the evolution of modern medicine-第34章

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　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　jewelpaper；　type　and　illustration　to　match；　as　you　may　see　for　yourselves　in　this　foliothe　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　his　autobiography；　who　gave　a　public　dissection　during　three　days　in　the　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；　New　York；　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　quoted　in　explanationin　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　anatomizingthose　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