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Home , Andreas Vesalius, Erasistratus, Galen, History of medicine

Singapore Med J 2003 Vol 44(5) : 229-230 In Stamps

Medicine in Stamps (1514-1564): Father of Modern S Y Tan, MD, JD and M E Yeow, BM, BCh* Professor of Medicine Adjunct Professor of Law, of Hawaii

* Dr Yeow is a medical graduate from Oxford, and an incoming resident.

or some 1500 years, ’s teachings ancient centre for anatomical studies. Indeed, Galen dominated the practice of medicine. He himself had travelled there in the 2nd Century A.D., F bequeathed the of clinical experimentation, although by that time, human was but his grip inhibited open discourse for a surprisingly forbidden, and only human skeletal remains were long time. Even as Galen correctly emphasised anatomy available for study. as the foundation of human , he drew many The Legacy of Vesalius: Andreas Vesalius was incorrect conclusions by extrapolating findings from born on the last day of 1514 into a Belgian family of dissecting animals rather than human cadavers. In . At the age of fifteen, he entered the the 16th century, courageous minds of the University of Louvain and at eighteen, studied openly challenged and finally supplanted Galenic medicine first at the University of and then at thoughts. Foremost among these was , the in Italy. At age twenty-three, he was appointed irrepressible Swiss who publicly burnt professor of and anatomy in Padua. As a Galen’s books, and Ambroise Paré, the gentle youth, Vesalius often carried out on small of France, who replaced old cruel methods with animals that he caught. The family lived near a wooded improved care of surgical . But to Vesalius, stretch of land known as Gallows Hill, where criminals the brilliant Belgian anatomist, goes the credit for were executed. Their bodies were left out in decisively liberating medicine from the the open, and Vesalius no doubt had errors of Galenic dogma. ample opportunity to become accustomed Anatomy Through the Years: Anatomy to human remains. At the University, is an ancient science. A picture of an anatomy was taught by a professor sitting elephant, with an outline of a within in his chair, intoning Galen’s text in , it, can be found in a prehistoric cave while a barber surgeon did the actual in Spain. However, the physicians of dissection, and a demonstrator pointed antiquity, including and his out the body parts to the bored students. followers, cured without understanding One of Vesalius’ professors was Jacques anatomy, and linked disease to patient Dubois, who would read the Galenic text as type, not organ dysfunction. Two ancient the dissector and demonstrator proceeded Greek physicians, Herophilus (4th Century B.C.) and with the dissection. However, the text did not always (3rd Century B.C.), stood out for their correspond to what the watchful young student special interest in anatomy. Both worked in , observed. For example, Galen’s book described the where limited human were allowed jawbone as being composed of two parts, whereas for a time. Herophilus came from the Hippocratic Vesalius observed that the human jawbone had only School, and described the anatomy of the eye, nervous one section. The professor in the meantime had not system, digestive tract and genitalia. Erasistratus, a bothered to match physical evidence with text, and follower of the competing Cnidian School, described had simply assumed that Galen could not be wrong. the structure of the heart, and . Importantly, Unimpressed by his formal training, Vesalius he recognised that symptoms of diseases could be continued to expand his anatomical knowledge by linked to specific organs. The influence of these carrying out dissections on executed criminals. It was this two physicians gave Alexandria the reputation as the careful dissection of human cadavers that set Vesalius apart 230 : 2003 Vol 44(5) Singapore Med J

from all who preceded him. In addition to his surgical schools of thoughts and ancient traditions in the search skills, he was an inspiring lecturer and demonstrator. for truth. One of his peers was , who He would step down from the high chair and personally did more than paint the Mona Lisa and the Last Supper. performed the dissections with such dexterity and Leonardo himself studied the human form as an skill that students were soon flocking to see the new anatomist, and made hundreds of drawings of both its professor at work. Within four months of his appointment external and internal parts. Another was Copernicus, in Padua, in collaboration with a young artist, Jan Stephen who startled the world by announcing that the church van Calcar, he published the Tabulae Anatomicae Sex, erred in holding that the earth was the centre of the a series of six beautiful and detailed anatomical plates universe. In fact, it revolved around the sun. of the and vascular system. But even the Renaissance was unforgiving of one Vesalius dissected to confirm the teachings of who contradicted the demigod that was Galen. Although Galen. He tried to reconcile discrepancies between Vesalius had some support from contemporaries such his own findings and what was written in Galen’s as and Realdo Columbo, many others texts. But he found himself increasingly at odds with assailed his findings. In Bologna, Matteo Corti, a devout Galen, whose conclusions were based on animal Galenist, openly challenged Vesalius on the value of dissections. Initially deferential to historic Greek his dissections. Following the publication of Fabrica, teachings, Vesalius grew steadily more confident of many more denounced Vesalius as a heretic. The most his own observations. He identified over two hundred hurtful criticism came from an unlikely source – his Galenic errors, including the illusion of the rete former Parisian teacher, Professor Sylvius – whose attack mirabile, a non-existent coil of blood vessels at the culminated in the book, “A Refutation of the Slanders base of the brain, so essential to Galen’s misplaced of a Madman Against the Writings of Hippocrates theory of “psychic .” and Galen.” Vesalius grew impatient and discouraged Finally declaring that Galen was “deceived by by the opposition, and eventually burnt his notes and his monkeys,” Vesalius, at the age of twenty-nine, manuscripts. He then resigned from his academic offered to the world his seven-volume magnus , post in Padua and became the personal physician to entitled De Humani Corporis Fabrica. Published in King Charles V, and later to King Philip II of Spain. But 1543, it was instantly recognised as an artistic and his days as a clinician were far from rosy, as most of scientific masterpiece. Vesalius believed that the the court physicians jealously opposed him. only true text was the , and so he In 1562, Vesalius left on a pilgrimage to , called it “the book of the human body that cannot lie.” after apparently performing a premature on a Fabrica features 663 folio pages and 300 accurate woman with a beating heart. It was a voyage of no return. and exquisite illustrations of the human anatomy. It is Two years later in 1564, his colleagues at Padua the first and only book of its kind, an awe-inspiring beckoned him back to academe, but a furious storm treasure of medical knowledge preserving the overcame his ship and many on board perished. The numerous dissections carried out by Vesalius. great anatomist survived the ordeal, only to be The very frontpiece of this work celebrates the author’s overpowered by illness on shore, where he died in a “vile new way of teaching. It shows Vesalius himself and impoverished inn in a solitary place, without any carrying out the dissection of a female cadaver as human assistance.” At the tender age of 50, one of he simultaneously assumes all three roles of teacher, mankind’s brightest stars had faded unceremoniously surgeon, and demonstrator. into the annals of . We do not know where Through six short years of intense careful he is buried. What we have is his priceless book and the anatomical observations, this extraordinary physician fitting epitaph of Fabrica’s mourning skeletal figure: of had restored the scientific quest for truth. “Genius lives on, all else is mortal.” From now on, medical progress will be firmly rooted in precise and verifiable anatomical sites. Anatomy REFERENCES will form the scientific basis for the subsequent Materials for this essay were excerpted or adapted contributions in , histology and pathology from the following sources: Arturo Castiglioni, from the likes of Magendie, Malpighi, and Virchow. A , 1941; Sherwin B. Nuland, And without knowing it, Vesalius had single- Doctors: The Biography of Medicine, 2nd edition, 1988; handedly discovered the missing piece, the sine qua I. Robinson and S. Nisenson, Giants of Medicine, 1962; non, for the eventual scientific practice of surgery. J. B. de C. M. Saunders and Charles D. O’Malley, The Rejection! Vesalius’ was the era of the Renaissance, Illustrations from the Works of Andreas Vesalius of a time of great turmoil and upheaval in the arts and Brussels, 1950; Henry E Sigerist on the History of , when scholars challenged and rejected old Medicine, edited by Felix Marti-Ibanez, 1960.