Kitabı oku: «The Popes and Science», sayfa 6

Under his fostering care the study of anatomy flourished to a remarkable degree at the University of Montpelier. The difficulty hitherto had been that it was very hard to procure bodies for dissecting purposes. It is easy to understand that friends of the dead would always prevent dissections as far as they could. They do so even at the present moment, and there are not many of us who find it in our hearts to blame them over much for it. Few of us are ready to make the sacrifice of our own dead. Even the poor in those days had friends who prevented the cutting up of their remains; for large alms-houses were not presided over by paid officials, but by religious, to whom their poor in their friendlessness appealed as kindred. There were not many prisons, and they were not needed because all felonies were punished by death. Guy de Chauliac realized that here was the best opportunity to procure bodies. Accordingly it was mainly through his instrumentality that a regulation was made handing over the dead bodies of malefactors to the medical school for dissecting purposes. It must be recalled that when he did this the Papal court was at Avignon, in the South of France, and exerted great influence over the University of Montpelier, situate not far away.

The reputation of the University of Paris is such that we should not expect her to be backward in this important department of education. As a matter of fact, there is abundant evidence of dissection having been carried on here at the end of the thirteenth century, and the practice was not interrupted at the beginning of the fourteenth century. Lanfranc, the famous surgeon who had studied with William of Salicet in Italy (we have already mentioned both of them and we shall have much to say of them hereafter), taught surgery from a very practical standpoint in Paris, and illustrated his teachings by means of dissections. Lanfranc was succeeded in Paris by Mondeville, whose name is also associated with the practice of dissection by most historians of medicine, and whose teaching was of such a practical character that there can be no doubt that he must have employed this valuable adjunct in his surgical training of students. In general, however, the records of dissecting work and of anatomical development are not near so satisfactory at Paris as in the Italian universities. As is the case in our own day and has always been true, universities were inclined to specialties in the Middle Ages, and the specialty of Paris was Philosophy and Theology. This was choice, however, not compulsion, any more than similar conditions in our own time. The medical school continued to be in spite of this one of the best in the world, though it was not famous for its original work, except in surgery, which is, however, the subject most nearly related to anatomy and the one whose development would seem necessarily to demand attention to anatomy.

With the Renaissance, which is usually said to begin after the fall of Constantinople in 1453, and the consequent dispersion of Greek scholars throughout Italy, a new spirit entered into anatomy as into every other department of intellectual life at this time. The reason for it is not easy to explain. Perhaps the spread of Greek texts with regard to medicine inspired students and teachers to try out their problems for themselves, and so a new impetus was given to anatomical investigation. Whatever it was that caused it, the new movement came unhampered by the Church, and Italy continued to be even to a greater degree than before the Mecca for medical students who wished to do original work in anatomy. During the last fifty years of the fifteenth century anatomy began its modern phase, and original work of a very high order was accomplished. There are five names that deserve to be mentioned in this period. They are Gabriele Zerbi, Achillini, Berengar of Carpi, Matthew of Gradi and Benivieni. Each of these men did work that was epoch-making in anatomy, and each has a place in the history of the science that will never be lost.

Zerbi, who did his work at Verona, traced the olfactory nerves and describes the nerve supply of the special senses more completely than it had ever been done before. After his time it was only a question of filling in the details of this subject. Achillini added much to our knowledge of the anatomy of the head, being the first to describe the small bones of the ear and also to recognize the orifices of Wharton's ducts. Besides this, which would have been quite enough to have given him a place in the history of anatomy, he added important details to what had been previously known with regard to the intestines, and described very clearly the ileocecal valve and suggested its function. Matthew of Gradi, or De Gradibus, was the first, according to Professor Turner in his article on Anatomy in the Encyclopaedia Britannica, who represented the ovaries in the correct light as regards their anatomical relations and their function.

The most important of these fifteenth century investigators in pure anatomy, however, is Berengarius or Berengar of Carpi, who did his work at Bologna at the end of the fifteenth and the beginning of the sixteenth century. His commentaries on Mondino's work show how much he added to that great teacher's instruction. If he had no other distinction than that of having been the first to undertake a systematic view of the several textures of which the body is composed, it would have been sufficient to stamp him as a great original worker in anatomy. He treats successively of the anatomical characters and properties of fat, of membrane in general, of flesh, of nerve, of villus or fibre, of ligament, of sinew or tendon, and of muscle in general. Almost needless to say, he must have made many dissections to obtain such clear details of information, and, as we shall see, he probably did make many hundreds. If he had done nothing else but be the first to mention the vermiform appendix, it would have been quite sufficient to give him a distinction in our day. Everything that he touched, however, he illuminated. His anatomy of the fetus was excellent. He was the first to note that the chest of the male was larger than in the female, while the capacity of the female pelvis was in the opposite ratio. In the larynx he discovered the two arytenoid cartilages. He recognized the opening of the common biliary duct, and was the first to give a good description of the thymus gland. All this, it must be remembered, before the end of the second decade of the sixteenth century, that is, almost before Vesalius was born.

Berengar's work was done at Bologna. Some five years before his death Bologna became a Papal city. There is no sign, however, that this change in the political fortunes of the city made any difference in Berengar's application to his favorite studies in anatomy. As we shall see in the chapter on The Papal Medical School, already the Popes were laying the foundations of their own great medical school in Rome, in which anatomy was to be cultivated above all the other sciences, so that there would be no reason to expect from other sources of historical knowledge any interruption of Berengar's work, and it did not come.

A fifth great student of anatomy during the fifteenth century was Benivieni, who has been neglected in the ordinary histories of anatomy because his work concerned itself almost exclusively with pathological, not with normal anatomy. In our increasing interest in pathology during the nineteenth century, he has very properly come in for his due share of attention. Professor Allbutt, in his address on the Historical Relations of Medicine and Surgery down to the Sixteenth Century, declares that Benivieni should be revered as the forerunner of Morgagni and as one of the greatest physicians of the late Middle Ages. Benivieni's life occupies almost exactly the second half of the fifteenth century, as he was born probably in 1448, and died in 1502. Allbutt says:–

"He was not a professor, but an eminent practitioner in Florence, at a period when, in spite of its Platonism, Florence on the whole was doing most for science; for as Bologna turned to law, Padua turned to humanism and philosophy. He was one of those fresh and independent observers who, like Mondeville, was oppressed by the authority neither of Arab nor Greek."

We are not interested, however, at the present time in what he accomplished for surgery, though there are a number of features of his work, including the crushing of stone in the bladder and his puncture of the hymen for retained menses, as well as his methods of division and slow extension of the cicatricial contractions resulting from burns near the elbow, which place him among the most ingenious and original of surgical thinkers. It is his interest in dissection that commends him to us here. He must have done a very great number of autopsies.

His interest in the causes of disease was so great that he seems to have taken every possible opportunity to search out changes in organs which would account for symptoms that he had observed. His place in anatomy and the history of pathology has not been properly appreciated in this matter, and Professor Allbutt claims for him the title of Father of Pathology, rather than for those to whom it has been given, and demands for his work done in Florence during the second half of the fifteenth century the credit of laying the real foundation-stones of the great science of pathological anatomy. Unfortunately, he died comparatively young and without having had time properly to publish his own contributions to medical science. Professor Allbutt says:–

"The little book De abditis causis morborum (brief title), was not published in any form by Antony Benivieni himself, but posthumously by his brother Jerome, who found these precious notes in Antony's desk after his death, and with the hearty cooperation of a friend competent in the subject, published them in 1506 in a form which no doubt justly merits our admiration. Benivieni's chief fame for us is far more than all this; it is that he was the founder of pathological anatomy. So far as I know, he was the first to make the custom and to declare the need of necropsy to reveal what he called not exactly "the secret causes," but the hidden causes of diseases. Before Vesalius, before Eustachius, he opened the bodies of the dead as deliberately and clear-sightedly as any pathologist in the spacious time of Baillie, Bright and Addison. Virchow, in his address at Rome, said Morgagni was the first pathological anatomist who, instead of asking What is disease? asked Where is it?"

But Benivieni asked this question plainly before Morgagni: "Not only," says he, "must we observe the disease, but also with more diligence search out the seat of it." The precept is so important, I will quote the original words: "Oportet igitur medicum non solum morbum cognoscere, sed et locum in quo fit, diligentius perscrutari."

Among the pathological reports are morbus coxae (two cases); biliary calculus (two cases); abscess of the mesentery, thrombosis of the mesenteric vessels; stenosis of the intestine; some remarkable cardiac cases, several of "polypus" (clot, which was a will-of-the-wisp to the elder pathologists); scirrhus of the pylorus, and probably another case in the colon; ruptured bowel (two cases); caries of ribs with exposure of the heart. He gives a good description of senile gangrene which even Paré did not discriminate. He seems to have had remarkable success in obtaining necropsies; concerning one fatal case he says plaintively, "Sed nescio qua superstitione versi negantibus cognatis," etc. Of another he says, "cadavere publicae utilitatis gratia inciso" (the case of cancer of the stomach). With this admirable and original leader, Italian medicine of the fifteenth century closes gloriously, to slumber for some fifty years, till the dayspring of the new learning. Of his work Malpighi says, and apparently with truth, "up to now it is the only work in pathology which owes nothing to anyone."

This should be enough, it seems to me, to settle the question that anatomy was permitted very freely before Versalius's time. I have said it in other places, but it may be well to recall here, that Berengar did his dissection at Bologna just before and after the time it became a Papal city and when Papal influence was very strong. In spite of the fact that in 1512 Bologna passed under the dominion of the Popes, there is no question of any interruption or hampering of Berengar's work in anatomy, and as a matter of fact, this great anatomist did not succeed to the professorship of anatomy, which had been held up to this time by Achillini, until in the very year when Bologna came under Papal sway, and had his opportunity to do his independent work only after this. Professor Turner can scarcely find words strong enough to set down his admiration for Berengar and his work. Besides what we have already quoted he says that, "the science of anatomy boasts in Berengar of one of its most distinguished founders."

The distinguished Edinburgh anatomist harbors no illusions with regard to any supposed opposition of the Church to dissection or to the development of anatomy. As a life-long student of anatomy who knew the history of his favorite science, he appreciated very well just who had been the great workers in it and where their work had been done. He says that "Italy long retained the distinction of giving birth to the first eminent anatomists in Europe, and the glory she acquired in the names of Mondino, Achillini, Berengar of Carpi, and Massa was destined to become more conspicuous in the labors of Columbus, Fallopius and Eustachius." These are the greatest names in the history of anatomy down to the beginning of the seventeenth century, with the single exception of Vesalius.

All this of anatomical development in Italy at universities that were directly under the ecclesiastical authorities would seem to settle all question of interference by the Popes or the Church with any phase of anatomical development. It does not seem sufficient for Dr. White, however. When I called attention to all these details of the history of anatomy, long before the reformation and before Vesalius, Dr. White's response was the following paragraph in which he explains how dissection came to be practiced at all, and reiterates not only his belief that Pope Boniface's bull prevented dissection, but even insists on what cannot but seem utterly absurd to any one who has read even the brief account I have given here, that except at one or two places, and then only to a very limited degree, dissection was not practiced at all. Here is how the history of dissection must be viewed according to Dr. White:–

"But Dr. Walsh elsewhere falls back on the fact that shortly after the decree of Pope Boniface VIII., which struck so severe a blow at dissection, the Venetian Senate passed a decree ordaining that a dissection of the human body should be made every year in the city of Venice, and he leaves his readers to conclude that this effectually proves that dissection had not really been discouraged by the Pope. The very opposite conclusion would be deduced by anyone familiar with the relations between the Republic of Venice and the Papacy. These two powers were always struggling against each other; again and again the Venetian Republic, in maintaining its rights, braved the Papal interdicts. The fact that it allowed dissections, so far from proving that the Pope allowed them, would seem to prove that in this case, and in so many other cases, and especially that of Vesalius of Padua, the Venetian Senate sought to show the Vatican that it would yield none of its rights to clerical control. This very fact–that Venice refused to be bound with regard to anatomical investigation by an order from the Vatican–seems to be entirely in the line with all the other facts in the case, which show that the Roman court had committed itself, most unfortunately, against the main means of progress in anatomy and medicine."

Here then is the answer that a modern historian and educator makes to all the representations with regard to the development of anatomy and the practice of dissection during the Middle Ages. If the practice of dissection was permitted it was in spite of the Popes. The fact that there were a dozen of medical schools in Italy at which dissection was carried on is ignored. The great anatomists of the fourteenth and fifteenth centuries simply did not exist–Dr. White knows nothing about them. There must be no admission that the Popes permitted dissection or any other form of science. Dr. White makes his last stand by a really marvelous tour d'esprit. It was Venice defying the Vatican that permitted dissection. This, he supposes, may help him, for anatomy did develop very wonderfully at Padua when it was Venetian territory. But, as pointed out by Roth, dissection was practiced very successfully, and the anatomical tradition established at Padua, before it came under the dominion of Venice. At all the other important cities of Italy dissection was carried on. We have given some of the evidence for Verona, for Pisa, for Naples, for Bologna, for Florence, and, be it remembered, even for Rome. Padua was the rival of Bologna in anatomy only for a comparatively short time. Bologna always maintained a primacy in the field of anatomy, and never more so than after she became a Papal city at the beginning of the sixteenth century. Vesalius taught and demonstrated not at Padua alone, but also at Bologna and at Pisa. For two centuries Rome was the most successful rival of Bologna, and hundreds of dissections were done in the Papal Medical School.

Of course, the appeal to Venetian opposition to the Papacy as an explanation for dissection being carried on in Italy in spite of ecclesiastical regulations to the contrary is only a subterfuge. It can only be found in histories written by those who refuse to see facts as they were, because those facts do not accord with pet theories as to Papal Opposition to Science, and the Warfare Between Theology and Science, which must be maintained at all costs, though with an air of apology always for having to tell such unpleasant truths of these old-time religious authorities.

THE GOLDEN AGE OF ANATOMY
VESALIUS

The Golden Age of discovery in anatomy culminated during the first half of the sixteenth century. This will not be surprising if it is but recalled that this period represents the culmination also of that larger golden age of achievement in art and letters, which has been called the Renaissance. Columbus and Copernicus were giving men a new world and a new universe. Raphael, Michael Angelo, Lionardo da Vinci, the Bellinis and Titian were creating a new world of art. Most of these artists were deeply interested in anatomy. Every phase of human thought was being born anew. Unfortunately, this word Renaissance has given rise to many misunderstandings. Many people have taken its significance of re-birth to mean that art and letters, and with them education and thinking, were born again into the modern world at this time with the coming in of the New Learning, just as if there had been nothing worth while talking about in these lines of human accomplishment in the preceding centuries. Taken in this sense, the word Renaissance is entirely a misnomer. Magnificent achievements in art and letters and every form of education preceded the Renaissance by at least three or four centuries. The Gothic cathedrals and the enduring artistic development that took place in their making, the magnificent organization of technical education in the training of artist artisans by the guilds of the time (we would be glad if our technical schools could accomplish anything like the same results, for evidently, though the name technical education is our invention, these medieval peoples had the reality to a high degree), and finally the universities, which have remained essentially the same down to our own day–all these serve to show how much was done for every form of education many centuries before the beginning of the Renaissance so-called.

It is not surprising that with this much of education abroad in the land men succeeded in making enduring literature in every form and in every country in Europe, and in setting examples of style in prose and verse that succeeding generations have nearly always gone back to admire lovingly. Such an amount of education and development of thinking could not have come without profound attention to science, and, as a matter of fact, there was much more anticipation of even what is most modern in our scientific thinking than most scholars seem to have any idea of. Personally, I have found, in writing the history of The Thirteenth the Greatest of Centuries, more that interested me in the science of this century than in almost any other department of its wonderful educational development.

We have already seen that while anatomy had during preceding centuries only the beginning of the development that it was destined to reach during the sixteenth century, it would be a serious mistake to think that the study of anatomy, having died in the old classical days, was not re-born until the sixteenth century. This would be to commit the error that many ardent devotees of the Renaissance make with regard to all the accomplishments of this period. In spite of the contrary almost universal impression, the Renaissance was not original to any marked degree. With the touch of the Greek spirit that had come again into the world, it only carried the preceding work of great original thinkers to a high order of perfection. This happened as well in anatomy as in art and architecture and literature. Anatomical science was a lusty infant of great promise when Vesalius, the Father of Anatomy, came on the scene. The great painters, Raphael and Lionardo and Michael Angelo, owed much to Giotto and Fra Angelico, who had preceded them, but not more than Vesalius and his contemporaries, who did such magnificent work in original anatomical investigation, owed to Mondino, Bertrucci, Zerbi, Achillini, and above all to Berengar of Carpi and Benivieni, who did their work before and just after the sixteenth century opened. There is never a sudden development in the history of any department of man's knowledge or achievement, as there is nothing absolutely new under the sun, though it is still the custom of the young man in his graduation essay to talk of such things, and older men sometimes fail to realize the truth that in history as in biology, life always comes from preceding life–omne vivum ex vivo--and there is no such thing as spontaneous generation.

If the achievements of this earlier period of scientific work, which affected anatomy even more than any of the other sciences, be kept in mind, the discussion of the Golden Age of Anatomy will find its proper place in the history of the relation of the Popes to science. Though the date of the Golden Age in Anatomy follows that of the so-called reformation, there is absolutely no connection between the two series of events, for the one took place in Germany and the other in Italy. The Golden Age of Anatomy was indeed a perfectly legitimate and quite to be expected culmination of the anatomical interest which had been gradually rising to a climax in the Italian universities during the preceding century. It has a definite place in the evolution of science, and is not a sudden or unlooked for phenomenon.

If there was any place in the world at the beginning of the sixteenth century in which the ecclesiastical authorities had much to say with regard to what should not be taught and what should not be studied in the universities, it was Italy. In spite of this fact, all medical men who wanted to do post-graduate work in medicine went down into Italy. This was especially true for those who desired to obtain ampler opportunities for anatomical study than were afforded by the rest of Europe. In his maturer years as a student of medicine, Vesalius went down to Italy in order to avail himself of the magnificent field for investigation that was provided there. This favorable state of affairs as regards research in anatomy had existed for more than a century before his time. It continued to be true for at least two centuries after his time. As a matter of fact, Italy was to the rest of the world of the fifteenth and sixteenth and seventeenth centuries the home of post-graduate opportunities in all sciences as well as in medicine.

These are not idle words, but are fully substantiated by the lives of the men who stand at the head of our modern medicine. More than a decade before Vesalius was born, Linacre, the distinguished English physician and founder of the Royal College of Physicians, went to Italy to complete his medical studies and incidentally also to round out his education in the midst of the new learning which was so thoroughly cultivated there. When Linacre was leaving Italy, with true classic spirit he set up a little altar on the top of the Alps whence he could get his last view of the Italian plains, and greeted the charming country that he was leaving so reluctantly with the beautiful name of Alma Mater Studiorum. To him, after his return to England, English-speaking medical men owe the establishment of the institution which above all others has helped to uplift the dignity of the medical profession and make the practice of the healing art something more than a mere trade–the Royal College of Physicians.

One of Vesalius's most distinguished fellow students at Padua was Dr. John Caius, who was later to become the worthy president of the Royal College of Physicians of England and the author of certain important medical works. Dr. Caius was the first to introduce the practice of public dissections into England. Caius and Vesalius were roommates, though at the time Vesalius was an instructor at the University, and the inspiration of his originality seems to have had a great effect upon young Caius. They were nearly of the same age, though Vesalius was a precocious genius, and Caius's greatness only showed itself in maturity. Caius was studying in Italy partly because the religious disturbances in England had made it uncomfortable for him to remain in his native country, for he was a firm adherent of the old Church and he hoped they would pass over, but mainly because he coveted the opportunities afforded by that country. Later in life, out of the revenues of his position as Royal Physician to Queen Mary and subsequently for some time to Queen Elizabeth, he founded the famous Caius College at Cambridge, usually called Key's College by Cantabrigians.

Before either of these men there had been a third distinguished English physician who had gone down to Italy for his education. This was the celebrated and learned John Phreas, who was born about the commencement of the fifteenth century. Very little is known of his career, but what we do know is of great interest. He was educated at Oxford and obtained a fellowship on the foundation of Balliol College. Afterward he seems to have studied medicine with a physician in England, but was not satisfied with the medical education thus obtained. He set the fashion for going down into Italy sometime during the first half of the fifteenth century, and after some years spent at Padua received the degree of doctor in medicine, which in those days carried with it, as the name implies, the right to teach. As not infrequently happens to the brilliant medical student, he settled down for practice in the university town in which he graduated, to take up both occupations, that of teacher and practitioner. He is said to have made a large fortune in the practice of physic. [Footnote 12] The best proof of his scholarship is to be found in some letters still preserved in the Bodleian and in the Library of Balliol College. Personally, I have considered that his career was interesting from another standpoint. I have often looked in history for the cases of appendicitis which occur so frequently in our day and with regard to which people ask how is it they did not occur in the past. The fact is, they did occur, but were unrecognized. People were taken suddenly ill, not infrequently a short time after a meal, and after considerable pain and fever, swelling and great tenderness in the abdomen developed, and they died with all the signs of poisoning. They were actually poisoned, not by some extraneous material, but by the putrid contents of their own intestines which found a way out through the ruptured appendix. These cases were set down as poisoning cases, and usually some interested person was the subject of suspicion. Dr. Phreas's learning had obtained for him an appointment to a bishopric in England, a curious bit of evidence of the absence of opposition between medical science and religion in his time. He died shortly after this, under circumstances that raised a suspicion of poisoning in the minds of some of his contemporaries–but raises the thought of appendicitis in mine,–and one of his rivals was blamed for it.

[Footnote 12: Like the other distinguished physicians of this time, John Phreas did not devote himself to medicine alone. He had a taste for literature, and besides being an accomplished scholar he was a poet.]

Nor did the custom for English medical students to go down to Italy to complete their education cease with the so-called reformation. Some two generations after Vesalius's time another distinguished Englishman, Harvey, went down to Italy to complete the studies he had already made and eventually to lay the foundation of that knowledge on which he was twenty years later to construct his doctrine of the circulation of the blood. This doctrine, however, remained merely a theory until the distinguished Italian anatomist, Malpighi, after another half century, demonstrated the existence of the capillaries, the little blood vessels which connect the veins and arteries, and by thus showing the continuity of both the blood systems, proved beyond all doubt the certainty of the teaching that the blood does circulate.