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Vesalius was highly criticized for differing with Galen, and in his book A Short History of Medicine (1955, revised in 1982), Erwin H. Ackerknecht notes that Vesalius became frustrated by the vocifer- ous criticism of his work. He accepted a position as court physi- cian to Charles V, who was Holy Roman Emperor and, as Charles I, king of Spain. His responsibilities were quite demanding. Charles was not particularly well, suffering from both gout and asthma, and so care of the king took time. In addition, it was general prac- tice that court physicians were also loaned out to noble families or royalty from friendly countries.

Vesalius asked permission to make a pilgrimage to the Holy Land, and it was reported that when he returned, he hoped to return to teaching. As it happened, he died before returning from the pilgrimage.

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Miguel Serveto (1511–53), known as Michael Servetus, was a Span- ish theologian and physician who lectured and wrote on geography and astronomy, but his deepest commitment was to theology. Ser- veto was the first to develop a coherent understanding of pulmo- nary circulation. The Islamic physician Ibn an-Nafis (1213–88) had written about pulmonary circulation 300 years earlier, but most Islamic medical and scientific discoveries were unknown in Europe at this time. Though Serveto was the first of the European physicians to recognize how the system worked, he did not have the reputation or the stature that permitted him to have an impact on the medical knowledge of his day.

Religion was Serveto’s prime interest, and at age 15 he entered the service of a Franciscan friar before studying medicine at the University of Paris. Though he began to practice medicine, he pri- marily traveled in religious circles, and this exposure made him aware of religious dogmatism and intolerance, and he became dis- tressed by papal ostentation. He began to fight against these issues, but Serveto was a difficult fellow who had trouble expressing his

beliefs in such a way that people could listen with an open mind. He became quite unpopular with both Catholics and Protestants, so when he moved to Lyon, he adopted a pseudonym, Michel de Villeneuve.

In 1546, he completed a draft of a treatise he wrote about reli- gion Christianismi restitution (On the restitution of Christianity). In it, he opposed baptism of infants as well as the idea of the Trin- ity. Amazingly, within this 700-page document on religion, Ser- veto describes pulmonary circulation; this is the first time it was correctly described by a European physician. Serveto wrote that he believed that an understanding of the movement of the blood would lead to a greater understanding of God. He recognized that Galen’s system was not correct, because by Serveto’s observation the blood seemed to travel to the lungs for its own nourishment, a point that Galen did not realize. Serveto noted that the pulmo- nary artery was very large and that blood moved forcefully from the heart to the lungs, so he considered that more blood than was necessary to nourish the lungs was traveling there and that there must be a reason for this. Serveto developed the theory that the reason for the change in the color of the blood was because aera- tion took place—that the bright red blood was charged with air before traveling to the left ventricle. Serveto also concluded that the passages between halves of the heart, written about by Galen, did not exist.

To Serveto, the significance of this treatise lay in the religious ideas he expressed. He sent a draft off to John Calvin (1509–64), a French Protestant reformer who was building a powerful follow- ing for a new religious system that taught predestination. Calvin corresponded with him a few times, kept the manuscript, and then refused further contact. The Protestant reformers saw Serveto with his very Christcentric view of the world as a dangerous radi- cal. When Serveto could not retrieve his manuscript, he rewrote the whole thing, and arranged for the printing of 1,000 copies in 1553. He then turned against Calvin, openly criticizing him.

The concept of religious freedom did not really exist in Ser- veto’s time. Some of Serveto’s letters to Calvin were found and

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The ScienTific RevoluTion and Medicine

turned over to leaders of the Catholic Inquisition, which was dedi- cated to rooting out any sort of disloyalty to the church. Serveto was imprisoned, but he managed to escape. Four months later, he attended a lecture given by John Calvin in Geneva, and he was recognized, arrested, and sentenced to death for heresy. He was burned at the stake, and most copies of his writings were destroyed as well.

Later, it was discovered that three copies of Serveto’s works had survived but had been hidden, and as a result pulmonary circula- tion continued to be largely misunderstood. It was left to William Harvey to more fully express this theory. (See chapter 4.)

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Vesalius’s anatomical studies were later pursued by Realdo Colombo (ca. 1516–59), an Italian apothecary who became an anatomist and laid the foundation for William Harvey to eventu- ally explain the flow of blood.

Colombo apprenticed to a well-respected Venetian surgeon for seven years and went on to study surgery and anatomy at the University of Padua. In 1543, Vesalius, a professor at Padua, left to oversee publication of Fabrica, and Colombo took over the teach- ing position he vacated. Colombo eventually moved on to become the first professor of anatomy at the University of Pisa. Later, he moved to the Papal University in Rome where he became surgeon to Pope Julius III.

Colombo was particularly skilled at dissection, and as he worked he began to realize that Vesalius was in error about the passage of blood within the heart. He noted the structure of the vessels, the absence of pores in the septum, and the location of the vessels. He obtained fetuses to dissect and noted that some vessels seemed to circle around the lungs. He outlined the circulation of the venous blood from the right ventricle through the pulmonary artery to the lungs, where it emerges bright red after mixing with “spirit” in the aria, and returning to the left ventricle through the pul- monary vein. He noted that the pulmonary veins had blood, not

air (pneuma) as Galen had taught. He also described the general action of the heart, stating that the blood is received into the ven- tricles during diastole (relaxation) and expelled from them dur- ing systole (contraction). His work on living animals and human cadavers gave him good insight on anatomy, and he wrote well and accurately about the organs within the thoracic cavity, including the pleura (membrane surrounding the lungs) and the peritoneum (membrane surrounding the abdominal organs).

Colombo may have defined pulmonary circulation as early as 1545, but his work De re anatomica (On things anatomical) was not published until 1559 when his children made certain that it happened. It was highly critical of Vesalius’s work and contained Colombo’s theories of the movement of the blood within the body. (He may have read Miguel Serveto, and it is not clear how much of Ibn an-Nafis’s theories were known to the Italians.)

Colombo was the first well-known anatomist to write on pul- monary circulation. Even then, his reputation was not strong enough to overcome the power of Galen’s writings. It took another 70 years before William Harvey came along and made public head- way in this area.