(17) French edition, 1668, English translation, same year. For adiscussion on the author of the weapon salve see Van Helmont, whogives the various formulas. Highmore (1651) says the "powder isa Zaphyrian salt calcined by a celestial fire operating in Leoand Cancer into a Lunar complexion."But she has ta'en the broken lance,And wash'd it from the clotted gore,And salved the splinter o'er and o'er.William of Deloraine, in trance,Whene'er she turn'd it round and round,Twisted, as if she gall'd his wound,Then to her maidens she did say,That he should be whole man and sound,(Canto iii, xxiii.)
and in Dryden's "Tempest" (V, 1) Ariel says:
Anoint the Sword which pierc'd him with the Weapon-Salve,And wrap it close from Air till I have timeTo visit him again.
From Van Helmont comes the famous story of the new nose that dropped off in sympathy with the dead arm from which it was taken, and the source of the famous lines of Hudibras. As I have not seen the original story quoted of late years it may be worth while to give it: "A certain inhabitant of Bruxels, in a combat had his nose mowed off, addressed himself to Tagliacozzus, a famous Chirurgein, living at Bononia, that he might procure a new one; and when he feared the incision of his own arm, he hired a Porter to admit it, out of whose arm, having first given the reward agreed upon, at length he dig'd a new nose. About thirteen moneths after his return to his own Countrey, on a sudden the ingrafted nose grew cold, putrified, and within few days drops off. To those of his friends that were curious in the exploration of the cause of this unexpected misfortune, it was discovered, that the Porter expired, neer about the same punctilio of time, wherein the nose grew frigid and cadaverous. There are at Bruxels yet surviving, some of good repute, that were eye-witnesses of these occurrences."(18)
(18) Charleton: Of the Magnetic Cure of Wounds, London, 1650, p.13.
Equally in the history of science and of medicine, 1542 is a starred year, marked by a revolution in our knowledge alike of Macrocosm and Microcosm. In Frauenburg, the town physician and a canon, now nearing the Psalmist limit and his end, had sent to the press the studies of a lifetime—"De revolutionibus orbium coelestium." It was no new thought, no new demonstration that Copernicus thus gave to his generation. Centuries before, men of the keenest scientific minds from Pythagoras on had worked out a heliocentric theory, fully promulgated by Aristarchus, and very generally accepted by the brilliant investigators of the Alexandrian school; but in the long interval, lapped in Oriental lethargy, man had been content to acknowledge that the heavens declare the glory of God and that the firmament sheweth his handiwork. There had been great astronomers before Copernicus. In the fifteenth century Nicholas of Cusa and Regiomontanus had hinted at the heliocentric theory; but 1512 marks an epoch in the history of science, since for all time Copernicus put the problem in a way that compelled acquiescence.
Nor did Copernicus announce a truth perfect and complete, not to be modified, but there were many contradictions and lacunae which the work of subsequent observers had to reconcile and fill up. For long years Copernicus had brooded over the great thoughts which his careful observation had compelled. We can imagine the touching scene in the little town when his friend Osiander brought the first copy of the precious volume hot from the press, a well enough printed book. Already on his deathbed, stricken with a long illness, the old man must have had doubts how his work would be received, though years before Pope Clement VII had sent him encouraging words. Fortunately death saved him from the "rending" which is the portion of so many innovators and discoverers. His great contemporary reformer, Luther, expressed the view of the day when he said the fool will turn topsy-turvy the whole art of astronomy; but the Bible says that Joshua commanded the Sun to stand still, not the Earth. The scholarly Melanchthon, himself an astronomer, thought the book so godless that he recommended its suppression (Dannemann, Grundriss). The church was too much involved in the Ptolemaic system to accept any change and it was not until 1822 that the works of Copernicus were removed from the Index.
THE same year, 1542, saw a very different picture in the far-famed city of Padua, "nursery of the arts." The central figure was a man not yet in the prime of life, and justly full of its pride, as you may see from his portrait. Like Aristotle and Hippocrates cradled and nurtured in an AEsculapian family, Vesalius was from his childhood a student of nature, and was now a wandering scholar, far from his Belgian home. But in Italy he had found what neither Louvain nor Paris could give, freedom in his studies and golden opportunities for research in anatomy. What an impression he must have made on the student body at Padua may be judged from the fact that shortly after his graduation in December, 1537, at the age of twenty-four, he was elected to the chair of anatomy and surgery. Two things favored him—an insatiate desire to see and handle for himself the parts of the human frame, and an opportunity, such as had never before been offered to the teacher, to obtain material for the study of human anatomy. Learned with all the learning of the Grecians and of the Arabians, Vesalius grasped, as no modern before him had done, the cardinal fact that to know the human machine and its working, it is necessary first to know its parts—its fabric.
To appreciate the work of this great man we must go back in a brief review of the growth of the study of anatomy.
Among the Greeks only the Alexandrians knew human anatomy. What their knowledge was we know at second hand, but the evidence is plain that they knew a great deal. Galen's anatomy was first-class and was based on the Alexandrians and on his studies of the ape and the pig. We have already noted how much superior was his osteology to that of Mundinus. Between the Alexandrians and the early days of the School of Salernum we have no record of systematic dissections of the human body. It is even doubtful if these were permitted at Salernum. Neuburger states that the instructions of Frederick II as to dissections were merely nominal.
How atrocious was the anatomy of the early Middle Ages may be gathered from the cuts in the works of Henri de Mondeville. In the Bodleian Library is a remarkable Latin anatomical treatise of the late thirteenth century, of English provenance, one illustration from which will suffice to show the ignorance of the author. Mundinus of Bologna, one of the first men in the Middle Ages to study anatomy from the subject, was under the strong domination of the Arabians, from whom he appears to have received a very imperfect Galenic anatomy. From this date we meet with occasional dissections at various schools, but we have seen that in the elaborate curriculum of the University of Padua in the middle of the fifteenth century there was no provision for the study of the subject. Even well into the sixteenth century dissections were not common, and the old practice was followed of holding a professorial discourse, while the butcher, or barber surgeon, opened the cavities of the body. A member of a famous Basel family of physicians, Felix Plater, has left us in his autobiography(19) details of the dissections he witnessed at Montpellier between November 14, 1552, and January 10, 1557, only eleven in number. How difficult it was at that time to get subjects is shown by the risks they ran in "body-snatching" expeditions, of which he records three.
(19) There is no work from which we can get a better idea of thelife of the sixteenth-century medical student and of the style ofeducation and of the degree ceremonies, etc. Cumston has givenan excellent summary of it (Johns Hopkins Hospital Bulletin,1912, XXIII, 105-113).
And now came the real maker of modern anatomy. Andreas Vesalius had a good start in life. Of a family long associated with the profession, his father occupied the position of apothecary to Charles V, whom he accompanied on his journeys and campaigns. Trained at Louvain, he had, from his earliest youth, an ardent desire to dissect, and cut up mice and rats, and even cats and dogs. To Paris, the strong school of the period, he went in 1533, and studied under two men of great renown, Jacob Sylvius and Guinterius. Both were strong Galenists and regarded the Master as an infallible authority. He had as a fellow prosector, under the latter, the unfortunate Servetus. The story of his troubles and trials in getting bones and subjects you may read in Roth's "Life."(20) Many interesting biographical details are also to be found in his own writings. He returned for a time to Louvain, and here he published his first book, a commentary on the "Almansor" of Rhazes, in 1537.
(20) M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1892. Anexcellent account of Vesalius and his contemporaries is given byJames Moores Ball in his superbly printed Andreas Vesalius, theReformer of Anatomy, St. Louis, 1910.
Finding it difficult, either in Paris or Louvain, to pursue his anatomical studies, he decided to go to Italy where, at Venice and Padua, the opportunities were greater. At Venice, he attended the practice of a hospital (now a barracks) which was in charge of the Theatiner Order. I show you a photograph of the building taken last year. And here a strange destiny brought two men together. In 1537, another pilgrim was working in Venice waiting to be joined by his six disciples. After long years of probation, Ignatius Loyola was ready to start on the conquest of a very different world. Devoted to the sick and to the poor, he attached himself to the Theatiner Order, and in the wards of the hospital and the quadrangle, the fiery, dark-eyed, little Basque must frequently have come into contact with the sturdy young Belgian, busy with his clinical studies and his anatomy. Both were to achieve phenomenal success—the one in a few years to revolutionize anatomy, the other within twenty years to be the controller of universities, the counsellor of kings, and the founder of the most famous order in the Roman Catholic Church. It was in this hospital that Vesalius made observations on the China-root, on which he published a monograph in 1546. The Paduan School was close to Venice and associated with it, so that the young student had probably many opportunities of going to and fro. On the sixth of December, 1537, before he had reached his twenty-fourth year and shortly after taking his degree, he was elected to the chair of surgery and anatomy at Padua.
The task Vesalius set himself to accomplish was to give an accurate description of all the parts of the human body, with proper illustrations. He must have had abundant material, more, probably, than any teacher before him had ever had at his disposal. We do not know where he conducted his dissections, as the old amphitheatre has disappeared, but it must have been very different from the tiny one put up by his successor, Fabricius, in 1594. Possibly it was only a temporary building, for he says in the second edition of the "Fabrica" that he had a splendid lecture theatre which accommodated more than five hundred spectators (p. 681).
With Vesalius disappeared the old didactic method of teaching anatomy. He did his own dissections, made his own preparations, and, when human subjects were scarce, employed dogs, pigs or cats, and occasionally a monkey. For five years he taught and worked at Padua. He is known to have given public demonstrations in Bologna and elsewhere. In the "China-root" he remarks that he once taught in three universities in one year. The first fruit of his work is of great importance in connection with the evolution of his knowledge. In 1538, he published six anatomical tables issued apparently in single leaves. Of the famous "Tabulae Anatomicae" only two copies are known, one in the San Marco Library, Venice, and the other in the possession of Sir John Stirling-Maxwell, whose father had it reproduced in facsimile (thirty copies only) in 1874. Some of the figures were drawn by Vesalius himself, and some are from the pencil of his friend and countryman, Stephan van Calcar. Those plates were extensively pirated. About this time he also edited for the Giunti some of the anatomical works of Galen.(21)
(21) De anatomicis administrationibus, De venarum arterinrumquedissectione, included in the various Juntine editions of Galen.
We know very little of his private life at Padua. His most important colleague in the faculty was the famous Montanus, professor of medicine. Among his students and associates was the Englishman Caius, who lived in the same house with him. When the output is considered, he cannot have had much spare time at Padua.
He did not create human anatomy—that had been done by the Alexandrians—but he studied it in so orderly and thorough a manner that for the first time in history it could be presented in a way that explained the entire structure of the human body. Early in 1542 the MS. was ready; the drawings had been made with infinite care, the blocks for the figures had been cut, and in September, he wrote to Oporinus urging that the greatest pains should be taken with the book, that the paper should be strong and of equal thickness, the workmen chosen for their skill, and that every detail of the pictures must be distinctly visible. He writes with the confidence of a man who realized the significance of the work he had done. It is difficult to speak in terms of moderation of the "Fabrica." To appreciate its relative value one must compare it with the other anatomical works of the period, and for this purpose I put before you two figures from a text-book on the subject that was available for students during the first half of the sixteenth century. In the figures and text of the "Fabrica" we have anatomy as we know it; and let us be honest and say, too, largely as Galen knew it. Time will not allow me to go into the question of the relations of these two great anatomists, but we must remember that at this period Galen ruled supreme, and was regarded in the schools as infallible. And now, after five years of incessant labor, Vesalius was prepared to leave his much loved Padua and his devoted students. He had accomplished an extraordinary work. He knew, I feel sure, what he had done. He knew that the MSS. contained something that the world had not seen since the great Pergamenian sent the rolls of his "Manual of Anatomy" among his friends. Too precious to entrust to any printer but the best—and the best in the middle of the sixteenth century was Transalpine—he was preparing to go north with the precious burden. We can picture the youthful teacher—he was but twenty-eight—among students in a university which they themselves controlled—some of them perhaps the very men who five years before had elected him—at the last meeting with his class, perhaps giving a final demonstration of the woodcuts, which were of an accuracy and beauty never seen before by students' eyes, and reading his introduction. There would be sad hearts at the parting, for never had anyone taught anatomy as he had taught it—no one had ever known anatomy as he knew it. But the strong, confident look was on his face and with the courage of youth and sure of the future, he would picture a happy return to attack new and untried problems. Little did he dream that his happy days as student and teacher were finished, that his work as an anatomist was over, that the most brilliant and epoch-making part of his career as a professor was a thing of the past. A year or more was spent at Basel with his friend Oporinus supervising the printing of the great work, which appeared in 1543 with the title "De Humani Corporis Fabrica." The worth of a book, as of a man, must be judged by results, and, so judged, the "Fabrica" is one of the great books of the world, and would come in any century of volumes which embraced the richest harvest of the human mind. In medicine, it represents the full flower of the Renaissance. As a book it is a sumptuous tome a worthy setting of his jewel—paper, type and illustration to match, as you may see for yourselves in this folio—the chef d'oeuvre of any medical library.
In every section, Vesalius enlarged and corrected the work of Galen. Into the details we need not enter: they are all given in Roth's monograph, and it is a chapter of ancient history not specially illuminating.
Never did a great piece of literary work have a better setting. Vesalius must have had a keen appreciation of the artistic side of the art of printing, and he must also have realized the fact that the masters of the art had by this time moved north of the Alps.
While superintending the printing of the precious work in the winter of 1542-1543 in Basel, Vesalius prepared for the medical school a skeleton from the body of an executed man, which is probably the earliest preparation of the kind in Europe. How little anatomy had been studied at the period may be judged from that fact that there had been no dissection at Basel since 1531.(22) The specimen is now in the Vesalianum, Basel, of which I show you a picture taken by Dr. Harvey Cushing. From the typographical standpoint no more superb volume on anatomy has been issued from any press, except indeed the second edition, issued in 1555. The paper is, as Vesalius directed, strong and good, but it is not, as he asked, always of equal thickness; as a rule it is thick and heavy, but there are copies on a good paper of a much lighter quality. The illustrations drawn by his friend and fellow countryman, van Calcar, are very much in advance of anything previously seen, except those of Leonardo. The title-page, one of the most celebrated pictures in the history of medicine, shows Vesalius in a large amphitheatre (an imaginary one of the artist, I am afraid) dissecting a female subject. He is demonstrating the abdomen to a group of students about the table, but standing in the auditorium are elderly citizens and even women. One student is reading from an open book. There is a monkey on one side of the picture and a dog on the other. Above the picture on a shield are the three weasels, the arms of Vesal. The reproduction which I show you here is from the "Epitome"—a smaller work issued before (?) the "Fabrica," with rather larger plates, two of which represent nude human bodies and are not reproduced in the great work. The freshest and most beautiful copy is the one on vellum which formerly belonged to Dr. Mead, now in the British Museum, and from it this picture was taken. One of the most interesting features of the book are the full-page illustrations of the anatomy of the arteries, veins and nerves. They had not in those days the art of making corrosion preparations, but they could in some way dissect to their finest ramifications the arteries, veins and nerves, which were then spread on boards and dried. Several such preparations are now at the College of Physicians in London, brought from Padua by Harvey. The plates of the muscles are remarkably good, more correct, though not better perhaps, on the whole, than some of Leonardo's.
(22) The next, in 1559, is recorded by Plater in hisautobiography, who gave a public dissection during three days inthe Church of St. Elizabeth.
Vesalius had no idea of a general circulation. Though he had escaped from the domination of the great Pergamenian in anatomy, he was still his follower in physiology. The two figures annexed, taken from one of the two existing copies of the "Tabulae Anatomica," are unique in anatomical illustration, and are of special value as illustrating the notion of the vascular system that prevailed until Harvey's day. I have already called your attention to Galen's view of the two separate systems, one containing the coarse, venous blood for the general nutrition of the body, the other the arterial, full of a thinner, warmer blood with which were distributed the vital spirits and the vital heat. The veins had their origin in the liver; the superior vena cava communicated with the right heart, and, as Galen taught, some blood was distributed to the lungs; but the two systems were closed, though Galen believed there was a communication at the periphery between the arteries and veins. Vesalius accepted Galen's view that there is some communication between the venous and arterial systems through pores in the septum of the ventricles, though he had his doubts, and in the second edition of his book (1555) says that inspite of the authority of the Prince of Physicians he cannot see how the smallest quantity of blood could be transmitted through so dense a muscular septum. Two years before this (1553),(*) his old fellow student, Michael Servetus, had in his "Christianismi Restitutio" annatomical touch with one another!
(*) See the Servetus Notes in the Osler Anniversary Volumes, NewYork, 1919, Vol. II.—Ed.
The publication of the "Fabrica" shook the medical world to its foundations. Galen ruled supreme in the schools: to doubt him in the least particular roused the same kind of feeling as did doubts on the verbal inspiration of the Scriptures fifty years ago! His old teachers in Paris were up in arms: Sylvius, nostrae aetatis medicorum decus, as Vesalius calls him, wrote furious letters, and later spoke of him as a madman (vaesanus). The younger men were with him and he had many friends, but he had aroused a roaring tide of detraction against which he protested a few years later in his work on the "China-root," which is full of details about the "Fabrica." In a fit of temper he threw his notes on Galen and other MSS. in the fire. No sadder page exists in medical writings than the one in which Vesalius tells of the burning of his books and MSS. It is here reproduced and translated.(23) His life for a couple of years is not easy to follow, but we know that in 1546 he took service with Charles V as his body physician, and the greatest anatomist of his age was lost in the wanderings of court and campaigns. He became an active practitioner, a distinguished surgeon, much consulted by his colleagues, and there are references to many of his cases, the most important of which are to internal aneurysms, which he was one of the first to recognize. In 1555 he brought out the second edition of the "Fabrica," an even more sumptuous volume than the first.
(23) Epistle on China-root, 1546, p. 196. Vesalius may be quotedin explanation—in palliation:
"All these impediments I made light of; for I was too young to seek gain by my art, and I was sustained by my eager desire to learn and to promote the studies in which I shared. I say nothing of my diligence in anatomizing—those who attended my lectures in Italy know how I spent three whole weeks over a single public dissection. But consider that in one year I once taught in three different universities. If I had put off the task of writing till this time; if I were now just beginning to digest my materials; students would not have had the use of my anatomical labours, which posterity may or may not judge superior to the rechauffes formerly in use, whether of Mesua, of Gatinaria, of some Stephanus or other on the differences, causes and symptoms of diseases, or, lastly, of a part of Servitor's pharmacopoeia. As to my notes, which had grown into a huge volume, they were all destroyed by me; and on the same day there similarly perished the whole of my paraphrase on the ten books of Rhazes to King Almansor, which had been composed by me with far more care than the one which is prefaced to the ninth book. With these also went the books of some author or other on the formulae and preparation of medicines, to which I had added much matter of my own which I judged to be not without utility; and the same fate overtook all the books of Galen which I had used in learning anatomy, and which I had liberally disfigured in the usual fashion. I was on the point of leaving Italy and going to Court; those physicians you know of had made to the Emperor and to the nobles a most unfavourable report of my books and of all that is published nowadays for the promotion of study; I therefore burnt all these works that I have mentioned, thinking at the same time that it would be an easy matter to abstain from writing for the future. I must show that I have since repented more than once of my impatience, and regretted that I did not take the advice of the friends who were then with me."
There is no such pathetic tragedy in the history of our profession. Before the age of thirty Vesalius had effected a revolution in anatomy; he became the valued physician of the greatest court of Europe; but call no man happy till he is dead! A mystery surrounds his last days. 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 age.
To the North American Review, November, 1902, Edith Wharton contributed a poem on "Vesalius in Zante," in which she pictures his life, so full of accomplishment, so full of regrets—regrets accentuated by the receipt of an anatomical treatise by Fallopius, the successor to the chair in Padua! She makes him say:
There are two ways of spreading light; to beThe candle or the mirror that reflects it.I let my wick burn out—there yet remainsTo spread an answering surface to the flameThat others kindle.
But between Mundinus and Vesalius, anatomy had been studied by a group of men to whom I must, in passing, pay a tribute. The great artists Raphael, Michael Angelo and Albrecht Durer were keen students of the human form. There is an anatomical sketch by Michael Angelo in the Ashmolean Museum, Oxford, which I here reproduce.(*) Durer's famous work on "Human Proportion," published in 1528, contains excellent figures, but no sketches of dissections. But greater than any of these, and antedating them, is Leonardo da Vinci, the one universal genius in whom the new spirit was incarnate—the Moses who alone among his contemporaries saw the promised land. How far Leonardo was indebted to his friend and fellow student, della Torre, at Pavia we do not know, nor does it matter in face of the indubitable fact that in the many anatomical sketches from his hand we have the first accurate representation of the structure of the body. Glance at the three figures of the spine which I have had photographed side by side, one from Leonardo, one from Vesalius and the other from Vandyke Carter, who did the drawings in Gray's "Anatomy" (1st ed., 1856). They are all of the same type, scientific, anatomical drawings, and that of Leonardo was done fifty years before Vesalius! Compare, too, this figure of the bones of the foot with a similar one from Vesalius.(24) Insatiate in experiment, intellectually as greedy as Aristotle, painter, poet, sculptor, engineer, architect, mathematician, chemist, botanist, aeronaut, musician and withal a dreamer and mystic, full accomplishment in any one department was not for him! A passionate desire for a mastery of nature's secrets made him a fierce thing, replete with too much rage! But for us a record remains—Leonardo was the first of modern anatomists, and fifty years later, into the breach he made, Vesalius entered.(25)
(*) This plate was lacking among the author's illustrations, butthe Keeper of the Ashmolean Museum remembers his repeatedlyshowing special interest in the sketch reproduced in JohnAddington Symonds's Life of Michelangelo, London, 1893, Vol. I,p. 44, and in Charles Singer's Studies in the History and Methodof Science, Oxford, 1917, Vol. I, p. 97, representing MichaelAngelo and a friend dissecting the body of a man, by the light ofa candle fixed in the body itself.—Ed.(24) He was the first to make and represent anatomical crosssections. See Leonardo: Quaderni d'Anatomia, Jacob Dybwad,Kristiania, 1911-1916, Vol. V.(25) See Knox: Great Artists and Great Anatomists, London, 1862,and Mathias Duval in Les Manuserits de Leonard de Vince: Del'Anatomie, Feuillets A, Edouard Rouveyre, Paris, 1898. For agood account of Leonardo da Vinci see Merejkovsky's novel, TheForerunner, London, 1902, also New York, Putnam.
LET us return to Padua about the year 1600. Vesalius, who made the school the most famous anatomical centre in Europe, was succeeded by Fallopius, one of the best-known names in anatomy, at whose death an unsuccessful attempt was made to get Vesalius back. He was succeeded in 1565 by a remarkable man, Fabricius (who usually bears the added name of Aquapendente, from the town of his birth), a worthy follower of Vesalius. In 1594, in the thirtieth year of his professoriate, he built at his own expense a new anatomical amphitheatre, which still exists in the university buildings. It is a small, high-pitched room with six standing-rows for auditors rising abruptly one above the other. The arena is not much more than large enough for the dissecting table which, by a lift, could be brought up from a preparing room below. The study of anatomy at Padua must have declined since the days of Vesalius if this tiny amphitheatre held all its students; none the less, it is probably the oldest existing anatomical lecture room, and for us it has a very special significance.
Early in his anatomical studies Fabricius had demonstrated the valves in the veins. I show you here two figures, the first, as far as I know, in which these structures are depicted. It does not concern us who first discovered them; they had doubtless been seen before, but Fabricius first recognized them as general structures in the venous system, and he called them little doors—"ostiola."
The quadrangle of the university building at Padua is surrounded by beautiful arcades, the walls and ceilings of which are everywhere covered with the stemmata, or shields, of former students, many of them brilliantly painted. Standing in the arcade on the side of the "quad" opposite the entrance, if one looks on the ceiling immediately above the capital of the second column to the left there is seen the stemma which appears as tailpiece to this chapter, put up by a young Englishman, William Harvey, who had been a student at Padua for four years. He belonged to the "Natio Anglica," of which he was Conciliarius, and took his degree in 1602. Doubtless he had repeatedly seen Fabricius demonstrate the valves of the veins, and he may indeed, as a senior student, have helped in making the very dissections from which the drawings were taken for Fabricius' work, "De Venarum Osteolis," 1603. If one may judge from the character of the teacher's work the sort of instruction the student receives, Harvey must have had splendid training in anatomy. While he was at Padua, the great work of Fabricius, "De Visione, Voce et Auditu" (1600) was published, then the "Tractatus de Oculo Visusque Organo" (1601), and in the last year of his residence Fabricius must have been busy with his studies on the valves of the veins and with his embryology, which appeared in 1604. Late in life, Harvey told Boyle that it was the position of the valves of the veins that induced him to think of a circulation.
Harvey returned to England trained by the best anatomist of his day. In London, he became attached to the College of Physicans, and taking his degree at Cambridge, he began the practice of medicine. He was elected a fellow of the college in 1607 and physician to St. Bartholomew's Hospital in 1609. In 1615 he was appointed Lumleian lecturer to the College of Physicians, and his duties were to hold certain "public anatomies," as they were called, or lectures. We know little or nothing of what Harvey had been doing other than his routine work in the care of the patients at St. Bartholomew's. It was not until April, 1616, that his lectures began. Chance has preserved to us the notes of this first course; the MS. is now in the British Museum and was published in facsimile by the college in 1886.(26)
(26) William Harvey: Prelectiones Anatomiae Universalis, London,J. & A. Churchill, 1886.
The second day lecture, April 17, was concerned with a description of the organs of the thorax, and after a discussion on the structure and action of the heart come the lines:
W. H. constat per fabricam cordis sanguinemper pulmones in Aortam perpetuotransferri, as by two clacks of awater bellows to rayse waterconstat per ligaturam transitum sanguinisab arteriis ad venasunde perpetuum sanguinis motumin circulo fieri pulsu cordis.
The illustration will give one an idea of the extraordinarily crabbed hand in which the notes are written, but it is worth while to see the original, for here is the first occasion upon which is laid down in clear and unequivocal words that the blood CIRCULATES. The lecture gave evidence of a skilled anatomist, well versed in the literature from Aristotle to Fabricius. In the MS. of the thorax, or, as he calls it, the "parlour" lecture, there are about a hundred references to some twenty authors. The remarkable thing is that although those lectures were repeated year by year, we have no evidence that they made any impression upon Harvey's contemporaries, so far, at least, as to excite discussions that led to publication. It was not until twelve years later, 1628, that Harvey published in Frankfurt a small quarto volume of seventy-four pages,(27) "De Motu Cordis." In comparison with the sumptuous "Fabrica" of Vesalius this is a trifling booklet; but if not its equal in bulk or typographical beauty (it is in fact very poorly printed), it is its counterpart in physiology, and did for that science what Vesalius had done for anatomy, though not in the same way. The experimental spirit was abroad in the land, and as a student at Padua, Harvey must have had many opportunities of learning the technique of vivisection; but no one before his day had attempted an elaborate piece of experimental work deliberately planned to solve a problem relating to the most important single function of the body. Herein lies the special merit of his work, from every page of which there breathes the modern spirit. To him, as to Vesalius before him, the current views of the movements of the blood were unsatisfactory, more particularly the movements of the heart and arteries, which were regarded as an active expansion by which they were filled with blood, like bellows with air. The question of the transmission of blood through the thick septum and the transference of air and blood from the lungs to the heart were secrets which he was desirous of searching out by means of experiment.
(27) Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinisin Animalibus, Francofurti, 1628.
One or two special points in the work may be referred to as illustrating his method. He undertook first the movements of the heart, a task so truly arduous and so full of difficulties that he was almost tempted to think with Fracastorius that "the movement of the heart was only to be comprehended by God." But after many difficulties he made the following statements: first, that the heart is erected and raises itself up into an apex, and at this time strikes against the breast and the pulse is felt externally; secondly, that it is contracted every-way, but more so at the sides; and thirdly, that grasped in the hand it was felt to become harder at the time of its motion; from all of which actions Harvey drew the very natural conclusion that the activity of the heart consisted in a contraction of its fibres by which it expelled the blood from the ventricles. These were the first four fundamental facts which really opened the way for the discovery of the circulation, as it did away with the belief that the heart in its motion attracts blood into the ventricles, stating on the contrary that by its contraction it expelled the blood and only received it during its period of repose or relaxation. Then he proceeded to study the action of the arteries and showed that their period of diastole, or expansion, corresponded with the systole, or contraction, of the heart, and that the arterial pulse follows the force, frequency and rhythm of the ventricle and is, in fact, dependent upon it. Here was another new fact: that the pulsation in the arteries was nothing else than the impulse of the blood within them. Chapter IV, in which he describes the movements of the auricles and ventricles, is a model of accurate description, to which little has since been added. It is interesting to note that he mentions what is probably auricular fibrillation. He says: "After the heart had ceased pulsating an undulation or palpitation remained in the blood itself which was contained in the right auricle, this being observed so long as it was imbued with heat and spirit." He recognized too the importance of the auricles as the first to move and the last to die. The accuracy and vividness of Harvey's description of the motion of the heart have been appreciated by generations of physiologists. Having grasped this first essential fact, that the heart was an organ for the propulsion of blood, he takes up in Chapters VI and VII the question of the conveyance of the blood from the right side of the heart to the left. Galen had already insisted that some blood passed from the right ventricle to the lungs—enough for their nutrition; but Harvey points out, with Colombo, that from the arrangement of the valves there could be no other view than that with each impulse of the heart blood passes from the right ventricle to the lungs and so to the left side of the heart. How it passed through the lungs was a problem: probably by a continuous transudation. In Chapters VIII and IX he deals with the amount of blood passing through the heart from the veins to the arteries. Let me quote here what he says, as it is of cardinal import:
"But what remains to be said upon the quantity and source of the blood which thus passes, is of a character so novel and unheard of that I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies, so much doth wont and custom become a second nature. Doctrine once sown strikes deeply its root, and respect for antiquity influences all men. Still the die is cast, and my trust is in my love of truth, and the candour of cultivated minds."(28) Then he goes on to say:
(28) William Harvey: Exercitatio Anatomica de Motu Cordis etSanguinis in Animalibus, Francofurti, 1628, G. Moreton'sfacsimile reprint and translation, Canterbury, 1894, p. 48.
"I began to think whether there might not be A MOVEMENT, AS IT WERE, IN A CIRCLE. Now this I afterwards found to be true; and I finally saw that the blood, forced by the action of the left ventricle into the arteries, was distributed to the body at large, and its several parts, in the same manner as it is sent through the lungs, impelled by the right ventricle into the pulmonary artery, and that it then passed through the veins and along the vena cava, and so round to the left ventricle in the manner already indicated."(29)
(29) Ibid. p. 49.
The experiments dealing with the transmission of blood in the veins are very accurate, and he uses the old experiment that Fabricius had employed to show the valves, to demonstrate that the blood in the veins flows towards the heart. For the first time a proper explanation of the action of the valves is given. Harvey had no appreciation of how the arteries and veins communicated with each other. Galen, you may remember, recognized that there were anastomoses, but Harvey preferred the idea of filtration.
The "De Motu Cordis" constitutes a unique piece of work in the history of medicine. Nothing of the same type had appeared before. It is a thoroughly sensible, scientific study of a definite problem, the solution of which was arrived at through the combination of accurate observation and ingenious experiment. Much misunderstanding has arisen in connection with Harvey's discovery of the circulation of the blood. He did not discover that the blood moved,—that was known to Aristotle and to Galen, from both of whom I have given quotations which indicate clearly that they knew of its movement,—but at the time of Harvey not a single anatomist had escaped from the domination of Galen's views. Both Servetus and Colombo knew of the pulmonary circulation, which was described by the former in very accurate terms. Cesalpinus, a great name in anatomy and botany, for whom is claimed the discovery of the circulation, only expressed the accepted doctrines in the following oft-quoted phrase:
"We will now consider how the attraction of aliment and the process of nutrition takes place in plants; for in animals we see the aliment brought through the veins to the heart, as to a laboratory of innate heat, and, after receiving there its final perfection, distributed through the arteries to the body at large, by the agency of the spirits produced from this same aliment in the heart."(30) There is nothing in this but Galen's view, and Cesalpinus believed, as did all his contemporaries, that the blood was distributed through the body by the vena cava and its branches for the nourishment of all its parts.(*) To those who have any doubts as to Harvey's position in this matter I would recommend the reading of the "De Motu Cordis" itself, then the various passages relating to the circulation from Aristotle to Vesalius. Many of these can be found in the admirable works of Dalton, Flourens, Richet and Curtis.(31) In my Harveian Oration for 1906(32) I have dealt specially with the reception of the new views, and have shown how long it was before the reverence for Galen allowed of their acceptance. The University of Paris opposed the circulation of the blood for more than half a century after the appearance of the "De Motu Cordis."
(30) De Plantis, Lib I, cap. 2.(*) Cesalpinus has also a definite statement of the circlewiseprocess.—Ed.(31) J. C. Dalton Doctrines of the Circulation, Philadelphia,1884; Flourens Histoire de la decouverte de la circulation dusang, 2d ed., Paris, 1857; Charles Richet Harvey, la circulationdu sang, Paris, 1879; John G. Curtis Harvey's views on the use ofCirculation, etc., New York, 1916.(32) Osler An Alabama Student and Other Biographical Essays,Oxford, 1908, p. 295.
To summarize—until the seventeenth century there were believed to be two closed systems in the circulation, (1) the natural, containing venous blood, had its origin in the liver from which, as from a fountain, the blood continually ebbed and flowed for the nourishment of the body; (2) the vital, containing another blood and the spirits, ebbed and flowed from the heart, distributing heat and life to all parts. Like a bellows the lungs fanned and cooled this vital blood. Here and there we find glimmering conceptions of a communication between these systems, but practically all teachers believed that the only one of importance was through small pores in the wall separating the two sides of the heart. Observation—merely looking at and thinking about things—had done all that was possible, and further progress had to await the introduction of a new method, viz., experiment. Galen, it is true, had used this means to show that the arteries of the body contained blood and not air. The day had come when men were no longer content with accurate description and with finely spun theories and dreams. It was reserved for the immortal Harvey to put into practice the experimental method by which he demonstrated conclusively that the blood moved in a circle. The "De Motu Cordis" marks the final break of the modern spirit with the old traditions. It took long for men to realize the value of this "inventum mirabile" used so effectively by the Alexandrians—by Galen—indeed, its full value has only been appreciated within the past century. Let me quote a paragraph from my Harveian Oration.(33) "To the age of the hearer, in which men had heard and heard only, had succeeded the age of the eye in which men had seen and had been content only to see. But at last came the age of the hand—the thinking, devising, planning hand, the hand as an instrument of the mind, now re-introduced into the world in a modest little monograph from which we may date the beginning of experimental medicine."