The Reformation
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In a tempest of disappointment at the attitude of these men, Vesalius burned a huge volume of Annotationes, and a paraphrase of the ten books of al-Razi’s Kitab al-Mansuri—an encyclopedia of medicine.62 In 1544 he left Italy to become second physician on the staff of Charles V, to whom he had judiciously dedicated the Fabrica. In the same year his father died, leaving him a considerable fortune. He married, and built a handsome home in Brussels. A second edition of the Fabrica was issued in 1555, with augmented and corrected text. It showed that artificial respiration could keep an animal alive despite incision of its chest, and that a stopped heart could sometimes be revived by bellows. Thereafter Vesalius made no contribution to anatomy. He absorbed himself in caring for his Imperial and lesser patients, and in the practice and study of surgery. When Charles abdicated, Vesalius became second physician to Philip II. In July 1559, the King sent him to aid Ambroise Paré in an attempt to save the wounded Henry II; Vesalius applied clinical tests that showed no possibility of recovery. Later in that year he and his family accompanied Philip to Spain.
Meanwhile others advanced anatomy. Giambattista Cano noted the venous valves (1547); Servetus explained the pulmonary circulation of the blood (1553); Realdo Colombo made the same discovery (1558), and proved it by experiment on the living heart; but another seventy years passed before Harvey’s epochal description of the course of the blood from heart to lungs to heart to arteries to veins to heart. The Arab physician Ibn al-Nafis had anticipated Servetus in 1285,63 and the tradition of his doctrine may have carried down into the Spain of Servetus’s youth.
Vesalius had some adventures left to him. The native physicians at the Spanish court made it a point of honor to disregard his diagnoses. When Don Carlos, Philip’s only son, suffered concussion of the brain from a fall (1562), Vesalius recommended trepanning. The advice was rejected, and the youth neared death. Relics and charms were applied to the wound, and pious people flogged themselves to persuade heaven to effect some miraculous cure; to no avail. Finally Vesalius insisted on opening the skull; it was done, and a large quantity of pus was drawn off. The Prince soon improved, and eight days after the operation Philip II attended a solemn procession of thanksgiving to God.64
Two years later Vesalius left Spain, for reasons still in dispute. Ambroise Paré told of an anatomist who brought most of Spain down upon his head by opening the body of a woman supposedly dead from “strangulation of the uterus”; at a further stroke of the surgeon’s knife, said Paré, the woman came suddenly back to life, “which struck such admiration and horror into the hearts of all her friends... that they accounted the physician—before of good fame and report—as infamous and detestable”;65 relatives do not always appreciate such unexpected recoveries. “Therefore,” continued the Huguenot surgeon, “he thought there was no better way for him, if he would live safe, than to forsake the country.” Hubert Languet, another Huguenot, told a similar story (c. 1579), named the physician as Vesalius, and claimed that Vesalius, by dissecting a living person, had become liable to the Inquisition, which he escaped by promising to make a penitential pilgrimage to Palestine. No contemporary source mentions the incident, and Catholic historians reject it as a fable.66 Perhaps Vesalius was just tired of Spain.
He returned to Italy, sailed from Venice (April 1564), and apparently reached Jerusalem. On the way back he suffered shipwreck, and died of exposure, far from any friend, on the island of Zante off the west coast of Greece (October 15,1564). He was fifty years old. In that same year Michelangelo died and Shakespeare was born. The splendor that had shone for a century in Italy was passing to the north.
VI. THE RISE OF SURGERY
Despite the advances of anatomy, the science and art of medicine were still in leading strings to Greek and Arabic authorities. The evidence of the senses hardly availed against the word of Galen or Avicenna; even Vesalius, when his dissections disproved Galen, said, “I could hardly believe my eyes.” Editions or translations of Galen or Hippocrates, while spreading old knowledge, discouraged new experiments—very much as the efforts of Petrarch and Ronsard to write Virgilian epics diverted and injured their natural genius. When Linacre founded what was later named the Royal College of Physicians (1518), its principal texts were his translations of Galen.
Therapy benefited from new drugs brought to Europe—cinchona, ipecacuanha, and rhubarb from America, ginger and benzoin from Sumatra, cloves from the Moluccas, aloes from Cochin China, camphor and cinnabar from China; and the development widened the use of native plants. Valerius Cordus compiled the first German pharmacopoeia (1546). The treatment of syphilis with infusions of guaiac wood from the West Indies was so popular that the Fuggers made another fortune by securing from their debtor, Jharles V, a monopoly on its sale in his realms.
The poverty and uncleanliness of the masses kept diseases always ahead of cures. Open heaps of refuse or dung poisoned the air, and sometimes littered the streets. Paris had a system of sewers, which Henry II proposed to empty into the Seine; the municipal authorities dissuaded him by explaining that the river was the sole drinking water that half the people had.67 Sewer commissions were set up in England in 1532, but as late as 1844 there were only two English towns where refuse was removed at public expense from the slums.
Epidemics were less virulent than in the Middle Ages, but they sufficed—along with high puerperal and infantile mortality, to keep the population almost stationary. Plagues swept through Germany and France repeatedly between 1500 and 1568. Typhus fever spread in England in 1422, 1577, and 1586, through the migrations of lice. The “sweating sickness”—probably a form of influenza—ravaged England in 1528, 1529, 1551, 1578; Germany in 1543-45; France in 1550-51; Hamburg and Aachen, we are told, each lost a thousand souls to it within a few days.68 Influenza was ascribed to celestial influences—hence its name. The bubonic plague reappeared in Germany in 1562, taking 9,000 of the 40,000 inhabitants of Nuremberg69—though we may suspect all plague statistics as exaggerations. Brighter sides of the picture are the fading out of leprosy and such mental disorders as St. Vitus’s Dance.
Medical practice progressed more slowly than medical knowledge. Quacks still abounded; despite some restrictive laws it was easy to practice medicine without a degree. Most babies were eased into the world by midwives. Specialism had hardly begun. Dentistry was not separated from medicine or surgery; barber surgeons extracted teeth, and replaced them with ivory substitutes. Nearly all physicians—Vesalius was one of the exceptions—left surgery to barber surgeons, who, however, must not be thought of as barbers; many of them were men of training and skill.
Ambroise Paré began as a barber’s apprentice, and rose to be surgeon to kings. Born (1517) at Bourg-Hersent in Maine, he made his way to Paris, and set up his barber’s stall in the Place St.-Michel. During the war of 1536 he served as a regimental surgeon. In treating soldiers he accepted the prevailing theory that gunshot wounds were poisonous, and (like Vesalius) he followed the current practice of cauterizing them with boiling elder oil, which turned pain into agony. One night the oil ran out, and for lack of it Paré dressed the wounds with a salve of egg yolk, attar of roses, and turpentine. On the morrow he wrote:
Last night I could hardly sleep for continually thinking about the wounded men whose hurts I had not been able to cauterize. I expected to find them all dead the next morning. With this in view I rose early to visit them. Greatly to my surprise, I found that those whom I had treated with the salve had very little pain in their wounds, no inflammation .... and had passed a comfortable night. The others, whose wounds had been treated with boiling elder oil, were in high fever, while their wounds were inflamed .... and acutely painful. I determined, therefore, that I would no longer cauterize the unfortunate in so cruel a manner.70
Paré had little education, and it was not till 1545 that he published his little manual, now a medical classic, on the treatment of wounds (Méthode de traicter les plaies). In the war of 1552 he proved that ligature of the artery was preferable to cauter
ization to check bleeding in amputations. Captured by the enemy, he earned his release by successful operations. On returning to Paris he was appointed head surgeon at the Collège St.-Côme, to the horror of the Sorbonne, where a professor innocent of Latin seemed a biological monstrosity. Nevertheless he became surgeon to Henry II, then to Francis II, then to Charles IX; and though a professed Huguenot, he was spared by royal order in the Massacre of St. Bartholomew. His Deux livres de chirurgie (1573) added little to the theory, much to the practice, of surgery. He invented new instruments, introduced artificial limbs, popularized the use of the truss in hernia, improved podalic version in childbirth, made the first exarticulation of the elbow joint, described monoxide poisoning, and indicated flies as carriers of disease. Famous in the annals of medicine is his demurrer to congratulations on his success in a difficult case: Je le pansay, Dieu le guarit—“! treated him, God cured him.” He died in 1590, age seventy-three. He had considerably improved the status and competence of surgeons, and had given France, in surgery, that lead which it was to retain for several centuries.
VII. PARACELSUS AND THE DOCTORS
In every generation men arise who, resenting the cautious conservatism of the medical profession, lay claim to remarkable cures by heterodox means, denounce the profession as cruelly laggard, perform wonders for a time, and then lose themselves in a mist of desperate extravagance and isolation. It is good that such gadflies should appear now and then to keep medical thought on its toes, and good that medicine should check hasty innovations in dealing with human life. Here, as in politics and philosophy, radical youth and conservative age unwillingly co-operate in that balance of variation and heredity which is nature’s technique of development.
Philippus Theophrastus Bombastus von Hohenheim called himself Aureolus as signifying the carat of his brilliance, and Paracelsus probably as a Latinization of Hohenheim.71 His father, Wilhelm Bombast von Hohenheim, was the illegitimate son of a hot-tempered Swabian noble. Left to shift for himself, Wilhelm practiced medicine among poor villagers near Einsiedeln in Switzerland, and married Elsa Ochsner, an innkeeper’s daughter and nurse’s aid, who soon afterward developed a manic-depressive condition. This ambivalent ancestry may have inclined Philip to instability, and to a resentful sense of capacities inadequately nurtured by his environment. Born in 1493, he grew up amid his father’s patients, and perhaps in undue familiarity with inns, whose unbuttoned life remained always to his taste. A dubious story alleges that the boy was emasculated by a wild boar or by drunken soldiers. No woman is known to have figured in his adult life. When he was nine his mother drowned herself. Probably for that reason father and son moved to Villach in Tirol. There, says tradition, Wilhelm taught in a school of mines and dabbled in alchemy. Certainly there were mines near by, and a smelter; and it is likely that Philip learned there some of the chemistry with which he was to revolutionize therapy.
At the age of fourteen he went off to study at Heidelberg. The restlessness of his nature showed now in his quick passage from one university to another—Freiburg, Ingolstadt, Cologne, Tübingen, Vienna, Erfurt, finally (1513-15) Ferrara—though such scholastic peregrination was frequent in the Middle Ages. In 1515, without having won a degree, Philip—now Paracelsus—took service as a barber surgeon in the army of Charles I of Spain. The campaign over, he resumed his footloose life. If we may believe him, he practiced medicine in Granada, Lisbon, England, Denmark, Prussia, Poland, Lithuania, Hungary, “and other lands.”72 He was in Salzburg during the Peasants’ War of 1525, treated their wounds, and sympathized with their aims. He had a socialist spell; he denounced money, interest, merchants, and advocated communism in land and trade, and equal remuneration for all.73 In his first book, Archidoxa (The Arch-Wisdom, 1524), he rejected theology and lauded scientific experiment.74 Arrested after the failure of the peasants’ revolt, he was saved from the gallows by evidence that he had never taken up arms; but he was banished from Salzburg, and left in haste.
In 1527 he was at Strasbourg, practicing surgery and lecturing to barber surgeons. His doctrine was a confusion of sense and nonsense, magic and medicine—though God knows how the future will describe our current certainties. He rejected astrology, then accepted it; he would not give an enema when the moon was in the wrong phase. He laughed at the divining rod, but claimed to have transmuted metals into gold.75 Animated, like the young Agrippa, by a thirst for knowledge, he sought anxiously the “philosopher’s stone”—i.e., some universal formula that would explain the universe. He wrote credulously about gnomes, asbestos salamanders, and “signatures”—the treatment of diseased organs with drugs resembling them in color or form. He was not above using magical incantations and amulets as cures76—perhaps as suggestive medicine.
But this same man, dripping with the delusions of his time, boldly advanced the application of chemistry to medicine. Sometimes he spoke like a materialist: “Man derives from matter, and matter is the whole universe.”77 Man is to the universe as microcosm to macrocosm; both are composed of the same elements—basically, salts, sulfur, and mercury; and the apparently lifeless metals and minerals are instinct with life.78 Chemotherapy is the use of the macrocosm to cure the microcosm. Man is, in body, a chemical compound; sickness is a disharmony not of Galen’s “humours” but of the chemical constituents of the body; here was the first modern theory of metabolism. By and large the therapy of the age depended for its drugs on the plant and animal world; Paracelsus, deep in alchemy, stressed the curative possibilities of inorganic materials. He made mercury, lead, sulfur, iron, arsenic, copper sulfate, and potassium sulfate parts of the pharmacopoeia; he spread the use of chemical tinctures and extracts; he was the first to make that “tincture of opium” which we call laudanum. He encouraged the use of mineral baths, and explained their diverse properties and effects.
He noted the occupational and geographical factors in disease, studied fibroid phthisis in miners, and first linked cretinism with endemic goiter. He advanced the understanding of epilepsy, and related paralysis and speech disturbances to injuries of the head. Whereas gout and arthritis had been generally accepted as natural and incurable accompaniments of increasing age, Paracelsus claimed that they were curable if diagnosed as due to acids formed by food residues too long retained in the colon. “All diseases can be traced to a coagulation of undigested matter in the bowels.”79 These acids of intestinal putrefaction he called “tartar” because their deposits in joints, muscles, kidneys, and bladder “burn like hell, and Tartarus is hell.”80 “Doctors boast of their [knowledge of] anatomy,” he said, “but they fail to see the tartar sticking to their teeth”;81 and the word stuck. He proposed to check the formation of such deposits in the body by a healthy diet, tonics, and improved elimination; he tried to “mollify” the deposits by using laurel oil and resin compounds; and in extreme cases he advocated surgery to allow the accretions to escape or be removed. He claimed to have cured many cases of gout by these methods, and some physicians in our time believe they have made cures by following Paracelsus’ diagnosis.
News of cures accomplished by Paracelsus in Strasbourg reached Basel. There the famous printer Froben was suffering acute pain in his right foot. The doctors advised amputation. Froben invited Paracelsus to come to Basel and diagnose the case. Paracelsus came, and effected a cure without use of the knife. Erasmus, then living with Froben and many ailments, consulted Paracelsus, who prescribed for him—we do not know with what success. In any case these famous patients gave the young doctor new fame, and a strange medley of circumstances brought him close to that university professorship which he coveted.
At this time the Protestants were a majority in the city council of Basel. Over the objections of Erasmus and the Catholic minority, they dismissed Dr. Wonecker, the city physician, on the ground that he had “uttered fresh words against the Reformation,”82 and they appointed Paracelsus in his place. The council and Paracelsus assumed that the appointment carried with it the right to teach in the university; but the facu
lty condemned the appointment, and—knowing the weakness of Paracelsus in anatomy—proposed a public examination of his fitness. He evaded the test, began practice as city physician, and gave public lectures in a private hall without university sanction (1527). He gathered students by a characteristic invitation:
Theophrastus Bombast of Hohenheim, doctor of both medicines and professor, greetings to the students of medicine. Of all disciplines medicine alone... is recognized as a sacred art. Yet few doctors today practice it with success, and therefore the time has come to bring it back to its former dignity, to cleanse it from the leaven of the barbarians, and to purge their errors. We shall do so not by strictly adhering to the rules of the ancients, but exclusively by studying nature and using the experience which we have gained in long years of practice. Who does not know that most contemporary doctors fail because they slavishly abide by the precepts of Avicenna, Galen, and Hippocrates? .... This may lead to splendid titles, but does not make a true doctor. What a doctor needs is not eloquence or knowledge of language and of books... but profound knowledge of Nature and her works....
Thanks to the liberal allowance the gentlemen of Basel have granted for that purpose, I shall explain the textbooks which I have written on surgery and pathology, every day for two hours, as an introduction to my healing methods. I do not compile these from excerpts of Hippocrates or Galen. In ceaseless toil I created them anew upon the foundations of experience, the supreme teacher of all things. If I want to prove anything I shall not do so by quoting authorities, but by experiment and by reasoning thereupon. If, therefore, dear reader, you should feel the impulse to enter into those divine mysteries, if within a brief lapse of time you should want to fathom the depths of medicine, then come to me at Basel.... . Basel, June 5, 1527.83