Part 1

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DAVID EDWARDES Introduction to Anatomy 1532

A FACSIMILE REPRODUCTION WITH ENGLISH TRANSLATION AND AN INTRODUCTORY ESSAY ON ANATOMICAL STUDIES IN TUDOR ENGLAND

BY C. D. O’MALLEY AND K. F. RUSSELL

STANFORD UNIVERSITY PRESS Stanford, California 1961

_English translation and Introduction_ © C. D. O’Malley _and_ K. F. Russell, 1961

PRINTED IN GREAT BRITAIN AT THE UNIVERSITY PRESS, OXFORD BY VIVIAN RIDLER PRINTER TO THE UNIVERSITY

TO THE MEMORY OF CHARLES SINGER FRIEND AND MENTOR

CONTENTS

INTRODUCTION 1 NOTES TO THE INTRODUCTION 25 FACSIMILE REPRODUCTION 31 ENGLISH TRANSLATION 53

Grateful acknowledgements are made for assistance from the National Science Foundation in the preparation of this work; to the British Museum for permission to photograph the only copy of David Edwardes’s _Introduction_ known to be in existence; and to the Wellcome Trust whose help made the publication of this work possible.

INTRODUCTION

On 22 August 1485 the battle of Bosworth provided its victor with the throne of England. Richard III died sword in hand and was unceremoniously buried in the Grey Friars at Leicester, and on that same day the victor, Henry Tudor, was as simply crowned and acclaimed by his troops as Henry VII. So began the Tudor dynasty in England which was to last until the death of Elizabeth in 1603, to be one of the most colourful periods of English history and to witness the arrival of the Renaissance in England. Later than its manifestation on the Continent, but thereby reaping the benefits of continental developments, English humanism as a result was soon to become no mean rival. The development of English literature is too well known for comment, while classical studies, and especially those in Greek, were to rival their continental counterpart by the end of the first quarter of the sixteenth century. Science, however, and more particularly medicine, were laggards.

In those closing years of the fifteenth century which ushered in the new Tudor monarchy the art of healing derived from two sources, the universities of Oxford and Cambridge and the organizations of barbers and surgeons. At Oxford medical teaching was organized by the fifteenth century, and medicine constituted one of the four faculties of the university together with theology, law, and arts. Yet at Oxford, as at Cambridge, the medical curriculum was long to remain medieval.[1] Both schools had taken their model from Paris, but whereas Parisian medicine had begun to stir and advance in the fifteenth century, the English universities remained somnolent. At Cambridge the degree of Doctor of Medicine required altogether twelve years of study based upon lectures and discussions drawn from medieval sources. While it is true that two years of this time were to be spent in the practice of medicine—seemingly a borrowing from the methods of Montpellier—there was no provision for human anatomical study,[2] although this was recognized and demonstrated with some slight annual regularity to the Parisian students from the latter fifteenth century onward.

If we turn to the other source of healing, the organizations of the barbers and the surgeons, in so far as anatomy was concerned the situation was no better and, indeed, it may be said to have been worse in view of the obvious relationship which ought to have obtained between surgery and anatomy. In London the fraternity of barbers existed as early as 1308,[3] and the craft of surgery as a body distinct from that of the barbers is recorded in 1368.[4] Both barbers and surgeons sought to establish rules of professional conduct for the members of their respective organizations as well as a period of time and a curriculum to be satisfied by aspirants to barbery or to surgery. Despite the efforts of the surgeons to control the practice of surgery, relegating to the barbers only the most simple and menial tasks, certain of the more ambitious barbers sought to go beyond such activities as beard-trimming, cutting, and phlebotomy, and this determination gave rise in the first quarter of the fifteenth century to the barber-surgeon[, no longer acting in the normal occupation of the barber and clearly divorced from his old trade.[5]

Throughout the fifteenth century the barber-surgeons and surgeons appear to have remained on fairly amicable terms, presumably carrying on much the same sort of practice. The surgeons, who took precedence on occasions of solemnities and festivities, were perhaps somewhat better trained, but nowhere is there any record that such training required the study of human anatomy.[6] One learned the trade by apprenticeship to a surgeon and by consulting textbooks of surgery. From surviving manuscripts it is possible to determine what these textual guides were: primarily such as those of the celebrated fourteenth-century surgeons, Gui de Chauliac and Henri de Mondeville. It is true that late medieval surgeons were accustomed to introduce the surgical subject by a short anatomical preface, medieval in character, the result of cursory and incomplete post-mortem examinations, but hardly sufficient to permit a proper grasp of anatomy even were that possible of attainment from literary sources.

Hence the opening of the Tudor dynasty in England witnessed a medicine and a surgery lacking the essential and fundamental knowledge of the human structure. The traditions of English medicine were medieval, and medieval medicine had not concerned itself especially with anatomy. If we compare continental medicine of the same period the situation is found to be considerably different. In the course of the fifteenth century anatomy was being practised—diffidently to be sure, but nevertheless recognized and employed in Paris where the first human dissection, in the form of a brief autopsy, had been performed in 1407.[7] The first human anatomy mentioned in the _Commentaries_ of the Medical Faculty of Paris was performed in 1477-8 on the body of an executed criminal,[8] but the incident is recorded without any suggestion of its being a novelty and so raises the possibility that there may have been other dissections in previous years. The practice of human anatomy was even earlier in Italy where there is record of an autopsy in 1286,[9] and in 1316 Mundinus, called the ‘Restorer of Anatomy’, completed his _Anothomia_ in which he describes his systematic dissection of the human body. Official decree permitted the practice of human dissection in many cities, especially those with medical schools, and such official recognition was granted at Bologna in 1405[10] and at Padua in 1429.[11] Elsewhere similar recognition of human dissection was obtained at Montpellier in 1340,[12] at Lerida in 1391,[13] at Vienna in 1435,[14] and at Tübingen in 1485.[15] As a consequence, by the opening of the sixteenth century a series of anatomical texts, based in varying degrees upon human dissection, began to appear, such as those of Benedetti, Achillini, and Berengario da Carpi.

The difference can be explained, at least in part, by the fact that on the Continent the classical revival of the Renaissance had caused or was causing medieval tradition to be replaced by that of classical antiquity. The Renaissance represented an effort to revive the spirit and interests of the classical world, and classical antiquity had been much interested in the structure of man. Especially important was the recovery of the Greek language and literature since it made possible the recovery of the writings of the great classical physicians, notably Hippocrates and Galen, for generally speaking classical Greece had shown more interest in human anatomy than had classical Rome. This recovery had occurred first in Italy, then moved northward across the Alps and only in the early sixteenth century did it reach England.

While even earlier some Englishmen had travelled to Italy to study the classical revival at its source, and even to study the more advanced Italian medicine of Padua, it may be said that Thomas Grocyn was the first significant leader of the new classical movement in England, in particular the recovery of Greek. He had managed to learn some Greek even in England, but it was not until after a trip to Italy in 1488, where he spent two years, that he returned to instil Oxford with an enthusiasm for classical Greek humanism.[16] But if Grocyn is of importance as an English pioneer in the recovery of Greek and Hellenic studies, of far greater importance for the present subject was Grocyn’s lifelong friend and ultimately the executor of his estate, Thomas Linacre.

Linacre looms very large in the revival of classical medicine which gave a general impetus toward a better and more modern medicine. Born at Canterbury about 1460 he was led ultimately by his studies to Oxford where he became a fellow of All Souls College in 1484.[17] Although by this time he could make some beginnings of the study of the revived classical literature, and even Greek, at Oxford, nevertheless it was still desirable if possible to pursue such studies in Italy, and with the opportunity offered him, Linacre travelled to that land about 1487, remaining at least until 1496,[18] in which latter year he received the degree of Doctor of Medicine from the University of Padua.[19]

Returned to England, Linacre taught Greek at Oxford. Grocyn was his friend, Sir Thomas More his pupil, and upon the arrival at Oxford of Erasmus, that great classical scholar likewise became an intimate, all of them enthusiasts and promoters of Greek studies.

However, as a physician Linacre had a special bent toward the Greek medical classics. This was manifested by the appearance in 1517 of his translation of Galen’s book _On Hygiene_. In 1519 this was followed by the _Method of Treatment_, in 1521 by the book _On Temperaments_, and two years later by the _Natural Faculties_ and _On the Use of Pulses_. In 1524 just after Linacre’s death a sixth translation, that of Galen’s _Differences of Symptoms_ and _Causes of Symptoms_, appeared. As yet very few physicians in England knew Greek, but they all knew Latin, and these accurate translations into clear, straightforward Latin made a considerable portion of Galen’s medical writings available for the first time. The contrast between medieval medical writings and those of Galen which had now been made available seemed to emphasize that general Renaissance belief that civilization had reached its peak in classical times and that much could be gained by a return to classical teachings, in this instance the teaching of classical physicians. It is true that only the Galenic books on medicine had been translated, but they were sufficient to whet the appetite for more, and as the new generation of physicians arose, now trained in Greek, if the pattern were followed, they would turn to the Galenic writings on anatomy in the original language as well as to those of Hippocrates.[20] The first of this younger generation who is recorded to have come under this Greek medical influence and made this possibility a reality produced two remarkable pioneer efforts: the first recorded dissection of a human body in England about 1531 and the first book on anatomy written in England, published in 1532, or, reckoned according to the Gregorian calendar, 1533.

The person responsible for these two milestones was named David Edwardes, or, in the Latin form he employed, Edguardus. However, very little is known of his life and activities. He was admitted as a scholar to Corpus Christi College, Oxford, on 9 August 1517, and the register of admissions indicates that he was then fifteen years old and a native of Northamptonshire.[21] He became Bachelor of Arts in 1522[22] although for a time previous to this, in 1521, he appears briefly to have held the readership in Greek, substituting for the regular reader, Edward Wotton, then abroad.[23] In 1525 Edwardes became Master of Arts,[24] and thereafter received a fellowship in the college. He is further mentioned in the account book of the college for 1527-8 as receiving 38_s._ 9_d._,[25] presumably for further teaching of Greek.

Corpus Christi College had been founded in 1515-16 chiefly through the magnanimity of Richard Foxe, Bishop of Winchester, and was provided with its statutes in 1517. The founder, strongly interested in the newly revived classical learning had provided for a chair of Greek, which, as has been mentioned, was briefly held by Edwardes in an interim capacity, while the first president of the college, John Claymond, was likewise a strong advocate of the new learning.

Perhaps not sufficient stress has been placed upon the contribution made by physicians, at least in England, to the revival of Greek studies, although it is sometimes difficult to determine which of the two disciplines, medicine or Greek, was the impulsion to the study of the other. Both Linacre and Wotton were serious students of Greek before they undertook medical studies, but once embarked upon medicine, both of them having studied at Padua, not only did they become especially conscious of the failings of medieval medicine in contrast to the classical, but the philosophical and literary aspects of Galen’s writings must have caused them to retain a concern with Greek literature as a whole even though their primary consideration had come to be a single facet of the body of that literature. Furthermore, the scientific nature of their interest permitted no equivocation in their knowledge of the language. Translations of Galen or Hippocrates required an exactitude beyond that of purely literary treatises. But whatever the relevancy of such remarks, it is certainly of significance that among the first teachers of Greek in England were Linacre, Clement, and Wotton, all physicians, and for our present purpose as it relates to David Edwardes, it should be noted that two of these men, Clement and Wotton, were associated with Corpus Christi College.

In addition to the stress upon Greek studies which must inevitably have led Edwardes to the classical Greek writers upon medicine and conducted him along the pathway already marked out by Thomas Linacre, there were in the college certain possibly more direct influences towards an interest in medicine which have already been alluded to. In short, John Clement, the early lecturer of Greek[26] was a physician and friend of Linacre as well as a fellow in the College of Physicians of London which Linacre had inaugurated in 1518, while still another student of medicine was Edward Wotton, Reader in Greek and later physician to Henry VIII, for whom Edwardes had briefly substituted.

Still another incentive toward medical study may have been a requirement in chapter 25 of the original statutes. In accordance with this all fellows of the college who held the degree of Master of Arts were required to assume holy orders, unless deputed to the study of medicine. It has been suggested that recipients of this exception were originally expected to attend to the medical needs of the other inmates of the college,[27] and it seems likely that Edwardes was one of these _medicinae deputati_.

Our next record indicates that he had removed to the University of Cambridge where in 1528-9, and upon payment of 3_s._ 4_d._[28] and after lecturing publicly upon Galen’s _De Differentiis Febrium_, he was incepted in medicine with recognition of ‘seven years study of medicine’, presumably at Oxford.[29]

In his only known book, to be considered later, Edwardes informs us that his first practice of medicine had been ‘at Bristol, having left my teachers only shortly before and begun to swim without any support’,[30] although it is not clear whether this represented a brief interlude between Oxford and Cambridge or after he had received his degree of Doctor of Medicine. Whatever the case may have been, the few remaining autobiographical references are to his practice in and around Cambridge. As a member of the Faculty of Medicine, it is possible that Edwardes was criticized for devoting an excessive amount of time to his private practice, since in 1530-1 permission was granted him to be excused from a statutory requirement of attendance at ‘all congregations, masses and exequies’.[31] Nevertheless he participated in the examinations of at least two students, one in 1537-8[32] and the other in 1540-1.[33]

Edwardes’s little book, to which reference was made above, was published in London in 1532 [O.S.] by Robert Redman. It is composed of two treatises of which the first, entitled _On Symptoms and Prognostications_ (_De Indiciis et Praecognitionibus_), deals with uroscopy and medical prognostication, and since it represents merely the continuation of a medieval tradition it is of little importance except, as has been said, for its few autobiographical details. In his practice of medicine Edwardes appears to have represented, as we might expect, a combination of the old and the new. While giving support to uroscopy and displaying some sympathy toward folk medicine, he also gave allegiance to Hippocrates and Galen, and like his continental colleagues of this period he was not averse to the introduction of a word or even several lines of Greek into his text, so indicating his enthusiasm for and his ties with the classical revival. Furthermore, he was certainly one of the first English physicians to appreciate Linacre and terms him ‘the most learned physician of his age’.[34]

The second treatise, _A Brief but Excellent Introduction to Anatomy_ (_In Anatomicen Introductio Luculenta et Brevis_), is, as has been mentioned, the first work published in England which was devoted solely to anatomy, and therefore despite its brevity it deserves some consideration in the general history of medicine and even greater consideration in that of English medicine. Turning our attention now to this treatise on anatomy it should be first noted that although printed in the same volume with the work on medical symptoms and sharing a common title-page with that work, the treatise on anatomy has a separate dedication to Henry Howard (1517?-1547), Earl of Surrey. It had been at the request of Henry VIII that this young nobleman took up residence at Windsor and lived there from 1530 to 1532 as the companion of Henry’s son, the Duke of Richmond. Since Edwardes had dedicated the first treatise to the Duke of Richmond on 21 December 1532, it is not difficult to comprehend his choice of the duke’s companion for the second dedication which bears the date 1 January 1532, or, according to the Gregorian calendar, 1533. There is nothing remarkable about this latter dedication, which contains the usual flattery, except for the final passage. There the author remarked upon the ignorance of anatomy among physicians, sometimes with lethal results. He recognized that the subject of anatomy was a difficult one, hence his treatise has been written with brevity and clarity. Later, as he promised, if opportunity were to be granted to him he would write a more elaborate work.

Hereafter, if God permit, I shall compose a complete book of anatomy in which I shall further the opinions of all the learned, to which my own opinion will be added. I could have done this at present but not, however, with the same effort or with the form of an introduction preserved. It remains that this little book, which we have enlisted in the service of the commonwealth, may be pleasing to you, for it recognizes the existence of those very few unlearned physicians by whose mistakes many perish, from which this fact will be gathered, that no parts of the body should be unknown to physicians.

This promise of a more extensive work in which the author was to include his independent anatomical observations, presumably based on further human dissection, appears not to have been fulfilled or, at any rate, there is no record of any such later and more extended anatomical treatise by Edwardes.

The text of this _Introduction to Anatomy_ fills no more than fifteen small pages, and its very brevity must have made it virtually useless; even the author says that it ‘is indeed a slight work’. The plan of presentation is that which had been popularized by Mundinus and was required by the relative speeds with which the different parts of the body succumbed to putrefaction during the course of dissection. Thus Edwardes first describes the lower venter, that is, the abdomen, abdominal cavity, and pelvis, next the thorax, and finally the brain and nervous system. Within his very brief presentation no mention is made of the extremities while, relative to the limits of the discussion, a preponderance of attention has been devoted to what were considered the organs of nutrition and blood manufacture.

The anatomical nomenclature is mildly astonishing, especially when one considers the time and place of composition. But if one considers that Edwardes was sufficiently learned in Greek to act as Reader in Greek at his college for a short period, it will not be too amazing to find him somewhat scornful of the terms employed by those he calls ‘Barbarians’, that is, the European school influenced by Moslem medical writers, chiefly through the _Canon_ of Avicenna, which employed an anatomical terminology drawn from Latin and from curious hybrid forms partly Latin, partly Greek, partly Arabic and in some parts from Hebrew. Edwardes, on the contrary, employs classical Greek terminology as, for example, omentum rather than the medieval _zirbus_ and mesenteric in preference to _meseraic_. In so far as his description extends, his nomenclature is as ‘modern’, if not more so, than that of some of the more learned anatomists on the Continent. Yet, while his vocabulary may be more modern his anatomy is not. Indeed, in the introduction he remarked, as has been mentioned, that in the future he hoped to write a more extensive work ‘to which my own opinion will be added’. By implication, then, in this first brief treatise he had drawn upon earlier authorities, and while we might expect that this student of Greek would turn to Galen and Hippocrates this is true only in part. The liver as he describes it is medieval, the three-chambered heart is Aristotelian, derived from those ‘Barbarians’ he scorned.

While the treatise is noteworthy as the first work written in England solely devoted to anatomy, the text intrinsically is of little further value except for one statement referring to the emulgent, or renal veins. ‘In the body of that one whom we dissected very recently the left branch had a higher place of origin. Very often, however, the opposite occurs, so that the right emulgent vein is carried higher in the body.’ Here we have the first reference to human dissection in England, in which, moreover, the anatomist observing through his own eyes rather than those of past authorities, noted a variation from the commonly given description of the emulgent veins, a description derived from Galen’s anatomical studies on animals.