The Story Of Anatomy Down To The Renaissance
( Originally Published 1911 )
We have seen that the supposed prohibition of anatomy by the Popes has no existence in reality. In spite of this fact, which it was easy for anyone to ascertain who wished to consult the documents asserted to forbid, a number of historical writers have insisted on finding religious or ecclesiastical, or theological, opposition to anatomical studies. Professor White has been most emphatic in his assertions in this regard. He admits that the supposed bull of prohibition had quite a different purport, yet he still continued to assert its connection with the failure of anatomy to develop during the Middle Ages. This presumed failure of anatomy during the Middle Ages is a myth. It continues to secure credence only in the minds of those who know nothing of the history of medical science during the thirteenth, fourteenth, and fifteenth centuries and who have not consulted the serious histories of medicine that treat of this time, but flourishes vigorously in the minds of those who have a definite purpose in making out a story of theological or Church opposition to science in general.
To counteract the false impression that has gained such wide acceptance in this matter, it has seemed advisable, in order to settle the question definitely once and for all, to trace the history of anatomical science from its beginning in the Middle Ages down to modern times. It will not be hard to show that there was a constant development and an unfailing interest in this subject. This can be understood even more clearly from the story of the development of surgery in the Middle Ages and its relations to anatomy than from the history of anatomy itself. As is well known, materials with regard to practical and applied science interest men more at all times, and documents with regard to them are more likely to be preserved, and so the history of surgery is very full, while the history of anatomy may prove not quite so satisfactory. It is true of all sciences, that there are periods when they have much less attraction than at other times, and the success of investigators and original workers is not always the same. As in nearly everything else, the real advances in all science come when genius makes its mark, and not merely because a large number of men happen to be interested in the subject. This will be found as true in anatomy as in other sciences, and so there are periods when not much is doing, but nowhere is there a trace of ecclesiastical opposition to account for these variations of interest.
There is no doubt at all that there was much popular opposition to the practice of dissection in the Middle Ages ; that has existed at all times in the world's history. It was very pronounced among the old Pagans in Rome as well as in Greece, and it prevented anatomical study to a very great degree. It continued to exist in modern times until almost the present generation. Indeed, it has not yet entirely disappeared, as any physician who has tried to secure autopsies on interesting cases knows very well. The New York Academy of Medicine is only a little over a half century old, and yet nearly every one of its early presidents had thrilling experiences in body-snatching as a young man, because no proper provision for the supplying of anatomical material had as yet been made by law, and bodies had to be obtained. The feeling of objection to having the bodies of friends anatomized is natural and not due to religion. It exists quite as strongly among the ignorant who have no religion as among the religiously inclined. It has not disappeared among the educated classes of our own time, religious or irreligious. If this is borne in mind, the history of the development of anatomy will be easier to understand.
The first definite evidence in modern history for the existence of the practice of dissection is a famous law of the German Emperor, Frederick II., from the first half of the thirteenth century. This law was promulgated for the two Sicilies, that is, for Southern Italy and Sicily proper, very probably in the year 1240. It has often been vaguely referred to, but its actual significance can only be understood from the terms of the law itself, which has been literally translated by Von Toply in his Studien Zur Geschichte der Anatomie in Im Mittelalter.1 The paragraph with regard to dissection runs as follows" As an enactment that will surely prove beneficial to health, we decree that no surgeon will be allowed to practice, in case he has not a written testimonial, which he must present to the teachers in the medical faculty, that he has for at least a year applied himself to that department of medicine which is concerned with the teaching and practice of surgery, and that he has, above all, learned the anatomy of the human body in this manner, and that he is fully competent in this department of medicine, without which neither surgery can be undertaken with success nor sufferers cured.
Such a regulation, as pointed out by Professor Pilcher in an article on the early history of dissection, and as we know by modern experience, does not come into force as a rule before the actual practice of what is prescribed, has been for some time the custom and its usefulness proved by the results attained. It seems very probable, then, that even at this early day the Emperor Frederick was only making into a law what had been at least a custom before this time. Lest anyone should think that this is a farfetched assumption, certain other paragraphs of this law, which show very definitely the high degree to which the development of medical teaching had reached, must be recalled. Frederick declared that medicine could only be learned if there was a proper groundwork of logic. Only after three years devoted to logic, then, under which term is included the grammar and philosophy of an ordinary undergraduate course, could a man take up the study of medicine. After three years devoted to medicine, to which it is again specifically declared another year must be added if surgery were to be practiced, a man might be given his degree in medicine, but must spend a subsequent full year in the practical study of medicine under the supervision of an experienced physician.
The law further decreed definite punishments for the practice of medicine without due warrant and violation of its regulations, and also regulated the practice of apothecaries. It is rather interesting to find that these were forbidden to share their profits with physicians, and the physicians themselves were not allowed to distribute their own medicines. In a word, practically every one of the problems in the practice of medicine which medical societies are trying to solve at the present moment, were also occupying the attention of the civil authorities about seven centuries ago. Anyone who reads this law will not be loath to believe that it represents the culmination of a series of efforts to regulate medical practice, and especially medical education, and that it was not merely a chance legal utterance that happened to touch a single important question for the first time. One of the paragraphs of the law even contains some clauses that would prevent fake medical schools and that establishes a board of medical examiners. This consisted of certain state officials and some professors of the art of medicine. In a word, medical education had reached a high grade of development, and medical practice was legally established on a high plane of professional dignity.
Salerno had already enjoyed a high reputation as a medical school for more than two centuries when Frederick's law was promulgated. It is true that we have no definite records of dissections done in the school. If these were not an uncommon occurrence, however, but came as did dissections later on, quite as a matter of course, the absence of such records, when we recall how liable to destruction were the meagre accounts of the university transactions of the time during the long period that has intervened and because of the many vicissitudes they were liable to, is not surprising. During the century following this decree there seems to be no doubt that dissections were done regularly, though perhaps not very frequently from our modern standpoint, at Salerno. Salerno, as we shall see in the chapter on The Papal Medical School, was always closely in touch with the ecclesiastical authorities, and especially with the Papacy. There was no hint of friction of any kind, either before or after this law of Frederick's. The question of ecclesiastical interference with dissection does not seem to have arisen at all, much less to have proved an obstacle to the development of medical science.
At the beginning of the fourteenth century the center of interest in anatomy and the matter of dissections shifts to Bologna. We have already discussed the question whether Mondino was the first to do public anatomies, and as to whether he performed only the few that by a narrow misunderstanding of certain of his own words have sometimes been ascribed to him. Professor Pilcher, in the article The Mondino Myth, already cited, is of the opinion, and gives excellent reasons for it, that Taddeo, the great Bolognese physician of the thirteenth century, who was Mondino's master, had done at least some dissections in Bologna. Personally I have long felt sure that Taddeo or Thaddeus, as he is sometimes called in the Latin form of his name, did not a few, but a number of dissections.
Professor Pilcher's account of him does not exaggerate his merits. I may say that he was one of the great Papal physicians of whom we shall have more to tell hereafter.
"Any comprehensive attempt to trace the real influences to which was due so great a step as a return to the practice of dissections of the human body, seems to me must be very defective if it failed to take into consideration the influence of such a man as Thaddeus (Italian Taddeo). That he was able to impress himself in the way in which history records that he did, both upon the general public and upon the scholastic foundations of Bologna, shows a strength of character and a mastery of the peculiar conditions of the moment in the fields of science and philosophy which made him a master and an inspirer. If he is to be considered in his proper historical light, as one who declares that the knowledge of the structure of the human body to a most minute degree is the foundation upon which all rational medicine and surgery must be built, then it is impossible to exaggerate the importance of the pivotal moment when, in the development of science, the human body began to be anatomized. Nor is any fault to be found with the custom which has crowned with the laurels of universal appreciation the names of those men who began and who continued anatomical study, who vulgarized the practice of dissection.
"In my own investigations and reflections upon the conditions which led up to this happy renewal of scientific search into the composition of the body of man, it has seemed to me that writers have hitherto fallen short of tracing through to its ultimate source, the earlier spirit of enthusiasm for knowledge, of insight into the problems of disease, and of contempt for traditionary shackles, to the influence of which, as shown by the master, Taddeo, the latter work of the pupil, Mondino, was in great measure due."
Medici, in his History of the School of Anatomy at Bologna,' quotes Sarti on The Distinguished Professors of the University of Bologna for proof of Taddeo's familiarity with dissection. Von Toply does not think that this quotation is enough absolutely to prove that Taddeo had done dissections, yet it would be hard to understand it unless some such interpretation is made. Taddeo was asked to decide a medico-legal question with regard to a pregnant woman. He refused, however, with a modesty that might well be commended to medico-legal experts of more modern times, to answer the question decisively, because he had never made a dissection of a pregnant woman. Sarti argues that it is evident from this that he had dissected other bodies more easy to obtain than those of pregnant women, or else that he had had the opportunity to make observations on them when dissected by others.
Certain of Taddeo's contemporaries must have had the incentive of his example to help them to a knowledge of human anatomy, for they surely could not have accomplished all that they did in surgery without experience in dissection, yet Taddeo was looked up to as a master by all of them.
Anyone who has read the contributions to surgery of William of Salicet and his great pupil Lanfranc, even if only what we give with regard to them in our chapter on Surgery during the Middle Ages, cannot but be impressed with the idea that they must have done human dissections. They do not mention this fact explicitly, but portions of their surgical works are taken up with the consideration of applied anatomy. They discuss the relations of various structures to one another, especially with reference to the surgery of them. Von Töply, in his Studies on the History of Anatomy in the Middle Ages, says that the anatomies written before William's chapters on applied anatomy, were most of them purely theoretic discussions meant to be guides for internal medicine, or else they were very short directions for those who undertook the practical work of the dismemberment of bodies, usually, however, with reference to animals rather than to human bodies. In William of Salicet we encounter, he says, for the first time a treatise on anatomy made with the deliberate purpose of its application to practical surgery. Everywhere William gives hints for surgical operations with special reference to the anatomical relations.
Puccinotti quotes from William of Salicet's surgery, written about 1270, a passage that shows how familiar this surgeon must have been with dissection. The nephew of Count Pallavicini received an arrow wound in the jugular vein and died within an hour. During his death agony he suffered from a peculiar form of rattle in his throat. It was thought that this might be due to the fact that the arrow had been poisoned. William was called in to decide this question, and found that there was nothing responsible for his death except the wound itself. He describes how he found the blood in the lungs and in the heart, and considers that the conditions that were present were due to the wound. Von Töply has suggested that William would have given more details had he actually examined these organs, but when the autopsy report is negative, such descriptive details are not usual even at the present time. If he had found reason for thinking that there was poison in the case, a careful description of the other organs would be necessary. The fact, however, that he was asked to decide such a question, would seem to indicate that he was supposed to have a knowledge of the normal appearances of human tissues when examined by dissection.
In everything else Lanfranc went farther than his master William, and he did so also in anatomy. Some of the details of his work will be found in our chapter on Surgery in the Middle Ages. He could not have been able to give the detailed instructions that he has for the treatment of every portion of the body only that he knew them by actual contact in the cadaver as well as the patient. His outlook upon scientific medicine and surgery would satisfy even the most exacting of modern experimental scientists. The famous aphorism of his runs as follows : " Every science which depends on operation is greatly strengthened by experience." More than anything else, however, surgery owes to Lanfranc the distinct advantage that he carried into the West as far as Paris, the methods which had come into existence in Italy, and were ever after to prove a precious heritage in the great French University. As Salicet's work was carried on by Lanfranc, at least as well was Lanfranc's work further advanced by his pupil and successor in the chair of surgery, Henri de Mondeville. This subject of surgical development will be treated in the chapter on Surgery in the Middle Ages. Here it is introduced only to emphasize the opportunity there must have been for anatomical study through dissection in the thirteenth century, or these men would not have made the marvelous progress they actually accomplished in this department.
With regard to Mondino, Taddeo's successor at Bologna, enough has been said already in the preceding chapter. About this time, however, very definite evidence begins to accumulate of the frequent practice of dissection. Roth, whose life of Vesalius is a standard work in the history of anatomy, has summed up most of what we know with regard to dissections in the early of the fourteenth century, in his chapter on Dissection Before Vesalius's Time. Roth's work is well known and is frequently, referred to in Dr. White's History of the Warfare of Science with Theology. There can be no question, then, but that in taking what Roth has to say I shall be quoting from a work with regard to which there can be no hint even of partiality. Roth himself was a Swiss, with no leaning toward the Church. There are certain portions of his book, indeed, in which he is inclined not to allow that the Church did as much for education in these times as she actually did. His study of the rise of anatomy can be accepted with absolute assurance, that it is at least not written from the standpoint of one who wants to make the situation with regard to anatomy more favorable than it actually was during the fourteenth century, for the sake of showing any lack of opposition on the part of ecclesiastics.
Some of the material that Roth has made use of has already been referred to in the preceding chapter, but it has seemed proper to repeat it here because this gives a connected account from a definite authority in the history of medicine, and especially of anatomy, with regard to the century immediately following the promulgation of Boniface's ace's bull. Besides, it gives an opportunity for such comments on various features of the history of anatomy, as he details it, as will bring out the significance of his remarks. His account will make it very clear that, far from the Papal bull in question having been universally construed as prohibiting dissections, as Dr. White says it was, it never entered into the minds of medieval anatomists to consider it as having any such signification. The bull was never thought of in that sense at all. It does not refer to anatomy or dissection and it never had any place in the history of anatomy until dragged into it without warrant by Daunou and other nineteenth century writers. Roth says :
" In the pre-Vesalian period the dissection of the human body was practiced, according to the terms of Frederick's law, for the instruction of those about to become physicians and surgeons. The natural place for this school anatomy for a dissection was called anatomia, or, erroneously, anatomia publica—was at the universities and the medical schools. Apart from teaching institutions, however, public anatomies were held in Strasburg and in Venice. Their purpose was the instruction of the practicing medical personnel of these towns. Dissections which were not made for general instruction were called private anatomies. They were performed for the benefit of a few physicians, or students, or magistrates, or artists. Private anatomies began to have special importance only toward the end of the pre-Vesalian period (this would be about the end of the fifteenth and the first quarter of the sixteenth century). It is a play of chance that the first historical reference to a dissection concerns a private anatomy, one undertaken for the purpose of making a legal autopsy. This was made in Bologna in the year 1302 (two years after the decretai supposed to forbid dissection). A certain Azzelino died with unexpected suddenness, after his physicians had visited him once. A magistrate suspected poison and commissioned two physicians and three surgeons to determine the cause of death. It was found that death resulted from natural causes. (As I have said, it would appear that this was not an unusual procedure, for unless medical autopsies had been done before, it does not seem probable that this method of determining the cause of death would have been so readily taken up.)
" Thirteen years later there is an account of the dissection of two female bodies, in January and March of the year 1315, performed by Mundinus." (We have already seen that the fact that the two female bodies should be especially mentioned, though taken by some historians of medicine to indicate that Mundinus had done but few dissections, will not stand such an interpretation, in the light of the evidence that he had dissected many male bodies at least, as his textbook of anatomy indeed makes very clear. These two dissections of females happened only to have special features that made them noteworthy.) " A few years later (1319) there is a remarkable document which tells the story of bodysnatching for dissecting purposes." (This would seem to be sufficient of itself to show that a number of dissections were being done, and, indeed, as I have already said, Rashdall, in his History of the Universities, states that, according to the University statutes teachers were bound to dissect such bodies as students brought to them.) Roth concludes with the words (italics are mine) : " These are a few, but weighty testimonies for the zeal with which Bologna pursued anatomy in the fourteenth century." (I may add that all of these concern the twenty years immediately following Pope Boniface's supposed prohibition.
Nor was the custom of making dissections any less active during the rest of the half century after the time when, if we are to believe Professor White, the decree of Boniface had been universally interpreted to forbid it. In a note to his history of dissection during this period in Bologna, Roth says : Without doubt the passage in Guy de Chauliac which tells of having very often (multitoties, many times, is the exact word) seen dissections must be considered as referring to Bologna." This passage runs as follows : My master, Bertruccius, conducted the dissection very often after the following manner : The dead body having been placed upon a bench, he used to make four lessons on it. First, the nutritional portions were treated, because they are so likely to become putrified. In the second, he demonstrated the spiritual members ; in the third, the animate members ; in the fourth, the extremities." (Guy de Chauliac was at Bologna studying under Bertruccius just before the middle of the fourteenth century. It is evident beyond all doubt, from what he says, that dissections were quite common. This is during the first fifty years after the decree. I shall show a little later that there are records of dissections during the second half of this century. Roth, however, goes on to tell next of the fifteenth century.)
Roth says nothing about the decree of Boniface VIII., nor of any possible effect that it had upon anatomy. The real historian, of course, does not mention things that have not happened. Roth confesses, as I have said, that he takes the material for his sketch of anatomy before Vesalius's time from Corradi. Corradi being an Italian, and knowing of the slander with regard to the Papal decree, explicitly denies it. Surely, here is material enough to convince anyone that all that Professor White has said with regard to the supposed effect of the misinterpretation of Boniface's decree is without foundation in the history of anatomy. Within twenty years after the bull was issued dissection was practiced to such an extent, that bodysnatching became so common that there were prosecutions for it, and public dissections seem to have been held every year in the universities of of Italy during most of the fourteenth century.
De Renzi gives an interesting account of the methods by which material was obtained for dissection purposes before governments made any special provision for this purpose. Naturally, the rifling of graves was resorted to by students intensely interested in the subject of anatomy. The first criminal prosecution for bodysnatching on record is in 1319, when some students brought a body to one Master Albert, a lecturer in medicine at the University at Bologna, and he dissected it for them. At this time, according to the statutes of the university, teachers of anatomy were bound to make a dissection if the students supplied the body. The whole party were brought to trial for this offence, though they do not seem to have suffered any severe penalty for their violation of the laws. At this time, according to De Renzi, there was a rage for dissection and many bodies were yearly obtained surreptitiously for the purpose.
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 wellknown 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, 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 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 gallstone." (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."' (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 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. )
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.
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 continned 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 Encyclopaeia 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 fore-runner 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 divisioning 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 with-out 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 public w 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 day spring 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 oldtime religious authorities.