The Evolution of Modern Medicine Part 11

There are two kinds of doctors; those who heal miraculously and those who heal through medicine. Only he who believes can work miracles. The physician has to accomplish that which G.o.d would have done miraculously, had there been faith enough in the sick man (Stoddart, p. 194). He had the Hippocratic conception of the "vis medicatrix naturae"--no one keener since the days of the Greeks. Man is his own doctor and finds proper healing herbs in his own garden: the physician is in ourselves, in our own nature are all things that we need: and speaking of wounds, with singular prescience he says that the treatment should be defensive so that no contingency from without could hinder Nature in her work (Stoddart, p. 213).

Paracelsus expresses the healing powers of nature by the word "mumia,"

which he regarded as a sort of magnetic influence or force, and he believed that anyone possessing this could arrest or heal disease in others. As the lily breaks forth in invisible perfume, so healing influences may pa.s.s from an invisible body. Upon these views of Paracelsus was based the theory of the sympathetic cure of disease which had an extraordinary vogue in the late sixteenth and seventeenth centuries, and which is not without its modern counterpart.

In the next century, in Van Helmont we meet with the Archaeus everywhere presiding, controlling and regulating the animate and inanimate bodies, working this time through agents, local ferments. The Rosicrucians had their direct inspiration from his writings, and such mystics as the English Rosicrucian Fludd were strong Paracelsians.(14)

(14) Robert Fludd, the Mystical Physician, British Medical Journal, London, 1897, ii, 408.

The doctrine of contraries drawn from the old Greek philosophy, upon which a good deal of the treatment of Hippocrates and Galen was based--dryness expelled by moisture, cold by heat, etc.--was opposed by Paracelsus in favor of a theory of similars, upon which the practice of homeopathy is based. This really arose from the primitive beliefs, to which I have already referred as leading to the use of eyebright in diseases of the eye, and cyclamen in diseases of the ear because of its resemblance to that part; and the Egyptian organotherapy had the same basis,--spleen would cure spleen, heart, heart, etc. In the sixteenth and seventeenth centuries these doctrines of sympathies and antipathies were much in vogue. A Scotchman, Sylvester Rattray, edited in the "Theatrum Sympathetic.u.m"(15) all the writings upon the sympathies and antipathies of man with animal, vegetable and mineral substances, and the whole art of physics was based on this principle.

(15) Rattray: Theatrum Sympathetic.u.m, Norimberge, MDCLXII.

Upon this theory of "mumia," or magnetic force, the sympathetic cure of disease was based. The weapon salve, the sympathetic ointment, and the famous powder of sympathy were the instruments through which it acted.

The magnetic cure of wounds became the vogue. Van Helmont adopted these views in his famous treatise "De Magnetica Vulnerum Curatione,"(16) in which he a.s.serted that cures were wrought through magnetic influence.

How close they came to modern views of wound infection may be judged from the following: "Upon the solution of Unity in any part the ambient air ... repleted with various evaporations or aporrhoeas of mixt bodies, especially such as are then suffering the act of putrefaction, violently invadeth the part and thereupon impresseth an exotic miasm or noxious diathesis, which disposeth the blood successively arriving at the wound, to putrefaction, by the intervention of fermentation." With his magnetic sympathy, Van Helmont expressed clearly the doctrine of immunity and the cure of disease by immune sera: "For he who has once recovered from that disease hath not only obtained a pure balsaamical blood, whereby for the future he is rendered free from any recidivation of the same evil, but also infallibly cures the same affection in his neighbour ... and by the mysterious power of Magnetism transplants that balsaam and conserving quality into the blood of another." He was rash enough to go further and say that the cures effected by the relics of the saints were also due to the same cause--a statement which led to a great discussion with the theologians and to Van Helmont's arrest for heresy, and small wonder, when he makes such bold statements as "Let the Divine enquire only concerning G.o.d, the Naturalist concerning Nature,"

and "G.o.d in the production of miracles does for the most part walk hand in hand with Nature."

(16) An English translation by Walter Charleton appeared in 1650, ent.i.tled "A Ternary of Paradoxes."

That wandering genius, Sir Kenelm Digby, did much to popularize this method of treatment by his lecture on the "Powder of Sympathy."(17) His powder was composed of copperas alone or mixed with gum tragacanth.

He regarded the cure as effected through the subtle influence of the sympathetic spirits or, as Highmore says, by "atomicall energy wrought at a distance," and the remedy could be applied to the wound itself, or to a cloth soaked in the blood or secretions, or to the weapon that caused the wound. One factor leading to success may have been that in the directions which Digby gave for treating the wound (in the celebrated case of James Howell, for instance), it was to be let alone and kept clean. The practice is alluded to very frequently by the poets.

In the "Lay of the Last Minstrel" we find the following:

(17) French edition, 1668, English translation, same year. For a discussion on the author of the weapon salve see Van Helmont, who gives the various formulas. Highmore (1651) says the "powder is a Zaphyrian salt calcined by a celestial fire operating in Leo and Cancer into a Lunar complexion."

But she has ta'en the broken lance, And wash'd it from the clotted gore, And salved the splinter o'er and o'er.

William of Deloraine, in trance, Whene'er she turn'd it round and round, Twisted, as if she gall'd his wound, Then to her maidens she did say, That he should be whole man and sound,

(Canto iii, xxiii.)

and in Dryden's "Tempest" (V, 1) Ariel says:

Anoint the Sword which pierc'd him with the Weapon-Salve, And wrap it close from Air till I have time To visit him again.

From Van Helmont comes the famous story of the new nose that dropped off in sympathy with the dead arm from which it was taken, and the source of the famous lines of Hudibras. As I have not seen the original story quoted of late years it may be worth while to give it: "A certain inhabitant of Bruxels, in a combat had his nose mowed off, addressed himself to Tagliacozzus, a famous Chirurgein, living at Bononia, that he might procure a new one; and when he feared the incision of his own arm, he hired a Porter to admit it, out of whose arm, having first given the reward agreed upon, at length he dig'd a new nose. About thirteen moneths after his return to his own Countrey, on a sudden the ingrafted nose grew cold, putrified, and within few days drops off. To those of his friends that were curious in the exploration of the cause of this unexpected misfortune, it was discovered, that the Porter expired, neer about the same punctilio of time, wherein the nose grew frigid and cadaverous. There are at Bruxels yet surviving, some of good repute, that were eye-witnesses of these occurrences."(18)

(18) Charleton: Of the Magnetic Cure of Wounds, London, 1650, p.

13.

Equally in the history of science and of medicine, 1542 is a starred year, marked by a revolution in our knowledge alike of Macrocosm and Microcosm. In Frauenburg, the town physician and a canon, now nearing the Psalmist limit and his end, had sent to the press the studies of a lifetime--"De revolutionibus...o...b..um coelestium." It was no new thought, no new demonstration that Copernicus thus gave to his generation.

Centuries before, men of the keenest scientific minds from Pythagoras on had worked out a heliocentric theory, fully promulgated by Aristarchus, and very generally accepted by the brilliant investigators of the Alexandrian school; but in the long interval, lapped in Oriental lethargy, man had been content to acknowledge that the heavens declare the glory of G.o.d and that the firmament sheweth his handiwork. There had been great astronomers before Copernicus. In the fifteenth century Nicholas of Cusa and Regiomonta.n.u.s had hinted at the heliocentric theory; but 1512 marks an epoch in the history of science, since for all time Copernicus put the problem in a way that compelled acquiescence.

Nor did Copernicus announce a truth perfect and complete, not to be modified, but there were many contradictions and lacunae which the work of subsequent observers had to reconcile and fill up. For long years Copernicus had brooded over the great thoughts which his careful observation had compelled. We can imagine the touching scene in the little town when his friend Osiander brought the first copy of the precious volume hot from the press, a well enough printed book. Already on his deathbed, stricken with a long illness, the old man must have had doubts how his work would be received, though years before Pope Clement VII had sent him encouraging words. Fortunately death saved him from the "rending" which is the portion of so many innovators and discoverers.

His great contemporary reformer, Luther, expressed the view of the day when he said the fool will turn topsy-turvy the whole art of astronomy; but the Bible says that Joshua commanded the Sun to stand still, not the Earth. The scholarly Melanchthon, himself an astronomer, thought the book so G.o.dless that he recommended its suppression (Dannemann, Grundriss). The church was too much involved in the Ptolemaic system to accept any change and it was not until 1822 that the works of Copernicus were removed from the Index.

VESALIUS

THE same year, 1542, saw a very different picture in the far-famed city of Padua, "nursery of the arts." The central figure was a man not yet in the prime of life, and justly full of its pride, as you may see from his portrait. Like Aristotle and Hippocrates cradled and nurtured in an AEsculapian family, Vesalius was from his childhood a student of nature, and was now a wandering scholar, far from his Belgian home. But in Italy he had found what neither Louvain nor Paris could give, freedom in his studies and golden opportunities for research in anatomy. What an impression he must have made on the student body at Padua may be judged from the fact that shortly after his graduation in December, 1537, at the age of twenty-four, he was elected to the chair of anatomy and surgery. Two things favored him--an insatiate desire to see and handle for himself the parts of the human frame, and an opportunity, such as had never before been offered to the teacher, to obtain material for the study of human anatomy. Learned with all the learning of the Grecians and of the Arabians, Vesalius grasped, as no modern before him had done, the cardinal fact that to know the human machine and its working, it is necessary first to know its parts--its fabric.

To appreciate the work of this great man we must go back in a brief review of the growth of the study of anatomy.

Among the Greeks only the Alexandrians knew human anatomy. What their knowledge was we know at second hand, but the evidence is plain that they knew a great deal. Galen's anatomy was first-cla.s.s and was based on the Alexandrians and on his studies of the ape and the pig. We have already noted how much superior was his osteology to that of Mundinus.

Between the Alexandrians and the early days of the School of Salernum we have no record of systematic dissections of the human body. It is even doubtful if these were permitted at Salernum. Neuburger states that the instructions of Frederick II as to dissections were merely nominal.

How atrocious was the anatomy of the early Middle Ages may be gathered from the cuts in the works of Henri de Mondeville. In the Bodleian Library is a remarkable Latin anatomical treatise of the late thirteenth century, of English provenance, one ill.u.s.tration from which will suffice to show the ignorance of the author. Mundinus of Bologna, one of the first men in the Middle Ages to study anatomy from the subject, was under the strong domination of the Arabians, from whom he appears to have received a very imperfect Galenic anatomy. From this date we meet with occasional dissections at various schools, but we have seen that in the elaborate curriculum of the University of Padua in the middle of the fifteenth century there was no provision for the study of the subject.

Even well into the sixteenth century dissections were not common, and the old practice was followed of holding a professorial discourse, while the butcher, or barber surgeon, opened the cavities of the body. A member of a famous Basel family of physicians, Felix Plater, has left us in his autobiography(19) details of the dissections he witnessed at Montpellier between November 14, 1552, and January 10, 1557, only eleven in number. How difficult it was at that time to get subjects is shown by the risks they ran in "body-s.n.a.t.c.hing" expeditions, of which he records three.

(19) There is no work from which we can get a better idea of the life of the sixteenth-century medical student and of the style of education and of the degree ceremonies, etc. c.u.mston has given an excellent summary of it (Johns Hopkins Hospital Bulletin, 1912, XXIII, 105-113).

And now came the real maker of modern anatomy. Andreas Vesalius had a good start in life. Of a family long a.s.sociated with the profession, his father occupied the position of apothecary to Charles V, whom he accompanied on his journeys and campaigns. Trained at Louvain, he had, from his earliest youth, an ardent desire to dissect, and cut up mice and rats, and even cats and dogs. To Paris, the strong school of the period, he went in 1533, and studied under two men of great renown, Jacob Sylvius and Guinterius. Both were strong Galenists and regarded the Master as an infallible authority. He had as a fellow prosector, under the latter, the unfortunate Servetus. The story of his troubles and trials in getting bones and subjects you may read in Roth's "Life."(20) Many interesting biographical details are also to be found in his own writings. He returned for a time to Louvain, and here he published his first book, a commentary on the "Almansor" of Rhazes, in 1537.

(20) M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1892. An excellent account of Vesalius and his contemporaries is given by James Moores Ball in his superbly printed Andreas Vesalius, the Reformer of Anatomy, St. Louis, 1910.

Finding it difficult, either in Paris or Louvain, to pursue his anatomical studies, he decided to go to Italy where, at Venice and Padua, the opportunities were greater. At Venice, he attended the practice of a hospital (now a barracks) which was in charge of the Theatiner Order. I show you a photograph of the building taken last year. And here a strange destiny brought two men together. In 1537, another pilgrim was working in Venice waiting to be joined by his six disciples. After long years of probation, Ignatius Loyola was ready to start on the conquest of a very different world. Devoted to the sick and to the poor, he attached himself to the Theatiner Order, and in the wards of the hospital and the quadrangle, the fiery, dark-eyed, little Basque must frequently have come into contact with the st.u.r.dy young Belgian, busy with his clinical studies and his anatomy. Both were to achieve phenomenal success--the one in a few years to revolutionize anatomy, the other within twenty years to be the controller of universities, the counsellor of kings, and the founder of the most famous order in the Roman Catholic Church. It was in this hospital that Vesalius made observations on the China-root, on which he published a monograph in 1546. The Paduan School was close to Venice and a.s.sociated with it, so that the young student had probably many opportunities of going to and fro. On the sixth of December, 1537, before he had reached his twenty-fourth year and shortly after taking his degree, he was elected to the chair of surgery and anatomy at Padua.

The task Vesalius set himself to accomplish was to give an accurate description of all the parts of the human body, with proper ill.u.s.trations. He must have had abundant material, more, probably, than any teacher before him had ever had at his disposal. We do not know where he conducted his dissections, as the old amphitheatre has disappeared, but it must have been very different from the tiny one put up by his successor, Fabricius, in 1594. Possibly it was only a temporary building, for he says in the second edition of the "Fabrica"

that he had a splendid lecture theatre which accommodated more than five hundred spectators (p. 681).

With Vesalius disappeared the old didactic method of teaching anatomy.

He did his own dissections, made his own preparations, and, when human subjects were scarce, employed dogs, pigs or cats, and occasionally a monkey. For five years he taught and worked at Padua. He is known to have given public demonstrations in Bologna and elsewhere. In the "China-root" he remarks that he once taught in three universities in one year. The first fruit of his work is of great importance in connection with the evolution of his knowledge. In 1538, he published six anatomical tables issued apparently in single leaves. Of the famous "Tabulae Anatomicae" only two copies are known, one in the San Marco Library, Venice, and the other in the possession of Sir John Stirling-Maxwell, whose father had it reproduced in facsimile (thirty copies only) in 1874. Some of the figures were drawn by Vesalius himself, and some are from the pencil of his friend and countryman, Stephan van Calcar. Those plates were extensively pirated. About this time he also edited for the Giunti some of the anatomical works of Galen.(21)

(21) De anatomicis administrationibus, De venarum arterinrumque dissectione, included in the various Juntine editions of Galen.

We know very little of his private life at Padua. His most important colleague in the faculty was the famous Monta.n.u.s, professor of medicine.

Among his students and a.s.sociates was the Englishman Caius, who lived in the same house with him. When the output is considered, he cannot have had much spare time at Padua.

He did not create human anatomy--that had been done by the Alexandrians--but he studied it in so orderly and thorough a manner that for the first time in history it could be presented in a way that explained the entire structure of the human body. Early in 1542 the MS.

was ready; the drawings had been made with infinite care, the blocks for the figures had been cut, and in September, he wrote to Oporinus urging that the greatest pains should be taken with the book, that the paper should be strong and of equal thickness, the workmen chosen for their skill, and that every detail of the pictures must be distinctly visible.

He writes with the confidence of a man who realized the significance of the work he had done. It is difficult to speak in terms of moderation of the "Fabrica." To appreciate its relative value one must compare it with the other anatomical works of the period, and for this purpose I put before you two figures from a text-book on the subject that was available for students during the first half of the sixteenth century.

In the figures and text of the "Fabrica" we have anatomy as we know it; and let us be honest and say, too, largely as Galen knew it. Time will not allow me to go into the question of the relations of these two great anatomists, but we must remember that at this period Galen ruled supreme, and was regarded in the schools as infallible. And now, after five years of incessant labor, Vesalius was prepared to leave his much loved Padua and his devoted students. He had accomplished an extraordinary work. He knew, I feel sure, what he had done. He knew that the MSS. contained something that the world had not seen since the great Pergamenian sent the rolls of his "Manual of Anatomy" among his friends.

Too precious to entrust to any printer but the best--and the best in the middle of the sixteenth century was Transalpine--he was preparing to go north with the precious burden. We can picture the youthful teacher--he was but twenty-eight--among students in a university which they themselves controlled--some of them perhaps the very men who five years before had elected him--at the last meeting with his cla.s.s, perhaps giving a final demonstration of the woodcuts, which were of an accuracy and beauty never seen before by students' eyes, and reading his introduction. There would be sad hearts at the parting, for never had anyone taught anatomy as he had taught it--no one had ever known anatomy as he knew it. But the strong, confident look was on his face and with the courage of youth and sure of the future, he would picture a happy return to attack new and untried problems. Little did he dream that his happy days as student and teacher were finished, that his work as an anatomist was over, that the most brilliant and epoch-making part of his career as a professor was a thing of the past. A year or more was spent at Basel with his friend Oporinus supervising the printing of the great work, which appeared in 1543 with the t.i.tle "De Humani Corporis Fabrica." The worth of a book, as of a man, must be judged by results, and, so judged, the "Fabrica" is one of the great books of the world, and would come in any century of volumes which embraced the richest harvest of the human mind. In medicine, it represents the full flower of the Renaissance. As a book it is a sumptuous tome a worthy setting of his jewel--paper, type and ill.u.s.tration to match, as you may see for yourselves in this folio--the chef d'oeuvre of any medical library.

In every section, Vesalius enlarged and corrected the work of Galen.

Into the details we need not enter: they are all given in Roth's monograph, and it is a chapter of ancient history not specially illuminating.

Never did a great piece of literary work have a better setting. Vesalius must have had a keen appreciation of the artistic side of the art of printing, and he must also have realized the fact that the masters of the art had by this time moved north of the Alps.

While superintending the printing of the precious work in the winter of 1542-1543 in Basel, Vesalius prepared for the medical school a skeleton from the body of an executed man, which is probably the earliest preparation of the kind in Europe. How little anatomy had been studied at the period may be judged from that fact that there had been no dissection at Basel since 1531.(22) The specimen is now in the Vesalianum, Basel, of which I show you a picture taken by Dr. Harvey Cushing. From the typographical standpoint no more superb volume on anatomy has been issued from any press, except indeed the second edition, issued in 1555. The paper is, as Vesalius directed, strong and good, but it is not, as he asked, always of equal thickness; as a rule it is thick and heavy, but there are copies on a good paper of a much lighter quality. The ill.u.s.trations drawn by his friend and fellow countryman, van Calcar, are very much in advance of anything previously seen, except those of Leonardo. The t.i.tle-page, one of the most celebrated pictures in the history of medicine, shows Vesalius in a large amphitheatre (an imaginary one of the artist, I am afraid) dissecting a female subject. He is demonstrating the abdomen to a group of students about the table, but standing in the auditorium are elderly citizens and even women. One student is reading from an open book. There is a monkey on one side of the picture and a dog on the other. Above the picture on a shield are the three weasels, the arms of Vesal. The reproduction which I show you here is from the "Epitome"--a smaller work issued before (?) the "Fabrica," with rather larger plates, two of which represent nude human bodies and are not reproduced in the great work.

The freshest and most beautiful copy is the one on vellum which formerly belonged to Dr. Mead, now in the British Museum, and from it this picture was taken. One of the most interesting features of the book are the full-page ill.u.s.trations of the anatomy of the arteries, veins and nerves. They had not in those days the art of making corrosion preparations, but they could in some way dissect to their finest ramifications the arteries, veins and nerves, which were then spread on boards and dried. Several such preparations are now at the College of Physicians in London, brought from Padua by Harvey. The plates of the muscles are remarkably good, more correct, though not better perhaps, on the whole, than some of Leonardo's.

(22) The next, in 1559, is recorded by Plater in his autobiography, who gave a public dissection during three days in the Church of St. Elizabeth.

Vesalius had no idea of a general circulation. Though he had escaped from the domination of the great Pergamenian in anatomy, he was still his follower in physiology. The two figures annexed, taken from one of the two existing copies of the "Tabulae Anatomica," are unique in anatomical ill.u.s.tration, and are of special value as ill.u.s.trating the notion of the vascular system that prevailed until Harvey's day. I have already called your attention to Galen's view of the two separate systems, one containing the coa.r.s.e, venous blood for the general nutrition of the body, the other the arterial, full of a thinner, warmer blood with which were distributed the vital spirits and the vital heat. The veins had their origin in the liver; the superior vena cava communicated with the right heart, and, as Galen taught, some blood was distributed to the lungs; but the two systems were closed, though Galen believed there was a communication at the periphery between the arteries and veins. Vesalius accepted Galen's view that there is some communication between the venous and arterial systems through pores in the septum of the ventricles, though he had his doubts, and in the second edition of his book (1555) says that inspite of the authority of the Prince of Physicians he cannot see how the smallest quant.i.ty of blood could be transmitted through so dense a muscular septum. Two years before this (1553),(*) his old fellow student, Michael Servetus, had in his "Christianismi Rest.i.tutio" annatomical touch with one another!

(*) See the Servetus Notes in the Osler Anniversary Volumes, New York, 1919, Vol. II.--Ed.