Читать книгу The Greatest Benefit to Mankind: A Medical History of Humanity - Roy Porter - Страница 44

Theological concerns loomed large in readings of the body, yet medicine too was concerned with the implications of the theory of embodiment and the soul. Scholastic medicine subscribed to the Chain of Being or Scale of Nature, with man as the midpoint between angels and brutes, distinguished from the beasts by possession of a rational soul. One consequence of this doctrine was that, considered in a purely physical light, the human body could be described in the same terms as that of a pig or a monkey. Belief in such a continuum of creation explains why the earliest medieval anatomies, conducted at Salerno and Bologna, could be performed on animals: the human soul was unique, so similarities between human and animal cadavers were not theologically worrying.

The first recorded public human dissection was conducted in Bologna around 1315 by Mondino de’ Luzzi (c. 1270–1326). Born into a medical family, Mondino graduated at Bologna, and rose to a chair of medicine there. His fame rests on his Anatomia mundini (c. 1316), which became the standard text on the subject. Built on personal experience of human dissection, the Anatomia was a brief, practical guide, treating the parts of the body in the order in which they would be handled in dissection, beginning with the abdominal cavity, the most perishable part. Relying on Galen and the Arabs, the Anatomia perpetuated old errors derived from animal dissections, such as the five-lobed liver and the three-ventricled heart. Mondino’s achievement derived from his intuition that the developing university-based education of his day required an introductory anatomy manual. The first printed version appeared in 1478, followed by at least forty editions – a clear recognition of how central anatomy was becoming to medical expertise.

Hitherto anatomy had played little part in medical education; it had no place in the Articella or the medical school of Salerno, though pigs had been dissected there. But from Mondino’s time learned physicians began to enunciate the view that medicine should be anatomy-based. Thereafter academic physicians gloried in public displays of human dissection and anatomy theatres were built. Dissection was justified largely in terms of natural philosophy and piety (the body demonstrated the wisdom of the Creator); the surgical benefits were rarely mentioned – clear evidence of the professional function of physicians’ anatomical knowledge.

Various factors contributed to the rise of human anatomy, among them Galen’s prestige (after all Galen had prided himself upon his dissecting abilities). Tampering with human remains was far from unknown in medieval Christendom. The wish to bring dead crusaders back from the Holy Land for burial had led to the custom of boiling up bodies to leave only the bones, and to the preservation of the heart of the deceased. Though this practice was condemned by Boniface VIII in 1300, the papal ban proved ineffective. From around 1250, autopsies also became regular in Italian, French and German towns, with surgeons called in to investigate homicide and establish cause of death. The step from a coroner’s postmortem to dissection was small.

Public dissection was spectacle, instruction and edification all in one. The corpse would be that of an executed criminal, presupposing municipal cooperation. It was sometimes staged in a church, usually in winter, since cold slowed putrefaction. Mondino’s order of dissection of the three main bodily cavities – first the lower abdomen, then the thorax and the skull – was designed with decay in mind. In illustrations of dissections, a physician resplendent in academic robes sits on a throne, intoning from a Galenic anatomical text, while a surgeon slits the cadaver with his knife, and a teaching assistant points out notable features. Whether or not dissections were actually conducted in this way, what is conveyed is the ritual of the performance: religious, civic, and university authorities agreed that the occasion must be accorded due gravity.

Book-driven anatomy – a demonstration of what was already known, within the explanatory framework of learned medicine – served many purposes, providing guidance to the student, who would not have been able to see much for himself. From Bologna, human dissection spread; the next key centre was Padua, which was popular with foreign students. In Spain, the first public dissection took place at Lerida in 1391; Vienna held its first in 1404. In England and Germany anatomy teaching with a human corpse did not become routine before 1550.

Anatomy had an impact upon medical illustrations – a subject bedevilled by modern prejudices about ‘realism’, for medievals who drew ‘childish’ images of the bones and arteries have been adversely contrasted with the new ‘scientific’ artists of the Renaissance (notably Leonardo da Vinci), admired for their realistic anatomical drawings. But the comparison is misleading. For one thing, Leonardo at times followed tradition rather than his eye, adopting, for instance, the standard five-lobed liver. For another, it is wrong to think that the apparent crudity of medieval images reveals ineptitude. Late medieval illustrations were not meant to depict minute documentary detail; they were diagrammatic teaching aids, schematically representing general truths – mnemonic rather than photographic.

The most common type of medieval medical illustration was the ‘Zodiac man’: a male figure marked up with blood-letting points or with the zodiac signs (Taurus controlled and cured diseases of the neck and throat, Scorpio the genitals, Capricorn the knees, Pisces the feet, and so forth). The right way and place to let blood was gauged by study of the constellations and the moon. There was also the group known as the ‘five-picture series’, standing for the five systems: arteries, veins, bones, nerves and muscles. Squatting figures with legs astride were occasionally used to show diseases, wounds and the influence of the stars and planets on body parts. There were also charts explaining how to examine urine. The success of such images is evident: they survived into the age of print, wound-men in particular continuing to crop up in surgery texts.

The late Middle Ages wear a gloom-laden appearance: painters gave Death a mocking grin and portrayed him accosting peasants, merchants and princes. Perhaps for this reason, and because it was roundly disparaged by Renaissance humanists, medieval medicine has never enjoyed a good press. Proud of recovering Hippocrates and Galen in the original Greek, humanists chid and despised their muddle-headed predecessors.

We should not blindly accept these judgments. Much was afoot before 1500: in particular the fifteenth century brought a rise in practical medicine, associated with the books of practica and case-histories (consilia) produced by Italian professors. Bedside consultations, autopsies and the spread of dissection gave Italian medical training an increasingly hands-on emphasis. It is ironic that from the 1490s the medical humanists reverted to theory, to philology and medicine’s ‘sacred’ books, notably through the Galen revival.

The later Middle Ages also consolidated the role of medicine in European society, with new institutions and regulations. At the time when the Salerno school was founded, physicians were to be found only in monasteries and palaces; five hundred years later they had infiltrated society (remember the physician on Chaucer’s pilgrimage) and were facing competition from other practitioners like barber-surgeons, professional bickering being but one sign of this growing medical presence. Other domains of life were falling under medical control: health officials directed urban hygiene and combated plague. From birth to death – and even beyond, if one had the misfortune to be cut up for a public anatomy display – medicine gained a hold that it had previously lacked or lost.

* Take for instance this section in the English translation by Sir John Harington (1561–1612) (who was, incidentally, the inventor of the water-closet):

Although you may drink often while you dine,

Yet after dinner touch not once the cup, …

To close your stomach well, this order suits,

Cheese after flesh, Nuts after fish or fruits.