Part 7

Vesalius devotes one hundred and eighty-eight pages to a description of the ligaments and the muscles. This part of his treatise, while it contains a few errors and does not reach the high plane of the first book, is superior to any work of its kind that had preceded it. Vesalius was the first writer to describe the internal pterygoid muscle. He denied the existence of a general muscle of the skin, and stated that the intercostal muscles merely separate the ribs without expanding or contracting the thorax. He held the view that nerves and muscles do not stand in any relation of proportionate strength to one another, large nerves often being distributed to small muscles. He also held that the tendons are similar in structure to the ligaments.

Vesalius’s plates of the superficial muscles are among the most beautiful that have ever appeared. They have been copied in practically all later treatises on anatomy, and have been used extensively by art-anatomists. His plates of the deeper muscles, while naturally not so pleasing to the eye, are wonderfully near accuracy. The different muscles are drawn to show function as well as structure.

The Third Book

The third part of the _Fabrica_, comprising sixty pages, is devoted to the veins and arteries. Vesalius begins with the definition of a vein, and describes the structure of these vessels in general. The term “artery” is treated in like manner. He introduces several small illustrations which serve to elucidate this part of the text. His first large plate in this section is devoted to the venae portae. This is followed by a full-page picture of the entire venous system. The arterial system is fully described and elaborately illustrated. To these is added another plate, in which both arteries and veins are represented in their natural order. In other plates he shows the special circulations—cerebral, portal, and pulmonary.

Vesalius described the valve which guards the foramen ovale in the foetus, and also noticed the valve-like fold which guards the entrance of each hepatic vein into the inferior vena cava. He also gave an admirable description of the vena azygos. Blinded by the ancient theory of the movement of the blood—a sort of flux and reflux in the veins, he overlooked the function of the venous valves. He described them as eminences, or projections, or accidental rugosities, which in no way interfere with the flux and reflux of the blood.

The Fourth Book

Vesalius devotes forty pages to the cerebral and spinal nerves. The anatomy of the brain is treated in the seventh book. His representations of the nerves are very creditable. He mentions eleven pairs of cranial nerves: the olfactory, the optic, the motores oculorum, the trifacial, the abducens, the portio dura, the portio mollis, the glosso-pharyngeal, the pneumogastric, and the spinal accessory.

His account of the brain—contained in the seventh book—is elaborately minute considering the time when it was written. His illustrations and description of this organ surpass those of scores of later authors. Vesalius fully describes the position of the brain; the membranes which cover it; the cavities, or ventricles, within it; the divisions of cerebrum, cerebellum, and medulla; the anatomy of the base, and the origins of the cerebral nerves. These structures are illustrated from different points of view.

The Fifth Book

The fifth book, comprising more than one hundred pages, is devoted to the organs of nutrition. Here we find an admirable account of the peritoneum, the mesentery, the omentum, the stomach and intestines, the liver, the spleen, and the genito-urinary tract—all of which structures are described and fully illustrated. In this book Vesalius also describes the foetus in utero.

The Sixth Book

In less than fifty pages Vesalius describes the contents of the thorax. He writes intelligently of the membrane lining the thorax, and then gives an account of the arteria aspera, as the trachea was formerly named. Passing on to the lungs, he next takes up the anatomy of the heart. He describes its position, form, and structure in better terms than had been done by preceding anatomists. The auricles, ventricles, and valves are carefully examined. His illustrations of both lungs and heart are excellent.

In the 1543 edition of the _Fabrica_, Vesalius adopts the erroneous view of Galen that openings exist in the septum of the heart. In the second edition of his book, published in 1555, he says that influenced by the views of Galen, he believed that the blood passes from the right to the left ventricle of the heart, through the septum, by means of the pores. Vesalius immediately adds that the septum of the heart is as dense and compact as the rest of this organ, and that not the smallest quantity of blood passes through the septum.

His account of this subject is best given in his own words:—“In recounting as above the structure of the heart, and the use of its different parts, I have followed in the main the doctrines of Galen; not that I regard them in all particulars as consonant with the truth, but because, in attributing new functions and uses to a number of parts, I am still distrustful of myself, and not long ago should hardly have ventured to differ from that Prince of Physicians by so much as a finger’s breadth. As for the dividing wall, or septum, between the ventricles forming the right side of the left cavity, the student of anatomy should consider carefully that it is equally thick, compact, and dense, with all the rest of the cardiac substance enclosing the left ventricle. And accordingly, notwithstanding what I have said about the pits in this situation, and at the same time not forgetting the absorption by the portal vein from the stomach and intestines, I still do not see how even the smallest quantity of blood can be transfused, through the substance of the septum, from the right ventricle to the left”.

Vesalius and other anatomists knew of the hepatic circulation, or at least believed in some communication between the portal and hepatic veins:—“The branches of this vein”—vena cava—“distributed through the body of the liver, come in contact with those of the portal vein; and the extreme ramifications of these veins inosculate with each other, and in many places appear to unite and be continuous”.

Vesalius knew that in several particulars the accepted physiology of the vascular system was wrong. If he could have lived a few years longer, it is possible that he might have solved the great problem which was made clear by William Harvey. In the light of our present knowledge some of Vesalius’s words are suggestive:

“When these matters are taken into account, many things at once present themselves in regard to the arterial system, which deserve careful consideration; especially the fact that there is hardly a single vein going to the stomach, the intestines, or even the spleen, without its accompanying artery, and that nearly every member of the portal system has a companion artery associated with it in its course. Again, the arteries going to the kidneys are of such size that they can by no means be affirmed to serve merely for regulating the heat of these organs; and still less can we assert that so many arteries are distributed to the stomach, intestines and spleen for that purpose alone. And there is, furthermore, the fact, which we must for many reasons admit, that there is through the arteries and veins a mutual flux and reflux of materials, and that within these vessels the weight and gravitation of their contents has no effect”.

The Seventh Book.

In the seventh book, consisting of less than sixty pages, Vesalius fully describes the anatomy of the brain, of the cranial nerves, and of the organs of sense. His description of the eye is not as near accuracy as might be expected. He places the crystalline lens in the centre of the globe. His description of the organ of vision was only slightly better than that which was given by Galen. Vesalius showed, however, that the optic nerve is not a hollow tube, and that it does not enter the eyeball exactly in the antero-posterior axis.

Conclusion

Considering the time in which he lived, Vesalius was remarkably free from errors. Although to him the arteries were carriers of vital spirits, the veins were the true blood vessels, and, according to the first edition of his great book, the septum of the heart was filled with foramina; yet, we must say with Baas, “these are all mere shadows necessary to the brilliancy of the picture”.

Vesalius was more than an anatomist. As a practical physician he had the highest reputation among his contemporaries. He was an accomplished scholar and was thoroughly conversant with the weaknesses of human nature, as is evident from many satirical touches in his writings. Although his great work contains many errors that a tyro of the present day would laugh at, it laid the foundations of our knowledge. Vesalius overthrew the idol of authority in anatomy and taught us to look at Nature with our own eyes.

Portal[24] has paid a splendid tribute to Vesalius. “Vesalius”, he says, “appears to me one of the greatest men who ever existed. Let the astronomers vaunt their Copernicus, the natural philosophers their Galileo and Torricelli, the mathematicians their Pascal, the geographers their Columbus, I shall always place Vesalius above all their heroes. The first study of man is man. Vesalius has this noble object in view, and has admirably attained it; he has made on himself and his fellows such discoveries as Columbus could make only by travelling to the extremity of the world. The discoveries of Vesalius are of direct importance to man; by acquiring fresh knowledge of his own structure, man seems to enlarge his existence; while discoveries in geography or astronomy affect him but in a very indirect manner”.

Like Harvey, Vesalius was obliged to defend his writings from fierce attacks. The most desperate of his opponents was his old master, Jacobus Sylvius, who was so wedded to the Galenic teachings that he asserted that since Galen’s time the thigh bones had changed their shape. He spoke of Vesalius as a “madman, Vesanus, whose pestilential breath poisons Europe”. Ponderous discussions were carried on between the friends and opponents of the great anatomist. The complete overthrow of the Galenists resulted.

If Vesalius had remained professor of anatomy in Padua, instead of being appointed physician to Charles the Fifth, at Madrid, in 1544, it is probable that the circulation of the blood would have been discovered by him.

In recent years attempts have been made to show that it was not Vesalius, but Leonardo da Vinci, who was the founder of modern anatomy. A considerable amount of controversial literature has accumulated on this subject. For our purpose it may suffice to quote the conclusions of McMurrich[25]:—“Leonardo was the first to create a new anatomy, but he created it for himself alone; Vesalius demonstrated a new anatomy to the world. It was the publication of Vesalius’s _Fabrica_ that revolutionized anatomy, while Leonardo’s drawings were lying unpublished, at first the cherished possessions of his favorite pupil Melzi, later in the Ambrosian Library in Milan, and still later forgotten in the Royal Library at Windsor. We must credit Leonardo as being the forerunner of the new anatomy, but Vesalius must be recognized as its founder”.

CHAPTER TWELFTH Contemporary Anatomists

Shortly after the publication of the _Fabrica_, great activity was manifested in anatomic research, and numerous opponents and critics of Vesalius appeared in the arena of science. The criticism of such men as Jacobus Sylvius and John Dryander, while it was of a violent type, was of much less importance than was that of Eustachius, Columbus and Fallopius. Vesalius was not without his partisans, of whom Ingrassias and Cannanus are worthy of mention.

Bartholomeus Eustachius

Eustachius was born at San Severino, a small city near Salernum, about the year 1520. He studied anatomy in Rome and made remarkable progress in this science. In the year 1562, as he informs us in his _Opuscula Anatomica_, he was professor of medicine in the Collegio della Sapienza at Rome. Like many other men of genius, Eustachius died in poverty. In August, 1574, having been called by the illness of Cardinal Rovere to Fossombrone, Eustachius died upon the journey.

To Eustachius posterity is indebted for a series of splendid copperplate engravings which were designed to illustrate the anatomy of the human body. These plates, the handiwork of Eustachius, and the first anatomical illustrations wrought in copper, were completed in 1552, only nine years after the first impression of the book of Vesalius. Unfortunately for himself, and worse for medical science, Eustachius was unable to publish them. If this magnificent atlas of anatomy could have been published when completed, the anatomical discoveries of the eighteenth century would have come two hundred years earlier. Unfortunately the entire text of the work is lost. For one hundred and thirty-eight years the Eustachian plates remained either in the family of Pinus, an intimate friend of the anatomist, or were buried in the Papal Library at Rome. When discovered they were presented by Pope Clement XI. to his physician, Lancisi, who published them with notes of his own, at Rome, in 1714. In 1740 they were issued under the direction of Cajetan Petrioli. Four years later the edition by Albinus appeared, which was republished in 1761. The anatomical writings of Eustachius were published during his lifetime, in 1564. It is upon his _Tabulae Anatomicae_ that the fame of this wonderful man is founded. If this work had been published in 1552, Eustachius would have divided with Vesalius the honor of founding human anatomy. The victim of circumstances, his name has been overshadowed by that of Vesalius, to whom in some respects he was superior. Deprived during life of his merited honors, Eustachius has been awarded a goodly share of posthumous fame.

Eustachius was the first anatomist to describe, with any degree of accuracy, the tube which bears his name. We can truly say he discovered it, since Alcmaeon dissected only the lower animals, and was not an accurate observer, as his view that goats breathe through the ears, amply testifies. Eustachius discovered the tensor tympani and stapedius muscles, the modiolus and membranous cochlea, and the stapes. The honor of the discovery of the stapes is claimed for no less than five renowned anatomists, namely, Fallopius, Ingrassias, Columbus, Colladus, and Eustachius. It is unnecessary to discuss this disputed claim to priority. The truth seems to be that the stapes was discovered by both Ingrassias and Eustachius, each independently of the other. In 1546 Ingrassias publicly demonstrated the little bone of the ear in his lectures at Naples. Fallopius, after learning from an eyewitness that Ingrassias had actually discovered and named the ossicle, relinquished his claim to the discovery. Columbus and Colladus filed their information at too late a date. Eustachius, as previously stated, finished his anatomical plates in 1552. His seventh plate shows, among other subjects, the auditory ossicles—malleus, incus and stapes—and tensor tympani muscle. These objects are delineated as taken from a human subject, and also from a dog.

Eustachius discovered the origin of the optic nerves, and the sixth cerebral nerves. He gives excellent pictures of the corpora olivaria and corpora pyramidalia; of the stylo-hyoid muscle; of the deep muscles of the neck and throat; of the suprarenal capsules, and of the thoracic duct. He also described the ciliary muscle. Eustachius was the first anatomist who accurately studied the teeth and the phenomena of the first and second dentition. In his researches he employed magnifying glasses, maceration, exsiccation, and various methods of injection.

Realdus Columbus

The first anatomical treatise containing an account of the lesser, or pulmonary circulation, was the monumental work, _De Re Anatomica, libri xv._, written by Realdus Columbus and sumptuously published at Venice in the year 1559. This, however, was not the first printed account of the lesser circulation. Six years prior to the publication of the book of Columbus, the unfortunate Servetus, in a theological treatise, described correctly the course of the blood in its transit through the lungs. Tried for heresy, Servetus was burned, together with all obtainable copies of his book. Although it had been printed, the work was suppressed; hence it follows that Columbus was the first to publish the great discovery. Of the life of this anatomist we know but little. Born at Cremona, a small Milanese village, the year of his birth is unknown. He died in 1559, while his book was being printed. A few copies were finished before his demise, since a copy belonging to the late Dr. George Jackson Fisher, of Sing Sing, N.Y., contains the author’s own dedication to Pope Paul IV., while in other exemplars, the dedication has been written by the two sons of Columbus, and is addressed to “_Pio IIII., Pont. Max_”. This prelate, on the death of Paul IV., on August 18, 1559, became the head of the Church.

Some writers have held that the discovery of the lesser circulation was not made by Columbus independently of Servetus, but that a copy of the book of Servetus had drifted into Italy and had been read by Columbus. There is no direct evidence to support this view. When Vesalius was called to Madrid as physician to Charles the Fifth, Columbus, in 1544, succeeded him in the University of Padua; two years later he filled the anatomical chair at Pisa, and in 1546, Pope Paul IV. called him to Rome. Here he spent the later years of his life, engaged in teaching anatomy and in writing his book. For forty years Columbus pursued his anatomical studies, and in that period he dissected an unusually large number of bodies. Fourteen subjects passed under his scalpel in a single year.

Columbus frequently made experiments upon living animals. He was the first to use dogs for such purposes, preferring them to swine. Book XIIII. of the work of Columbus is upon the subject of vivisection, _De viva sectione_. In this he tells us how to employ living dogs in demonstrating the movements of the heart and brain, the action of the lungs, etc. Columbus was the first anatomist who demonstrated experimentally that the blood passes from the lungs into the pulmonary veins. “When the heart dilates”, says Columbus, “it draws natural blood from the vena cava into the right ventricle, and prepared blood from the pulmonary vein into the left; the valves being so disposed that they collapse and permit its ingress; but when the heart contracts, they become tense, and close the apertures, so that nothing can return by the way it came. The valves of the aorta and pulmonary artery opening, on the contrary, at the same moment, give passage to the spirituous blood for distribution to the body at large, and to the natural blood for transference to the lungs”.

Like Servetus, Columbus held to the idea of “spiritus”. Harvey was the first physiologist who recognized the circulation as purely a movement of blood. All before him assumed the existence of a mixture of air and blood. Columbus, pupil and prosector of Vesalius, like his great master, denied the existence of foramina in the cardiac septum.

Gabriel Fallopius

Gabriel Fallopius (1523-1562), of Modena, was a noted Italian anatomist. In his twenty-fifth year he was made professor of anatomy at Pisa. Although the span of his life was short, he will be remembered always as the discoverer of the tubes which bear his name. According to Fisher, Fallopius “described the ear more minutely than had ever before been done. He discovered the little canal along which the facial nerve passes after leaving the auditory; it is still called the _aquaeductus Fallopii_. He demonstrated the fact of the communication of the mastoid cells with the cavity of the tympanum; and also described the fenestrae rotunda and ovalis. In the treatment of diseases of the ear, he used an aural speculum, and employed sulphuric acid for the removal of polypi from the meatus. In some of his supposed discoveries he had long been anticipated; for example, the tubes which bear his name were known and accurately described by Herophilus, over three hundred years before the Christian era, and also by Rufus of Ephesus, of whom Galen speaks as the best anatomist of the second century. Rufus refers to two varicose and tortuous vessels passing from the testes (as the ovaries were called) to the cavity of the uterus. Fallopius, however, gave a full account of their course, position, size and structure. He cut into them and found them hollow, gave them the name of tubae seminales, and posterity attached his name to them, and in time came to a better comprehension of their true function. This is not the only instance in the history of anatomical discovery where the name of a person, not its discoverer, has been given to an organ. Allusion has been made to Fallopius as a botanist; a genus of plants, _Fallopia_, has been named in honor of him”.

Fallopius was appointed professor of anatomy at Pisa, in the year 1548; and later, at the instance of the Grand Duke of Tuscany, Cosimo I., he received a professorship at Padua, as successor to Vesalius. Besides the chair of anatomy and surgery and of botany, he also held the office of superintendent of the new botanic garden in that city. Fallopius remained in Padua to the day of his death, which occurred in 1562. He was very properly succeeded by his favorite pupil, Fabricius ab Aquapendente, who had been for some time previously his anatomical demonstrator. His collected works, as published in Venice, 1606, embrace twenty-four treatises distributed in three folio volumes. Only one of his works was published during his lifetime, namely, his _Observationes Anatomicae_, Venice, 1561, which is considered one of his most valuable books, containing, as it does, most of his discoveries and his animadversions on the works of other anatomists.

This was written as a supplement to the anatomy of Vesalius, for it follows the same order, passes upon the same subjects, corrects the inaccuracies of the Vesalian treatise, and supplies what is wanting. Throughout the work Fallopius treats Vesalius with great respect, and never mentions him without an honorable title. Vesalius wrote an answer to this work, entitled, _Observationum Fallopii examen_, in which he acknowledges the courtesy of Fallopius, but, as argument progresses, appears to be out of temper.

After the death of Fallopius it was thought that no successor except Vesalius could be found competent to fill his place. Accordingly Vesalius was chosen. The news of his appointment reached him while he was returning from a pilgrimage to Jerusalem. Unfortunately he was shipwrecked and perished, otherwise history would have afforded an example of the master filling the chair of the pupil.

John Philip Ingrassias