamb, in order to conserve the human material. Now the human cadaver is placed on the table; all eyes are turned upon it, for such a demonstration occurs only at long intervals. Vesalius speaks first of the difference in the structure of joints at different ages and in different sexes, illustrating his remarks by means of drawings and by an abundant supply of bones of man and of the lower animals.

Now comes the dissection. This is made rapidly and in regular order. Its course depends upon the amount of material at hand; if the professor resorts to two bodies, as in the year 1538, the demonstration is handled in grand style. Vesalius uses the first body for a comprehensive examination of the muscles, ligaments and viscera; whilst the second cadaver is devoted to the relations of the veins, arteries, nerves and viscera. The text of the _Fabrica_ is written according to this plan of public dissection.

At times Vesalius attempted to teach the whole of anatomy on one cadaver. In this event, osteology was followed by the dissection of the abdominal muscles layer by layer, the demonstration closing with an examination of the entire contents of the abdomen. The pelvic organs were reached by incision and separation of the symphysis pubis. If the cadaver was that of a female, the dissection began with the mammary glands and then passed to the inferior venter. In pregnancy the foetal membranes were removed intact, and were placed in a vessel filled with water. The foetus was opened and its anastomosing vessels were found. For demonstrating the cotyledons, the uterus of a sheep or goat was used. After the thorax had been raised by means of a log or brick, Vesalius passed to the face and the anterior part of the neck, freely exposing the muscles on one side and the vessels and nerves on the other. Then followed the unilateral preparation of the muscles of the shoulder and back, then those of the mouth, which were approached by means of division of the lower jaw; and, finally, the pharynx and the larynx were exposed. The rectus anticus muscle was next brought into view, whereupon Vesalius detached the head from the vertebral column. Decapitation was followed by an examination of the cranium; the skull-cap was sawed and the brain was dissected in its natural position. Then came the examination of the eye, which Vesalius dissected in two ways: either by a complete section, or layer by layer from without inwards.

The ear and the cavities of the frontal and sphenoidal bones were next opened, provided these bones were not needed for the setting up of a skeleton. Finally he took up the extremities, demonstrating the muscles of an arm and a leg on one side, and the nerves and vessels on the other. The anatomy lesson ended with the introduction of numerous vivisections.

Vesalius could not entirely escape disputations, but he gave to them a close anatomic basis. Theoretical physiology was repugnant to him; for him physiology was not speculation but the sequel of anatomic research. If he at times gave free reign to his views, he indicated them as mere theories. He did not ignore pathologic conditions, but he handled them as briefly as possible. Fearing to tire his audience with too much variety, he confined his students closely to the structure of the human body.

The merit of Vesalius’s public dissections, and the impression which they made upon his auditors, can be appreciated only by comparison with similar demonstrations made by his predecessors. The large and enlightened audience remained day by day for a period of three or four weeks. He says not a word about the physical and mental strain incident to such a strenuous course, in which his entire time was employed. The courses brought great financial profit to the professor.