Part 8

With regard to the bodies of condemned criminals, people began to countenance the procedure, and while unwilling as yet to give them freely, allowed the bodies to be taken. Corradi, quoted by Puschmann, says "that laws against the desecration of graves, without being abolished, became a dead letter. The authorities interfered only if decided violence had been used or a great scandal raised. Such consequences were likely to follow only if, in the ardor of their enthusiasm for anatomical knowledge, students rifled the graves of well-known {76} persons or took the bodies of those whose relatives discovered the desecration and proceeded against the marauders by legal measures."

At the Italian universities after the middle of the fourteenth century there is abundant evidence for perfect freedom with regard to dissection. We have already shown by our quotation from Roth that Bertrucci was very active in dissection work and did many public dissections. He was followed by Pietro di Argelata, who died toward the end of the fourteenth century. These men followed Mondino in the chair of anatomy at Bologna, and Julius Pagel, in his chapter on Anatomy and Physiology in Puschmann's Handbuch der Geschichte der Medizin (Vol. I., p. 707), says that "the successors of Mondino were in a position, owing to the gradual enlightenment of the spirit of the time and the general realization of the importance of anatomy as well as the fostering liberality of the authorities, _to make regular, systematic dissections of the human body._" This would bring us down, then, to the end of the fourteenth century.

To return now to Roth, who takes up the next century. He says:

"For the fifteenth century, the university statutes of Bologna for the year 1405 furnish many sources of information. There is a special division which is concerned with the _annual anatomy or dissection_ that had to be made and the selection of the persons to be present, the payment of the expenses and other details. An addition to the statutes, made in the year 1442, determines the arrangement of the delivery of the body from the city to the university authorities. Every year two bodies, one male and one female, must be provided for the {77} medical school dissections. In default of a female body, a second male body was to be provided. In the presence of such detailed regulations, the absence almost entirely of details as to the actual performance of dissections can mean very little. Bologna reached its highest development as a medical school at the beginning of the sixteenth century when Alexander Achillinus and Jacob Berengarius had charge of the public dissections there. Of these I shall speak later." (All this is at the University of Bologna, where ecclesiastical influence was supreme and where the Popes exercised their jurisdiction as the ultimate authority to be appealed to in all disputed educational questions.)

Roth continues: "Padua had, like Bologna, dissection in the fourteenth century. There is the record of a dissection made in the year 1341, in which Gentilis made the discovery of a gall-stone." (It is evidently not because the dissection was unusual, but because the discovery was unusual, that this incident is mentioned. The dissections were such ordinary occurrences as not to deserve special mention except for some particular reason.)

"Much more is known about dissection at Padua in the fifteenth century, when the city had become Venetian." [Footnote 11] (It is significant to note that the previous occurrence was in pre-Venetian days, for Professor White insists that it was the Venetian authorities, in opposition to the Pope, who allowed dissection at Padua. Here is the rebuttal of any such theory.) "Bertapaglia, in his Surgery, has the record of the dissection of a criminal made under the direction of Master Hugo De Senis, on {78} the 8th of February, 1429. On the 4th of April, 1430, the dissection of a woman was made. In 1444 Professor Montagnana speaks of fourteen dissections at which he had been present." (This would seem to indicate that dissections were quite common and that the occasional records of them give no proper idea of their actual number.)

[Footnote 11: Note that this is a full century before Vesalius's time, who, Professor White insists, reintroduced dissection.]

I would not wish to produce the impression, however, that Italy was the only place in Europe in which dissections were freely done during the fourteenth and fifteenth centuries. There is no doubt that anatomy and surgery and every branch of medicine was cultivated much more assiduously and with much better opportunities provided for students down in Italy, than anywhere else in the world. This of itself alone shows the utter absurdity of the declarations that the Church was opposed to medical progress in any way, since the nearer the center of Christendom, the more ardor there was for investigation and the more liberty to pursue original researches. Other countries also began to wake up to the spirit of progress in medical education that was abroad. In France there were two centers of interest in anatomy. One of these was at Montpelier, the other at Paris. It is interesting to note, however, that the men to whom anatomical progress is due at these universities obtained their training, or at least had taken advantage of the special opportunities provided for anatomical investigation to be had, in the Italian cities. Guy de Chauliac I have already mentioned. He is spoken of as the Father of Modern Surgery, and there is no doubt that he did much to set surgery on a very practical basis and to make anatomy a fundamental feature of the training for it. He declared that it was absurd to think that surgeons could do good work unless they knew their anatomy.

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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 {80} 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 {81} 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 {82} 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 {83} 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 {84} 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 {85} 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 Pare 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."

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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.

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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 {88} 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 {89} 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_.