Health and Education

VESALIUS THE ANATOMIST

I cannot begin a sketch of the life of this great man better than by trying to describe a scene so picturesque, so tragic in the eyes of those who are wont to mourn over human follies, so comic in the eyes of those who prefer to laugh over them, that the reader will not be likely to forget either it or the actors in it.

It is a darkened chamber in the College of Alcala, in the year 1562, where lies, probably in a huge four-post bed, shrouded in stifling hangings, the heir-apparent of the greatest empire in the then world, Don Carlos, only son of Philip II., and heir-apparent of Spain, the Netherlands, and all the Indies.  A short sickly boy of sixteen, with a bull head, a crooked shoulder, a short leg, and a brutal temper, he will not be missed by the world if he should die.  His profligate career seems to have brought its own punishment.  To the scandal of his father, who tolerated no one’s vices save his own, as well as to the scandal of the university authorities of Alcala, he has been scouring the streets at the head of the most profligate students, insulting women, even ladies of rank, and amenable only to his lovely young stepmother, Elizabeth of Valois, Isabel de la Paz, as the Spaniards call her, the daughter of Catherine de Medicis, and sister of the King of France.  Don Carlos should have married her, had not his worthy father found it more advantageous for the crown of Spain, as well as more pleasant for him Philip, to marry her himself.  Whence came heart-burnings, rage, jealousies, romances, calumnies, of which two last—in as far at least as they concern poor Elizabeth—no wise man now believes a word.

Going on some errand on which he had no business—there are two stories, neither of them creditable nor necessary to repeat—Don Carlos has fallen down stairs and broken his head.  He comes, by his Portuguese mother’s side, of a house deeply tainted with insanity; and such an injury may have serious consequences.  However, for nine days the wound goes on well, and Don Carlos, having had a wholesome fright, is, according to Doctor Olivarez, the medico de camara, a very good lad, and lives on chicken broth and dried plums.  But on the tenth day comes on numbness of the left side, acute pains in the head, and then gradually shivering, high fever, erysipelas.  His head and neck swell to an enormous size; then comes raging delirium, then stupefaction, and Don Carlos lies as one dead.

A modern surgeon would, probably, thanks to that training of which Vesalius may be almost called the father, have had little difficulty in finding out what was the matter with the luckless lad, and little difficulty in removing the evil, if it had not gone too far.  But the Spanish physicians were then, as many of them are said to be still, as far behind the world in surgery as in other things; and indeed surgery itself was then in its infancy, because men, ever since the early Greek schools of Alexandria had died out, had been for centuries feeding their minds with anything rather than with facts.  Therefore the learned morosophs who were gathered round Don Carlos’s sick bed had become, according to their own confession, utterly confused, terrified, and at their wits’ end.

It is the 7th of May, the eighteenth day after the accident, according to Olivarez’ story: he and Dr. Vega have been bleeding the unhappy prince, enlarging the wound twice, and torturing him seemingly on mere guesses.  “I believe,” says Olivarez, “that all was done well: but as I have said, in wounds in the head there are strange labyrinths.”  So on the 7th they stand round the bed in despair.  Don Garcia de Toledo, the prince’s faithful governor, is sitting by him, worn out with sleepless nights, and trying to supply to the poor boy that mother’s tenderness which he has never known.  Alva too is there, stern, self-compressed, most terrible, and yet most beautiful.  He has a God on earth, and that is Philip his master; and though he has borne much from Don Carlos already, and will have to bear more, yet the wretched lad is to him as a son of God, a second deity, who will by right divine succeed to the inheritance of the first; and he watches this lesser deity struggling between life and death with an intensity of which we, in these less loyal days, can form no notion.  One would be glad to have a glimpse of what passed through that mind, so subtle and so ruthless, so disciplined and so loyal withal: but Alva was a man who was not given to speak his mind, but to act it.

One would wish, too, for a glimpse of what was passing through the mind of another man, who has been daily in that sick chamber, according to Olivarez’ statement, since the first of the month: but he is one who has had, for some years past, even more reason than Alva for not speaking his mind.  What he looked like we know well, for Titian has painted him from the life—a tall, bold, well-dressed man, with a noble brain, square and yet lofty, short curling locks and beard, an eye which looks as though it feared neither man nor fiend—and it has had good reason to fear both—and features which would be exceeding handsome, but for the defiant snub-nose.  That is Andreas Vesalius, of Brussels, dreaded and hated by the doctors of the old school—suspect, moreover, it would seem, to inquisitors and theologians, possibly to Alva himself; for he has dared to dissect human bodies; he has insulted the medievalists at Paris, Padua, Bologna, Pisa, Venice, in open theatre; he has turned the heads of all the young surgeons in Italy and France; he has written a great book, with prints in it, designed, some say, by Titian—they were actually done by another Netherlander, John of Calcar, near Cleves—in which he has dared to prove that Galen’s anatomy was at fault throughout, and that he had been describing a monkey’s inside when he had pretended to be describing a man’s; and thus, by impudence and quackery, he has wormed himself—this Netherlander, a heretic at heart, as all Netherlanders are, to God as well as to Galen—into the confidence of the late Emperor Charles V., and gone campaigning with him as one of his physicians, anatomising human bodies even on the battle-field, and defacing the likeness of Deity; and worse than that, the most religious King Philip is deceived by him likewise, and keeps him in Madrid in wealth and honour; and now, in the prince’s extreme danger, the king has actually sent for him, and bidden him try his skill—a man who knows nothing save about bones and muscles and the outside of the body, and is unworthy the name of a true physician.

One can conceive the rage of the old Spanish pedants at the Netherlander’s appearance, and still more at what followed, if we are to believe Hugo Bloet of Delft, his countryman and contemporary.10  Vesalius, he says, saw that the surgeons had bound up the wound so tight that an abscess had formed outside the skull, which could not break: he asserted that the only hope lay in opening it; and did so, Philip having given leave, “by two cross-cuts.  Then the lad returned to himself, as if awakened from a profound sleep, affirming that he owed his restoration to life to the German doctor.”

Dionysius Daza, who was there with the other physicians and surgeons, tells a different story: “The most learned, famous, and rare Baron Vesalius,” he says, advised that the skull should be trepanned; but his advice was not followed.

Olivarez’ account agrees with that of Daza.  They had opened the wounds, he says, down to the skull before Vesalius came.  Vesalius insisted that the injury lay inside the skull, and wished to pierce it.  Olivarez spends much labour in proving that Vesalius had “no great foundation for his opinion:” but confesses that he never changed that opinion to the last, though all the Spanish doctors were against him.  Then on the 6th, he says, the Bachelor Torres came from Madrid, and advised that the skull should be laid bare once more; and on the 7th, there being still doubt whether the skull was not injured, the operation was performed—by whom it is not said—but without any good result, or, according to Olivarez, any discovery, save that Vesalius was wrong, and the skull uninjured.

“Whether this second operation of the 7th of May was performed by Vesalius, and whether it was that of which Bloet speaks, is an open question.  Olivarez’ whole relation is apologetic, written to justify himself and his seven Spanish colleagues, and to prove Vesalius in the wrong.  Public opinion, he confesses, had been very fierce against him.  The credit of Spanish medicine was at stake: and we are not bound to believe implicitly a paper drawn up under such circumstances for Philip’s eye.  This, at least, we gather: that Don Carlos was never trepanned, as is commonly said; and this, also, that whichever of the two stories is true, equally puts Vesalius into direct, and most unpleasant, antagonism to the Spanish doctors.11

But Don Carlos still lay senseless; and yielding to popular clamour, the doctors called in the aid of a certain Moorish doctor, from Valencia, named Priotarete, whose unguents, it was reported, had achieved many miraculous cures.  The unguent, however, to the horror of the doctors, burned the skull till the bone was as black as the colour of ink; and Olivarez declares he believes it to have been a preparation of pure caustic.  On the morning of the 9th of May, the Moor and his unguents were sent away, “and went to Madrid, to send to heaven Hernando de Vega, while the prince went back to our method of cure.”

Considering what happened on the morning of the 10th of May, we should now presume that the second opening of the abscess, whether by Vesalius or someone else, relieved the pressure on the brain; that a critical period of exhaustion followed, probably prolonged by the Moor’s premature caustic, which stopped the suppuration: but that God’s good handiwork, called nature, triumphed at last; and that therefore it came to pass that the prince was out of danger within three days of the operation.  But he was taught, it seems, to attribute his recovery to a very different source from that of a German knife.  For on the morning of the 9th, when the Moor was gone, and Don Carlos lay seemingly lifeless, there descended into his chamber a Deus e machinâ, or rather a whole pantheon of greater or lesser deities, who were to effect that which medical skill seemed not to have effected.  Philip sent into the prince’s chamber several of the precious relics which he usually carried about with him.  The miraculous image of the Virgin of Atocha, in embroidering garments for whom, Spanish royalty, male and female, has spent so many an hour ere now, was brought in solemn procession and placed on an altar at the foot of the prince’s bed; and in the afternoon there entered, with a procession likewise, a shrine containing the bones of a holy anchorite, one Fray Diego, “whose life and miracles,” says Olivarez, “are so notorious;” and the bones of St. Justus and St. Pastor, the tutelar saints of the university of Alcala.  Amid solemn litanies the relics of Fray Diego were laid upon the prince’s pillow, and the sudarium, or mortuary cloth, which had covered his face, was placed upon the prince’s forehead.

Modern science might object that the presence of so many personages, however pious or well intentioned, in a sick chamber on a hot Spanish May day, especially as the bath had been, for some generations past, held in religious horror throughout Spain, as a sign of Moorish and Mussulman tendencies, might have somewhat interfered with the chances of the poor boy’s recovery.  Nevertheless the event seems to have satisfied Philip’s highest hopes; for that same night (so Don Carlos afterwards related) the holy monk Diego appeared to him in a vision, wearing the habit of St. Francis, and bearing in his hand a cross of reeds tied with a green band.  The prince stated that he first took the apparition to be that of the blessed St. Francis; but not seeing the stigmata, he exclaimed, “How?  Dost thou not bear the marks of the wounds?”  What he replied Don Carlos did not recollect; save that he consoled him, and told him that he should not die of that malady.

Philip had returned to Madrid, and shut himself up in grief in the great Jeronymite monastery.  Elizabeth was praying for her step-son before the miraculous images of the same city.  During the night of the 9th of May prayers went up for Don Carlos in all the churches of Toledo, Alcala, and Madrid.  Alva stood all that night at the bed’s foot.  Don Garcia de Toledo sat in the arm-chair, where he had now sat night and day for more than a fortnight.  The good preceptor, Honorato Juan, afterwards Bishop of Osma, wrestled in prayer for the lad the whole night through.  His prayer was answered: probably it had been answered already, without his being aware of it.  Be that as it may, about dawn Don Carlos’ heavy breathing ceased; he fell into a quiet sleep; and when he awoke all perceived at once that he was saved.

He did not recover his sight, seemingly on account of the erysipelas, for a week more.  He then opened his eyes upon the miraculous image of Atocha, and vowed that, if he recovered, he would give to the Virgin, at four different shrines in Spain, gold plate of four times his weight; and silver plate of seven times his weight, when he should rise from his couch.  So on the 6th of June he rose, and was weighed in a fur coat and a robe of damask, and his weight was three arrobas and one pound—seventy-six pounds in all.  On the 14th of June he went to visit his father at the episcopal palace; then to all the churches and shrines in Alcala, and of course to that of Fray Diego, whose body it is said he contemplated for some time with edifying devotion.  The next year saw Fray Diego canonised as a saint, at the intercession of Philip and his son; and thus Don Carlos re-entered the world, to be a terror and a torment to all around him, and to die—not by Philip’s cruelty, as his enemies reported too hastily indeed, yet excusably, for they knew him to be capable of any wickedness—but simply of constitutional insanity.

And now let us go back to the history of “that most learned, famous, and rare Baron Vesalius,” who had stood by and seen all these things done; and try if we cannot, after we have learned the history of his early life, guess at some of his probable meditations on this celebrated clinical case; and guess also how those meditations may have affected seriously the events of his after life.

Vesalius (as I said) was a Netherlander, born at Brussels in 1513 or 1514.  His father and grandfather had been medical men of the highest standing in a profession which then, as now, was commonly hereditary.  His real name was Wittag, an ancient family of Wesel, on the Rhine, from which town either he or his father adopted the name of Vesalius, according to the classicising fashion of those days.  Young Vesalius was sent to college at Louvain, where he learned rapidly.  At sixteen or seventeen he knew not only Latin, but Greek enough to correct the proofs of Galen, and Arabic enough to become acquainted with the works of the Mussulman physicians.  He was a physicist, too, and a mathematician, according to the knowledge of those times; but his passion—the study to which he was destined to devote his life—was anatomy.

Little or nothing (it must be understood) had been done in anatomy since the days of Galen of Pergamos, in the second century after Christ, and very little even by him.  Dissection was all but forbidden among the ancients.  The Egyptians, Herodotus tells us, used to pursue with stones and curses the embalmers as soon as they had performed their unpleasant office; and though Herophilus and Erasistratus are said to have dissected many subjects under the protection of Ptolemy Soter in Alexandria itself: yet the public feeling of the Greeks as well as of the Romans continued the same as that of the ancient Egyptians; and Galen was fain—as Vesalius proved—to supplement his ignorance of the human frame by describing that of an ape.  Dissection was equally forbidden among the Mussulmans; and the great Arabic physicians could do no more than comment on Galen.  The same prejudice extended through the middle age.  Medical men were all clerks, clerici, and as such forbidden to shed blood.  The only dissection, as far as I am aware, made during the middle age was one by Mundinus in 1306; and his subsequent commentaries on Galen—for he dare allow his own eyes to see no more than Galen had seen before him—constituted the best anatomical manual in Europe till the middle of the fifteenth century.

Then, in Italy at least, the classic Renaissance gave fresh life to anatomy as to all other sciences.  Especially did the improvements in painting and sculpture stir men up to a closer study of the human frame.  Leonardo da Vinci wrote a treatise on muscular anatomy: the artist and the sculptor often worked together, and realised that sketch of Michael Angelo’s in which he himself is assisting Fallopius, Vesalius’ famous pupil, to dissect.  Vesalius soon found that his thirst for facts could not be slaked by the theories of the middle age; so in 1530 he went off to Montpellier, where Francis I. had just founded a medical school, and where the ancient laws of the city allowed the faculty each year the body of a criminal.  From thence, after becoming the fellow-pupil and the friend of Rondelet, and probably also of Rabelais and those other luminaries of Montpellier, of whom I spoke in my essay on Rondelet, he returned to Paris to study under old Sylvius, whose real name was Jacques Dubois, alias Jock o’ the Wood; and to learn less—as he complains himself—in an anatomical theatre than a butcher might learn in his shop.