Durant W. The Reformation. A History of European Civilization from Wyclif to Calvin: 1300-1564

of the airplane) opened the Atlantic and other oceans to European

trade, and left the Mediterranean in a commercial- soon, therefore, in

a cultural- backwater; the Renaissance moved from Italy to the

Atlantic states. Europe, possessing better ships and guns, a

hardier, more acquisitive and adventurous population, conquered-

sometimes colonized- one after another of the newly discovered

lands. Native populations were put to unwontedly steady and arduous

work producing goods for Europe; slavery became an established

institution. The almost-smallest continent became the richest; that

Europeanization of the globe began which has been so sharply

reversed in our time. The mind of Western man was powerfully

stimulated by the distance, immensity, and variety of the new lands.

Part of Montaigne's skepticism would root in the fascination of exotic

ways and faiths. Customs and morals took on a geographical

relativity that sapped old dogmas and certainties. Christianity itself

had to be viewed in a new perspective as the religion of a minor

continent amid a world of rival creeds. As humanism had discovered a

world before Christ, and Copernicus had exposed the astronomic

insignificance of the earth, so exploration and the commerce that

followed it revealed vast realms beyond and ignoring Christianity. The

authority of Aristotle and the other Greeks was damaged when it

appeared how little of the planet they had known. The Renaissance

idolatry of the Greeks declined, and man, swelling with Renaissance

pride at his new discoveries, prepared to forget his lessened

astronomic size in the expansion of his knowledge and his trade.

Modern science and philosophy rose, and undertook the epochal task

of reconceiving the world.

IV. THE RESURRECTION OF BIOLOGY

-

The biological sciences, which had made hardly any progress since

the Greeks, now came back to life. Botany struggled to free itself

from pharmacy and stand on its own feet; it succeeded, but

inevitably its masters were still medical men. Otto Brunfels, city

physician at Bern, began the movement with his Herbarum vivae icones

(1530-36)- "living pictures of plants"; its text was largely filched

from Theophrastus, Dioscorides, and other predecessors, but it also

described the native plants of Germany, and its 135 woodcuts were

models of fidelity. Euricius Cordus, city physician to Bremen, set

up the first botanical garden (1530) north of the Alps, attempted an

independent summary of the nascent science in his Botanilogicon

(1534), and then returned to his medical medium in his Liber de

urinis. His son Valerius Cordus wandered recklessly in the study of

plants, met his death in the search at the age of twenty-nine

(1544), but left for posthumous publication his Historia

plantarum, which vivdly and accurately described 500 new species.

Leonard Fuchs, professor of medicine at Tubingen, studied botany at

first for pharmaceutics, then for its own sake and delight. His

Historia stirpium (1542) was typical of scientific devotion; its 343

chapters analyzed 343 genera, and illustrated them with 515

woodcuts, each occupying a full folio page. He prepared a still more

comprehensive work with 1,500 plates, but no printer would undertake

the expense of its publication. The genus Fuchsia is his living

memorial.

Perhaps the most important single idea contributed to biology in

this period was Pierre Belon's demonstration, in his Histoire...

des oyseaux (1555), of the astonishing correspondence of the bones in

men and birds. But the greatest figure in the "natural science" of

this age was Conrad Gesner, whose work and learning covered so wide

a field that Cuvier called him the Pliny, and might have called him

the Aristotle, of Germany. Born of a poor family in Zurich (1516),

he showed such aptitude and industry that the city joined with private

patrons to finance his higher education in Strasbourg, Bourges, Paris,

and Basel. He made or collected 1,500 drawings to illustrate his

Historia plantarum, but this work proved so expensive to print

that it did not emerge from manuscript till 1751; its brilliant

classification of plant genera by their reproductive structures

reached the light too late to help Linnaeus. He published during his

lifetime four volumes (1551-58), and left a fifth, of a gigantic

Historia animalium, which listed each animal species under its Latin

name, and described its appearance, origin, habitat, habits,

illnesses, mental and emotional qualities, medical and domestic

uses, and place in literature; the classification was alphabetical

instead of scientific, but its encyclopedic accumulation of

knowledge invited biology to take form. Insufficiently used up by

these labors, Gesner began a twenty-one-volume Bibliotheca

universalis, in which he set out to catalogue all known Greek, Latin,

and Hebrew writings; he completed twenty volumes, and earned the title

of Father of Bibliography. In an aside called Mithridates (1555)

he attempted to classify 130 languages of the world. His Descriptio

Montis Pilati (1541) was apparently the first published study of

mountains as forms of beauty; Switzerland now knew that it was

majestic. All these enterprises were accomplished between 1541 and

1565. In that year Conrad Gesner, the incarnate spirit of study, died.

Meanwhile Juan Vives's De anima et vita (1538) almost created

modern empirical psychology. As if to elude the skepticism that Hume

would expound two centuries later about the existence of a "mind"

additional to mental operations, Vives advised the student not to

ask what the mind or soul is, since (he felt) we shall never know

this; we must inquire only what the mind does; psychology must cease

to be theoretical metaphysics and must become a science based on

specific and accumulated observations. Here Vives anticipated by a

century Francis Bacon's emphasis on induction. He studied in detail

the association of ideas, the operation and improvement of memory, the

process of knowledge, and the role of feeling and emotion. In his book

we see psychology, like so many sciences before it, emerging painfully

from the womb of their common mother, philosophy.

V. VESALIUS

-

In 1543 Andreas Vesalius published what Sir William Osler judged the

greatest medical work ever written. `063753 His father, Andreas

Wessel, was a prosperous apothecary in Brussels; his grandfather had

been physician to Mary of Burgundy and then to her husband

Maximilian I; his great-grandfather had been city physician at

Brussels; his great-great-grandfather, a physician, had composed a

commentary on Avicenna's Kanun; here was a social heredity

outmatching Bach's. Subjected to it from birth, Vesalius soon

developed a passion for dissection. "No animal was safe from him. Dogs

and cats, mice, rats, and moles were meticulously dissected by

him." `063754 But he did not neglect other studies. At twenty-two he

lectured in Latin, and readily read Greek. At Paris (1533-36) he

studied anatomy under Jacques Dubois, who gave to many muscles and

blood vessels the names they bear today. For a long time, like his

teachers, he accepted Galen as a Bible; he never lost respect for him,

but he respected much more the authority of observation and

dissection. With some fellow students he made many trips to the

charnel houses where were gathered the bones exhumed from the Cemetery

of the Innocents; there they became so familiar with the parts of

the human skeleton that, he tells us, "we, even blindfolded, dared

at times to wager with our companions, and in the space of half an

hour no bone could be offered us... which we could not identify by

touch." `063755 Frequently, in the classes of Dubois, the bold young

anatomist would displace the "barber surgeons" to whom actual

dissection was usually delegated by the physician professor, and would

himself expertly expose the parts relevant to the lecture. `063756

When his sovereign Charles V invaded France (1536), Vesalius retired

to Louvain. Hampered by a shortage of corpses there, he and his friend

Gemma Frisius (later famous as a mathematician) snatched one out of

the air. His account reveals his passion:

-

While out walking, looking for bones in the place where, on the

country highways... those who have been executed are customarily

placed, I happened upon a dried cadaver.... The bones were entirely

bare, held together by the ligaments alone.... With the help of

Gemma I climbed the stake and pulled off the femur.... The scapulae

together with the arms and hands followed.... After I had brought

the legs and arms home in secret and successive trips... I allowed

myself to be shut out of the city in the evening in order to obtain

the thorax, which was firmly held by a chain. I was burning with so

great a desire. ... The next day I transported the bones home

piecemeal through another gate of the city. `063757

-

The burgomaster saw the point, and thereafter gave the anatomy

classes whatever cadaver could be released; "and he himself," says

Vesalius, "was in regular attendance when I administered an

anatomy." `063758

A man with such "burning desire" could not keep his temper cool.

He fell into a hot dispute with a teacher about methods of

venesection, left Louvain (1537), and rode down the Rhine and across

the Alps to Italy. He was already so proficient that before the end of

that year he received his doctor's degree at Padua cum ultima

diminutione - "with the maximum diminution" of the fee; for the higher

a student's standing the lower his graduation fee. On the very next

day (December 6, 1537) the Venetian Senate appointed him professor

of surgery and anatomy at the University of Padua. He was

twenty-three.

During the following six years he taught at Padua, Bologna, and

Pisa, doing hundreds of dissections with his own hands, and issuing

some minor works. Under his direction Jan Stefan van Kalkar, a pupil

of Titian, drew six plates which were published (1538) as Tabulae

anatomicae sex. A year later Vesalius, in a Venesection Letter,

supported Pierre Brissot of Paris on methods of bloodletting. In the

course of his argument he revealed some results of his dissections

of the venous system, and these observations contributed to the

discovery of the circulation of the blood. In 1541-42 he joined

other scholars in a new edition of the Greek text of Galen. He was

astonished by Galenic errors that the simplest human dissection

would have disproved- that the lower jaw had two parts, the sternum

seven distinct bones, the liver several lobes. Only on the

assumption that Galen's dissections had been of animals, never of men,

could these errors be explained and forgiven. Vesalius felt that the

time had come to revise the science of human anatomy in terms of the

dissection of man. He prepared his masterpiece.

When Johannes Oporinus printed at Basel in 1543 the De humani

corporis fabrica ( On the Structure of the Human Body ), a large

folio of 663 pages, what must have struck the reader at once was the

title page- an engraving worthy of Durer, which pictured Vesalius

demonstrating the anatomy of an opened arm, with half a hundred

students looking on. And then the illustrations: 277 woodcuts of

unprecedented anatomical accuracy and high technical excellence,

made mostly by Van Kalkar, with scientifically irrelevant and

artistically attractive landscapes behind the figures- a skeleton, for

example, at a reading desk. These cuts were so fine that some have

thought they were designed in the studio of Titian, perhaps under

his supervision; to which we must add that Vesalius drew several of

them with his own hand. He accompanied the blocks watchfully in

their journey by mule pack over the Alps from Venice to Basel. When

the printing was complete the blocks were carefully preserved; later

they were bought, exchanged, and lost; in 1893 they were found

secreted in the library of the University of Munich; they were

destroyed by bombing in the second World War.

What should have aroused more astonishment than these drawings was

that the text- a triumph of typography but also a scientific

revolution- was by a youth of twenty-nine. It was a revolution because

it ended the reign of Galen in anatomy, revised the whole science in

terms of dissection, and so established the physical basis of modern

medicine, which begins with this book. Here for the first time were

described the true course of the veins and the anatomy of the heart;

here was the epochal statement that the most careful dissection showed

none of those pores through which Galen had supposed the blood to pass

from one ventricle of the heart to the other; so the way was

prepared for Servetus, Colombo, and Harvey. Galen was corrected

again and again- on the liver, the bile ducts, the maxillae, the

uterus. Vesalius, too, made errors, even of observation, and failed to

take the great leap from the anatomy of the heart to the circulation

of the blood. But here were accurate descriptions of scores of

organs never so well described before, and every part of the body

opened to science with a confident and masterly hand.

He suffered from the defects of his qualities. The pride that upheld

him through years of minute study made him quick to take offense, slow

to recognize the achievements of his predecessors and the

sensitivity of his rivals. He was so in love with "that true

Bible... the human body and the nature of man" `063759 that he hurt

many theological toes. He referred sarcastically to the

ecclesiastics who seemed most attracted to his lecture room when the

reproductive organs were to be studied and shown. `063760 He made many

enemies; and though Gesner and Fallopio hailed his work, most of the

older professors, including his former teacher Dubois, condemned him

as an insolent upstart, and sedulously picked flaws in his book.

Dubois explained that Galen had not been wrong, but that the human

body had changed since Galen's time; so, he thought, the straight

thigh bones, which, as everyone saw, were not curved in accordance

with Galen's description of them, were the result of the narrow

trousers of Renaissance Europeans. `063761

In a tempest of disappointment at the attitude of these men,

Vesalius burned a huge volume of Annotationes, and a paraphrase of

the ten books of al-Razi's Kitab al-Mansuri - an encyclopedia of

medicine. `063762 In 1544 he left Italy to become second physician

on the staff of Charles V, to whom he had judiciously dedicated the

Fabrica. In the same year his father died, leaving him a

considerable fortune. He married, and built a handsome home in

Brussels. A second edition of the Fabrica was issued in 1555, with

augmented and corrected text. It showed that artificial respiration

could keep an animal alive despite incision of its chest, and that a

stopped heart could sometimes be revived by bellows. Thereafter

Vesalius made no contribution to anatomy. He absorbed himself in

caring for his Imperial and lesser patients, and in the practice and

study of surgery. When Charles abdicated, Vesalius became second

physician to Philip II. In July 1559, the King sent him to aid

Ambroise Pare in an attempt to save the wounded Henry II; Vesalius

applied clinical tests that showed no possibility of recovery. Later

in that year he and his family accompanied Philip to Spain.

Meanwhile others advanced anatomy. Giambattista Cano noted the

venous valves (1547); Servetus explained the pulmonary circulation

of the blood (1553); Realdo Colombo made the same discovery (1558),

and proved it by experiment on the living heart; but another seventy

years passed before Harvey's epochal description of the course of

the blood from heart to lungs to heart to arteries to veins to

heart. The Arab physician Ibn al-Nafis had anticipated Servetus in

1285, `063763 and the tradition of his doctrine may have carried

down into the Spain of Servetus's youth.

Vesalius had some adventures left to him. The native physicians at

the Spanish court made it a point of honor to disregard his diagnoses.

When Don Carlos, Philip's only son, suffered concussion of the brain

from a fall (1562), Vesalius recommended trepanning. The advice was

rejected, and the youth neared death. Relics and charms were applied

to the wound, and pious people flogged themselves to persuade heaven

to effect some miraculous cure; to no avail. Finally Vesalius insisted

on opening the skull; it was done, and a large quantity of pus was

drawn off. The Prince soon improved, and eight days after the

operation Philip II attended a solemn procession of thanksgiving to

God. `063764

Two years later Vesalius left Spain, for reasons still in dispute.

Ambroise Pare told of an anatomist who brought most of Spain down upon

his head by opening the body of a woman supposedly dead from

"strangulation of the uterus"; at a further stroke of the surgeon's

knife, said Pare, the woman came suddenly back to life, "which

struck such admiration and horror into the hearts of all her

friends... that they accounted the physician- before of good fame

and report- as infamous and detestable"; `063765 relatives do not

always appreciate such unexpected recoveries. "Therefore," continued

the Huguenot surgeon, "he thought there was no better way for him,

if he would live safe, than to forsake the country." Hubert Languet,

another Huguenot, told a similar story (c. 1579), named the

physician as Vesalius, and claimed that Vesalius, by dissecting a

living person, had become liable to the Inquisition, which he

escaped by promising to make a penitential pilgrimage to Palestine. No

contemporary source mentions the incident, and Catholic historians

reject it as a fable. `063766 Perhaps Vesalius was just tired of

Spain.

He returned to Italy, sailed from Venice (April 1564), and

apparently reached Jerusalem. On the way back he suffered shipwreck,

and died of exposure, far from any friend, on the island of Zante

off the west coast of Greece (October 15, 1564). He was fifty years

old. In that same year Michelangelo died and Shakespeare was born. The

splendor that had shone for a century in Italy was passing to the

north.

VI. THE RISE OF SURGERY

-

Despite the advances of anatomy, the science and art of medicine

were still in leading strings to Greek and Arabic authorities. The

evidence of the senses hardly availed against the word of Galen or

Avicenna; even Vesalius, when his dissections disproved Galen, said,

"I could hardly believe my eyes." Editions or translations of Galen or

Hippocrates, while spreading old knowledge, discouraged new

experiments- very much as the efforts of Petrarch and Ronsard to write

Virgilian epics diverted and injured their natural genius. When

Linacre founded what was later named the Royal College of Physicians

(1518), its principal texts were his translations of Galen.

Therapy benefited from new drugs brought to Europe- cinchona,

ipecacuanha, and rhubarb from America, ginger and benzoin from

Sumatra, cloves from the Moluccas, aloes from Cochin China, camphor

and cinnabar from China; and the development widened the use of native

plants. Valerius Cordus compiled the first German pharmacopoeia

(1546). The treatment of syphilis with infusions of guaiac wood from

the West Indies was so popular that the Fuggers made another fortune

by securing from their debtor, Charles V, a monopoly on its sale in

his realms.

The poverty and uncleanliness of the masses kept diseases always

ahead of cures. Open heaps of refuse or dung poisoned the air, and

sometimes littered the streets. Paris had a system of sewers, which

Henry II proposed to empty into the Seine; the municipal authorities

dissuaded him by explaining that the river was the sole drinking water

that half the people had. `063767 Sewer commissions were set up in

England in 1532, but as late as 1844 there were only two English towns

where refuse was removed at public expense from the slums.

Epidemics were less virulent than in the Middle Ages, but they

sufficed- along with high puerperal and infantile mortality, to keep

the population almost stationary. Plagues swept through Germany and

France repeatedly between 1500 and 1568. Typhus fever spread in

England in 1422, 1577, and 1586, through the migrations of lice. The

"sweating sickness"- probably a form of influenza- ravaged England

in 1528, 1529, 1551, 1578; Germany in 1543-45; France in 1550-51;

Hamburg and Aachen, we are told, each lost a thousand souls to it

within a few days. `063768 Influenza was ascribed to celestial

influences- hence its name. The bubonic plague reappeared in Germany

in 1562, taking 9,000 of the 40,000 inhabitants of

Nuremberg- `063769 though we may suspect all plague statistics as

exaggerations. Brighter sides of the picture are the fading out of

leprosy and such mental disorders as St. Vitus's Dance.

Medical practice progressed more slowly than medical knowledge.

Quacks still abounded; despite some restrictive laws it was easy to

practice medicine without a degree. Most babies were eased into the

world by midwives. Specialism had hardly begun. Dentistry was not

separated from medicine or surgery; barber surgeons extracted teeth,

and replaced them with ivory substitutes. Nearly all physicians-

Vesalius was one of the exceptions- left surgery to barber surgeons,

who, however, must not be thought of as barbers; many of them were men

of training and skill.

Ambroise Pare began as a barber's apprentice, and rose to be surgeon

to kings. Born (1517) at Bourg-Hersent in Maine, he made his way to

Paris, and set up his barber's stall in the Place St.-Michel. During

the war of 1536 he served as a regimental surgeon. In treating

soldiers he accepted the prevailing theory that gunshot wounds were

poisonous, and (like Vesalius) he followed the current practice of

cauterizing them with boiling elder oil, which turned pain into agony.

One night the oil ran out, and for lack of it Pare dressed the

wounds with a salve of egg yolk, attar of roses, and turpentine. On

the morrow he wrote:

-

Last night I could hardly sleep for continually thinking about the

wounded men whose hurts I had not been able to cauterize. I expected

to find them all dead the next morning. With this in view I rose early

to visit them. Greatly to my surprise, I found that those whom I had

treated with the salve had very little pain in their wounds, no

inflammation... and had passed a comfortable night. The others,

whose wounds had been treated with boiling elder oil, were in high

fever, while their wounds were inflamed... and acutely painful. I

determined, therefore, that I would no longer cauterize the

unfortunate in so cruel a manner. `063770

-

Pare had little education, and it was not till 1545 that he

published his little manual, now a medical classic, on the treatment

of wounds ( Methode de traicter les plaies ). In the war of 1552 he

proved that ligature of the artery was preferable to cauterization

to check bleeding in amputations. Captured by the enemy, he earned his

release by successful operations. On returning to Paris he was

appointed head surgeon at the College St.-Come, to the horror of the

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