COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD Columbia . 100? Soranus. 130—200 Galen. ib. Aretaeus. 400 ? Moschion. 1316 Mondino di Luzzi. 1522 Berengario da Carpi. 1543 Vesalius. (1552) Eustachius. 1561 Fallopius. 1672 De Graaf. 1681 Malpighi. 1726 Ruysch. 1730 Douglas. 1745 Haller. 1747 Albinus. 1754 Sraellie. 1754 Donald and Alexander Monro, 1757 Roederer. 1774 William Hunter. Chronological List of Names referred to in " Early Contributions of Anatomy to Obstetrics " arranged according to the year in which their Work appeared. (For system of grouping, set text.) EARLY CONTRIBUTIONS OF ANATOMY TO OBSTETRICS. A. H. F. BARBOUR, M.A., B.Sc, M.D., F.R.C.P.E.. LECTURER ON MIDWIFERY AND DISEASES OF WOMEN, EDINBURGH MEDICAL SCHOOL : ASSISTANT PHYSICIAN FOR DISEASES OF WOMEN, ROYAL INFIRMARY, EDIN- BURGH ; JUNIOR ASSISTANT PHYSICIAN TO ROYAL MATERNITY AND SIMPSON MEMORIAL HOSPITAL ; PHYSICIAN TO THE WOMEN'S DISPENSARY ; INSPECTOR OF EXAMINATIONS IN MIDWIFERY ; CORRESPONDING FELLOW OF THE ROYAL ACADEMY OF MEDICINE OF TURIN. [Read before the Edinburgh Obstetrical Society, yt/i May 1888. PRINTED BY OLIVER AND BOYD, EDINBURGH. MDCCCLXXXVIII. ■ With us ther was a Dnctour of Phisik, In al this world ne was ther non him lyk To speke of phisik and of surgerye ; Wei knew he the olde Esculapius, And Deiscorides, and eek Rufus ; Old Ypocras, Haly, and Galien ; Serapyon, Eazis, and Avycen ; Averrois, Damascien, and Constantyn ; Bernard, and Gatesden, and Gilbertyn." Chaucer's Proloam . "There, now ! What do you say to this copy of Joannes de Ketam, Venice, 1522? Look at these woodcuts — the first anatomical pictures ever printed, doctor, unless these others of Jacobus Berengarius are older ! Take a look, too, at my Vesalius — not the Leyden edition, doctor, but the one with the grand old original figures, — so good that they laid them to Titian. And look here, doctor, I couldn't help getting this great folio All >inus, 1747, — and the nineteenth century can't touch it, doctor — can't touch it for com- pleteness and magnificence, — so all the learned professors tell me ! Brave old fellows, doctor, and put their lives into their books as you gentlemen don't pretend to do now-a-days." Master Byles Gridley in Oliver Wendell Holmes' "Guardian Angel." EARLY CONTRIBUTIONS OF ANATOMY TO OBSTETRICS. In these " Early Contributions of Anatomy to Obstetrics;"' we have to review the time from the foundation of medicine under Hippocrates to the end of the sixteenth century. We may group them under three periods — 1. Before the Christian era; 2. From the commencement of the Christian era to the fall of Rome ; 3. (after the break of the ten centuries of the Dark Ages) From 1500 a.d. to the close of the sixteenth century. Each of these periods begins with an important name — the first with Hippocrates ; the second with Soranus ; the third with Berengario da Carpi. 1 First Period. This period extends up to the Christian era ; and, in addition to Hippocrates, with whom it begins, we have to notice the names of Aristotle, Herophilus, and Celsus. In the history of medicine, the name from which everything dates is Hippocrates, the " Father of Medicine " {flor. circa 470- 400 B.C.). 2 He dissected animals only. This probably explains the idea which prevailed in his time, and even at a much later date, that the human uterus consisted of two cavities. One of his aphorisms runs, " Male foetuses are oftenest in the right, and females in the left." 3 The same idea is seen in the less certain Hippocratic writing, ire pi e7riKV7J (Aknf ov '6£x oy * <&&< xadup~ Reproduction of opening sentence from Soranus — the MS. published in Paris in 155/,. Drawing of uterus (reduced } scale) from Berengario da Carpi. Drawing of uterus from Moschion. Drawing of uterus (reduced J scale) FROM VESALIUS 7 cover our ignorance we have depreciated one of those subjects which are deemed useful." After paying this tribute to the view of his school, he gives an admirable account of the anatomy of the organs of generation. Ermerins gives the Greek text compared and revised, and also a Latin version. We have made the follow- ing translation of the chapter on anatomy from the Greek original. No apology is needed for introducing it here, so that English readers may become acquainted with this splendid and long-buried contribution of anatomy to obstetrics. [Translation of the Chapter on the Anatomy of the Female Organs of Generation, from the work of Soranus on " Diseases of Women"'] Chap. IIT. — The Nature of thic Uterus and Female Pudenda. Uterus. — The Uterus, j) pv^Tpa, is called also vo-ripa and 5e\ays, like the end of a bronchus — becoming hard through the passage of discharges and by parturition. I It is interesting to note that, even at this early period, the effect of cellulitis in causing uterine displacement had been noticed. - See one of the passages quoted from Aretw us. 3 'S.iKva. literally agourd; then a. cupping-glass, because shaped like the long gourd. In the edition of < lelsus by E Milligan, an ancient brazen eucurbitula is figured ; but the belly is rounder and the neck is foreshortened. Celsus tells us that it was used by pouring a hot liniment into the tiask, the mouth of which was then applied to the skin. 4 i.e., mouth, now os uteri, by which term we shall translate it throughout. 6 Neck, now cervix. c The narrow part of the neck, now isthmus. 7 The stem. v Shoulders. 9 Literally ribs, then sides. 10 Literally the hollow or belli] of a drinklng-cup ; including more than what we now call fundus, which Soranus names jjdais- II The lowest part or b'se, now fundus. What we call the "body of the uterus," Soranus thus divides into two portions : (1), the pleura or sides, corre- sponding in position to the horns ; (-2), the puthmen or widest part, correspond- ing to the rest of the body except the basis or fundus. '12 The hollow. is Thebelly. 14 Literally a hollow, then a bosom-like fold of a garment. The term is usually restricted to the vagina, hence our word " colpitis," and is thus used by Soranus further on ; here it includes the cavity of the uterus. 18 UTtpvyunaTa, literally wings; Videpostea on •• External Genitals." 10 Literally five or six fingerbreadths, the fingerbreadth being about T 7 S inch. This is more accurate than that given in Quain's Anatomy, which makes it 4 in. along anterior wall and 5 to in. along posterior. ,r ('/. .). Matthew- Duncan's Lectures on Sterility, London 1884, p. 1.31. 18 ('/. Burton's " Observations on the Cervix becoming more Patulous during Menstruation,'' Brit. Med. Jour., L884, ii. p. 607. >'■> Vide antea . 9 Structure. — The whole uterus is as far as possible fibrous, 1 not com- posed of fibres alone, but also of veins, arteries, and flesh. Of these, the fibres come from the membranes of the spine, but the arteries and veins from the vena cava and the large artery lying on the spinal column — for two veins spring from the vena cava and two arteries from the large artery, of which one vein and artery run towards each kidney ; but before these enter the kidneys they bifurcate, two branches going to each kidney and two embracing the uterus, so that the latter receives four vessels — two arteries and two veins. 2 From these, an artery and vein pass to each ovary. 3 Ovaries. — The Ovaries grow out from the side near the isthmus about opposite to the middle of the uterus. 4 They are not of firm consistence, are glandular, and are covered with their own membranes. In shape they are, unlike the male organs, long and somewhat flat ; and are round and broad at their base. The spermatic vessel from the uterus is carried out of each ovary, and, being placed along the sides of the uterus as far as the bladder, enters into the neck of the latter. 5 Whence it appears that the seed of the female, inasmuch as it is poured out, does not play a part in the production of life. Of this we shall speak when we treat of the seed. 6 There are some, amongst whom is Chius, who say that there are suspen- sory ligaments for the ovaries ; and we have seen the same with our own eyes in a woman suffering from hernia, in whom during the operation the ovary fell clown through relaxation of the vessels which support and sur- round it, and with these the suspensory ligament came down. 7 Surfaces of Uterus. — The whole uterus is made up of two coats, which differ in their arrangement like parchment. s The outer is more fibrous and smooth and firm and white ; the inner is more fleshy and villous and soft and red 9 — intertwined throughout with vessels, which are most numerous and noteworthy over the broadest part of the body, 10 where the seed becomes adherent and from which the menstrual discharge takes place. 11 Those two coats are kept together by softer and more fibrous bands ; and, accordingly, when these are stretched, the uterus frecpuently falls down, 1 ~Sevpd}5r)s from vevpov, a sinew, nerve. 2 It is difficult to understand Soranus' description here. It is only on the left side that the uterine veins open into the renal. We must, however, remember that fifteen centuries must elapse before the idea of filling the vessels with wax, so as to allow of their being dissected out, springs up in the fertile mind of Swammerdam (1672). 3 Aidvpios, literally double, then twin, then testicle or ovary. 4 ITap' endrepov irXevpbv ava els. " Pleura " corresponds to the middle segment of the side of the uterus, v. antea. 5 It is not clear what vessel is here referred to. From the fact that it enters the neck of the bladder, we might suppose it to be the ureter ; but, as it is distinctly said that it enters the ovary and also runs down the side of the uterus, it is more probably the uterine artery. 6 Soranus evidently missed the discovery of the tubes made by Fallopius fourteen centuries afterwards, and supposed that the ova were carried into the bladder and ejected. 7 Perhaps the Fallopian tube is referred to here. 9 Soranus is here describing the wall of the uterus as seen on its two surfaces — the peritoneal and mucous-membrane ; we must remember that he is not describing the coats of the uterus as in section — an altogether modern method. In preparing parchment, two layers of papyrus were woven together. 10 UvdpL-rjv, the widest part of the body, v. antea. 11 This incidental reference to the menstrual discharge as coming from the body of the uterus is worthy of note. C 10 the fibrous coat remaining in its place, the other one descending inverted. 1 Further, commonly in multipara?, the uterus has folds running towards the body, usually two, and closely folded so as to be like, felt ; in those who have borne, the whole uterus is stretched out and becomes rounded.' 2 Uiocles 3 says that there are cotyledons 4 in the cavity of the uterus called Tr\(KTdvac' or Kepalcu. 6 which are nipple like outgrowths, broad at the base, and narrowing to the top ; that they lie on both sides, being devised by Nature for the sake of teaching the embryo to practise beforehand how to draw at the nipples of the breast. 7 But they make anatomy speak falsely, for the cotyledons are not found ; and what they say about them is contrary to Nature, as has been proved in treatises on generation. Sympathetic Relations of Uterus. — We must not suppose that the uterus is essential to life, tor not only does it falldown, but in some it may be cut away without causing death, 8 as Themiso 9 has recorded, and they say that in Galatia pigs fatten after the uterus is cut out. Nevertheless, it affects sympathetically the stomach and membranes. 10 It has, moreover, a certain sympathetic relation to the mammae: at all events, when it grows larger at puberty, the breasts also swell out simultaneously ; and although it brings the seed 11 to perfection, yet the mammae prepare milk for the nourishment of the offspring when born ; and when the menses How freely the milk dries up, while as long as the milk comes freely the discharge does not appear; so also in those past their prime, when the uterus grows smaller the mammae likewise somehow waste away, and when the embryo is diseased their size is reduced — in fact when in the pregnant we sec the breasts tall away and contract, we anticipate that there will be a miscarriage. So much for the nature of the uterus. Vagina. — The Female Pudenda are also called /,u\7ros ywaLKuos. u The wall is fibrous and somewhat rounded, like intestine, more roomy at its inner and narrower at its outer end ; and in it sexual intercourse takes place. It is attached internally to the cervix uteri. externally to the labia, interiorly to the breech, laterally to the fleshy parts of the acetabula, superiorly to the neck of the bladder — for this last, as we have said, extending beyond the os uteri and being placed close above the genitals, opens at its end into the urethra. Accordingly, it is evident that the vagina lies beneath the neck of the bladder, but upon the anus and the sphincter and the lowest part of the rectum. Its length, as we have mentioned above, varies not only with age, or with sexual intercourse, in which the cervix being elongated like the male organ takes up some part of the I Soranus apparently thinks that in Inversion the whole wall is not inverted. - Soranus is here apparently speaking of the two stems of the arbor vitse ; and does he here, like Khstner. refer to the arbor vitai's being less marked in multipara 1 than in nulliparae? We note that he does not think it worth while to contradict the received view that the uterus consisted of several cavities; he contents himself with simply describing what he has seen. :! Diodes lived about the end of the 4th century B.C. 4 'Ibis word means (1), tht suckers or the feelers of the polypus; (2), hence the feelers themselves ; also (3), in plural, certain vessels at the month of the uterus of some animals (Hippocrates . ■"' Literally, feelers of the polypus. I! Literally, horns. 7 Soranus is evidently here poking fun at Diodes. 8 Where is the recorder of recent statistics of extirpation of the uterus > '•' Quoted elsewhere by Soranus, but I cannot find when he lived 10 Miji/iyyes — nervous system (?). II i.e., ovum or embryo. 12 Here used, as will be evident from what follows, of the vagina. He goes on to describe the vaginal walls, etc. 11 vagina ; but also some have by nature a longer cervix, and others a very- much shortened one. The length [of the vagina] is in most adults 4 inches. It is certainly closed and narrower in virgins, being furnished with folds held together by vessels taking their rise from the uterus ; these cause pain in first sexual intercourse when the folds are opened out, for they are broken and discharge the blood usually seen. For the view is false that a thin partition-membrane has grown up, barricading the vagina ; that this is broken, and causes pain at first sexual intercourse or sooner when menstruation sets in ; and that, grown thicker, it produces the disease called atresia. For in the first place, it is not found in dissection ; and in the second place, in virgins it ought to offer resistance to examination with a probe, for the probe penetrates deeply ; in the third place, if the membrane was the cause of pain in intercourse, excessive pain must necessarily accompany the appearance of menstrua- tion, and not be delayed till coitus. 1 Further, if the membrane's becoming thick caused atresia, we should find it in the same place constantly, in the same way in which we always see other parts each in its own place. But in cases of atresia, the obstructing membrane is found at one time near the labia, at others in the middle of the vagina, 2 at others at the os uteri. So much for the vagina. External Genitals. — The pails seen outside are called irTepvyw/jLara, 3 forming, as it were, the lips of the vagina. They are thick, fleshy, and extending down beside each thigh, as it were, diverging from each other ; above, they end in what we call vify^i?, 4 which is the beginning of the two labia. In Nature this fleshy prominence is muscular, and it is called " nymphe " through its being covered as brides are veiled. 5 Below the clitoris another fleshy prominence lies concealed, which belongs to the neck of the bladder ; it is called the urethra. The rough portion forming a fold within is ealled xe'A.os. G Bladder. — The Female Bladder differs from that of the male ; for the former is larger, and has the neck curved, the latter is smaller with a straight neck. The nature of the female organs having been described, we go on to the functions of the Uterus: — Menstruation, Conception, Pregnancy; and, after development of the foetus, Parturition. Following the natural order, we shall speak first of Menstruation." In reading this chapter no one can fail to be impressed with the scientific orderliness with which the subject is treated, the exclusion of matter adventitious to anatomy, and the dogged keeping to facts. In the subject matter we note the following statements as of peculiar interest in relation to more modern work: — "When these (the ligaments) are shortened by inflammation, it (the uterus) is dragged over and lies to the side." "It (the os externum) becomes open at certain times, as in the orgasm of coitus, to receive the semen, and during menstruation that the blood may escape. 1 Soranus here combats some view that the hymen was always imperforate, and hence had to be broken even when menstruation sets in. 2 AldoTov — here used for the vagina. 3 i e., -wings — the labia majora. 4 Not what we now term the nymphse (labia minora), but the clitoris, as is evident from his description of its relations. Alo. to rats vv/ji.v ywatKeiuv iradQv, Moschionis de mulierum passionibus liber. F. O. Dewez, Viennse. Apud Rud. Graffer et Soc, 1793. D 14 are the ovaries placed ? Concerning the menstrual cleansing, why is it so called ?" etc. Putting aside the first question, answered in the first section of Soranus which we have not translated, those that follow take up the topics treated in his anatomical chapter and in the same order, with the exception that the vagina and external genitals are passed over. The questions that follow are based on the topics of the next section of Soranus which deals with menstruation; and the topics throughout are on the whole the same as his and in similar order. The form of the hook is an instructive example of how systematic and thorough the teaching at that time must have been. It is a catechism with 152 questions and concise answers such as might easily be committed to memory; and it has this further interest, that it contains what was thought to be the earliest drawing of the human uterus. 1 In our illustrations we have reproduced this drawing. From the foregoing it will be evident that this work of Moschion's is based on the teaching of Soranus, though when Moschion lived, and what the exact relation of the two books to each other is, lies wrapped in obscurity. Moschion admits in his preface that his book is not an original, but a translation from a Greek text for the use of " Latin matrons and obstetricians' 2 unskilled in the Greek tongue." This original Latin Moschion is lost. The Greek version, which we have in the College of Physicians' Library, is considered by Weber (quoted byErmerins) to have been produced in the sixth century at Constantinople ; and the extant Latin version is, according to the same authority, a still more recent reproduction of this Greek one. 3 Further, it is 1 I here mention tin- generally received view, but when we come to speak of Vesalius we shall find evidence that this drawing is a modern interpolation. The letters in the diagram are in Latin, those in tin- text in Greek, which shows, r think, that the cut is nol of tin- same date as tin- text. As tar as tin- mere lettering goes, we might consider tin- cut to be the older, for Dewez says that Moschion's original work was written in Latin. " Moschion," he writes, "as is evident from tin- preface to my MS., wrote tin- book for tin- sake of Latin matrons and obstetricians as being ignoranl of the < rreek tongue ; there- fore In- wrote in Latin, not in Greek. It is not unlikely that time has destroyed the Latin work, and only the (heck version written in very late ( treek has come down to us." Tin- term- in Moschion's text are the same as those of Soranus, except that tin- neck ami isthmus together make the xV " not *rau\6s, nXevpa becomes ■n-Xdyia, and wv0/i^v becomes jiddos. I think also that .Moschion transposes the lasl two: for Soranus everywhere uses pdais for the parts between the Fallopian tubes corresponding to the base on which the cucurbita or cupping- glass -land-, while Moschion applies it to the "cavity," to which tin- term is clearly inapplicable. This may also be tin- reason why the word -n-vOix-qv lias dropped out (meaning, as it does, " the belly of a flask") and is replaced by fiddos — " the deepest place." - •■ < Ibstetrician " is the Latin obstetrzx, sin .win- that the art was at this time practised by women. :; •• My (Weber's) own opinion is that the Latin foetus was a product of the Schola Salernitana, to which we owe many translations of that kind." 15 held by Weber and Ermerins that even the original Moschion is not based directly on Soranus, but on a work on Diseases of Women written in the fourth century by Caelius Aurelianus, who in his turn drew from Soranus. If this view be correct, we must place Moschion somewhere during the fourth century, or between it and the sixth. 1 These various editions of Moschion show that the book was widely used, and hence that the valuable work of Soranus in Gynaecology aud Obstetrics was during these centuries not altogether lost. We only hope that the students of obstetrics of those days read Moschion not Galen. It is interesting to follow the history of this book through its various stages in the light of these different editions : and we would suggest that the first Latin version, for the use of Latin- speaking matrons and midwives, was produced before the fall of the Western Empire in the fifth century ; its Greek sister just fits in with the development of the Eastern or Greek-speaking Empire at Constantinople in the sixth century; and the version in bar- barous Latin points to a later period, when learning was beginning to make way again in Western Europe. During the following centuries, Anatomy suffered the fate of all science in the lethargic sleep of the Dark Ages. It fared even worse than other sciences, because Islamism distinctly forbade both dissection and the representation of parts of the human body. It was not till the beginning of the fourteenth century that it roused itself again, and that in Italy where the world's life was intensest. The intellectual energy of Italy was at that time concentrated in the University of Bologna. Of the Bolognese School of Medicine at this time, Sir William Turner in his learned History of Anatomy 2 writes — " The University of Bologna, which, as a school of literature and law, was already celebrated in the twelfth century, became in the course of the following one not less distinguished for its medical teachers. Though the misgovernment of the municipal rulers of Bologna had disgusted both teachers and students, and given rise to the foundation of similar institutions in Padua and Naples, and though the School of Salerno, in the territory of the latter, was still in high repute, it appears, from the testimony of Sarte, that Medicine was in the highest esteem in Bologna, and that it was in such perfection as to require a division of its professors into physicians, surgeons, physicians for wounds, barber-surgeons, oculists, and even some others. Notwithstanding these indica- tions of refinement, however, anatomy was manifestly cultivated rather as an appendage of surgery than a branch of medical 1 Dewez informs us that Gessnerus is wrong in making Moschion live in Nero's time, for the son of that Julia Agrippina whom Moschion says he cured of sterility had the cognomen of Diogenes which Nero had not. 2 Encyclopaedia Britannica, ninth eel., vol. i. p. 805. 16 science. ... In this state matters appear to have proceeded with the Medical School of Bologna till the commencement of the fourteenth century, when the circumstance of possessing a teacher of originality enabled this University to be the agent of as great an improvement in medical science as she had already effected in jurisprudence. This era, indeed, is distinguished by the appear- ance of Mondino, under whose zealous cultivation the science first began to rise from the ashes in which it had been buried. This Father of Modern Anatomy, who taught in Bologna about the year 1315, quickly drew the curiosity of the medical profession by well-ordered demonstrations of the different parts of the human body. In 1315, he dissected and demonstrated the parts of the human body in two female subjects; and in the course of the following year he accomplished the same task on the person of a single female." Though Mondino dissected three female bodies, he evidently did not examine the uterus, for in his Text-book of Anatomy, issued in 1310, he describes the uterus as containing seven cavities. This volume, as the first modern work based on dissection, gained such a position " that here and there in Italy it was decreed by law that anatomy should not be taught from any other book " (Haller). Mondino's text-book, with its defective and altogether erroneous description of female pelvic anatomy, was thus for the next two centuries the standard work in Italy. Soranus and Moschion lay buried and forgotten. It is for this reason that, although the revival of General Anatomy begins with Mondino, the revival of Obstetric Anatomy (which marks the commencement of our Third Period) does not date from him. Towards the end of the fourteenth century a great impulse to the study of anatomy came from the students of Art. To Giotto's failures to represent hands and feet and the position of the limbs in different postures, we are more indebted for the revival of interest in anatomy than appears on the surface. The first anatomical drawings (for there are no illustrations in the works of Mondino), if not the first efforts to get at what lay below the skin, were by Leonardo da Vinci (1452-1518) — great in anatomy as in ait. Not only have we his own anatomical drawings, but we read that he illustrated the anatomist Mark Antonio de la Torre's book for him. 1 Of Michael Augelo's work, Haller says, 2 — •■ Exact anatomical skill is seen in his drawings ; nevertheless he represented muscles more stiffly than is right. Twenty-two anatomical plates of his are mentioned, which he drew himself." Choulant 3 gives a plate of one of his drawings, in which, although the skin is not removed, the muscles come out very strongly; alongside of the figure is a scale giving the proportions of the 1 Choulant's Gexchirltte mid Bibliographic der anatomischen Abhildinuj, etc., Leipzig, 1852, p. G. - Op. cit., ]>. 164. 3 Op. cit., p. 11. 17 different parts of the body. Raphael also left behind him several anatomical studies. We thus find an intimate relationship established between anatomy and art, they rendering one another mutual assistance. Anatomy aids art by giving it what is below the skin — the signi- ficant in the anatomical substratum of a given posture or action. Art aids anatomy by giving it, according to Choulant, three forms of illustration : (a), the diagram ; (b), the picture of an organ as an individual; (c), the representation of the type — the result of the study of many individuals, so as to get at the typical or normal, and eliminate the accidental or abnormal. This last is necessarily the result of many drawings of individual specimens, and represents what is common to all. This distinction made by Choulant is suggestive; for if we look at these three modes of representation comparatively we find that each has had its own place in history, and has now its own work to do. The first, or diagram, was earliest in history, for men could sketch in the general features of an organ before they knew it intimately (by " intimately " I mean in detail and exactly) : its work nowadays is chiefly as an aid to expression in teaching — by a rough diagram one can often show what one means mure quickly and more clearly than in words. The second, or drawing of the individual, came next — when a specimen of a given organ was first carefully studied and described : its work is in research, the gaining of new know- ledge. The third, or drawing of the type, came last, when enough of specimens had been studied individually to allow of generaliza- tion : its work is in handing on what has been accumulated, i.e., in teaching — in teaching only ; it is of no use in research. The Diagram, the Picture of an Individual Organ, the Drawing of the Type : each does its own work as an aid to expression, research, teaching. After this digression on these artist-anatomists and the service rendered by art to the study of anatomy, we return to the pure anatomists ; and among them the name of Berengario da Carpi stands out, and with him we make our Third Period begin. Third Period. This period commences with the work of Berengario da Carpi at the beginning of the sixteenth century, and it embraces also that of Vesalius, of Enstachi, and of Ballopio, — all of whom belong- to the same century. As we have said, we make this period begin with Berengario da Carpi, "primus humanae anatonriae instaurator," as Haller calls him. 1 Rightly " instaurat or " (re-storer), for he only brings obstetrical anatomy back to where Soranus left it. Son of a surgeon, he studied anatomy from a boy. He took his degree at 1 Op. cit., torn. i. p. 167. IS Bolcxma, and, after teaching surgery for some time at Pavia, returned to his university town to fill the chair of surgery. The University of Bologna still retained its position as tlie first in Italy. As in Edinburgh now, the University was the pride of the town, which even adopted on its coins the University motto, " Bononia docet." As a school of painting, too, Bologna had. become famous, especially through Francesco Francia, who did not die till 1517; so that, from the friendly relationship we have described between art and anatomy, we can well believe that Berengario, the professor of surgery, must often have met the dis- tinguished artist and Master of the Mint. After leaving Bologna in 1527, Berengario lived for some time in Piome, where he became famous for treating syphilis by mercurial inunction, and made a large fortune, which he left to the Duke of Ferrari. 1 Berengario did splendid work in Anatomy. He boasts of dis- secting at least a hundred bodies. He was even accused of cutting them up alive, but his " Anatomia vivorum" refers to what a surgeon might see in the course of an operation. His first work was to publish (1521)a Commentary on the Authorised Text-Book of Mondino. 2 He gave the results of his own dissections in a separate treatise, the Isagoge breves, etc.? which was published in the follow- ing year. Both of these works are noteworthy from two points of view: — (1.) They are the first text-books of anatomy with illustra- tions — the first efforts after an exact representation according to nature. The quaint attitudes and rugged execution are against them. The attitudes, representing the subjects as if alive, are an introduction of art into anatomy which the purely scientific spirit resents. The ruggedness is due to defective means of repro- duction, and an interesting paper might be written on the influence, of methods of reproduction on anatomical drawing — the "Wood, Copper, and Stone Ages. Still, the illustrations of Berengario are 1 We have the following quaint reference to him in Astruc : — "James; Carpensis, as he was the only one who knew this secret medicine, viz., using unctions and quicksilver in curing the venereal disease, was rendered so rich by that alone, that he died attested of (left in his will) forty thousand crowns in silver, besides plate, all which he left to the Duke of Ferrari. For all the water, adds Fallopius, runs to the sea." — A Treatise of Venereal Disease, etc., by John Astruc. London, 1756. Book v. p. 155. 2 " Commentaria cum amplissimis additionibus super Anatomiam Mundini van run, textn ejusdem in pristinum it verum nitorem redacto. Impressum BononifE per Hieronymum de Benedictis ; pridie Nonas Martii. mdxxi." 3 The College of Physicians 1 Library has nol the \^-i-l edition, bul tlii- one of 1535, published at Venice (entered in the catalogue under the name Berengarius Carpus, as if it were the work of a different man from the author of the Commentaria] : — "Anatomia Caipi, Tsagogt breves perlucidt ac uberime, in Anatomiam humani corporis, a, comuni Medicorum Academia, usitatam, a, Carpo in Almo H noniensi Gymnasio Ordinariam Chirurgia publicoz Docente, ad suorum Scholasticorum preces in luce date. Venetiis, Anno D. mccccxxxv." The title-page is adorned with a vigorous woodcut of Berengario at work among his pupils. On the last page of the 1 kit is described as—" Impressum Venetiis per Bernardinum de fotalibus Venetum, mdxxxv.'' 19 truly artistic productions. Choulant 1 says of him: — "Himself engaged in art, and associated with artists and the friends of art, he has kept the artistic standpoint in his works." (2.) These two books are further noteworthy as contributions to Obstetrics. The only viscus which he considers worthy of reproduction is the uterus ; and in making and publishing his section of it, he forever uprooted and cast out the erroneous teaching of Mondino. The plate represents a female figure standing with a veil behind her, which she holds over her head with the left hand. The abdomen is laid open ; the uterus and cervix divided coronally. There is grim humour in representing the subject as holding in her right hand, for purposes of demonstration, the front half of the divided uterus and cervix. The description is as follows : — " You have in the belly of this figure the uterus laid open, in which you will see certain black points indicating the heads of the veins, which are called cotyledons. You have, further, the uterus laid open outside the body, on which rests ^he index finger, And in the fundus of the uterus you will see a certain depression indicating a right and left half; but I have not found in the uterus any other division. The black points are the cotyledons, and you will see that the cervix does not possess these." This illustration with descriptive note appears in the Com- mentaries, and is repeated in the Isagoge. The Isagogc gives in addition a plate of the uterus (reproduced in our illustrations) seen from the outside and laid open, with this note : — " Because things repeated ten times are wont to please, you have here two uteri, of which the one is turned outside-in, where you will see how, through the whole cavity, there are many black points indicating round cotyledons, which are not present in the neck. In the other figure you will see the natural womb with its testicles and spermatic vessels, and the ligaments with which its horns are bound. You will see also the neck and the os through which menstrual blood and foetus pass and the semen enters." Passing from the work of Berengario we come to the three other great contributions in the sixteenth century made by anatomy to obstetrics — those of Vesalius, Eustachi, and Fallopio. Vesalius (1514-1564), a doctor's son, a native of Brussels, studied arts at Louvain, and medicine at Montpellier and Paris. He then returned to Louvain. where he began to teach anatomy, of which he became Professor at Padua in 1537, and his name thus comes to be linked with those of Fallopio and Eustachi in the Italian School of Anatomy. He worked chiefly at human anatomy, and, according to Choulant, secured the services of the best artists of the day to reproduce his preparations. He is even said to have employed Titian, but as that artist was upwards of sixty years of age when Vesalius published his first plates, it is more probable that Titian deputed his pupil Stephen von Calcar 1 Op. cit., p. 8, 20 to do the work. In 1538 he published his first six plates at Venice, and in 1543, when only twenty-nine years of age, his immortal work Be humani corporis fabrica libri septem. Further, in 1546, in a letter Be radice china epistola, he criticised Galen's work, showing that that anatomist dissected not men but monkeys, and mixed up his conjectures from the dissection of animals with old descriptions — whence his mistakes as to the uterus and other organs. The College of Physicians' Library contains a 1555 edition of the seven books on Human Anatomy 1 and a 1564 edition of the plal In the illustrations of the fifth book of his anatomy we have very fair representations of the uterus, cervix, and vagina — a great stride forward from the rude illustrations of Berengario First, we see (Fig. 24) the abdomen laid open, all the intestines cut away except the rectum, and the mesentery and omentum drawn aside so as to show the position of the uterus and bladder- seen through the brim. Fig. 25 is similar, only the peritoneum has been dissected off. In the description he says, " we have as far as possible deprived the uterus of the outer covering which the peritoneum affords to it. removing all the membranes as thor- oughly as possible, that we may see the vessels which carry the material of the semen to the ovaries, and again the seed from them to the uterus." From the plate and this description it is evident that Vesalius did not understand the Fallopian tubes. Fig. 26 shows the uterus removed from the body and seen from below; while Figs. 27 and 28 are very good drawings of the uterus and vagina removed from the body, the uterus being divided coronally. We have reproduced this figure, as far as it shows the uterus, in our illustrations. In Figs. 28 and 29 we have the uterus of the . and the cow. Fig. 30 shows a pregnant" uterus laid open, also the fetus and membranes: Figs. 31 and 32 the ovum from the dog and the ox. In the edition of anatomical plates referred to we have most of these figures reproduced in one plate, and in addition exactly the same drawing of the uterus as we have seen in Moschion's work, but with different letters and modern descrip- tion. The mode of representing the ovaries ami vessels resembles the other drawings of Vesalius ; it shows the uterine artery which was not known to Moschion; all the other illustrations of Vesalius are apparently of his own dissections and no mention is made of 1 Air' ■ Vesalii Bruxillensis, scholae medicorum Pativinae professoris, de Humani corporis fabrica, libri septem. Basileae, ex orhcino Joannia Oporini, anno salutis per Christum partes mdlv. mense Augusto. 2 Anatomes tot i addita est epitome innumeris meml'- 'in de corporis humani fabrica • And. Vesalius, Paris, mdlxiiii. j U this from a human subject ? Haller says in a foot-note (Op. cit., torn. i. p. 18-2) :— •' Vesalius confesses that he had rarely cut intoagravid uterus (Bad. . p. 207) and had not yet dissected one when he was publishing his work. ' 21 this illustration as being borrowed from Moschion : for these reasons we think that the illustration in Moschion's work is a modern interpolation, which would deprive Moschion of the credit of being the first to give an illustration of the uterus. Of the life of Vesalius, after publishing his immortal work, Haller says : — " The very fame of Vesalius spoiled his splendid work. Having become the first authority by his success in treat- ment, he spent the great part of his life after this at the court of Charles V. and Philip II. — a most acceptable court-physician, but shut out from all anatomical work except sometimes the examination of men dying from some unusual disease. Hence he did not add to nor correct the new edition of his great work in 1555, as might have been expected from his zeal for anatomy." He died in 1564, on a pilgrimage to Jerusalem, the generally received reason for which journey Haller endorses: he had cut down on the heart of a man who had just died so as to feel it beating with his hand, and through the clemency of Philip II. was allowed to expiate this crime by a pilgrimage to Jerusalem ; on his way home he was called to take the place of Fallopio at Padua, but was wrecked on his journey thither. JEustachi (1500-1 574j. — -The anatomical engravings of Bar- tolomeo Eustachi, or Eustachius as he is more commonly called, were, according to Sir Wm. Turner, completed in 1552 (nine years after the impression of the work of Vesalius), but were not published till nearly two centuries afterwards (1714) by Lancisi. 1 This book is in the College of Physicians' Library. There are two plates of the uterus — one showing the arrangement of the vessels, especially their relation to the round ligament. The descriptive notes to the plates are by Lancisi. The next plate shows the external genitals and the fundus as seen through the brim ; the uterus and vagina removed from the body, seen from the outside and in coronal section ; the human foetus with its membranes (chorion and amnion) and the placenta lying separate. With Gabriel Fallopio, or Fallopius as we usually call him (1523-1563), Haller 2 makes the Italian School of Anatomy begin, "which from the Eevival of Learning during the following century was supreme, so that there were few anatomists who did not go out from it." In the course of a short life (he died at forty) he greatly enriched anatomy. Besides being unwearied in research, he was a blameless man, "unjust to no one, except, perhaps, Eustachius — a bitter man to whom none of his contemporaries were friendly." 1 Tabulae Anatomicee Clarissimi viri Bartliolomeei Eustachii quas e tenebris tandem vindicatas et sanctissimi domini Clementis xi. Pont. Max munificentia dono acceptas preefatione notisque illustravit, ac ipso suae Bibliothecse dedica- tions die ptiblici j oris fecit Jo. Mariz Lancisius. Rome, 1714. - Op. cit., torn. i. p. 218. 22 His chief work was his Anatomical Observations published at Venice in 1561 ; the earliest edition of it in the College of Physicians' Library is in the complete works of Fallopius, published at Frankfort in 1600. 1 In these Observations 2 he devotes several paragraphs to the organs of generation in the female. After mentioning that the term cervix is often wrongly applied so as to include vagina, and that ib should be limited to that part in which the os uteri is, he describes the clitoris as follows : — '• It springs by a double origin, one from each bone of the pubis, and in both the aforesaid origins it has plainly muscular tissue, though little for the size of the structure. There are vessels running along the dorsum just as in the male member, and it ends in a certain extremity which looks like the glans, being contained in a sort of skin like tin- prepuce, which skin unites those two structures of the external genitals which are called by the Greeks, especially Soranus, Pterygomata. All this part of the pudenda a- it is small and hidden in the more tatty pari of the pubis has thus escaped the notice of anatomists, and so escaped it that I have been the first to lay bare the same in recent years. 3 ( If lIh- hymen he says : — "There is another structure to he noted in this sinus in women, which anatomists sometimes find and laugh at those who place a membrane there. But to my mind they are not thus to he laughed at." And he goes on to describe it as a membrane not entire, "hut perforated in the middle by a hole of such a size that in adults tin- point of the little finger can easily enter." He refers to Soranus's difficulty with regard to it, and says: " For the satisfaction of that great man let me say that the membrane does not seem to me very linn, and i> perforated like a ring." Of the uterus he writes : 3 — "I now come to the uterus, in which, if I explain my view openly, I doubt not that you will .-mile, since I am about to say things which not only contradict' the accounts of the ancients and moderns, hut also over- turn completely certain teachings, or at least make them totter. Never- theless, I shall not desist nor fear the quiet smile of a learned man. since I shall recount what I have seen again and again with my own eyes, and also showed openly to other-. ' lb- then describes the round ligaments: — "They are not muscular, although they appear somewhat red and fleshv. hut are twin fibrous processes springing from the sides of the uterus, and sometimes filled up with a fleshy cord so that they look red. Ascending to the inguinal region and perforating the peritoneum just as the seminal vessels do in the male, they pa— out through the opening of 1 Gahrielis Falloppii Mutinensis Physici ac Chirurgi prasclarissimi in felicissimo Gymnasio Patavino olim rem Anatoroicam et Chirurgicam admira- bili cum laude profitentis ; Opera omnia, in unum congests et in inedicinse studiosorum gratiam excusa, etc: Francofurti apud haeredes Andreae Wecheli, M DC. - Opera Omnia, p. 4l'o. 3 Op. fit., p, 421. the tendon of the descending oblique muscles ; . . . . and when out- side the abdomen, they turn slightly towards the pubis, and there end through being lost in the fat." Of the ovaries, he says : — " All anatomists assert with one voice that semen is made in the female testes, and that they are found full of semen, which I could never see although I gave no small labour that I might learn this. I have seen in them indeed some vesicles as it were turgid sometimes with water or a watery fluid, sometimes yellowish, sometimes limpid ; but I have never seen semen except in the spermatic vessels themselves or those called ' excretory.' They affirm also that those spermatic vessels spring from the ovaries, and are united completely to them, and end in the so-called horns of the uterus, which is not at all the case, since I could never see those seminal tubes united to the testes unless the uterus was patho- logical." After commenting on this, he thus describes the tubes with which his name has ever since been associated: — " That slender and narrow seminal duct rises, fibrous and pale, from the horn of the uterus itself ; becomes, when it has gone a little bit away, appreciably broader, and curls like a branch (capreolus) until it comes near the end, then losing the horn-like curl, and becoming very broad, has a distinct extremity which appears fibrous and fleshy through its red colour, and its end is torn and ragged like the fringe of well-worn garments, 1 and it has a wide orifice which lies always closed through the ends of the fringe falling together ; and, if these be carefully separated and opened out, they resemble the orifice of a brass trumpet. Wherefore since the seminal duct from its beginning to its end has a likeness to the bent parts (capreoli) of this classic instrument, separate or attached, therefore it has been called by me the Uteri Tuba. These are present not only in the human bodies, but also in the sheep, cows, and all other animals which I have dissected." He further describes 2 the blood supply to the uterus, showing that there are two sources on either side — what we now speak of as the ovarian and uterine arteries — -and that there is an anastomosis not only between these vessels on the same side, but between those of opposite sides. It is noteworthy that Fallopius made out this anastomosis before the injection of vessels was used as an aid to dissection. " The spermatic arteries and veins (although anatomists may affirm that, as in man, they mingle before they come to the ovaries) are sometimes carried without uniting 3 beyond the ovaries, and thus go so plainly to the uterus itself and the seminal duct [Fallopian tube], which most of them surround, that they can be recognised by every one ; for there belongs to the uterus a double set of arteries and veins — the one the seminal [ovarian], coming clown from above ; the other those which spring from the sides of the vessels of the sacrum. The latter, they say, are spread over the sinus, or (to use their term) cervix ; the former over the uterus itself or fundus. But it should be known that these upper vessels, before 1 Extremumcpie lacerum valde et attritum est veluti sunt pannorum attri- torum fimbriae. 2 Op. cit, p. 422. 3 '* Sejunctse aliquot ultra testem feruntur." 24 they are all spread out, anastomose in the uterus with some from below, and thus united enter the part of the fundus near the cervix or the sinus [vagina] itself ; also that, although now and then they go to join other vessels, 1 some branches from those lower vessels pass upwards to supply the fundus, which, as soon as they enter the substance of the uterus, anastomose, or are united with the aforesaid vessels from above. Thus there is always present a continual anastomosis, either outside the uterus or immediately beneath the peritoneum which covers the uterus, or in the substance of the latter. I think that this anastomosis has been neglected by anatomists, because during pregnancy the very copious supply of blood brought by the seminal vessels (as is evident in some pregnant persons) may be discharged into the vagina through these lower veins, whereas otherwise the monthly discharge is got rid of directly through the fundus uteri. 1 could not lie laughed at by anatomists were I to say that in the substance of the uterus itself some twigs of those vessels of the right and left side are so united that the vessels become one. I do not say all of them, but some ; and therefore that there is a community between the vessels on the right and left, and that nutriment is carried to the foetus by both kinds of vessels, although the umbilical ramifications [in the placenta] throw their roots into one side of the uterus only." Iii the next paragraph he touches on the anatomy of the preg- nant uterus, — " One thing, finally. I have observed in all the women whom I have dis- sected who died either during or immediately after or before labour, that the piece of flesh which is called by me placenta always occupies or sticks to one of the two portions of the uterus in which ends the opening of the seminal duct (Fallopian tube) ; and this also I have noted, that this opening is, as it were, the centre of the whole space occupied by the placenta. " In those parts which belong to the foetus I have some points in which I differ from the vest of anatomists, — (1st), This, which I said when I was treating of the umbilical arteries, that without doubt the arteries which are carried with the umbilical vein and urachus to the foetus are alway double in nature, 2 though often there is one only, which, as it is formed of the two large arteries of the chorion joined, also divides into two before entering the umbilicus, so as to pass to the arteries of the sacrum; (2nd), That the fleshy cake which coalesces with the uterus for the sake of the security of the vessels is never to be considered among the membranes of the foetus. "Although some say that Galen called it chorion, this is false; for Galen knew it well, not, indeed, in man, but in other animals, and calls it ' ilesh concreted round the mouths of the vessels,' but not chorion." It is worthy of note that Fallopius here speaks of having dis- sected cadavera from women in labour and post-partum, but the passages quoted are all that lie tells us of the anatomy of the pregnant uterus. In the next paragraph he says that Hippocrates called this concretion (placenta) "cotyledons," which leads him into an excursus 15 on the history and use of that term. He shows that Diocles, quoted by Soranus, held them to be mammae; Prax- asoras and Galen to be crater-like eminences at the mouths of 1 In conjuncta inferantur — lit., are borne into joined vessels. - Xempe perpetuo geminas esse arterias. :; Op. cit.. pp. A±2-i->4. 25 vessels; while Aristotle described them as little cups (kotvXoi, used by Homer for "cups"), convex towards the uterine wall, with nutritive material heaped up in them (like a phlegmon pro- ducing a tubercle), which exudes into the foetus. '■ Therefore the cups (or cotyledons) are those things of which Aristotle spoke, and truly they are not found in the human or canine uterus as anatomy teaches, but only in that of horned animals and of those men- tioned by Aristotle ; . . . and only in pregnancy." At the conclusion of this argument he points out the error of Hippocrates with a grace and dignity, as well as a desire to put the best construction on what another had taught, worthy of imitation : " This being settled, what shall we say if Hippocrates mentions ' cups ' ? May the Manes of so great a man spare me, a man who was the presiding deity of the medical art, when I say that he spoke the truth in words that deceived ! For if any one would doubt (my opinion) that crude or cold humours or even mucus contained in the uterus are the cause of abortion, he would walk blind in daylight ; but that these humours are contained in cotyledons is false, because there are no cotyledons. In the mouths of vessels these humours may be contained, but being there they would by no means cause abortion." Eallopius made another contribution to Obstetrics in his descrip- tion of the bones of the foetus in the Expositio de Osd'bus — in Haller's quaint language, " Ossa enim foetum primus inter mortales contemplatus est." These four men — Berengarius, Vesalius, Eustachi, and Fallopio — made the chief contributions of anatomy to obstetrics during the sixteenth century; and with that century our study of the " early contributions" should end. Important their contributions were — so important that on the first superficial glance over the field it seems as if the harvest were reaped, and little left to be gathered in. Dr John Barclay, the Extra- Academical Lecturer on Anatomy in Edinburgh at the beginning of this century, has thus wittily compared the work done by these men with that of those who followed them : — " Gentlemen, wbile carrying on your work in the dissecting-room, beware of making anatomical discoveries ; and, above all, beware of rushiuo- ^ v ith them into print. Our precursors have left us little to discover. You mav perhaps fall in with a trifling supernumerary muscle or tendon, a slight deviation or extra branchlet of an artery, or perhaps a minute stray twio- of a nerve, — that will be all. But beware ! Publish the fact, and ten chances to one you will have it shown that you have been forestalled lon» ago. Anatomy may be likened to a harvest field. First come the reapers" who, entering upon untrodden ground, cut down great store of corn from all sides of them. These are the earliest anatomists of modern Europe, such as Vesalius, Fallopius, Malpighi, and Harvey. Then come the gleaners, who gather up ears enough from the bare ridges to make a few loaves of bread. Such were the anatomists of last century — Valsalva Contunnius, Haller, Winslow, Vicq dAzyr, Camper, Hunter, and the two Monros. Last of all come the geese, who still contrive to pick up a few 2G grains scattered here and there among the stubble, and waddle home in the evening, poor things, cackling with joy because of their success. Gentlemen, we are the geese." 1 Dr Barclay's humorous statement does not hold true of the anatomy of obstetrics, for while the contributions hitherto made by anatomy to obstetrics deal principally with the anatomy of the uterus before pregnancy, a little consideration will show us that the field of the anatomy of pregnancy and labour was before the eighteenth century unreaped. To throw a bridge over the gap between the " early contribu- tions " and the work of more recent date, we shall just touch upon one or two names familiar to us in obstetrical anatomy, and thus join the old with the new. In the seventeenth century we have two names — Malpighius (1628 to 1694), and Graofiiis (1041 to 1673). Malpighi was Professor of Anatomy at Messina and Bologna, and published in 1681 his monograph, De Utero Epistola, in which he describes the mucous glands in the uterus of the calf, the muscular fibre of the wall, and the corpora lutea of the ovary. 11. de Graaf, whose name has become immortal in the Graafian follicle, published at Leyden in 1672 his De Mv.lie.rwm Organis Generationi inservientibus ; and shortly before his premature death, his Partium Genitalium Defensio. In the former of these he describes— in the human female — the uterine vessels and those of the foetus, the corpus luteum, and the mucous glands of the uterus. In the eighteenth century, most of the names group themselves round the illustrious Hatter (1708-1777), and we cannot refrain from quoting from a bit of autobiography he gives us 2 in his work to which we so often have had occasion to refer. " I may be allowed here to review my life— that part which belongs to anatomy. Knowing too well how unequal I was to the great task I undertook of building up physiology from the foundation, 1 shall show, if I do not mistake, that I made some efforts to get nearer the truth." After dissecting animals at Tubingen under Duvernoi, who used dogs when human bodies failed, he went a mere boy to Leyden to attend Boerhaave's lectures. " I heard Boerhaave's lectures," he writes, " with incredible pleasure." "That incomparable man gave his teaching so honestly, clearly, and fully, that while he might have equals in matter, he had none in the art of teaching. I worked alongside of Albinus with no small reward, imitating on the opposite side of the body what this distinguished man was demonstrating to Ins industrious students on the other 1 often went to the "excellent old man Ruysch, frequently with commissions from Boerhaave. There was in him the greatest zeal, patient work in in- jection, and he was very skilful in preserving bodies. In 1727, I went to England, and became acquainted with James Douglas, from whom I might have derived much greater benefit — for the great man allowed me i The Story of the University of Edinburgh, by Sir Alex. Grant, Bart. London : Longmans, Green, & Co.: 1884. Vol. ii. p. 390. - Op. cit., torn. ii. p. 195. 27 to share in the work which he was carrying on diligently in completing the description of the bones. I saw, and with no small admiration, his great wealth of skeletons and hones — some lying with their ligaments in salt water, others cut in every direction with a saw. But the great rush of people from the whole of Europe for the inauguration of the new king — that prince to whose munificence I owe much, George the Second — drove me to Paris. There I heard Le Dranium as a guest, and dissected with him. I confess (may the good old man forgive me) that I was disappointed at the paltriness of what was called the theatre, and by the too rapid dissection which could not investigate anything very carefully. Further, when I saw Winslow tracing out the most minute parts of the human structure, I was not satisfied until, along with a surgeon de la Garde, I got at my own expense secretly a supply of dug-up dead bodies in which I might examine the nerves and vessels of the heart, the muscles of the hand, and other things, more carefully and with something of the detail of Winslow. But the spiteful curiosity of a labourer overturned this opportunity of learning ; for having dug under the wall to see what I was doing, he reported my name to the guardians of public safety. To escape heavy penalty, perhaps the galleys, I had to hide, and have the bodies removed." After other appointments, we find him settled at Gottingen. Of his work there he says : — "I had only to build an anatomical theatre and procure a supply of bodies. I arranged that the bodies of criminals should be brought to me from all parts to be dissected, that those of the illegitimate should also he handed over, and thus I got an ample supply of cadavera, especially of children. It was thus easy for me to prosecute with greater zeal the anatomy of the arteries, which at that age could be better demonstrated than the muscles, and had been incompletely, even erroneously described, for the beautiful injections of the Belgians were directed rather to the intricate arrangement of the minuter vessels than to the more general distribution called pojjularly " Angiologia." Haller had the faculty not only of continuous labour him- self, but also of setting others to work ; and if we owe a great deal to him, we owe much also to his students. " Further, another idea very fortunately occurred to me. When I saw numerous eager young students flocking to the new academy and seeking the highest honours, I advised each to take up for himself some difficult point of anatomy or physiological question, to which he might devote himself for two winters. There were plenty of cadavers at their com- mand ; I helped the studies of the young fellows as much as I could, and made many investigations (experimenta) on different animals — in fact, an incredible number. Accordingly, as several of the young men were simultaneously devoting their ieisure, which was greater than mine, each to a single part of our noble art, much more progress was made than any industry of mine alone could have effected. To this day it gives me the greatest satisfaction to turn to the exquisite descriptions of the nerves by Meckel, Anderschen, and others, that careful study of the sheep which Kuhlemann undertook, and the admirable anatomical pre- parations of some of the rest of the young men. Nor has light failed to shine from this Institution upon Physiology. " But as human affairs are imperfect, I, who had been called from clinical practice to anatomy, was compelled to lay aside such inquiries ; being driven from lecture-room and chair by failing health, loss of sleep, and a weakness of the right hand which threatened paralysis. I had to 28 sacrifice honours, rewards, and the hope of learning and achievement dearer than all these, to the preservation of life and health. Labours of a very different kind were awaiting me in my native land, which those coming alter me will hardly believe to have been imposed upon me, unless they he familiar with the genius of free republics. "Nevertheless from the hours claimed by my country. I snatched some for myself. As opportunity offered I measured carefully the motion of the blood, in- _ the form of the bones and the rest of the foetus, dissected pregnant animals, studied the anatomy of brain and eyes, and worked also at pathology ; I thus kept up in some degree my practice in anatomy." He speaks thus regretfully of having to give up his time to public affairs : — "I have always praised the g 1 fortune of Albinus, and should almost have envied it if that loftiest of men had not used so well the great opportunity he had. This distinguished man gave mure than fifty years to a single art, drawn aside by no other duties ; he was able to forego all honours for the perfecting of his subject." The latter part of his life was given to legal and political work, and he writes thus sorrowfully of his having to give up his favourite studies for public duty: — ' : My lot drove me to the different departments of law, to a laborious magistracy, to the care of the Republic, to difficult negotiations with neighbouring states and kings, and to various other duties. Therefore let a generous posterity pardon me if I have not done more than I was able for, have left here and there some things incomplete, and Lave been compelled to take some things from otherssince I could not have observed everything myself. Let them, I pray, take the will for the deed." To almost all of those whose names are mentioned in this interesting bit of autobiography, Obstetrics is indebted for some anatomical contribution. Albinus, with whom Haller dissected in Paris, has given us seven plates of the gravid uterus, published at Leyden in 1T47. 1 The plates are drawn full-size, and are beautiful as works of art, but they lack the accurate anatomical detail which characterizes Hunter's work. " The excellent old man Ruysch" a native of the Hague and professor at Amsterdam, is known to us as the author of the " Tractatus de musculo in fundo uteri observato, antea a nemine detecto /' in this he describes the muscular fibre of the fundus uteri as forming a detrusor placenta. The James Douglas, whose wealth of skeletons and bones excited Haller's admiration, is better known to us as the 1 />'. . s '. Albini Tabula septem uteri mulieria gravida rum jam prirturiret mortvce. Lugduni Batavorum, mdccxlviii. In the College of Physicians' Library we have these hound up with his magnificent plates of the bones and muscles. Plate I is an outline of the figure of the uterus ; Plate II., one-half nf the uterine wall removed, showing the ovum in the cavity ; Plate 111., one- half of the membranes in addition removed to show the foetus ; Plate IV., foetus removed, showing placenta attached to the uterine wall ; Plate V., uterus and placenta removed from body : Plate VI., the complete ovum ; Plate VII.. uterine cavity with ovum removed, showing placental site. An appendix -how- the attitude of the foetus in id 29 describer of the peritoneum round the uterus, and especially of the pouch which bears his name. 1 To the idea which fortunately occurred to Haller of advising his students to take up an anatomical point, and work at it for a graduation thesis, obstetrics is greatly indebted. Volume V. of his Selected Theses on anatomical subjects is devoted to the Organs of Generation. 2 In it we find, amongst others, his own disserta- tion on the " Oblique Situation of the Uterus, and the Seminal Vessels ;" Naboth's essay on " Sterility in Women/' which survives in the name of the ISTabothian follicles of the cervix; also Vater's essay on the "Gravid Uterus," giving a drawing of a six- months' pregnant uterus — one of the very early representations of the Gravid Uterus. To Edinburgh men it will be of interest to know that amongst Haller's students was Donald Monro, son of Alexander (Monro primus), the Professor of Anatomy in our University. He read before an Edinburgh society a paper 3 on the maternal and foetal vessels in the placenta, showing by injection that there is no com- munication between them. His father had read before the same Society an elaborate essay on the " Nutrition of Foetuses ; " and in the same volume we have two essays on ' the Anatomy of the Pregnant Uterus, from his younger brother Alexander Monro, " student of medicine in the University of Edinburgh." Another of Haller's pupils was the distinguished anatomist and obstetrician Raiclerer, whose seven plates 4 of the gravid uterus are less diagrammatic than those of Albinus, the drawings of cervix and ovary being especially good. Along with the plates of Albinus and Ecederer we must mention those of another famous man, although his name is not connected with that of Haller. In 1754 Smellie published in London his beautiful series of plates, which are so well known to English obstetricians that I need say nothing 1 A Description of the Peritoneum and of that part of the Membrana Cellularis which lies on its outside, with an account of the true situation of all the Abdominal Viscera. London, 1730. 2 Disputationum Anatomicarum Selectarum. Vol. V. Organa generationis, Collegit edidit prcefatus est Albertus de Haller. Gottingse apud Viduam Abram Vandenhoeck, Acad. Typogr. mdccl. 3 The Dissection of a Woman with Child ; and Remarks on Gravid Uteri : By Dr Donald Monro, Physician at London. Article 17 in Essays and Obser- vations, Physical and Literary, vol. i. p. 403. Edinburgh, 1754. 4 Icones uteri humani observationibus illustrates. Gottingse sumptibus Vandenhoeckianis, mdcclvii. Plate I. represents a parturient uterus seen from the outside ; Plate II., same uterus laid open to show foetus and placenta in their natural position ; Plate III., same with foetus removed to show placenta ; Plate IV., gravid uterus at the sixth month, seen from the outside and with vessels injected ; Plate V., foetus and placenta in natural position ; Plate VI., internal surface of same gravid uterus as V., showing filamentous tunic of secundines, openings of tube and of cervix into uterus, and cervical canal laid open ; Plate VII. shows internal surface of the cervix, virgin uterus from outside and in coronal section, ovary of virgin, Graafian vesicles, ovary of pregnant woman, and various corpora lutea. 30 about them. Our reason for mentioning Sinellie's name here is that we regard the work of Albinus, Rcederer, and Smellie as together forming the first considerable contribution to the anatomy of the uterus in pregnancy in contrast to that of the non-pregnant organ, which had up to that time monopolized attention. This subject was during the eighteenth century systematically worked out, and attained its greatest development in the hands of William Hunter. By this brief survey of the work of the seventeenth and eighteenth centuries we have sought to bridge over the gap between the " Early Contributions of Anatomy to Obstetrics " and the work of Hunter, which we have dealt with in a former paper x — his immortal contribution, " The Description of the Gravid Uterus." 1 ''Sectional Anatomy of Labour," Transactions of the Edinburgh Obstetrical Society, 1886-1887, and Edinburgh Medical Journal, 1887. I'KINTKD liY OLIVER AND BOYD, EDINBURGH. DATE DUE C28 (747) MIOO nm~ EG611 B23 Barbour Barly contributions of anatomjr to obstetrics "RG- S/t 7B 23