Philosophical Considerations on the History of Anatomy.

By CHARLES GREENE CUMSTON, M. D., Boston, Mass.

Anatomy was the only exact and experimental science known. to the ancient physicians. It is to anatomy, that the human mind owes the only method capable of properly directing its footsteps in the obscure labyrinth of nature. The Hindoo physicians, and much later Hippocrates, and after him Galen, believed that anatomy was the basis of medicine and not many years ago the same opinion was expressed by Virchow in an emphatic manner. He says: "In going over the history of medicine it will be seen that in all ages the durable progress of this science had anatomical discoveries as its basis and each great medical epoch was preceded by a series of new ideas relative to the structure of the human body". I expect to point out in a future article that the influence of anatomy is not alone limited to the vast sphere of medicine, but was also very considerable on the progress and the development of natural sciences, and particularly on the philosophy of these sciences.

The study of anatomy encountered many, and almost insurmountable, difficulties for a long time and these difficulties were always due to beliefs, prejudices and human foolishness. As far back as we can go in the history of man, we find a cult of the dead, at times based on fear, at others on particular beliefs relative to future life, a cult always greater for the dead than for the living. Thus at certain epochs anatomists had greater facilities for the dissection of living bodies than of cadavers. Whether or not the cadavers were embalmed, burned or buried, to study or to dissect them was considered a great profanation. Thus the knowledge of anatomy was obtained among the ancients by dissection of animals while the anatomists of the Middle Ages only possessed that knowledge which they derived from the writings of the ancients. It is certain that Hippocrates, who was very religious, did not dissect human bodies, and it is more than probable that the same applies to Aristotle because he says: "The parts of man are unknown and nothing certain is known about them. But one must judge by the resemblance that they must have with the parts of other animals, which have relationships with each other."

It is no less certain that the anatomists of the School of Alexandria dissected bodies of men, thanks to the liberality of Ptolemy. Celsus who detested anatomy and anatomists, even re

lates that Herophilus, "this physician or this butcher" dissected a large number of men, upon whom he first practiced experiments. As to Galen our knowledge is less certain, in spite of the enormous number of volumes left us by the anatomists of the Middle Ages, who during several centuries occupied themselves with the serious question, namely, to know if the magister (Galen) did or did not dissect the human body. The contradictions are due perhaps to the master himself, because undoubtely he most frequently limited his anatomical knowledge to the dissection of animals and more particularly the monkey, which according to Galen, is the animal which most nearly resembles man". But on the other hand the following remark is to be found in his writings: "if I live I will some day describe the structure of the bodies of beasts, and I will demonstrate the anatomy of their parts just as I now demonstrate the anatomy of all the parts of men." However this may be it is more than probable that Galen had many opportunities of studying human anatomy on account of the peculiar situation that he held, for he had at his disposal the cadavers of abandoned children, and even the living bodies of those condemned to death, if we are to rely upon the word of Celsus.

It is almost superfluous to state that during the Middle Ages little, if any, dissecting was done. The "master" having discovered all that there was to discover in anatomy, the act of dissection would mean to cast doubt on his veracity. Now, doubt in those days was a profanation and a profanation cost dearly in the Middle Ages. We must come to the XIV century before we find theoretical anatomy becoming replaced by practical anatomy. Frederick II, Emperor of Germany and King of both Sicilies, allowed physicians to open human bodies in spite of the repeated excommunications of the Pope, and not only did he allow this to be done, but he showed his great broadness of mind by prohibiting the practice of medicine to those who had not dissected human bodies for a period of one complete year.

Thanks to the intelligent and continued tolerance of the kings of Sicily a remarkable school of anatomists came to light in a little corner of Italy to which I shall have occasion again to refer. At about the same time, namely towards the end of the XIV century, in France, Louis d'Angou, seigneur of Montpellier, allowed physicians to dissect the bodies of criminals after execution. Up to the year 1483 the School of Paris remained refractory to this movement, but after this the students began to request that they should receive some practical instruction and knowledge in anatomy. However, dissection was clandestinely carried on at the Hôtel de Nesle, domo regia de Nesle. In 1676 an archdeacon was therein installed and made chief of the practical work and this person was no other than the celebrated anatomist Riolan, and upon his persistent and pressing demands, an amphitheatre was finally constructed in 1704.

Soon under the influence of the brilliant culture of the an

atomists of the Renaissance, the study of anatomy and the taste for dissection became more and more extended. Bodies were seized, or bought or stolen from the executioner or grave-digger, and more than one anatomist has paid with his fortune, his liberty or even his life for his boldness. The Faculty of Medicine of Paris finally found itself under obligations to request a sort of monopoly of the cadavers of criminals, and then as is pointed out by Carlieu in his very interesting book entitled: L'ancienne Faculté de médecine de Paris, "each execution was awaited for with impatience and became a day of great emotion, I will not say of great joy, for the medical students.' The relationship which at this time had become very strained between the Faculty of Medicine and the School of Surgeons, became more and more so, and from time to time there were real battles fought between them in order to procure a body.

Upon a certain day the archdeacon perceived that a body belonging to the Faculty had disappeared, and after several days of fruitless search in every corner of Paris the body in question was found in the possession of the great obstetrician Moriceau. After several useless negotiations his house was surrounded by the police which was obliged to wage a war before it could come into possession of the said cadaver. The following story, which has been told by Fallopius himself is not less amusing. [We see nothing amusing in it. To us it is repulsive in its frank brutality. But we must bear in mind the ardent zeal of the newly awakened love of science and the low state of the morals of the times.-ED.] On the order of the Duke of Ferrare, a man condemned to death was sent to him. "The poor fellow was already congratulating himself for having escaped death and asked me to intervene in his behalf to the Prince." For all reply Fallopius gave him a drachm of opium, but the unfortunate man soon became awake again and our anatomist was obliged to repeat the dose and double it. He then goes on to say that "He died and I dissected him." [In other words in his ardent love for science, Fallopius did not disdain the rôle of poisoner. Ed.]

Berenger de Capri of Bologna one day dissected two Spaniards afflicted with syphilis, for which crime he was expelled from the territory of Ferrare. In 1562 the Faculty of Medicine asked for the body of a certain Jean Despeature in order to undertake "sur icelluy aucune expérience concernant l'art et la science de médecine."

At the end of the XVIII century the rigorous feeling against anatomists diminished and finally at the beginning of the XIX century it was hardly thought of. At the present time anatomists are working in peace, but unfortunately the same cannot be said of the physiologists in this country and in England, where the same antiquated feelings exist among a certain portion of our

narrow-minded public who would wish to see what they term a "vivisector" tried and punished like an ordinary criminal.

Medicine is the oldest of all sciences and the historians of the Middle Ages did not hesitate to look for its traces in the days preceding the deluge. Galen did not go so far and for good reason. According to him the first physician and anatomist that was known is probably Esculapius, the son of Apollo, who, following the anagramm made on this word by Plato was a god of music, archer and physician. "Esculapius in the first place learned medicine from his father and afterwards taught it to other men. Before him there was no other physician". It is quite evident that Galen is mistaken in his belief and according to Portal the first physician that is known, that is to say the first who has left any of his writings, is Melampea who lived in 1380 B. C. He was a poet, shepherd and physician and he appears to have all the rights to the title of the father of purgation. It is told that it was by administering a purgative that he saved the life of the king's daughter, who later became his wife.

Anatomical notions probably date back as far as the first ceremonies of sacrifices. The custom of inspecting the viscera after immolation in order to there read the will of the gods, and on the other hand the absolute injunction not to sacrifice unhealthy animals must have made the acquisition of anatomical knowledge indispensable to those charged with this work. Others give a less honorable origin to anatomy, believing that it was commenced by the first butchers, because Plato compared,physicians to cooks and Galen begs the latter to give him some ideas relative to the circulation. However this may be, the anatomical notions accumulated up to the time of the siege of Troy were quite numerous and we note with pleasure that the warriors in this war were accompanied by real surgeons, the most remarkable of whom are without doubt Machaon, the son of Esculapius, and Podalirius, who are mentioned by Homer.

Just a word about Hippocrates. It is hardly probable that he ever left a special work on anatomy. It might be believed that his anatomical knowledge was quite extensive, because Galen exposed it at some length in a special work which unfortunately has been lost, and that Hippocrates, whose professional honesty was so great, performed operations such as trephining, paracenthesis, thoracocenthesis and etc. It however must be said that his anatomical ideas quite frequently denote more imagination than exact knowledge. He believed that the heart was the origin of the blood and pituit; water came from the spleen, while the arteries contained the spirit. The brain became imbibed with a serous fluid like a sponge, and contained the understanding, prudence, etc.

I shall not refer to the anatomical knowledge of the pure philosophers. It was in most instances nil, a fact which did not

prevent them from emitting anatomical and embryological theories. If, in point of fact, physicians were separated from philosophers as is stated by Hippocrates, the same cannot be said of the latter, who were desirous of being universal in their work.

For the moment I would speak of Plato who, with his extremely gross ideas of anatomy, nevertheless treated before his students questions of physiology and embryology. Among other things he states that the bone marrow is that part of man which forms first, that it soon becomes covered with bone tissue, which itself in turn later becomes covered with flesh and skin. He thought that the soul resided in the chest and reason in the brain. The lungs refreshed the blood and moderated the pressures, thanks to the air and water which passed thru them directly from the mouth.

If we consider Aristotle, it will be at once seen that his anatomical knowledge was greatly superior to that of his predecessors and contemporaries, but so great is the power of tradition and custom that this incomparable man, who commanded for centuries human thought, this man was himself dominated by the error of the ancient times, in that he described things that he was unable to see and spoke of things that he unfortunately did not look at. Thus he also occupied himself with the localization of the soul and reason, but on the other hand he came to the conclusion that the posterior portion of the cranium was empty. The brain, according to him, was composed of earth and phlegm; it is an inert mass having no important function; it is not medullary and is not the origin either of the marrow nor of the nerves and being insensible it takes no part in the sensibility, while being deprived of vessels it only serves in cooling the heart. He thought that the heart was the origin of the blood and the nerves, the latter being nothing less than the terminal portions of the arteries. The liver favors the digestion of the food, while the spleen plays the part of a sponge and the kidneys liquefy the excrements. The lungs dilate on account of the heat of the heart. The testicles were given for the well-being and not as an absolute necessity: not ad absolute, but ad bene esse. He describes three ventricles in the heart, namely, a middle one which is the smallest and only contains temperate blood. The second which is on the right only contains hot blood, while the third and left only contains cold blood. He also described the aorta and believes that it ends by nerves and commences by the trachea by the intermediary of which air passes into the arteries. He refers to the jejunum, rectum and colon. He likewise enriches the nomenclature of anatomy and divides the body into regions, such as the head, neck, body and limbs, and so to speak, he found the science of similar parts, when he distinguishes the simple solid and liquid parts and the composite parts, such as the organs and

limbs.

The moral and political downfall of Greece, the intolerance which took the place of the liberty of thought and speech, natur