Thursday, January 10, 2013

1543: Vesalius sparks end to dark ages of medicine

So our friend Claudius Claudius Galen wrote his book of anatomy and medicine in the 2nd century, just prior to the end of the Roman era of western civilization.  For greater than a thousand years physicians amid this civilization, instead of thinking on their own and advancing medicine, worshiped Galen as a god of medicine. His writings contained all the knowledge required of medical students.

Surely over the years there were errors observed in Galen's words, although these errors were always overlooked, explained away as "probably nothing."   Medical curiosity was frowned upon, and all was forgotten as the world dipped into a dark ages. 

People were content to remain ignorant until a man by the name of Andreas Vesalius wrote a book that stunned the scientific and medical community back into existence.  

Vesalius was born in 1514, "into a world of physicians, pharmacists and royal patronage," explains Lois N. Magner.  "His father was imperial pharmacist to Charles V and often accompanied the Emperor on his travels.  As a youth, Vesalius began to teach himself anatomy by dissecting mice and other small animals."(4, page 158)

Galen's mighty reign as god of medicine ended almost as soon as Vesalius became a student at the University in Paris.  This is where we find him entering through the large doors, entering a large observatory with a podium in the front and a dissecting table with a fresh corps lying on top of it.  Vesalius seems oblivious of the stench of rotting flesh as he takes a position close to the table and waits for the professor and his assistant to enter.

Within fifteen minutes the room is crowded with students hovering to see a young assistant cut into the chest of the body. Standing behind his assistant, behind the podium which has a copy of one of Galen's books on top of it, we find professor Jacobus Sylvius, who was born in Amiens, France, who began teaching anatomy at Paris in 1531.  (7, page 200)

He reads Galen's words as his assistant displays what Galen is explaining. His voice is strong and powerful, radiating full and strong so even at the rear of the auditorium we can hear his every word.  His assistant usually dissects an animal, we know from our history lessons, but today his students are privy to an actual human dissection. This is something Sylvius did for his students only once a year.  


Historian Kerfoot D. Shute said in 1910, that Jacobus 
Sylvius (1478-1555): "was an uncompromising Galenist.  
He preached Galen in everything, and trusted Galen 
more than he did his own eyes. To him instruction in 
anatomy was reading a chapter of Galen and though he, 
on rare occasions,  made use of imperfect dissections
of the human body these dissections were simply for the 
purpose of illustrating and making the teachings of Galen
and not for the purpose of disproving Galen."(7, page 200)



As Sylvius reads, loud and clear, the one assistant does the cutting, and another points to each part of the body being described by Galen.  It's actually a neat system, and they have it down pat, as though they have done this hundreds of times before. (3, page )

After the dissection is done all the men are clear of the room except Vesaleas and Sylvius

Andreas says, "What you read and what your assistant pointed to did not agree."

Sylvius shouts, "There are no errors in the writings of Galen."

Andreas says, "Galen taught that the liver was five-lobed, that the breastbone had seven segments, that a network of blood vessels could be found under the brain.  You believe every word of it, although those features couldn't be found in the body right under your eyes.  You see exactly what Galen tells you to see!

Sylvius shouts, "Get out!" He points to the door.

"If the corpse and book don't agree, then the error is in the book!"

"If the error and book don't agree, then the error is in the corpse!"

 "God forbid you doubt Galen."

"Get out!" Sylvius points aggressively this time.

"Michelangelo and van Calcar know more about the human anatomy than you, professor!"

"GET OUT!

"Those artists need accurate description of the body!  They study it up and down so they can accurately draw the body.  You guys merely studied Galen!

"YOU ARE A MAD MAN!

"Hmph!" is the noise that escapes Vesaleus, as he rushes out through the large doors, which bang shut in his absence.  We follow his path, and catch up to him as he trudges down the middle of a dirt road, dust spewing as a horse and buggy buz past.  He coughs.

Vesalius stops in front of a fountain and says, perhaps talking to us:
I am not content to just believe everything Galen writes.  The best teacher of the human body is not Galen but the human body. I stole a skeleton and studied it, yes I did.  I learned the human breastbone did not have eight segments as Galen described, it had only three parts.  How could a teacher as magnificent as Galen have gotten it wrong?" 
Andreas Vesalius (1514-1564)
There is a long pause as Vesaleas appears to be gazing at his shadow waddles in the twinkling water. 
Then by chance one day I dissected an Ape.  It occurred to me:  Galen never even dissected a human body, otherwise he would have known the human sternum had only three parts.  For thousands of years doctors treated diseases based on the anatomy of apes not of humans."  
Vesalius turns to look our way, as tough he knows we are real, although we know he's actually looking at Sevalius as he exits the observatory.  Sevalius does not stop, perhaps pretending he does not hear the young Vesalius as he says:
"I have a mission.  I hope you read of my discovery for history's sake!"
Vesaleas smiles.

Back in the time machine we sit and think about the day's events.  To Galen's defense we must remember  in both ancient Greece and Rome it was considered sacrosanct and illegal to dissect a human body.  In fact, it was illegal to even touch a corpse except for preparing it for burial.  Even in the 16th century it was illegal without permission. While Sylvius probably obtained a legal corpse, most dissections were performed on bodies stolen from cemeteries.

By his coming out in the open with his discovery, Vesaleas came head to head with his colleagues in the medical community.  His fellow physicians ridiculed him to the point he had no choice but to leave Paris without a degree. (4, page 158)

Surely this set him back for a while,but it did not slow him down. Surely there were other men like Vesalius who had suspected Galen of being wrong, although Vesalius had access to something that none of those men had: the Gutenberg Printing Press.  It was invented in 1448 by Johannes Gutenberg, but by 1537 the press had become commonplace, and just about all great minds eager to publish a book had access to it.  Vesalius needed it big time in order to return medicine to western civilization.

Vesalius was hired as professor at the University of Padua in 1537 (3,4) and decided to dissect the bodies himself. His colleagues wondered why he would waste his time considering Galen had described the human body so perfectly.  Learning from dissecting is a waste of time, they said, and all that was needed could be learned simply by opening up one of Galen's books. (3, page)

Later that same year he becomes a medical doctor and was appointed to "lecturer-demonstrator" of anatomy and surgery.  From sun up to sun down, three days a week, he demonstrated and lectured about the human body in front of ever growing crowds of medical students.  (4, page 158)

To mark his independence from Galen, Vesalius arranged a public dissection lecture in which he demonstrated over 200 differences between the skeleton of apes and humans, while reminding his audience that "Galen's work is based on the dissection of apes."

His fellow professors, including his old instructor, cried foul.   Sylvius wrote letters explaining how crazy Vesaleas was, and even called him a "mad man." (2, page 159)

Yet despite their cries, it would be Vesaleas who laughed last.  He was the one who was noted to be correct by history. He was the one who became famous for his observation.  He would become so popular that within a few years he would have enough money to hire an artist by the name of jan Stephen van Calcar to draw the human body as it was being dissected by him.  
Andreas Vesalius published the first accurate book of anatomy on the
printing press at Basle in 1543.  While the book in and of itself was
controversial, the title page shown here shows an engraving of
the teacher and his students examining a cadaver. (6, title page)

This book was published in the year 1543 in Basle when Vesalius was only 28.  This first accurate book of the human anatomy was called De Humani Corporuis Fabrica, or "The Fabric of the Human Body." It consisted of 700 pages, and the title page consisted of the teacher and his students studying a cadaver, which in itself must have been controversial.  (5, page 89)

This was a major scientific breakthrough, and the spark that would end the dark ages of medicine and the dawn of the scientific revolution.  From this point on human anatomy would be taught based on accurate pictures and descriptions, as opposed to Galen's ignorant descriptions. 

He continued to meet fierce opposition from his fellow professors with chants such as: "You are ruining our reputation!" They shouted such filth at him in the halls of the university he worked.  They accused him of crimes.  Many wrote books against Vesalius.  Instead of completing more medical work, he spent the next 20 years fighting to get others to recognize the importance of the Fabric.

This engraving shows Vesalius displaying the the muscular system of
a human arm.  This was among many engravings displayed inside his
book that were created by jan Stephen van Calcar 
This is just the way it was in the 16th century: statements of scientific fact did not come without a fight.  Yet it was a fight worth fighting.  Thanks to the courageous acts of Vesaleas a spark was lit under the medical community that would grow into a full and flourishing flame within a few years.  

Historians like John Hudson Tiner now recognize Vesaleas's discoveries about Galen's lies as one of the top ten most important medical discoveries of all time.  Yet unfortunately Vesalius never lived to see its acceptance into modern medicine.  His later travels took him out of Europe and nothing is known about when nor how he died.

Although there are theories.  In his history of medicine, the father of modern medicine, William Henry Osler, explained one theory:  (2, page 160).
"The story is that he had obtained permission to perform a post-mortem examination on the body of a young Spanish nobleman, whom he had attended.  When the body was opened, the spectators to their horror saw the heart beating, and there were signs of life!  Accused, so it is said, by the Inquisition of murder and also of general impiety he only escaped through the intervention of the King, with the condition that he make a pilgrimage to the Holy Land.  In carrying this out in 1564 he was wrecked on the island of Zante, where he died of a fever or of exhaustion, in the fiftieth year of his life."
Regardless, Vesalius is a hero in every medical history. Actually, it wasn't Vesalius alone who saved medicine, as there is another hero in our story, and his name was Johannes Gutenberg.  Gutenberg provided the method, and Vesalius used it to create a spark.

Shortly after his death ancient Greek medicine returned west, was transcribed from Arabic back into western languages.  Yet along with the old wisdom came a plethora of new remedies and a young pharmaceutical profession. (5, page 75, 82)

Click here for more asthma history.

References:
  1. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
  2. Osler, William, "The Evolution of Modern Medicine: A series of lectures at Yale University on the Silliman Foundation in April, 1913," New Have, Yale University Press, 1921,
  3. Tiner, John Hudson, "Exploring the History of Medicine," (the conversation in this post is based on the writings of Tineralthough the actual words are made up by me). 
  4. Magner, Lois N, "A History of Medicine," page 160
  5. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
  6. Vesalius, Andreas, "De Humani Corporis Fabrica Libre Septem," 1555,
  7. Shute, D. Kerfoot, "The life and works of ndreas Vesalius," Old dominion journal of medicine and surgery, Tomkin, Beverly R. Tucker, Douglas Vanderhoof, Murat Willis, R.H. Wright, editors, 1910, Richmond Virginia, The Old Dominion Publishing Corporation, pages 195-211

No comments:

Post a Comment