The origin of Western
Medicine from the dissections practiced by Mondino de
Luzzi is discussed in
Therivel's GAM/DP Theory of Personality and Creativity.
Western Medicine's
Origin
The DP Origin of Western Medicine
-- On the History of Scientific Use of Dissection -
Mondino de' Luzzi
Excerpts from volume 1 chapter 13 and volume 4 chapter
14 of William A. Therivel's The GAM/DP Theory
of Personality and Creativity (G stands
for genetic endowment, A for assistances of youth,
M for misfortunes of youth, DP for division
of power, UP for unity of power). For an introduction
to the GAM part of the theory click "Introduction
to GAM"; for an introduction to the DP
part click on "Introduction
to DP".
In this website, the reader is also offered a shortcut:
The GAM/DP Synopsis
and an expanded version, The GAM/DP
Summary of volumes 1 through 4.
A) From Volume 1
The use of dissection
(autopsy) of dead human bodies for scientific purposes
is what differentiated Western medicine from the healing
and curing approaches of the other civilizations. Because
of this fundamental difference, the practice of dissection
of humans deserves to be seen as the real beginning
of Western medicine. Without dissection, there is no
way to know how the human body is made, how it functions,
how it can be repaired and cured. The prohibition of
dissection in other civilizations has been one of the
primary reasons for their lack of further medical progress
beyond some very promising beginnings.
Very correctly, Roy Porter
has entitled his 1997 medical history of the humanity:
The Greatest Benefit to Mankind, but without
scientific research this benefit would have remained
very small. Indeed, in the words of Benjamin Gordon:
"The lack of scientific knowledge bound medical
practice to superstition, to the beliefs in amulets,
and to the reliance on herb decoction, astrology, and
uroscopy" (1959, p. 592). And without dissections
there would have been no scientific understanding of
the body first and then of the diseases.
"Because Hindus
were prohibited by their religion from cutting the
dead body, their knowledge of anatomy was limited"
(Underwood & Rhodes, 1993, p. 776). Not only the
Hindus were restricted, but also the Jews, the Muslims,
and the Byzantines. Among the Jews: "Respect
for the dead, and the utmost reverence for the human
body after death are enjoined by both Jewish law and
custom. The rabbis deduce the prohibition of the desecration
of the corpse as well as the duty of the reverent disposal
of the body by burial as soon as possible after death
from Deuteronomy 21:22, 23. Mutilation of the body,
whether for anatomical dissection or for post-mortem
examination, would appear to violate the respect due
to the dead, and is consequently to be forbidden. [There
were exceptions, and later special rules, for the Medical
School of the Hebrew University in Jerusalem, led to
the Law of Anatomy and Pathology passed by the
Knesset in 1953. Yet,] in 1965, following allegations
of widespread abuse of the safeguards contained in the
Law, certain Orthodox circles in Israel agitated to
have the law amended by reverting to the strict limited
permission given by Ezekiel Landau [who in the 18th
century said that autopsy on the body of a Jew was permitted
only in order to find the cause of his death if in the
same hospital another patient was suffering from the
same symptoms, so that the autopsy would immediately
help]" (Rabinowitz, 1971, pp. 932-3).
In Byzantine medicine,
"Great stress, almost to the point of worship,
was laid on ancient tradition. The medicine of Galen
(Claudius Galenus, ca. 130-200 A.D.) and other ancient
physicians (as interpreted by the church of course)
was considered the last word on the subject of medicine.
Independent thought was considered a heresy even by
physicians themselves. . . . Byzantine medicine, to
be exact, is a mechanical preservation of ancient thought
or an anthology of the classical medical writings"
(Gordon, 1959, p. 44). In these conditions, any idea
of going beyond the dissection of animals as practiced
by Galen would have been anathema.
In the Islamic countries,
"the theory and thought of the Greeks were left
untouched and treasured up after careful systematization
and classification. It must be remembered that the Muslims
were strictly prohibited from dissecting either human
bodies or living animals. Thus experiment was practically
impossible in medicine, so that none of Galen's anatomical
and physiological errors could be corrected" (Meyerhof,
1931, p. 344).
Williams and Steffens
had similar comments in their discussion of the great
Arabic physician Rhazes (al-Razi, ca. 865-925): "Rhazes
also was well-versed in anatomy, although here he was
forced by religious circumstances to rely upon tradition,
particularly Galen, rather than upon first-hand observation.
Dissection of cadavers was forbidden by Islamic law.
Thus, the treatises by Razes and other Islamic physicians
did little more than echo their Greek predecessors"
(1979, p.195).
The scientific study
of the human body through dissection was unique to the
West for a long time. Among the pioneers, two names
stand out: those of Mondino de' Luzzi and Andrea Vesalius."The
first recorded public human dissection was conducted
in Bologna around 1315 by Mondino de Luzzi (c. 1270-1326).
. . . 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" (Porter, 1997,
p. 132).
After the famous public
dissection by Mondino in Bologna in January 1315 and
his writing of Anatomia Mundini of 1316-17, things
started rolling: public dissections were decreed in
1377 at the university of Montpellier, "and Catalonia
Lerida followed suit in 1391. At Bologna, where dissection
had long been customary, it received official recognition
in the University Statutes in 1405, and the same event
took place at Padua in 1429. (Singer, 1955, p. 79).
And the Church?
There was a papal bull:
Detestande feritatis [abhorred wounds] issued
in 1299, but it "did not prohibit dissections,
but the cutting up of corpses and their boiling in order
to separate the bones from the flesh. That practice
had originated during the Crusades to make possible
the repatriation of at least part of the body. . . .
Boniface VIII's prohibition was frequently lifted in
favor of powerful people who were able to pay for the
necessary indult or license" (Sarton, 1947, p.
266). Specifically, the bull read: "Persons cutting
up bodies of the dead and barbarously cooking them in
order that their bones be separated from their flesh
are by the very act excommunicated" (quoted by
Gordon, 1959, p. 422). Yet even in this limited form,
the papal ban proved ineffective, and various followers
of Mondino--De Cahuliac, Achillini, Benedetti, Berengario--used
to cook parts of the body to liberate the bones from
the flesh (Favaro, 1929, p. 115).
On one side we can admire
how open-minded Pope Boniface VIII was, on the other
we can see that the popes in those times had limited
moral and practical authority. In 1315, the year of
the first public dissection by Mondino, Christianity
had no pope. The Holy See, already forced to move to
Avignon, was vacant from 1314 to 1316. The French members
of the college, who out-numbered the Italians, were
unable to agree amongst themselves. Finally they agreed
on another Frenchman, Jacques Dréze de Cahous,
who reigned as John XXII from 1316-1334, after Clement
V (1305-1314) who, as already mentioned, is one of the
three popes that Dante placed in Hell with Nicholas
III (1277-1280), and Boniface VIII (1294-1303).
Shortly after, Christianity
suffered its Great Schism of 1378 to 1417, when
there were two, and later three, rival popes, each with
his own following, his own Sacred College of Cardinals,
and his own administrative offices. The spectacle of
rival popes denouncing each other produced great confusion
and resulted in a tremendous loss of prestige for the
papacy, especially in Italy, the country most involved
in the fight among popes of the Roman obedience, Avignon
obedience, and the Pisan obedience.
However, all this did
not mean a major increase in lay power, not by the emperor,
nor by kings or signori. These, indeed, were
years of Division of Power, when new things could be
tried out.
B) From Volume 4
The beginning of this
scientific understanding of the human body is relatively
new in the history of mankind, and can be dated with
some precision to the early years of the fourteenth
century when Mondino de' Luzzi made his first public
dissections of human cadavers at Bologna, and then described
them in his famous Anotomia Mundini of 1316-17.
Before this date, and elsewhere in the World (with the
exception of some work done in Alexandria around 300
B.C.), there were such strong religious/ethical prohibitions
against dissection of human cadavers that the beginning
of the medical science was blocked.
In chapter 13 of volume
1 of my GAM/DP Theory, I briefly discussed the
contrast between what had been done in the West and
what had not been done elsewhere, and how the visitor
mentality which began at Canossa 1077 (see chapter
11 of volume 1) and the existence of a greater division
of power (DP) in Italy at the time of Mondino de' Luzzi,
were essential for the beginning of the medical use
of dissection. Still, more needs to be said on this
important subject, especially on the forensic (partial)
dissections and on the university public/book-driven
(complete) dissections (e.g., those of Mondino de'
Luzzi) which preceded the truly scientific dissections
(e.g., those of Vesalius). We also need to examine the
exceptional conditions in Alexandria at the time of
Ptolemy I which favored the dissections by Herophilus,
and then discuss the rapid surge of the unity of power
(UP) under Ptolemy II and the consequent decline of
the Alexandrian School of Medicine.
Before proceeding, we
need to appreciate how revolutionary those first dissections
at Bologna were because, from our present point of view,
those dissections may not seem so heroic; so un-heroic,
in fact, that a number of modern historians have been
critical of the slow pace with which things progressed,
and astonished that the dissections by Mondino de' Luzzi
were not performed more scientifically and did not produce
major anatomical discoveries. However, at a minimum,
these historians forgot to ask why scientific dissection
was not practiced in the other civilizations, nor did
they address the strong repulsion against tampering
with human cadavers which was also an integral part
of the Greco-Roman world and of the first twelve centuries
of Christianity:
[In
mainland Greece] knowledge of human internal anatomy
had been seriously hampered by superstitious beliefs
which still invested the human corpse. Religious
scruples, veneration of the dead and dread of the
corpse itself had all combined to bring about a
deeply entrenched and powerful taboo against human
dissection. (Longrigg, 1993, p. 184)
As long as men have still been capable of humane
sensitivity, it has never been possible to dissect
without a feeling of inner revulsion. No one, aware
that the body into which he is cutting is the body
of a human being, can do so without emotional resistance,
even though his reason may refute all arguments
and show him that his feelings are unreasonable....
The Hellenistic physicians had at least had the
help of the kings, who were themselves schooled
in philosophy. The Roman Empire permitted no dissections.
Only in Egypt, as Galen says, not in the European
provinces, could anatomy still be practiced. The
latinized world at any rate allowed no dissecting,
and it is not by chance that a Latin writer tells
that even dissection of animals was sufficient grounds
for convicting him of the practice of magic. (Apuleius,
Apologia, ch. 25 ff.) (Edelstein, 1932/1967,
pp. 279, 280, 283) |
There had, indeed, been
a short-lived exception around 300 B.C. when Herophilus
and Erasistratus had been able to practice dissections
on human cadavers in Alexandria, with the help of Ptolemy
I. However their work was neither repeated nor expanded:
"In Alexandria human pathological necropsies were
probably obtained without difficulty; in Rome the current
prejudice against them was prohibitive, and it persisted
even into the fifteenth century" (Allbutt, 1921/1970,
p. 161).
The situation was not
much different during the early Middle Ages, thereby
explaining the admiration by Lino Sighinolfi (1930)
for the Bolognese School of Medicine which, toward the
end of the thirteenth century had been able to "overcome
the obstacles kept for long centuries by the prejudices
on the inviolability of the cadavers and the blind faith
in the authority of Galen, through the direct study
of anatomy" (p. 9).
It is, therefore, against
this very restrictive background that we must place
our understanding of the first steps in the Western
practice of the dissections of cadavers.
Dissections in the West evolved in four stages, each
preparing the way for the next:
- Forensic/post
mortem dissections, to establish the cause of
death in uncertain cases
- (Simple)
University-public-bookdriven dissections, to teach
anatomy (Mondino de' Luzzi)
- (Formal)
University-public-bookdriven dissections, to teach
anatomy (post Mondino
- Scientific
dissections, to learn more about the human body
(Vesalius)
Public dissections,
practiced first at the University of Bologna in 1315,
were indeed exceptional, the result of the DP between
emperors and popes, which had begun at Canossa in 1077
and had been greatly expanded, after the battle of Legnano
of 1176, by the freedoms granted by the Magna Carta
of the Communal Freedoms of 1183. After Bologna,
the practice of public dissection spread throughout
Europe: Montpellier, 1377; Lerida, 1391; then Prague,
1460; Paris, 1478; Tübingen, 1485.