V. VESALIUS

In 1543 Andreas Vesalius published what Sir William Osier judged the greatest medical work ever written.53 His father, Andreas Wessel, was a prosperous apothecary in Brussels; his grandfather had been physician to Mary of Burgundy and then to her husband Maximilian I; his great-grandfather had been city physician at Brussels; his great-great-grandfather, a physician, had composed a commentary on Avicenna’s Kanun; here was a social heredity outmatching Bach’s. Subjected to it from birth, Vesalius soon developed a passion for dissection. “No animal was safe from him. Dogs and cats, mice, rats, and moles were meticulously dissected by him.”54 But he did not neglect other studies. At twenty-two he lectured in Latin, and readily read Greek. At Paris (1533-36) he studied anatomy under Jacques Dubois, who gave to many muscles and blood vessels the names they bear today. For a long time, like his teachers, he accepted Galen as a Bible; he never lost respect for him, but he respected much more the authority of observation and dissection. With some fellow students he made many trips to the charnel houses where were gathered the bones exhumed from the Cemetery of the Innocents; there they became so familiar with the parts of the human skeleton that, he tells us, “we, even blindfolded, dared at times to wager with our companions, and in the space of half an hour no bone could be offered us... which we could not identify by touch.”55 Frequently, in the classes of Dubois, the bold young anatomist would displace the “barber surgeons” to whom actual dissection was usually delegated by the physician professor, and would himself expertly expose the parts relevant to the lecture.56

When his sovereign Charles V invaded France (1536), Vesalius retired to Louvain. Hampered by a shortage of corpses there, he and his friend Gemma Frisius (later famous as a mathematician) snatched one out of the air. His account reveals his passion:

While out walking, looking for bones in the place where, on the country highways... those who have been executed are customarily placed, I happened upon a dried cadaver... The bones were entirely bare, held together by the ligaments alone.... . With the help of Gemma I climbed the stake and pulled off the femur... The scapulae together with the arms and hands followed.... After I had brought the legs and arms home in secret and successive trips... I allowed myself to be shut out of the city in the evening in order to obtain the thorax, which was firmly held by a chain. I was burning with so great a desire.... The next day I transported the bones home piecemeal through another gate of the city.57

The burgomaster saw the point, and thereafter gave the anatomy classes whatever cadaver could be released; “and he himself,” says Vesalius, “was in regular attendance when I administered an anatomy.”58

A man with such “burning desire” could not keep his temper cool. He fell into a hot dispute with a teacher about methods of venesection, left Louvain (1537), and rode down the Rhine and across the Alps to Italy. He was already so proficient that before the end of that year he received his doctor’s degree at Padua cum ultima diminutione—“with the maximum diminution” of the fee; for the higher a student’s standing the lower his graduation fee. On the very next day (December 6, 1537) the Venetian Senate appointed him professor of surgery and anatomy at the University of Padua. He was twenty-three.

During the following six years he taught at Padua, Bologna, and Pisa, doing hundreds of dissections with his own hands, and issuing some minor works. Under his direction Jan Stefan van Kalkar, a pupil of Titian, drew six plates which were published (1538) asTabulae anatomicae sex. A year later Vesalius, in a Venesection Letter, supported Pierre Brissot of Paris on methods of bloodletting. In the course of his argument he revealed some results of his dissections of the venous system, and these observations contributed to the discovery of the circulation of the blood. In 1541-42 he joined other scholars in a new edition of the Greek text of Galen. He was astonished by Galenic errors that the simplest human dissection would have disproved—that the lower jaw had two parts, the sternum seven distinct bones, the liver several lobes. Only on the assumption that Galen’s dissections had been of animals, never of men, could these errors be explained and forgiven. Vesalius felt that the time had come to revise the science of human anatomy in terms of the dissection of man. He prepared his masterpiece.

When Johannes Oporinus printed at Basel in 1543 the De humani corporis fabrica (On the Structure of the Human Body), a large folio of 663 pages, what must have struck the reader at once was the title page—an engraving worthy of Dürer, which pictured Vesalius demonstrating the anatomy of an opened arm, with half a hundred students looking on. And then the illustrations: 277 woodcuts of unprecedented anatomical accuracy and high technical excellence, made mostly by Van Kalkar, with scientifically irrelevant and artistically attractive landscapes behind the figures—a skeleton, for example, at a reading desk. These cuts were so fine that some have thought they were designed in the studio of Titian, perhaps under his supervision; to which we must add that Vesalius drew several of them with his own hand. He accompanied the blocks watchfully in their journey by mule pack over the Alps from Venice to Basel. When the printing was complete the blocks were carefully preserved; later they were bought, exchanged, and lost; in 1893 they were found secreted in the library of the University of Munich; they were destroyed by bombing in the second World War.

What should have aroused more astonishment than these drawings was that the text—a triumph of typography but also a scientific revolution—was by a youth of twenty-nine. It was a revolution because it ended the reign of Galen in anatomy, revised the whole science in terms of dissection, and so established the physical basis of modern medicine, which begins with this book. Here for the first time were described the true course of the veins and the anatomy of the heart; here was the epochal statement that the most careful dissection showed none of those pores through which Galen had supposed the blood to pass from one ventricle of the heart to the other; so the way was prepared for Servetus, Colombo, and Harvey. Galen was corrected again and again—on the liver, the bile ducts, the maxillae, the uterus. Vesalius, too, made errors, even of observation, and failed to take the great leap from the anatomy of the heart to the circulation of the blood. But here were accurate descriptions of scores of organs never so well described before, and every part of the body opened to science with a confident and masterly hand.

He suffered from the defects of his qualities. The pride that upheld him through years of minute study made him quick to take offense, slow to recognize the achievements of his predecessors and the sensitivity of his rivals. He was so in love with “that true Bible... the human body and the nature of man”59 that he hurt many theological toes. He referred sarcastically to the ecclesiastics who seemed most attracted to his lecture room when the reproductive organs were to be studied and shown.60 He made many enemies; and though Gesner and Fallopio hailed his work, most of the older professors, including his former teacher Dubois, condemned him as an insolent upstart, and sedulously picked flaws in his book. Dubois explained that Galen had not been wrong, but that the human body had changed since Galen’s time; so. he thought, the straight thigh bones, which, as everyone saw, were not curved in accordance with Galen’s description of them, were the result of the narrow trousers of Renaissance Europeans.61

In a tempest of disappointment at the attitude of these men, Vesalius burned a huge volume of Annotationes, and a paraphrase of the ten books of al-Razi’s Kitab al-Mansuri—an encyclopedia of medicine.62 In 1544 he left Italy to become second physician on the staff of Charles V, to whom he had judiciously dedicated the Fabrica. In the same year his father died, leaving him a considerable fortune. He married, and built a handsome home in Brussels. A second edition of the Fabrica was issued in 1555, with augmented and corrected text. It showed that artificial respiration could keep an animal alive despite incision of its chest, and that a stopped heart could sometimes be revived by bellows. Thereafter Vesalius made no contribution to anatomy. He absorbed himself in caring for his Imperial and lesser patients, and in the practice and study of surgery. When Charles abdicated, Vesalius became second physician to Philip II. In July 1559, the King sent him to aid Ambroise Paré in an attempt to save the wounded Henry II; Vesalius applied clinical tests that showed no possibility of recovery. Later in that year he and his family accompanied Philip to Spain.

Meanwhile others advanced anatomy. Giambattista Cano noted the venous valves (1547); Servetus explained the pulmonary circulation of the blood (1553); Realdo Colombo made the same discovery (1558), and proved it by experiment on the living heart; but another seventy years passed before Harvey’s epochal description of the course of the blood from heart to lungs to heart to arteries to veins to heart. The Arab physician Ibn al-Nafis had anticipated Servetus in 1285,63 and the tradition of his doctrine may have carried down into the Spain of Servetus’s youth.

Vesalius had some adventures left to him. The native physicians at the Spanish court made it a point of honor to disregard his diagnoses. When Don Carlos, Philip’s only son, suffered concussion of the brain from a fall (1562), Vesalius recommended trepanning. The advice was rejected, and the youth neared death. Relics and charms were applied to the wound, and pious people flogged themselves to persuade heaven to effect some miraculous cure; to no avail. Finally Vesalius insisted on opening the skull; it was done, and a large quantity of pus was drawn off. The Prince soon improved, and eight days after the operation Philip II attended a solemn procession of thanksgiving to God.64

Two years later Vesalius left Spain, for reasons still in dispute. Ambroise Paré told of an anatomist who brought most of Spain down upon his head by opening the body of a woman supposedly dead from “strangulation of the uterus”; at a further stroke of the surgeon’s knife, said Paré, the woman came suddenly back to life, “which struck such admiration and horror into the hearts of all her friends... that they accounted the physician—before of good fame and report—as infamous and detestable”;65 relatives do not always appreciate such unexpected recoveries. “Therefore,” continued the Huguenot surgeon, “he thought there was no better way for him, if he would live safe, than to forsake the country.” Hubert Languet, another Huguenot, told a similar story (c. 1579), named the physician as Vesalius, and claimed that Vesalius, by dissecting a living person, had become liable to the Inquisition, which he escaped by promising to make a penitential pilgrimage to Palestine. No contemporary source mentions the incident, and Catholic historians reject it as a fable.66 Perhaps Vesalius was just tired of Spain.

He returned to Italy, sailed from Venice (April 1564), and apparently reached Jerusalem. On the way back he suffered shipwreck, and died of exposure, far from any friend, on the island of Zante off the west coast of Greece (October 15,1564). He was fifty years old. In that same year Michelangelo died and Shakespeare was born. The splendor that had shone for a century in Italy was passing to the north.

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