The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter
condemned for heresy on entering Calvin’s Geneva, and burnt at the stake.
It was in The Restoration of Christianity that Servetus announced the pulmonary transit of the blood, within the framework of an heretical account of how the Holy Spirit entered man. The Bible taught that the blood was the seat of the soul and that the soul was breathed into man by God: there had therefore to be a contact point between air and blood. This led Servetus to denounce Galen’s whole scheme. Blood did not go through the septum; he proposed instead a path from the right to the left heart through the lungs. Blood was mixed with air (that is, spirit) in the lungs, rather than in the left ventricle. Confirmation lay in the size of the pulmonary artery – its design was too large to transmit blood for the lungs alone. Servetus’s views had no influence on the development of anatomy, not least because almost all copies of his book were burnt with their author.
Renaissance dissections increased knowledge of the structure of man and other animals. But while precipitating an anti-Galen reaction, Vesalian anatomy followed his precepts: without Galen no Fabrica. Humanist anatomy was conservative in theory. No anatomist opposed the traditional Galenic tripartite division of physiologic function (venous, centered on the liver; arterial, centered on the heart; and sensory/motor, centered on the brain), even when anatomical structures and vascular connections crucial to the scheme were being discredited (for instance, the rete mirabile). For all their radical rhetoric, Vesalius’s generation shored up ancient medicine and philosophy even as they exposed its factual errors. All the same, Renaissance anatomists enormously elevated the standing of their subject. Its status had been low; it was not listed among the ancient major divisions of medicine, and was stigmatized by its surgical connexions; but the appointment of the physician Vesalius at Padua served notice that anatomy and surgery were to be incorporated into the wider humanist medical movement. The Fabrica’s preface argued for the unity of the different medical arts; physicians should not disdain to use their hands, an adage equally dear to contemporary experimental natural philosophers.
Anatomy became integrated into learned medicine – even in backward England, thanks to John Caius (1510–73). Caius was a Galenist physician and protégé of Thomas Linacre, who had been largely responsible for the founding of the College of Physicians in 1518, and for the medical lectureships at Oxford and Cambridge.
Educated at Gonville Hall in Cambridge, from 1539 Caius studied at Padua, teaching Greek and collecting manuscripts, particularly those of Galen, whom he idolized. On his return, he settled in the capital, being admitted Fellow of the College of Physicians in 1547. In his nine terms as president, Caius attempted to mould the college along continental lines, regulating medicine according to the best Galenic standards. He reorganized its statutes, and introduced formal anatomies into its lectures, also demonstrating anatomy before the Barber-Surgeons Company. In Cambridge he refounded his old hall in 1557 as Gonville and Caius College, serving as its master from 1559 and fostering a strong medical tradition, from which William Harvey (1578–1657) was to benefit. Through enthusiasts like Caius and his equivalent in Leiden, Pieter Pauw (1564–1617), anatomy became incorporated throughout Europe into the humanist revival.
Anatomists presented their subject as the cutting edge; the way to certain knowledge was through the senses, especially by ‘autopsia’, seeing for oneself. Though the Paduan Aristotelian philosopher Cesare Cremonini (1552–1631) was still insisting in 1627 that anatomy could never be the foundation of medicine (only causes, the domain of philosophy, and not observation could lead to certainty), the sheer success of anatomy swept this dogma aside. Dissections became public events: at Bologna they were staged during the annual carnival, the macabre fascination of the memento mori, juxtaposing life and death, contributing to the appeal. Rembrandt’s ‘The Anatomy Lesson of Dr Nicolaes Tulp’ (1632), shows that anatomy had become one of the spectacles and symbols of the age. Not only the method of medicine, anatomy became accepted as a window onto the human condition.
SURGERY
Surgery saw fewer significant changes, and still played second fiddle to physic, being relatively unaffected by the new anatomy. Restricted largely to the body’s surface, surgeons dealt with the many accidents of life. They set fractures, treated burns, contusions, knife wounds and the increasingly common gunshot wounds, tumours and swellings, ulcers and various skin diseases; syphilis was usually handled as a surgical condition. Surgery was seen as a skilled craft: ‘A chirurgien should have three divers properties in his person,’ judged John Halle (1529–68), ‘that is to say, a heart as the heart of a lion, his eye like the eyes of an hawk, and his hands as the hands of a woman.’
Through most of Europe, surgery continued to be taught by apprenticeship and organized in guilds. In London a master surgeons’ guild had been founded in 1368; the Mystery or Guild of the Barbers of London received its charter from Edward IV in 1462; and in 1540, by Act of Parliament, the Guild of Surgeons merged with the Barbers to form the Barber-Surgeons Company, its first master being Thomas Vicary (c. 1490–1561); Holbein painted Henry VIII chartering the company, which continued until 1745. An active member was William Clowes (1544–1603), who worked as a naval surgeon before setting up in practice in London and being appointed surgeon at St Bartholomew’s Hospital in 1575. Military operations in the Low Countries (1586) gave him ample experience, and in 1588 he was appointed surgeon to the fleet. Clowes’s treatises on wounds, venereal disease and scrofula were written in racy vernacular, with young surgeons in mind, presenting personal case histories.
Clowes was one of a line of able common-or-garden surgeons: John Woodall’s (1556–1643) The Surgeon’s Mate (1617) served as a manual of naval surgery, attacking the bad habits of ‘blaspheming the name of the Almighty’ and the ‘dedication to the pot and Tobacco-pipe’ which were all too common among apprentices; Richard Wiseman (1621–76) was honoured as the ‘father of English surgery’. His Several Chirurgical Treatises (1676) dwelt on military and naval problems, while his Treatise of Wounds (16 j 2), jocularly known as Wiseman’s Book of Martyrs, advertised itself as specially for ships’ doctors ‘who seldom burden their cabin with many books’. He picked up much of his experience during the English Civil War, and his account of military surgery reveals its horrors: cannonballs and gunshot caused horrifying wounds, and amputation and trepanation were often the only remedies, conducted on the battlefield or on a storm-tossed vessel.
Fabricius left a graphic description of a sixteenth-century amputation:
I was about to cut off the thigh of a man of forty yeares of age, and ready to use the saw, and Cauteries. For the sick man no sooner began to roare out, but all ranne away, except only my eldest Sonne, who was then but little, and to whom I had committed the holding of his thigh, for forme only; and but that my wife then great with child, came running out of the next chamber, and clapt hold of the Patient’s Thorax, both he and myselfe had been in extreme danger.
This may not have been an uncommon scene before anaesthesia was available.
‘He who wishes to be a surgeon should go to war,’ Hippocrates had advised, and the battlefield became accepted as the school of surgery. Growing use of gunpowder had worsened the injuries confronting field-surgeons, because cannonballs and lead shot destroyed far more tissue than arrows or swords and left gaping wounds prone to infection. Many of the most popular vernacular handbooks, such as the Buch der Wund-Artzney (1497) [Book of Wound Dressing] of Hieronymus Brunschwig (1450–1533) and the Feldbuch der Wundartzney (1517) [Fieldbook of Wound Dressing] of Hans von Gersdorff (c. 1455–1529), were based on field experience. Brunschwig’s work contains the earliest printed illustrations of surgical instruments, and endorsed the view that shot wounds were poisoned by gunpowder and so required cautery. Gersdorff explained how to extract bullets with special instruments and dress wounds with hot oil. Amputated stumps were to be enclosed in an animal bladder, after controlling haemorrhage by pressure and styptics. Thomas Gale (1507–87) published An Excellent Treatise of Wounds made with Gonneshot (1563) – the first English work on the subject.
The most acclaimed Renaissance surgeon, Ambroise Paré (1510–90), also learned his craft through war. In 1533 he served as aide-chirurgien to the chief Paris hospital, the Hôtel Dieu; and from