THE AGE OF RENOVATION.

This Age of Renovation (extending from the commencement of the fifteenth century to the present time, according to Renouard's classification) is divided into the Erudite Period, comprising the fifteenth and sixteenth centuries, and the Reform Period, comprising the seventeenth and eighteenth centuries, and one should add, in fact, the nineteenth. In general literature this age is known as that of the Renaissance, and is one of whose beginning a great deal has been written, and so much better than I can put it in this brief work, that to general sources I should perhaps refer those who are interested in knowing how and why there came about such a tremendous change in methods and habits of thought and in acquirement of knowledge. But it is the history of medicine that at this time we particularly desire, and our minds must be, in some slight degree, prepared for the great changes to be recounted by some, with the conditions which brought about this revolution. It was truly an awakening in every department of knowledge and along every line of study; it was as if the minds of men had been dormant and lost their power of receptivity, and, after a long period of torpor, awakened in a new atmosphere amid new surroundings; as if there had burst upon them a sudden appreciation of ability to do things hitherto undreamed of, and to acquire knowledge such as hitherto had been possessed by none. Once free from the shackles imposed by authority of the past, these minds severed their Gothic bonds, and started forth in every direction with the ardor of youth and the interest of novelty, all engaging in the general enterprise of erecting from the débris of antique science a new temple to the mind in which to worship. While some delved among the records of the past, others sought to bind the past and present, and others, bolder yet, cut entirely loose from it, rejected all tradition, and would fain have built this temple with entirely new materials.

Now, what led to this sudden awakening? Was it chance, or the effect of certain causes which had long been operating'? It has been seen that hospitals and various institutions, whose foundations were dedicated to humanity, were erected in all parts of Europe; that gradually there had come about a better social organization; that there had been a diminution of conflicts between princes and their vassals, and the relations between the two were more nearly at an equilibrium. Moreover, the invention of the compass, which rendered long voyages less dangerous and more frequent, opened up to trade regions hitherto inaccessible or unknown, and attracted interest toward commerce as a means of pecuniary gain. The telescope had been invented, and astronomy was able to seize upon some of the facts by it revealed, and thereby to make more interesting calculations concerning the motions of celestial bodies, and attain a knowledge of our solar system and its laws. Gradually the microscope shed light upon the hitherto unseen; engraving on copper had added its power of illustration to the works of the great writers as they appeared; but above all, that which brought about this condition of affairs was the discovery of the art of printing. The first attempts in this direction were made between the years 1435 and 1440, and by the united efforts of three men, whose names deserve mention so long as their art persists,—namely, Guttenberg, Faust, and Shoeffer. Thanks to them, the same information could be multiplied in manifold form and transmitted to all parts of the civilized globe. In this way intelligence and reason become triumphant; thenceforward the dominion of brute force was broken, and knowledge, because capable of dissemination, became imperishable.

At the commencement of the Erudite Period Arabic literature still predominated in medicine. Rhazes, Haly-Abbas, and Avicenna were universally invoked and explained. But a taste for Greek literature began to prevail in the universities of Italy, and was finally extended to every part of Europe, especially after the taking of Constantinople by Mahomet II, Emperor of the Turks, in 1453. This disaster, which at first bade fair to be a mortal blow to Greek literature and language, strange to say, served only to hasten their resurrection in the Occident. Constantinople having been given over to pillage at this time, most of its learned men escaped, carrying with them all manuscripts that could be seized; most of these found refuge in Italy, and enlightened protectors in the allpowerful prince of the house of Medici, in Florence, in the popes at Rome, and in Alphonso, of Arragon, King of Naples and Sicily. Everywhere these fugitives spread the knowledge of the masterpieces of Greek literature and art, and in this way a taste for books, libraries, and sound erudition was diffused, while the Greek and Latin classics were hunted up and published with great patience and ardor; thus the works of the old writers were edited, translated, commented upon, and everywhere disseminated throughout Europe.

Among those who devoted themselves to the thankless task of editing, and purifying from interpolations, the works of the classic writers was Nicholas Léonicenus, born near Vincenza in the year 1428, who studied medicine at Padua and taught it for more than sixty years at Ferrara. He possessed great vigor of mind, with purity of manners and serenity of soul, and was the first to translate directly from Greek into Latin the aphorisms of Hippocrates and portions of the writings of Galen. He combated in every way the infatuation of his contemporaries for the Arabians and their lore, and called attention to many of the errors of men who, like Pliny the naturalist, had fallen for lack of fully understanding the Greek authors they compiled. At the ripe age of ninety-six he died, regretted by all.

Thomas Linacre, of Canterbury, a contemporary of Léonicenus, though younger (1461-1524), studied first at the University of Oxford, went to Italy in 1484, and in Florence attracted the attention of Lorenzo de Medici, who made him the companion of his own children, to whom he gave the best possible advantages. In due time he returned to England, where his talents speedily won him high station, and he became physician to King Henry VIII, and later to Queen Mary. Linacre was the first Englishman, it is said, who spoke purely the language of the Romans. He translated several books of Galen that are still esteemed; and caused the founding of two chairs, one at Oxford, the other at Cambridge, whose incumbents were charged with the duty of explaining the works of Hippocrates and Galen. But he is most entitled to the gratitude of his countrymen for his influence in founding the College of London. To appreciate properly its importance and his merits, we must remember the obstacles that had to be surmounted; for at that time bishops alone had the right to accord, in their own dioceses, permission to practice medicine, and, consequently, the healing art was abandoned entirely to monks and illiterate empirics. It was well that Linacre had influence at court, else he could never have obtained the reform of such overwhelming abuses; but he triumphed in spite of powerful opposition, and secured the issue of letters patent which prohibited the practice of medicine by any one who had not received a degree in one of the two universities in the kingdom, and been examined by the President of the College of London assisted by three others. This was the achievement which gave this learned man the title of "Restorer of Medicine" in England.

Léonicenus and Linacre, who were of the early Erudite Period, also merit mention not merely because of literary talents, but because they were the first eminent physicians to embrace the study of Greek classics, and to propagate the knowledge therein contained. Subsequently others followed the same course,—too many, in fact, to be enumerated; but it was easy to follow after such leaders. From the time when men began to realize the superiority of Greek models over prolix Arabian commentaries, they were anxious to seek the light at its source, and applied themselves with avidity to the study of the originals. At this time copies of Greek authors were few in number and in a deplorable condition, owing to neglect. To rediscover them, to purify, to eliminate what was not original, to rearrange, and finally to multiply by the aid of the printing-press was an extended labor requiring great knowledge, rare sagacity, and commendable patience. One of the greatest publications in medical literature belonging to this epoch was a complete edition of the Hippocratic writings, translated into Latin by Anuce Foes,—a poor, but learned, practitioner, who lived on the products of his business as pension physician in the city of Metz,—and issued from Frankfort-on-the-Main in 1495. To this master-work Foes consecrated forty years of his life. Another treatise belonging to this same time, less important, perhaps, from a medical point of view, but nevertheless showing great erudition, was a treatise on the gymnastics of the ancients, by Jerome Mercurial is, a work said to be not less precious to historians than antiquarians. It was by such intense zeal and hard labor that true erudition was restored in Europe.

Following now some of the special branches of medical learning and their development, let us look first at anatomy and physiology. I have already related the salient points of the life and labors of Mondino, of whom it is said that, about the year 1315, while professor at Bologna, he dissected the bodies of two women, and shortly after published an epitome of anatomy illustrated with wood-cuts. Also has been mentioned the prohibition of anatomical study pronounced by Pope Boniface VIII, in 1300. It was only toward the close of the fifteenth and the early years of the sixteenth century that this prejudice began to abate; the popes, who then stood at the head of scientific movements, withdrew their interdictions, and the universities of Italy gave public dissections. Achillini, Benedetti, and Jacques Berenger dissected at Bologna, Padua, and Pavia, previous to the year 1500; soon afterward their example was generally followed.

Jacques Dubois, whose name was Latinized into Jacobus Sylvius, was born in 1478, in a village near Amiens; he studied in Paris, where he worked most industriously at anatomy, which later he was so successful in teaching. He was the first to arrange all the muscles of the human body, to determine their functions, and to give names to those of them which had not yet been so designated. He discovered the valves of the large veins, and was the first to study the blood-vessels by means of colored injections. He gave the same careful attention to pharmacy, and in Paris, before a large class of students, began lectures, on anatomy, physiology, hygiene, pathology, and therapeutics; these he continued until the faculty, on account of jealousy, interrupted them. He then, in 1529, went to Montpellier, but returned two years later to become a member of the faculty, and once more lectured with the greatest eclat. Later yet he became a successor to Vidius in the Royal College,—a position he retained up to his death in 1555. His medical writings were extensive and marked by great accuracy, while for anatomy he did a great deal, contributing much to popularize it. He dissected a great number of animals and as many human cadavers as he could procure, the number, however, being small. Unfortunately, he subordinated all his own research to the authority of Galen, being himself among those anatomists who permitted themselves to be so far misled.

[Original]

The man of genius and courage, who accepted the truth of what his eyes revealed to him, and who was the true reformer in anatomy, was Andreas Vesalius, born at Brussels, in 1514, of a family already illustrious in medicine. He studied at the University of Louvain, where he early revealed the inclinations of the anatomist, since in his leisure moments he was wont to amuse himself in dissecting small animals. Near Louvain was a place where criminals were executed; and Vesalius, having observed the body of one from which the soft parts had all been cleaned away by ravenous birds, only the bones and ligaments remaining, detached the extremities separately, and then carried off the trunk by night, thus possessing himself of his first skeleton. Attracted by the fame of Sylvius, lie afterward went to Paris to become his pupil, but, not content with the lessons of his master, continued to observe for himself. On the hill Montfauçon, where executions took place, he disputed with dogs and vultures for the remains of criminals, or by stealth disinterred bodies from the cemeteries at the greatest personal risk. So great was his application that his progress became rapid, and at the age of twenty he gave instruction to fellow-students; at twenty-two he became Professor of Anatomy at Padua, being appointed by the Senate of Venice; at twenty-nine he issued his great work on anatomy, which showed a completeness that left far in the rear all that had hitherto been published on this subject. The following year he was called by the Emperor Charles V to the court of Madrid, then the most brilliant in Europe, where he became the first physictan, and from this time abandoned his anatomical labors.

[Original]

He was the first who dared to dispute the words of Galen and point out his errors,—to ascertain that the greater part of Galen's descriptions, having been made from monkeys, did not correctly represent human anatomy. This audacity raised a crowd of vehement opponents, the least reasonable and most fanatic being his old master, Sylvius; but even these onslaughts could not conceal the truth. The minds of men generally were ripe for the revolution whose signal-fire was thus lighted, and no sooner did Vesalius appeal from the decision of Galen to observation of nature than a crowd of anatomists were ready to follow his method. He died in 1564.

One who, at Padua, had been first his pupil, then his co-laborer,—namely, Columbus, born at Cremona in 1490,—succeeded him. Columbus criticised, in some respects, the statements of his eminent predecessor, which he could better do, since he is said to have dissected fourteen bodies every year, as well as to have practiced venesection. He came so near to discovering the mystery of the circulation that it is strange how he could have missed it. He even appreciated the systole and diastole of the heart and the connection thereof with dilatation and contraction of the arteries. He knew, also, that the pulmonary veins conducted arterial blood, and that the pericardium was a shut sac. He even appreciated the lesser circulation, since he described how the blood left the right side of the heart and passed into the lungs, and came back through the veins into the left ventricle; because of this discovery, and in spite of his utter failure to appreciate the greater circulation, he has been by some regarded as entitled to the credit which is universally given to Harvey. From his position as teacher in Padua Columbus was called to Pisa, and from Pisa to Rome, where he died in 1559.

[Original]

Another of the great anatomists of this period, second only in fame to Vesalius, was Eustachius, born about the beginning of the sixteenth century. He became physician to the Duke of Urbino, and in Rome a city physician and professor of anatomy, continuing to teach in the latter city until overtaken by his final sickness. He was a defender of Galen rather than an opponent, and sought to shelter his reputation from the attacks of Vesalius. In his praise it must be said that, for his day, he was a great anatomist; his chief discoveries were in the domain of comparative anatomy. He brought to bear upon his work a knowledge of embryology which enabled him, for instance, to describe the kidneys and the teeth much more accurately than would otherwise have been possible; he noted, also the pathological changes in bodies dissected, and is brought daily to our minds as we think of the connecting channel between the pharynx and the middle ear, to which his name has been given.

He died in 1574.

[Original]

Fallopius, born in Modena, in 1523, was professor successively at Ferrara, Pisa, and Padua. He cultivated anatomy with the greatest ardor, and, in consequence, his name is also linked with that of Vesalius, as are those of Herophilus and Erasistratus in the history of ancient anatomy. His anatomical researches included all parts of the human body, and his name has been given to the tube through which the ovum enters the cavity of the uterus. Death overtook him in the year 1562.

Jerome Fabricius, better known as Fabricius ab Aquapendente, was born in the town of the latter name, near the southern end of the Apennines, in 1537, received his no early education in Padua, and studied anatomy under Fallopius, whose assistant he also was. After the death of the latter he succeeded to the professorship of anatomy, and later built, at his own expense, a large anatomical theater, in which he lectured and demonstrated to students from all parts of the world. Toward the end of his life he had accumulated a large number of specimens, and published extensively on anatomy, embryology, physiology, and surgery. Though often accredited with discovering the valves of the veins, he is not entitled to that honor, since Erasistratus, Sylvius, Vesalius, and others had previously described them, Estiennes had seen them in the azygos veins, and Canano in other veins. His true claim to glory rests upon embryological researches, which he was the first to undertake in a comparative way. In De Formato Foetu he elucidated the development of the embryo and its membranes by a long list of observations on lower animals of many species. He was probably the first to describe the uterine decidua. Fabricius died in 1619.

This Fabricius must not be confused with the almost-as-renowned Fabricius Hildanus, who was born in Hilden, near Düsseldorf, in 1560. Under the German name of Wilhelm Fabry he became widely known as a surgeon, and, after traveling through France, settled in Hilden, but later moved to Cologne, where he founded an academy. His first treatise—on gangrene and sphacelus—quickly made him known, and went through eleven editions. From Cologne he went successively to Genf, Lausanne, and Polen; returned to Cologne; and finally, after several other visits, settled in Bern, where he died of gout and asthma (in 1634.). His frequent changes of location were, perhaps, less the result of instability than a testimony to his reputation, inasmuch as he was invited from one place to another. He has been, with propriety, named the "German Paré," since he rendered such great service to German surgery, and was not only an expert therein, but likewise a cultivated physician and polished humanitarian; in fact he was ahead of his time, by many years, in these regards, as is shown by his recommending amputation in cases of gangrene, and his writings concerning gunshot wounds. He enjoyed a ripe experience also in obstetrics, and even instructed his wife in the obstetric art and praised her ability most highly. His most important contributions to literature were in the field of surgery, and these passed through numerous editions, while his opinions and practice are quoted even to-day.

[Original]

During this epoch many modifications were introduced and improvements made in the teaching of medicine. Permanent amphitheaters were established for dissection, and chairs of anatomy created, their incumbents being paid out of the public treasury. The popes, appear to have taken the initiative in this respect, which accounts for the great number of subjects with which Eustachius was supplied, as compared with Vesalius, who obtained only two or three in a year. Up to this time the razor had been the sole instrument of dissection, but was now replaced by the scalpel, which remains in use to-day. By the labors of the few men mentioned anatomy acquired a degree of perfection which it had never attained under the Greeks. Skillful artists put their labors upon paper, and plates and descriptions made from anatomical preparations represented the various parts of the human body with more fidelity than had been supposed possible. Nerves, tendons, and ligaments were no longer confused, but traced so far as possible from origin to ramifications. Ancient errors generally were corrected. It was proven that there was no bony structure in the tissue of the heart, that the partition between its cavities was not porous; and attentive examination of its valves led to the discovery of the lesser circulation by Columbus. Michael Servetus, whom John Calvin burned at the stake, was perhaps the first to note this phenomenon. He saw that the blood could not penetrate directly from the right into the left cavity of the heart, but that it was necessary for the whole fluid to pass through the lungs, where it became impregnated with the vital spirit of the atmosphere, and reached afterward the left auricle; the position of the valves in the pulmonary arteries and veins clearly confirmed his conjecture. Moreover the size of the pulmonary arteries was enormous, and disproportionate to the quantity of blood necessary for the nutrition of the lungs, which seemed to prove that this was not, as had been believed, the sole purpose of those vessels. It was about this time that Fabricius ab Aquapendente pointed out valves in veins in various parts of the body, and that Columbus and Andreas Cesalpinus explained more fully the mechanism of the lesser circulation; in fact, the former so closely approached an appreciation of the purpose of the vascular system that some have thought he really knew it, but the passages in his writings thought to sustain this opinion are not at all conclusive. He seems to have confused the action of the heart during sleep with that during the waking hours; and although he realized that the blood could not flow backward through the arteries, that the vena cava was the only vessel which permitted the entrance of blood into the heart, and though he spoke of anastomosis between arteries and veins and remarked that if a band be applied around a limb the veins swell below the ligature, he contented himself with comparing the motion of the blood with the flux and reflux of Euripus, as Aristotle had done. It is even thus that he tortured his mind in trying to reconcile two irreconcilable theories,—i.e., the opinion of the ancients on the motion of the blood and recent discoveries in the anatomy of the vascular system.