Blood and Guts (5 page)

The chain supporting the skeleton hangs some nine feet off the
ground, and the corpse itself is considerably bigger than Vesalius.
Even if he manages to get it down, he realizes he has little chance of
carrying it home in one piece. With time against him, the obvious
solution is to take one bit at a time, so Vesalius jumps up and grabs
one of the legs. Tugging hard – it's surprising how strongly the
femur is attached to the bones of the pelvis – he pulls it towards him
until the ligaments rip with a hollow tearing sound and the joint
pops out of its socket. He hauls it clear as the skeleton lurches to
one side, dancing crazily on the end of its chain.

Vesalius then pulls off the second leg, twisting it out of its
socket. The bones pile up at his feet. Next he decides to take the
arms, but has to be careful not to damage the ligaments holding
together the fragile bones of the hands. He also has to reach them.
Fortunately, the wooden scaffold is rough and he can climb up,
grabbing the swaying chain to pull the stinking corpse closer. Using
one hand to steady himself, he grabs an arm with the other, gives it
a sharp twist to pop it out of the joint and drops it to the ground.
He then yanks the chain to spin the body round and reaches across
for the second arm.

Jumping to the ground, he bundles up the bones in his cloak,
like firewood, and hastens towards the city, keeping to the shadows
as he makes his way home. Once there, he dumps the pile of bones
on his kitchen table and, pausing only to pick up a hammer, heads
back to the gibbet. He is determined to remove the rest of the body.

The head and trunk are all that remain, but the chain is
attached to the top of the backbone and takes some hefty blows
from the hammer before it comes free. Although he tries to catch
them, these final body parts – the ribcage, pelvis and skull – fall to
the ground, so he jumps down and wraps them in his cloak.

The gibbet casts a long shadow in the moonlight as Vesalius
scrabbles around in the dirt to gather any stray pieces of cartilage
and stuff them into his pockets.

The final challenge is to get back into the city. Night has fallen
and the curfew is in place. Returning through the main gate would
be foolish. Even an educated man such as Vesalius would have a
hard job explaining his mission to the watch-keepers. He heads
instead for another gate – one where he can slip past the guards
unnoticed or, at worst, bribe them to get in.

Stealing a corpse from a gibbet might seem enough work for
one night, but Vesalius is a man possessed. Safely back home, he
now has a substantial collection of bones on his kitchen table –
but they are starting to smell. There is more flesh on the bones than
he thought. In the warmth of the kitchen, even the smoky fire
can't disguise the sickly stench. Not only is this unpleasant, but the
neighbours will notice. This could only lead to difficult questions.
So, undeterred, Vesalius sets about stripping the corpse down to
its bare bones.

After placing a large pan of water to heat on the fire, Vesalius
gets a knife and scrapes away any last shreds of muscle, tendons and
skin. He reaches his fingers into joints to separate out the cartilage
and places this carefully to one side. When the water has boiled, he
drops in the bones. He tries to keep the bones of some parts – such
as the hands and feet – together as much as possible.

After a few minutes, he drains away the fat, straining the liquid
to avoid losing any odd pieces of cartilage or fragments of bone. By
daybreak the task is complete, the rotten flesh is discarded outside
in the gutter and the bones and cartilage are gathered in an enormous
pile on his kitchen table. Now all Vesalius has to do is put the
skeleton back together again.

Although technically illegal, bodysnatching wasn't a wholly
unusual pastime for a medical student. Few people were likely to
complain if the remains of a criminal or pauper went missing.
Frankly, it was doing everyone a favour. Neither was this the first
time Vesalius had been involved in stealing a body. Desperate
for some hands-on experience of anatomy, he had already joined
with other young physicians to take bodies from the cemeteries
of Paris when he was at medical school. But dead human bodies
were difficult to come by, and Vesalius had a plan for his boiled-up
bones.

In sixteenth-century Europe, Galenic medicine was as healthy
as ever (unlike many of the patients who received treatment).
Galen's 'scientific' writings had been recently rediscovered, translated
and adapted; his theories re-examined and absorbed into
the Christian doctrine for the modern European age. Medical
treatment involved a thorough examination of the patient. The
pulse would be read and therapy prescribed, depending on the
imbalance of the humours. Just as in Galen's day if you went to
the doctor with a fever there was a good chance he would get out
the bleeding bowl or reach for the purgative and funnel to clear
out your bowels.

But whereas the study of medicine was a respected, even noble,
profession, surgeons were, as Vesalius would bemoan, considered
little better than servants. There was, however, a growing fascination
with anatomy. This was led, to a large extent, by artists. Renaissance
artists were enthralled by the human body, its form, bone structure
and musculature. And in the same way that doctors looked to Galen
for insights, artists took inspiration from the beautiful statues of
ancient Greek and Roman culture. A few years earlier, Leonardo da
Vinci had become intrigued by the mechanics of the body. He
produced intricately detailed drawings of human anatomy, of the
brain, blood vessels and nervous system. Unfortunately, they
remained unpublished during his lifetime.

Human dissection, almost always of criminals, was rare but gaining
in popularity as part of medical training. Students were expected
to attend lectures on human anatomy. At these, a professor would
stand in a pulpit to read from Galen's text, while an assistant opened
up the body. But these events could become awkward affairs when it
became apparent that what Galen had described bore little relation
to the anatomical reality of the human body. People were beginning
to realize that, for all his genius, Galen had probably cut open
animals rather than people. Some in the medical profession – particularly
precocious medical students – were starting to question his
wisdom. For surgery to develop, someone had to get a proper grip
on where everything was and how it worked.

Vesalius set himself the task of reaching a fuller understanding
of human anatomy. Back in his kitchen he began to sort out
the bones and cartilage of the skeleton. He painstakingly identified
each bone and laid it out in the correct position until his human
jigsaw gradually came together. The parts that were missing, the
foot and kneecaps, he 'obtained' from another corpse. There are
206 different bones in the human body, and Vesalius eventually
laid out every one before carefully wiring them together into a
skeleton that could be hung from a hook – not unlike the gibbet it
was originally taken from.

The reconstructed skeleton was only the start. Over the next six
years Vesalius dissected as many bodies as he could lay his hands on.
Many were those of executed criminals; others he acquired from
cemeteries. The contributions these dead people made to medicine
were considerable. With their help, Vesalius was soon able to map
every single organ, muscle and ligament in the human body.

Within the next few years Vesalius popularized dissection
and started holding public anatomy demonstrations. These were
attended by hundreds of spectators – not just medical students.
Dissection became such a popular entertainment that the supply
of bodies started to run out. This created a lucrative source of
employment for less desirable elements of society. Working in
gangs, bodysnatchers (or resurrectionists, as they would later be
known in Victorian London) could make a comfortable income.
However, the profession wasn't without its occupational hazards.
Even if the authorities turned a blind eye, bodysnatching was still
illegal. There was also the risk of picking up diseases. A small
infected cut and you could soon be joining the other bodies
destined for the dissecting table.

Vesalius published his work in
De Humani Corporis Fabrica
(The
Construction of the Human Body). The invention of printing, using
movable type and woodcuts, allowed him to include technically
accurate and lavish illustrations. These pictures accurately identify
the locations of all the major organs, nerves and muscles in the
human body. The woodcuts show corpses posed in various unlikely
situations, as if they are still alive. A picture revealing human
muscles has the figure posed on a hillside in front of a town. There
is a corpse dangling from a pulley and a skeleton resting against a
tomb as if contemplating the meaning of life (or death).

The book was widely distributed and read by medical practitioners
across Europe. In it Vesalius corrected more than two hundred
of Galen's mistakes. These ranged from the structure of bones to
the shape of the liver. In the second edition of his book, Vesalius
also ruled out a connection (through Galen's micro-holes) between
the two sides of the heart. However, even though he had worked out
the structure of the heart, he still believed arteries originated in the
heart and agreed with Galen that veins started in the liver. It was
another eighty years before William Harvey concluded that the
blood circulated around the body (see Chapter 2).

After 1300 years of stagnation, anatomy was finally on a firm
scientific footing. Physicians and surgeons at last knew how the
human body fitted together. Vesalius had broken the first barrier to
the development of modern surgery. However, there were still three
more barriers to go.

A field near Turin, Italy, 1537

This is what happens when a musket shot hits a human body.

The bullet punctures the skin. As it does so, it drags fragments
of clothing and gunpowder with it. The shot rips through the flesh,
burning the tissue and splaying slivers of skin outwards. It gouges its
way through the muscle, tearing apart the muscle fibres and severing
tendons, veins and arteries.

As an artery wall is ruptured, blood starts to spray from the
wound – pulsing at high pressure into the cavity the bullet has
drilled. The bullet slows as it reaches the bone. The bone splinters,
scattering sharp fragments. The two ends of the broken bone smash
outwards through the skin. By now, the bullet has lost momentum
and becomes lodged in the wound, mixing with the congealing
bloody broth of muscle, bone, cloth and skin.

Injuries from musket bullets were far worse than anything that
had been seen with daggers, swords or arrows. When a blade or
arrow enters the body it inflicts a 'clean' wound and, with any luck,
comes straight out again. But with the invention of the musket, and
the larger guns that went with it, the battlefield was transformed.
The few battlefield surgeons available had to cope with overwhelming
casualties on a daily basis. When the guns opened fire and the
men fell, the smoke mingled with a flume of fine red mist – blood
spraying upwards from the injured and dying men.

Ambroise Paré had never seen such horror. The twenty-seven-year-old had been appointed as a battlefield surgeon to the French
infantry commander at the siege of Turin. The army had been
sent into northern Italy by the king, François I, in a long-running
dispute over territory with the Holy Roman emperor, Charles V.
By the time Paré arrived, the carnage was already horrific. To
get close to the battlefield he had to ride across the bodies of
dead and fatally wounded soldiers. Picking his way between them
as best he could, he was forced to ignore their dying moans
and pleas for help.

As Vesalius had noted, in sixteenth-century European medicine
even experienced surgeons held little standing in society. The
people who practised surgery were usually barbers. They had
received no formal medical training and spent most of their time
trimming beards or lopping off the odd wart. They might sometimes
be employed to assist doctors with bloodletting. As for Paré, he was
neither qualified nor registered as a surgeon. He had been working
as a barber-surgeon at the largest hospital in Paris, he had no
academic qualifications and no experience of anything other than
the most basic surgical procedures. Everything he learnt about the
profession (if it could even be described as such a thing) came from
hands-on experience. He was familiar with basic anatomy and the
theories of more advanced surgical techniques, such as amputation,
but had not had the opportunity to put his knowledge into practice.
He was going to have to learn fast.

Although the technology of war had advanced considerably over
the last few centuries, battlefield surgery had changed very little.
Surgeons had few options at their disposal. Any substantial wounds
or compound fractures of a leg or arm usually meant the limb had to
be removed. If a bullet entered a soldier's abdomen, surgeons might
attempt to remove it with their fingers, or try to drain the wound of
blood (and later pus as infection developed), but could do little else.
For any seriously wounded soldier, the odds of survival were poor.
However, surgery might give them a chance of life.

Every day Paré would saw off limbs. To stop the bleeding he
used a hot cauterizing iron. As the leg or arm was removed, he
placed the iron against the flesh – searing the muscle, blood vessels
and skin together. Bullet wounds received the same treatment.
With larger wounds, boiling oil was applied instead. Poured into
the hole left by the bullet, the oil would burn everything it touched,
destroying tissue but defeating blood flow. There was a belief at the
time that gunpowder was poisonous, so cauterizing with an iron or
pouring in hot oil had the secondary effect of destroying any
poison. Or so the theory went. When bullets had failed to kill the
soldiers, the shock of having boiling oil poured into their wounds
often finished the job.