Andreas Vesalius, the Reformer of Anatomy :: CHAPTER FIFTH Sojourn in Paris

CHAPTER FIFTH Sojourn in Paris

Illuminated capital

One thought was uppermost in the mind of Vesalius, and that was to follow the profession of his ancestors, just as in ancient Greece the sons of the Asclepiadae naturally adopted the vocation of their fathers. Andreas possessed an excellent preliminary education and was especially proficient in the Greek and Latin languages; he also knew something of Hebrew and much of Arabic. It was in the year 1533 that the young Belgian travelled to Paris for the purpose of obtaining a medical education. At that time the French capital was the Mecca of the medical world—Paris, that city where classical medicine first secured support (ubi primum medicinam prospere renasci vidimus)[11]. In Paris, under the leadership of Budaeus, Humanism had enjoyed a rapid growth; and here Petrus Brissotus, after gaining the doctor’s cap in the year 1514, produced a revolution by delivering his lectures from the books of Galen in place of the treatises of AverrÖes and of Avicenna. At his own expense Brissotus published Leonicenus’s translation of Galen’s Ars Curativa, in order that his pupils might not be misled by the incorrect text of the Arab authors. It will be recalled that, long before this time, classical Greek and Latin medical literature had passed through the distorting crucible of Saracenic translations. At this period medical science, purified from Arabic dross, was taught in a splendid manner in Paris by such eminent professors as Jacobus Sylvius, Jean Fernel, and Winter of Andernach. At their feet sat young men from the remotest parts of Europe.

The most popular of the Paris teachers was Jacobus Sylvius, or Jacques Dubois, whose Latinized name is perpetuated in anatomical nomenclature. He was born at Louville, near Amiens, in 1478. In his early years he was noted for his scholarly attainments in the Greek, Latin and Hebrew languages and was the author of a French grammar. His anatomical knowledge was gained under Jean Tagault, a famous Parisian practitioner and surgical author.

SYLVIUS

Sylvius was noted for his industry, for his eloquence, and above all for his avarice. It was the inordinate desire for money which led him to abandon philology for medicine. While studying under Tagault he began a course of medical lectures, explanatory of the works of Hippocrates and Galen, with such success that the Faculty of the University of Paris protested on the score that Sylvius was not a graduate. He then went to Montpellier, whose medical professors had long held a high position, where, according to Astruc, he received the doctor’s cap at the end of November, 1529. He was then above fifty years of age. Armed with this degree, he returned to Paris and immediately entered the lists as an independent medical teacher, but was again halted by the Faculty who ruled that he must first receive the Bachelor’s degree. This he gained on June 28, 1531. Sylvius then resumed his lectures with such success that his classes in the CollÉge de TrÉguier numbered from four to five hundred, while Fernel, who was a professor in the CollÉge de Cornouailles, lectured to almost empty benches. In 1550, Henry the Second named Sylvius Professor of Medicine, as the successor of Vidus Vidius, in the recently established CollÉge de France. Sylvius died January 13, 1555, and was interred in the paupers’ cemetery as he had wished.

Sylvius was not only an eloquent lecturer but he was also a demonstrative teacher. He was the first professor in France who taught anatomy from the human cadaver. In his lectures on botany he used a collection of plants to elucidate the subject. His chief fault was a blind reverence for ancient authors. He regarded Galen’s writings as gospel; if the cadaver presented structures unlike Galen’s description, the fault was not in the book but in the dead body, or, perchance, human structure had changed since Galen’s time! In one of his early books[12], Sylvius declared that Galen’s anatomy was infallible; that Galen’s treatise, De Usu Partium, was divine; and that further progress was impossible!

The character of Sylvius was contemptible. He was a man of vast learning and at the same time was rough, coarse and brutal. His avarice led him to endure the cold winters of Paris without the benefit of a fire; in severe weather he would play at football, or engage in other violent exercise in his room, to save the cost of fuel. Once, and once only, did his friends find him hilarious; they wondered and asked the cause. Sylvius said he was happy because he had dismissed his “three beasts, his mule, his cat and his maid”. He was notoriously rigid in exacting his fees from students, and on one occasion he threatened to stop his lectures until two delinquents should pay their dues. Although he was supposed to have amassed great wealth, little of it was found after his death, and these sums were secreted in secluded places. In 1616, when his former residence in the rue Saint-Jacques was demolished, numerous gold pieces were found. His reputation for miserliness followed him beyond the grave, as witness his epitaph:

Sylbius hic situs est, gratis qui nil dedit unquÀm,

Mortuus et gratis quod legis ista dolet.

“Sylvius lies here, who never gave anything for nothing:

Being dead, he even grieves that you read these lines for nothing.”

In controversies he was violent and vindictive—a pastmaster in the use of bitter language. Jealous of the fame of other anatomists, he was particularly enraged when, in later years, he was opposed by Vesalius. Sylvius spoke of him not as Vesalius, but as Vesanus, a madman, who poisoned Europe by his impiety and clouded knowledge by his blunders. Such was the man who, in the mid-part of the sixteenth century, filled the position of highest honor in the Medical Faculty of the CollÉge de France[13].

Sylvius rendered valuable service in naming the muscles which, prior to his time, were designated by numbers. These, says Northcote[14] “were differently applied by almost every author; so that it was the description, and not the name, that must lead one to know what part was meant by such authors; and this required a previous thorough knowledge of anatomy”. He is the first writer who mentions colored injections and is supposed to have discovered this useful adjunct of anatomical study. He was the first anatomist who published satisfactory descriptions of the pterygoid and clinoid processes of the sphenoid bone, and of the os unguis. He gave a good account of the sphenoidal sinus in the adult but denied its existence in the child, as had been affirmed by Fallopius[15]. Sylvius also wrote intelligently concerning the vertebrae but incorrectly described the sternum. His observation concerning the valves in the veins gave rise to much discussion; the honor of priority in the discovery, however, belongs to other anatomists—Estienne and Cannanus. His discoveries in cerebral anatomy have caused his name to be attached to the aqueduct, the fissure and the artery of Sylvius.

The manner in which Sylvius conducted his anatomical course is known to us by his own writings, by the testimony of Moreau[16], and by that of Vesalius[17]. Thus the course for the year 1535 began with the reading, by Sylvius, of Galen’s treatise De Usu Partium. When the middle of the first book was reached, Sylvius remarked that the subject was too difficult for his students to understand and that he would not plague his class with it. He then jumped to the fourth book, read all to the tenth book, discussed a part of the tenth and omitting the eleventh, twelfth and thirteenth, he took up the fourteenth and the remaining three books. Thus he omitted all that Galen had said concerning the extremities. A second Galenic work which Sylvius used was the anatomico-physiologic treatise, De Musculorum Motu. Not infrequently the professor was unable to demonstrate in dissection the parts on which he had lectured. Thus, on one occasion, the students succeeded in finding the pulmonary and aortic valves which Sylvius had failed to find on the preceding day.

Joannes Guinterius of Andernach

Another famous member of the Paris Faculty of this period, and a man whose life-story reads like a romance, was Joannes Guinterius, the beggar of Deventer. Guinterius (Gonthier, Guinther, Guinter, Winter, or Winther), who is often called John Winter of Andernach, from the name of the town in which he was born, lived between the years 1487-1574, and rose to eminence in both the literary and the medical worlds. Born of humble parents, he was sent at an early age to the University of Utrecht. Leaving this institution because of his poverty, he went to Deventer where he was reduced to the necessity of begging in the streets. He drifted to the University of Marburg, and here displayed such brilliant talents that he soon obtained employment as a teacher in the small town of Goslar, in Brunswick. His growing reputation for learning led to his appointment to the chair of Greek in the noted University of Louvain.

WINTER OF ANDERNACH

Desiring to study medicine, Guinterius went to Paris in 1525; he received the Bachelor’s degree in 1528, and the full medical title two years later. He passed a brilliant examination which won for him the commendation of the most eminent professors. Remaining in Paris, he engaged in practice and in teaching, and rapidly rose to eminence. In addition to conducting courses in anatomy, he translated into Latin the writings of the most noted Greek medical authors of antiquity—the books of Galen, of Oribasius, of Paul of Aegina, of Caelius Aurelianus, and of Alexander of Tralles—all of which were held in high esteem in the sixteenth century. His fame reached far beyond the boundaries of France. Christian III., the enlightened king of Denmark, who was noted for his love of literature, sought to attach him to the Danish court, but the honor was refused. Having become a convert to the religious views of Luther, Guinterius found that his life was in danger; he left Paris and resided for a time in Metz. He soon removed to Strassburg, where he was received with distinguished honors and was appointed to a professorship in the University. Owing to the activity of his enemies, his position became insecure; accordingly, he resigned his chair and spent a considerable time in travelling throughout Germany and Italy. In the year 1562, Ferdinand I., in appreciation of the great merits of Guinterius, raised him to the highest distinction by placing him among the nobles of the land; and thus the beggar of Deventer became a nobleman of Strassburg. His life ended October 4, 1574.

Like Sylvius, Guinterius was a teacher of men who became greater than himself—Vesalius, Servetus and Rondelet sat upon his benches. Like Sylvius, he placed his faith in Galen and failed to grasp the great truth that anatomical science is based, not on the writings of the Fathers but on dissection of the dead body.

Jean Fernel

JEAN FERNEL

The third bright star of the Paris constellation was Jean Fernel (1485-1558), of Amiens, who was regarded as the ablest physiologist of his time and was physician-in-ordinary to Henry the Second. Fernel dipped deeply into philosophy, geometry and mathematics. Before entering the medical profession he issued three books on mathematic and geometric subjects. He received the medical degree in 1530, but continued his study of mathematics with such ardor that he was almost ruined financially. On the advice of his friends he entered upon the practice of medicine in Paris and met with remarkable success. He was skilled in anatomy and surgery and accompanied his sovereign upon numerous military expeditions. His medical writings are contained in many volumes and concern a variety of subjects, such as physiology, therapeutics, surgery, pathology, the treatment of fevers and the venereal diseases.

Fernel’s medical views were powerfully influenced by the teachings of an unfortunate French philosopher, Pierre de la RameÉ, or Ramus, who, like many other Protestants, lost his life on Saint Bartholomew’s Night. Brutally assassinated, his body was dragged through the streets of Paris and then was thrown into the Seine; but his system of philosophy survived and exercised a potent influence until it was eclipsed by the doctrines of Descartes.

Ramus, who was an uncompromising opponent of the Aristotelian philosophy, pointed out the defects and suggested the reforms in the system of University education. He compared the teaching of medicine with that of theology, much to the disparagement of the latter:—“The reason”, said he, “why medicine is better taught, and the lectures are better attended than in theology is, that those who teach it know it, and practice it, and their disputations are chiefly on the books of Hippocrates and Galen; whilst the theologians observe a strict reticence on questions of the Old Testament, which they read in Hebrew, as well as of the New, which they read in Greek, but display their learning in subtle questions respecting the pagan philosophy of Plato and Aristotle”.[18] Ramus endeavored to withdraw the minds of both physicians and medical students from the authoritative dogmas of the ancient physicians and to substitute therefor the intelligent study of Nature. The practical trend of his mind is shown in his suggestion that institutions should be arranged for clinical teaching.

RAMUS

Just as Ramus had become an Eclectic in philosophy, so Fernel sought the best from various sources and different medical systems. Like Ramus, he cast off the yoke which authority had placed upon him; and proposed carefully planned principles which should lead to the discovery of truth. Like Ramus, Fernel presented his views in a clear style and in better order than was to be found in the writings of his predecessors. Like Ramus, he adopted the good and rejected the bad, regardless of whether it had been said by Aristotle, or by Galen, or by Hippocrates. Fernel was a reformer who stood for freedom of thought, which, up to his time, had suffered from the despotism of the scholastics. Although many of Fernel’s physiologic and pathologic ideas seem ridiculous when viewed in the light of modern knowledge, yet he deserves praise for daring to oppose ancient dogmas, and for pointing the road to progress. In breadth of view, Fernel was far superior to Sylvius and Guinterius.

The anatomical teaching in Paris in the early part of the sixteenth century was far from satisfactory. There was too much lecturing and theorizing from Galen’s texts, and too little of actual dissection. Vesalius, who was not backward in his criticisms, says that the dissections were made by ignorant barbers, and during the whole time that he was in Paris he never saw Guinterius use a knife upon a cadaver. Only at rare intervals was a human body brought into the amphitheatre, and then the dissection lasted less than three days. It comprised only a superficial study of the intestines and abdominal muscles; no other muscles were studied. The bones, veins, arteries and nerves were almost wholly ignored. The great lights of the Paris profession were totally unfit to give to the young Belgian what was his heart’s desire. They were ignorant and knew it not. It is not surprising that, on more than one occasion, Vesalius brushed the ignorant prosectors aside, took the knife into his own hands, and carried out the dissection in a systematic manner. His zeal and learning won the admiration of Guinterius who spoke of Vesalius and Servetus in loving terms;—“first Andreas Vesalius, a young man, by Hercules! of singular zeal in the study of anatomy; and second, Michael Villanovanus (Servetus), deeply imbued with learning of every kind, and behind none in his knowledge of the Galenic doctrine. With the aid of these two, I have examined the muscles, veins, arteries and nerves of the whole body, and demonstrated them to the students”.[19]

Vesalius must have had many blue days in Paris—days when he longed to have a free hand in dissection. A weaker character than his would have fitted peacefully into the established order of things, but not of such stuff was Andreas made. The difficulties which beset his path only stimulated him to work the harder; he firmly resolved to devote his energy, his talents and his life to anatomical study and teaching. He decided to secure the opportunity to dissect the human body and to rival the ancient Alexandrian professors who taught the subject. “Never”, he says, “would I have been able to accomplish my purpose in Paris, if I had not taken the work into my own hands”. The Book of Nature which Sylvius lauded, but kept his pupils from studying, was now opened by Vesalius. He dissected numerous dogs and studied the only part of human anatomy that was available, namely, the bones. In his search for materials for a skeleton he haunted the Cemetery of the Innocents. On one occasion, when he went to MontfauÇon, the place where the bodies of executed criminals were deposited and bones were plentiful, Vesalius and his fellow-student were attacked by fierce dogs. For a time the young anatomist was in danger of leaving his own bones to the hungry scavengers. By such dangers he gained what the Paris professors could not supply. He became a master of the osseous system, so much so that, when blindfolded, he was able to name and describe any part of the skeleton which was placed in his hands. His talents were recognized by both professors and students; and at the third anatomy which he attended in Paris he was requested to take charge of the dissection. To the satisfaction of the students, as well as to the astonishment of the barbers, he made an elaborate dissection of the abdominal organs and of the muscles of the arm.

VIVISECTION OF A PIG
(From the “Fabrica”, 1543)

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