Out of the Flames Page 11

  IN THE HISTORY OF SCIENCE, there has never been a single individual who did as much to both move his discipline forward and hold it back as did Galen. He was born in 130 A.D. in Pergamum, in what is now Turkey, the son of an architect who named him “quiet and peaceful” so he wouldn't be like his mother. Galen was first trained as a philosopher but at seventeen switched to botany and medicine, and then went off to study in Alexandria, the preeminent center of medical learning at the time. After he finished school, he returned home and got his first break when he was assigned as head of sports medicine at the local gladiatorial school.

  Medical knowledge in the second century was primarily reliant upon the teachings of Hippocrates and Aristotle and suffered from several enormous disadvantages, none so great as the absolute prohibition against human autopsy. Although a few hardy Greeks had taken a peek inside a dead person as early as 500 B.C., by Galen's day the Romans were sure that if you cut a person up after he or she was dead, the spirit would come back and get even. Also, the revenge would not necessarily be restricted to the person who did the cutting. Thus a physician was forced to conduct his business lacking the fundamental blueprint of the trade. It was like a mechanic trying to figure out what was wrong with your car without being allowed to open the hood.

  But Galen was at gladiatorial school, where there was no shortage of grisly and extensive wounds that a curious and enterprising young physician could peer into. It was an effective way to learn a lot about muscles and bones, and at least see a lot of blood. Galen also observed that in those fallen warriors who received spinal injuries, the exact location of the trauma on the spine determined which areas of the body lost muscle function. An injury just above the waist meant that only the legs would be paralyzed, while one above the shoulders meant that use of the arms was lost as well. With the most serious spinal injuries, the victim lost the ability to breathe and died altogether. From these observations, Galen developed a hypothesis about nerve and spinal cord function.

  Not only was Galen unusually successful in patching up the gladiators, but he also began to apply his extensive knowledge of botany to curing illness and disease. Depending on the condition, he variously prescribed opium, wine, turpentine, honey, grape juice, and barley water, as well as plant extracts and the occasional cold compress. He became an expert pharmacologist and traveled widely to obtain unusual herbs, plants, or flowers.

  He did so well in Pergamum that he took himself and his growing reputation to Rome to become a celebrity physician, a venture at which he was almost immediately successful. “[I] called on the mighty in the morning and dined with them in the evening,” he wrote. He was soon lecturing, and his fame spread to the point where the sick wrote to him from all across the empire. So confident was Galen in his healing ability that he had no qualms about prescribing by mail. Here, too, he was often successful, and it was said that Galen “left no clinical studies, only miraculous cures.” He became sufficiently renowned that he was summoned by the emperor, Marcus Aurelius, and appointed as personal physician to his son Commodus.

  (Commodus, who has since been immortalized by Hollywood in the movie Gladiator, was not killed in the arena by Russell Crowe but rather strangled in his bathtub by a wrestler named Narcissus after being insufficiently poisoned by his mistress. The real Commodus could not have been farther from the preening coward of the film. He was the only emperor to actually enter the arena as a combatant. He personally fought tigers, panthers, and elephants, and was said to have once killed one hundred tigers using only one hundred arrows before breakfast.)

  Galen did as much as he could to learn about human anatomy. With human corpses forbidden, he procured goats, pigs, and monkeys and cut them open. (Monkeys were best, of course, but you couldn't always get a monkey.) From these dissections, called anatomies, Galen went on to correctly theorize about human kidney and bladder function, as well as describing the role of the brain in controlling such functions as sight and speech. But observing only dead animals had its shortcomings. There is not necessarily a strict congruence between the innards of people and animals. Even primates have a substantially different physiology from humans. As a result, many of Galen's extrapolations, like that of a lobed liver and a two-boned lower jaw, were simply wrong.

  Another drawback to Galenic anatomy was the inability to examine bodily processes, most of which ceased after death. Nowhere did this cause more problems than in the description of the circulatory system. While Galen did demonstrate that arteries carry blood, not air—a major step forward in the second century—and described the structural differences between arteries and veins, as well as mapping out heart valves, he also believed that the liver, not the heart, was the system's main organ and that blood moved from the liver to the outer portions of the body to create flesh. In addition, Galen taught that the arterial and venous systems were separate and that blood moved from the left side of the heart to the right through pores in the septum, or dividing wall. The heart was the spiritual rather than the mechanical hub of the system and, according to Galen, was the hottest part of the body. The lungs filled with air only to cool the heart and keep it from exploding.

  As to disease, Galen drew on Aristotle and postulated that all bodily disorders were caused by an imbalance in the four “humors” present in each person—blood, phlegm, yellow bile (choler), and black bile (melancholy). Each person had his or her own distinctive balance of these four humors, and too much or too little of one or more of them caused illness. (It also meant that each person had his or her own unique body temperature.) A proper rebalancing of the humors would provide a cure, so recommended treatments were often limited to inducing a patient to bleed, sweat, vomit, urinate, or have diarrhea. It was no picnic to be ill in the second century.

  While there is no doubt that Galen produced a remarkable and persuasive portrait of the body and its functions, what caused him to evolve into the figure of omniscient authority that he eventually became was that he wrote everything down. Galen was the most prolific author of his time. He put out over five hundred separate books, few of them short. In medicine alone, he produced over twenty thousand pages of text—and that is just what has survived, only about a third of the total. He wrote not only on medicine but also on botany and philosophy, and was not above penning a play or two when things got slow on the science front.

  All of his books, thousands upon thousands of pages, went into the great library at Alexandria. From there, he was discovered by the Church. Overwhelmed by the sheer bulk of his knowledge and impressed by the spiritual foundations of Galen's corporeal philosophy, the Church adopted him fully and completely. He was said to have been divinely inspired and infallible, and it became heresy to go against him. He was translated into Latin and disseminated throughout the Christian world. New approved versions of Galen were produced all the time, and no medieval medical office was complete without the sixteen or so volumes that came to constitute the Galenic canon.

  Although by the sixteenth century there was a good deal of evidence around that Galen had made some glaring errors, the Church continued to restrict the sciences of medicine and anatomy to the findings of a man who never saw the inside of a human being.

  IT “WAS IN 1525 that the sanctity of Galen got its first major jolt. The House of Aldus (then being run by the tightwad Torresani, Erasmus's favorite) published a compilation of Galen's work in the original Greek, drawn, of course, from all those manuscripts that had made their way to Italy from Constantinople. In this translation, there were some noticeable differences from the Church-approved texts. Suddenly there were two Galens, and the fight was on. The differences were largely trivial, often only a matter of semantics, but this was the first time that anyone had debated anything at all about medicine in hundreds of years.

  Inevitably, some even began to question Galen altogether. The renegade Swiss physician Theophrastus Phillippus Aureolus Bombastus von Hohenheim, who, in a wise professional move, shortened his name to Paracelsus (although reasons for
that particular choice remain obscure), began to spout the laughable notion that disease originates from agents outside the body causing a disruption in body chemistry, and not from an imbalance in the humors. Paracelsus, who gained favor and notoriety in Strasbourg when he cured Johann Froben—yes, that Froben, Erasmus's and Luther's publisher—and lost it soon after when Froben relapsed and died, also said that medicines should not be merely herbal but also include animal and especially mineral substances as well—in fact, anything that worked. (Not all of Paracelsus's views were so enlightened. He also claimed that he could turn rocks into gold and that the stars foretold the optimum time to administer an enema. Also, his own personal hygiene was so lax that when he had a new coat made every month and tried to give the old one away, no one would take it because it smelled so bad.) Labeled as a quack and a charlatan by the established medical community, Paracelsus nonetheless remained adamant about his theory of chemical rather than humoric imbalance. For most of his life, despite the praise of Erasmus, whom he also treated, he was hounded from place to place and died in poverty.

  Galen notwithstanding, almost every student of medicine or anatomy in the sixteenth century realized that nothing could move forward without firsthand observation. The spur for this observation turned out to be not so much a thirst for scientific knowledge as a thirst for profit.

  By the 1530s, the medical profession had a firmly established hierarchy. At the very top were physicians, whose authority sprung primarily from their ability to read Latin. Much as the Church had used Latin to keep knowledge of the Scriptures from the laity, physicians since Hippocrates had used Latin to keep medical knowledge from anyone but themselves. Being a physician largely meant being a scholar—someone who could read and interpret the old texts—learning from books rather than empirically.

  Directly under the physicians came the surgeons, and then the barbers. Surgeons were craftsmen, members of a guild with requirements for entry and set prices for their services. They had some book learning, but not nearly as much as physicians. As the people who were actually treating wounds, setting bones, or cutting people open, they were, by necessity, empiricists, much like the ship captains who preferred heresy to shipwreck.

  Barbers were at the bottom of the ladder—they knew no Latin and their skill was minimal. They were, however, cheap. Anyone who couldn't afford a surgeon got a barber. More disquieting for the surgeons, physicians often opted for the less expensive barber when contracting for a dissection. The competition sometimes boiled over. At the University of Paris, “the resentment of the surgeons was expressed in a complaint to the faculty… in which it was asserted that the barbers had independently obtained the body of an executed criminal, and that certain members of the faculty had not only demonstrated its anatomy, but furthermore in French rather than in Latin.” “Independently obtained” meant that they stole it.

  It was soon clear to the surgeons that the only way they could maintain their competitive edge on the barbers was to make sure that their knowledge of the body was so much better that no one who could afford to would ever choose the cheaper alternative. And the only way to ensure better knowledge was to have more dissections.

  Although empiricism was pushing hard against tradition at the University of Paris in 1536, the university lagged somewhat behind its Italian counterparts in its use of human dissection as a research and teaching tool. Human dissections, although allowed, were still reasonably rare. Bodies were difficult to come by—only the corpses of executed criminals were permissible. And dissections were expensive. You had to pay the executioner, his assistants, and the boatman who brought the body across the river, then buy breakfast for everyone including the two men who had cut off the cadaver's head and buried it in secrecy so as not to offend the populace. You also had to rent a table and buy vinegar to wash the body. When it was over, there was the mess to clean up and payment to the priest to allow you to bury the bits and pieces of the body that were left, with a little extra for a Mass for the soul of the dead criminal.

  Dissections were performed in a corner room of the medical school that could be sealed off from the rest of the building by a heavy wooden door. It was round, about thirty feet across, and rose straight up to a peaked roof about fifty feet high. Students could observe close in from ground level or from a walkway set about fifteen feet up. There was a row of large windows behind the walkway and another row of windows between the walkway and the roof. These windows provided the only ventilation for the entire room, the only way to rid the room of the smell.

  The two most distinguished professors of medicine at the university during Servetus's tenure there were Jacobus Sylvius and Jean Guinter of Andernach. Both men were leaders of Parisian academic medicine, particularly of anatomy, but they had very different methods of instruction. Sylvius, by all reports a dour, foul-tempered bigot, was nevertheless by far the more popular teacher. He once had nine hundred copies of a book printed up as required reading for his general studies course; they all sold out in a few days and more had to be printed. It was common practice at the time for the professor to sit in a high chair during dissections and read to the observing students from Galen (in Latin, of course) while a barber or surgeon actually cut up the body. Since the barbers didn't understand Latin, however, they never knew what it was they were supposed to be displaying at any one time. (One student complained that he could have learned more from “a butcher in his stall.”)

  Unlike his fellow physicians, Sylvius got right in there and cut up the body himself. Because he didn't get too many human bodies, he was more likely to dissect dogs (which were plentiful). He also employed other, somewhat more unorthodox means of acquiring specimens. A writer of the period who audited Sylvius's class wrote:

  I recall having heard the eloquent Jacobus Sylvius lecture on Galen's Use of parts to a remarkable audience of scholars of all nations… I have seen him bring in his sleeve sometimes a thigh or sometimes the arm of someone hanged, in order to dissect and anatomize it. They stank so strongly and offensively that some of his auditors would readily have thrown up if they had dared; but the cantankerous fellow with his Picard head would have been so violently incensed, threatening not to return for a week, that everyone kept silent.

  Sylvius was responsible for identifying valves in the veins as well as a number of other important blood vessels and muscles, but he remained a staunch Galenist. When faced with obvious errors in the Galenic model, he asserted that Galen had been right but that the human body had changed over the years, “and not for the better.” The thigh bone had become straighter, for example, because people had come to wear tighter pants. To Sylvius, the only possible improvement in medical science was a better, more literal translation of Galen's original Greek texts.

  Guinter de Andernach taught much more in the traditional mode. Although he was a kindly man, friendly to his students, his principal contribution to their education was unintentional. Because he himself did not dissect the corpse, he left more of the work to his student assistant. The student assistant was responsible for preparing the cadaver for dissection, which meant at the very least a space close to the barber during the actual lecture. In some cases, it even meant actually taking charge of the knife. This represented an invaluable opportunity to see what was in the body up close. Dissections were crowded, and those in the back, while removed from the stink, were also removed from the lesson. The student chosen for this honor was always at the very top of the class. He was christened “archdeacon of students” by the others.

  Guinter had two such student assistants, one right after the other, whom he felt compelled to cite for excellence. The first, Andreas Vesal-ius, he described as “a young man by Hercules, singularly proficient in anatomy.”

  IF ANYONE COULD BE SAID to have been bred for greatness in the field of medicine, it was Vesalius. Family lore had it that his great-greatgrandfather, Peter Witing, was physician to Emperor Frederick III. His great-grandfather, Johannes de Wesalia, was professor of medici
ne at the newly opened University of Louvain as well as city physician of Brussels and court physician to Charles the Bold. It was Johannes who was granted the family heraldic symbol. Since these were unfortunately assigned based on the family name, Vesalius's family wound up with three weasels. Johannes was also responsible for accumulating the family fortune, which was considerable, and for the purchase of a large estate in Brussels.

  Johannes's eldest son, Everard—Vesalius's grandfather—advanced the family's social position still further. He became physician to Emperor Maximilian, his wife, Mary of Burgundy, and their son, Philip the Fair, later married to Juana the Mad and father to Charles V. Everard, who died young, probably in his thirties, was actually knighted, which was rare for a doctor.

  In spite of this pedigree, Vesalius almost didn't make it because Everard never bothered to marry Vesalius's grandmother, and so their son, Andries Van Wesele, Vesalius's father, was born out of wedlock. Illegitimacy (outside the papacy) was a major handicap in those days, and Andries's expectations were thus necessarily reduced. He rose only to the position of apothecary, although he was apothecary to Charles V and, as such, had to follow the court around from place to place. This meant that he was rarely home, which wasn't so bad since instead of living on the beautiful Van Wesele estate, Vesalius and his parents had been forced to set up housekeeping in the much more déclassé neighborhood of Bovendael. Bovendael, which was basically skid row, was conveniently located near the Montagne de la Potence, which was a wooded area where they tortured and executed criminals. In those days, they couldn't be bothered to cut down the bodies after they'd killed them, so the Van Wesele family always had a clear view from their sitting-room window of decaying, stinking corpses, half-eaten by birds. A more direct source of inspiration for a budding anatomist would be hard to come by.