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Marcia Crocker Noyes
(1869 – 1946)
Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore... This is certainly an article that can be called "A Moment in History"
Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]
Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.
The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.
Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!
Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.
Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.
Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.
In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.
The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.
Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]
NOTE: This article has been modified from the original Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.
Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding
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By Maurits Biesbrouck, MD. Continued from "Andreas Vesalius’ fatal voyage to Jerusalem (1)".
Front cover of C. D.O'MALLEY,
Andreas Vesalius of Brussels 1514 1564,
Many other letters of Languet, in that period, to his friends and acquaintances were published but surprisingly in none of them he repeated the story, just as if it was of no importance (or even wrong) (4). We found it not even in his Historica descriptio susceptae a caesarea maiestate executionis... (Aug. 1567), in a copy of which North found his manuscript on the first flyleaf. In his biography of Hubert Languet the French biographer Henri Chevreuil found no mention of it either (5). The overall impression is that this short message is not more than a gossip written by Languet as a fait divers, perhaps who knows somewhat light-hearted after a couple of glasses on that first day of the new year. Apparently Languet didn’t believe in the story himself as he begins with the words ‘Fama est…’ (Rumour has it…) and he continues with the remark that the story with the direct motive for his Jerusalem travel is a remarkable (mirabilis) one. His letter concerns only that motive, thus things that happened some twelve months before, and were not at all very recent. He gives no details on Vesalius’s death itself. Languet and Peucer knew each other well. That same year 1565 Languet returned to Germany after a mediation of Peucer, but later on he returned to France (6). In any case it can not be regarded as a genuine letter, as such writings, for obvious reasons, normally treat on different subjects and are considerably longer. C.D. O'Malley, who gives an English translation too, calls this story "wholly unacceptable" (7).
The best and most detailed account of Vesalius’s last months is indeed to be found in O’Malley’s biography, but he was apparently not yet aware of the letters found by Barón Fernández. Yet it represents the first proper attempt to distinguish truth from fabrication. O’Malley was convinced that the ulterior motive behind Vesalius’ journey to Jerusalem was to escape the Spanish court and take up for a second time the chair in anatomy in Padua, which had fallen vacant, as a result of the death of Gabriele Falloppio, well before Vesalius’s departure.
The letters found by José Barón Fernández
After the congress of 1962 José Barón Fernández, a Spanish pediatrician, published his discovery of the four relevant letters, that he came across in the archives of Simancas (Spain), also in his Vesalius biography of 1970 (8). They were:
• a letter from the king of Spain to Garcihernandez, at his embassy in Venice;
• an answer from his ambassador ad interim;
• followed by an additional letter; and
• a letter from Bonifacio de Ragusa, custodian in Jerusalem, also addressed to the king (9).
Each of them concerns Vesalius’s trip to the Holy Land, a journey or pilgrimage, which was the subject of so much speculation.
Letter 1: from Philip II to Garcihernandez
This first letter is thus from Philip II, son of Emperor Charles V, and king of Spain, and is addressed to Garcihernandez, secretary to his ambassador, who was temporarily in charge of the Spanish embassy in the then powerful and wealthy Republic of Venice. The letter was written in Monzon, in Aragon, and dated January 1564. It reads in translation:
“ … Doctor Vesalius, who gives you this [letter], was the physician of the Emperor, my late father, and is now the same for me. He served his Majesty and likewise serves me, so that I have now very willingly allowed him and granted him permission, to travel to Jerusalem and visit the Holy Sepulchre of our Redeemer, in which he is motivated by piety. With my grateful consent, I expressly urge you, to help him on his way, so that he has a good passage, and to give him every help and assistance, …, so that he may swiftly travel there in safety, and remain there for as short a time as possible, in order that he may return with the same speed, so as to resume his service to me. Kindly encourage him to do this on my behalf. Monzon, January 1564.”
So, the king stresses that he gave Vesalius the permission to travel, and that the motive was his pious desire to visit the holy places. The Spanish ruler asks his ambassador to provide Vesalius with the necessary facilities for his journey, and to guarantee his safety, and also to ensure that he returns as soon as possible, in order to resume his service at the royal court.
Article continued here: Andreas Vesalius’ fatal voyage to Jerusalem (3).
Sources and author's comments:
4. Huberti Langueti Epistolae ad Joachimum Camerarium Patrem et Filium, Lipsiae et Francofurti, Mauritius Georgius Weidmannus, 1685. Also The Correspondence of Sir Philip Sidney and Hubert Languet, London: William Pichering, 1845. And Hubert Langueti ... Epistolae secretae ad principem ... Augustum Sax. Ducem ..., Halae Hermunduror., J. F. Zetler en H. G. Mussellus, 1699
5.Henri CHEVREUIL, Hubert Languet, Paris: L. Potier, 1856.
6. Oscar SCHOLTZ, Hubert Languet als kursächsischer Berichterstatter und Gesandter in Frankreich wärend der Jahre 1560-1572, Halle: Hermann Gesenius, 1875, 62 pp.
7. Charles Donald O'MALLEY, Andreas Vesalius of Brussels 1514 1564, Berkeley and Los Angeles: University of California Press, 1964, 8°, XV-480 pp.; see p. 304.
8. BARON FERNANDEZ, José. Andrés Vesalio: su vida y su obra, Madrid, Consejo Superior de Investigaciones Cientificas, Instituto “Arnaldo de Villanova”, 1970, 8°, XIX-312 pp., ill.; see pp. 234-248.
9. Ragusa is Italian for Dubrovnik in Croatia.
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This article was written by Maurits Biesbrouck, MD. It is an expanded version of Dr. Biesbrouck’s communication on the International Conference Vesalius Continuum on the Ionian island of Zakynthos (Greece) on September 5th, 2014. This study is the result of a close collaboration with Dr. Biesbrouck’s colleagues and friends Prof. Omer Steeno and Dr. Theodoor Goddeeris, as a trio nicknamed ‘Cerberus’ by Theo Dirix, then the Consul of Belgium in Athens, and co-organizer of the conference with Pascale Pollier, Mark Gardiner and Ann Van de Velde.
In this overview I will try to tell something about the reasons for Andreas Vesalius’ travel, his stay in the Holy Land, his return voyage, the cause of his death, his burial place, and his epitaph. This text contains some new details and insights since our previous publications (1).
Title page of Barón Fernández’s
Vesalius biography (1970)
The legends
Many biographers wrote about the last months of Andreas Vesalius’ life. But because the necessary primary sources have been lacking, most of their stories should be regarded now as speculative. Thanks to the discovery of several letters in the archives of Simancas by José Barón Fernández in 1962 various points became clearer. As he presented the letters at the 19th International Congress on the History of Medicine in Basel in September of that year, it remains very strange that his important contributions remained unnoticed. Yet they were published at several instances in Spanish, a world language (2).
But first, something about the legends. The most persistent story, has it that Vesalius performed a dissection in Spain, on a nobleman whose heart was still beating when he exposed it, causing a great outcry. As a result Vesalius was condemned to death by the Inquisition, a sentence being commuted to perform a pilgrimage to Jerusalem, thanks to the intervention of Philip II, king of Spain.
There are numerous variants of this story, and anyone looking through the literature, invariably comes across one of these. Apart from this story - a legend as we must assume - here is a summary of the other so-called reasons that led Vesalius to travel to Jerusalem, according to different writers: for killing a woman; for dissecting a cleric’s mistress; because of an insatiable lust for wealth; to be away from his (quarrelsome) wife; troubles with the Galenist Spanish physicians; to escape from the tiresome Spanish Court; a promise after recovering from an illness; etc.
What is remarkable is that all these stories, without exception, only started to circulate after Vesalius’ death. It may be interesting however to look at the origin of the Inquisition story, the most tenacious one. This was caused by a short letter (merely twenty-four short rules) from Hubertus Languetus (1518-1581), a French diplomate, written in Paris on January 1st, 1565 to Caspar Peucer (1525-1602), physician and son-in-law of Philipp Melanchthon (1497-1560). That was ten weeks after Vesalius’s death. Michael J. North (Head of Rare Books and Early Manuscripts in the History of Medicine Division at the National Library of Medicine) had the lucky idea to reproduce a manuscript of it (3).
[Note: The manuscript is two pages and can be seen here: [Page 1]; [Page 2].
Here is a transcription:
De morte Vesalii ex literis Huberti Langueti, scriptis ad D. D. Casparum Peucerum anno Theos krononias 1565 Mense janu.
Fama est Vesalium esse mortuum audivisti proculdubio eum Hierosolymam esse profe ctum. Causa istius profectionis est mirabilis ut ad nos perscriptum est. Commissus erat eius curae viri nobilis in hispania, quem cum obiisse existimaret, nec satis causam mortis sibi percepisse videretur, petebat ab amicis uti sibi liceret corpus dissecare. Cumque pectus apperuisset, reperit cor palpitans. Cognati illius mortui non contenti erant illum accusare factae caedis accusarent impietatis apud inquisitionem existimantur se ibi vindictam vehementiorem assecuturos. Cum iam constaret de caede, nec tam facile excusaretur error medici tam periti, voluit omnino inquisitio de eo sumere supplicium. Vixque potuit autoritate sua vel potius precibus eum a tanto periculo eripere Rex ipse. Tandem concessum est Rei, et toti aulae pro eo deprecanti, ea conditione, ut ad expiandum illud scelus proficisceretur Jerosolymam ad montem Sinai. Vale. Datur Lutetiae calend Janu. anno a nato Christo 1565.
Translation
On the death of Vesalius, from a letter by Hubert Languet, written to doctor Caspar Peucer in January 1565 pcn.
Rumor has it that Vesalius is dead. You undoubtedly heard of his travel to Jerusalem. The reason for his departure, as it was written to us, is remarkable. In Spain the cure of a nobleman was trust to him. Thinking he was deceased, but not convinced about the cause of his death, he asked his friends to dissect the body. But on opening the chest he found the heart beating. The relatives of the deceased, not satisfied with an accusation for the committed murder, found it necessary to accuse him of godlessness before the Inquisition to obtain a more severe punishment. Once things became clear it was not so easy to excuse that error in a man of such an experience.
In short, the Inquisition intended to execute him. The King himself hardly succeeded to withdraw him from that great danger, relying on his authority or rather on his appealing. Eventually the King, and the entire Court that was pleading for him, were given in, on the condition that he should make a travel to the Mount Sion near Jerusalem, as a penalty for that crime. All the best, Paris, January 1st, 1565.
Article continued here: Andreas Vesalius’s fatal voyage to Jerusalem (2).
Sources and author's comments:
1. Maurits BIESBROUCK, Omer STEENO. ‘The last months of Andreas Vesalius. Part I - From Monzon (Aragon) to Jerusalem’ in Vesalius - Acta Internationalia Historiae Medicinae, 2010, 16 (no. 2): 100-106, ill.; IDEM, ‘The last months of Andreas Vesalius. Part II - From Jerusalem to Zakynthos (Zante)’ in Vesalius - Acta Internationalia Historiae Medicinae, 2011, 17 (no. 1): 30-34, ill. Also Maurits BIESBROUCK, Theodoor GODDEERIS, Omer STEENO. ‘The Last Months of Andreas Vesalius: a Coda’ in Vesalius - Acta Internationalia Historiae Medicinae, 2012, 18 (no. 2): 70-75, ill..
2.For the various publications on this subject by José Barón Fernández (and by others as well) see section ‘bibliography’ in www.andreasvesalius.be
3. Michael J. NORTH, ‘The Death of Andreas Vesalius’ in Circulating Now, U.S. National Library of Medicine, 15.10.2014, 2 pp., ill.; see http://circulatingnow.nlm.nih.gov/2014/10/15/ the-death-of-andreas-vesalius/. > Also https://www.facebook.com/nationallibraryofmedicine/ posts/10152749352150491.
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Pavlos Plessas
Pavlos Plessas was born and brought up on the island of Zakynthos (Zante) in Greece. He lives in London but maintains an internet blog that explores the history of his native island. He is a historian of the island and an internet blogger.
Knowing the island, its history and its people he never believed that Vesalius was shipwrecked, left to die helpless and buried near the beach of Laganas. When the local interest in Vesalius was rekindled by the visit of Pascale Pollier and Theo Dirix, he tried to separate the evidence from rumours and speculation to see if a rational explanation of the mystery could be found.
He was approached by Pascale Pollier and Theo Dirix and asked to assist in their search for Vesalius' grave. With the help of local people and old maps he found the approximate location of the Santa Maria church, by which Vesalius had been buried. The scientific work of Dr. Sylviane Dederix confirmed that this was indeed the spot where the church once stood.
Thanks to Pavlos Plessas for collaborating with "Medical Terminology Daily" and allowing us to re-publish his work on "Powerful indications that Vesalius died from scurvy", presented originally at the 2014 "Vesalius Continuum" meeting in Zakynthos, Greece.
UPDATE: Pavlos' article and theory was refutted by Theo Dirix and Dr. Rudi Coninx. both contributors to this blog. Their article is entitled "Did Andreas Vesalius really die from Scurvy?". Not to be undone, Pavlos published his own rebuttal to their theory in the article "An answer regarding the death of Andreas Vesalius".
Following are some links to Pavlos Plessas' blog articles:
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- Written by: Pavlos Plessas
Text from the presentation at the 2014 Vesalius Continuum Meeting in Zakyhnthos, Greece by Pavlos Plessas.
Continued from: Powerful indications that Vesalius died from scurvy (3)
Metellus mentioned another witness during Boucherus’ narration of their terrifying journey and Vesalius’ end. With him was his friend Johannes Echtius, an esteemed physician. Echtius was one of only a handful of doctors who had studied this new deadly disease, scurvy, and the very first person to write a treatise on it . In that treatise he had given the illness a name: scorbutus.
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It is hard not to feel that this meeting between Echtius and Boucherus was not by chance, but, since nothing is known about it, any hypothesis made, however reasonable, will remain no more than a supposition.
Fortunately, Echtius’ presence in that meeting gives us the opportunity to discern, through his friend’s letters, whether the 16th century expert believed that scurvy was Vesalius’ cause of death. Echtius had identified six conditions that made someone susceptible to scurvy, which he believed was contagious. The first was gross and corrupt diet, like the one on board ships, and the use of corrupt water in conditions of clean water shortage. The remaining five could all lead to scurvy independently, even if the diet had been good, because they generated an excess of melancholic humour, which in his opinion was the cause of the disease. As number five he had listed worrying.
It is easy to see what Metellus was pointing at when he accused Vesalius of having failed to provide adequately for himself. Pilgrims used to take with them their own supplies to complement the ship’s often unpalatable food. Echtius and Metellus believed that the ship’s food put Vesalius in danger of scurvy and he failed to take enough of his own. The subsequent shortages made things worse and, additionally, forced Vesalius to resort to drinking stale and foul water. His extreme worrying, after the disease appeared in others, made it almost inevitable that he too would contract scurvy. His sudden collapse and death did not come as a surprise either since this frequent scorbutic outcome is mentioned in Echtius’ treatise .
By expressing his conviction about the reasons that led to Vesalius’ death Metellus shows that he must have held a firm opinion on which precisely disease had killed him. Yet, incredibly, he fails in both his letters to name it expressly. Again, only scurvy can convincingly explain this failure. Echtius had written his treatise on scurvy in 1541 in the form of a letter , which for a long time had remained unknown even to some of the few doctors that had shown a keen interest in the disease. The treatise was not published until 1564, the year Vesalius died, in a book by Balduinus Ronsseus , and even then it was wrongly attributed to Johannes Wierus, who had sent it to Ronsseus. This error was only possible because Ronsseus, although he had been interested in scurvy for at least a decade , had not until then become aware of it. Consequently he had probably never come across the name scorbutus either. When the doctors of that time did not confuse scurvy with St Anthony’s fire, icterus niger, syphilis or leprosy, those who had a vague idea what they were dealing with, called it magni lienes, or stomacace and sceletyrbe. It would have been pointless for Metellus to inform his correspondents, a publisher and a theologian, that Vesalius had died from an illness Echtius called scorbutus when the word was meaningless even to well informed physicians.
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Echtius may have been the world authority on scurvy but there were aspects of Boucherus’ story he must have found puzzling. The disease had broken out in the Mediterranean, an area that was believed to be free of scurvy. The diet of the crew had been bad, they worked hard and often spent the night sleepless – numbers 1, 3 and 4 respectively in his list of preliminary causes of scurvy – yet they did not get infected. Scorbutic Nostalgia remained unobserved for another two centuries, so Vesalius’ weird behaviour must have also caused him to wonder. Echtius then, along with Metellus, could not have invented this story, simply because they were unable to see that everything in it actually made sense. Neither could Boucherus have made up the story, because he knew much less about scurvy, if he knew anything at all. The probability that the events had been invented and put together randomly is absolutely negligible, given their perfect correlation with conditions that favoured an outbreak of scurvy, the timing of the outbreak, and the described symptoms; more so if all these are combined with the story having been afterwards presented to the planet’s most experienced scurvy expert.
Therefore, it is suggested that Metellus’ letters give a true account of Vesalius’ last days, and, simultaneously, that Vesalius, suffering from scurvy and seriously affected by scorbutic Nostalgia, managed to reach the southern part of the mythical kingdom of Odysseus – the land foremost associated with nostalgia since the dawn of history – and deposited there his own lifeless body.
Initial page of this article here.
Personal note: My sincere thanks to Pavlos Plessas for contributing this article to "Medical Terminology Daily". His theory and the evidence he presents is compelling, and although not proven, a powerful case is made for the cause of Vesalius' death at the gates of the port of Zakynthos, Greece. The fate and lost location of the illustrious anatomist's body is also researched in another article in this blog. I am proud to have been one of the many international attendees to the 2014 meeting in the island of Zakynthos. Dr. Miranda.
UPDATE: The case made by Pavlos Plessas is compelling, robust, and makes sense. Still, there are others that do not agree to his position, creating a discussion on the subject. In 2017, three years after his presentation in Zakynthos, Theo Dirix and Dr. Rudi Coninx published the article "Did Andreas Vesalius really die from scurvy?" which you can read here.
Sources and author's comments:
27. De Scorbuto, vel Scorbutica passione Epitome in 1541.
28. “… aliquoties vero desinit subito, ac mortali deliquio animi”.
29. The letter was addressed to a Dr Blienburchius of Utrecht. See Petrus Forestus, Observationum et Curationum Medicinalium, Tomus Secundus, Libri decem posteriores, Rouen 1553, p. 419.
30. De magnis Hippocratis Lienibus Libellus, Antwerp 1564, pp. 26a – 31b.
31. See De magnis lienibus Hippocratis, Plinique stomacace seu sceletryrbe epistola of 1555 in page 152 of Ronsseus’ De hominis primordiis hystericisque affectibus centones, published in 1559. I am indebted to Theodoor Goddeeris for pointing this out.
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- Written by: Pavlos Plessas
Text from the presentation at the 2014 Vesalius Continuum Meeting in Zakyhnthos, Greece by Pavlos Plessas.
Continued from: Powerful indications that Vesalius died from scurvy (2)
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Traditional herbal medicine from just north of Jerusalem reveals a not so unexpected legacy. Several plants are considered effective in the treatment of scurvy by local healers (14). This means that scurvy was well known in the area until recently. There is also more solid evidence from not too long ago: in a United Nations report from 1951 it is mentioned that not only many of the Palestinian refugees suffered from a mild form of scurvy but it was widespread amongst the general population of Jordan and Gaza (15). Gaza is by comparison much more fertile than Jerusalem. If the natives suffered from scurvy, what luck could the wandering foreigners have? When not on the road, living off preserved foods, pilgrims like Vesalius stayed and dined at monasteries. Fredrik Hasselquist, an 18th century naturalist, came across an outbreak of scurvy amongst the monks of exactly such a monastery, the one in Bethlehem (16). Hasselquist attributed their illness to eating salted fish and staying indoors.
In fact Vesalius, who travelled around in very high temperatures, was in a worse position than the monks. In a clinical experiment Michelsen and Keys showed (17) that, in conditions similar to those Vesalius would have faced, up to 4 mg of Vitamin C daily can be lost through perspiration, irrespective of dietary intake and concentration in the plasma. Vesalius would not have gone through the gruelling regime of the experiment’s subjects; however, the accumulative impact over his long stay in the area would have been significant.
It is by no means certain that Vesalius stayed in the Holy Land for three whole months. Hubert Languet wrote (18) that he intended to visit Mount Sinai, and Metellus hinted that he may have actually met Boucherus in Egypt. If this is true, he would have spent up to a month and a half in one of the harshest deserts on earth. His diet would have been similar to that on a ship: preserved or long lasting foods with perhaps some fresh meat, extremely poor in Vitamin C (19). His brief passage through the fertile Nile Delta would not have helped him much as he would have coincided with the annual inundation of the Nile, when almost all fertile land was either submerged or recently planted. The only fruit that would have been abundant in Egypt in early September is dates; but those contain virtually no Vitamin C (20).
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Mentioning Vesalius’s symptoms was not in Metellus’ intentions. He did, however, mention two inadvertently. The first is Vesalius’ anxiety and fear, although Metellus considered them as one of the causes of his disease. Kinsman and Hood showed (21) that, in fact, personality changes and in particular hypochondriasis, depression, and hysteria, are the very first symptoms of scurvy. Such changes seem to have a physiological rather than a purely psychological basis according to Harrison (22). It is worth noting that, according to Solenander, Vesalius was taciturn by nature and melancholic, which may be an indication, that, unknown even to himself, he was already ill by the time Boucherus met him.
Depression was considered a cause rather than a symptom of scurvy for centuries after Vesalius’ death as we can see in a Sanitary Commission Report from the American Civil War. Alongside it another exciting factor is mentioned: nostalgia (23).
Thomas Trotter, who had called it (the depression) “Scorbutic Nostalgia”, observed it to be “the harbinger of Scurvy” and described it as “a desire of being on land” (24). Instinctively the sick person longed to be where the cure for his illness could be found. The most intriguing aspect of Vesalius’ altered behaviour was his fear of being buried at sea. It is as if his desire to be on land was so strong that he could not bear the thought of being away from it forever.
The second mentioned symptom is Vesalius’ collapse and instant death. The sudden death of scorbutic patients, often while they felt well enough to engage in some activity and while doing their utmost, has been observed and documented in several medical treatises and in accounts of long sea voyages (25). So many died after stepping out of the hold and onto the deck, or during and immediately after their disembarkation, that it was believed the change of air could kill a man with scurvy (26). This is exactly how Vesalius’ death is described: he dropped dead, soon after landing and while striving to complete the short walk to the first buildings of Zakynthos.
Article continued here: Powerful indications that Vesalius died from scurvy (4)
Initial page of this article here.
Sources and author's comments:
14. 6% of the plant species in use, according to Raeda Tawfeeq Ebrahim Daoud in Studies on Folkloric Medicinal Plants Used by Palestinians in the Qalqilia District, An-Najah National University, Nablus 2008, p. 32, table 3.3.
15. Assistance to Palestine Refugees, Report of the Director of the United Nations Relief and Works Agency for Palestine Refugees in the Near East, General Assembly, Official Records: Sixth Session, Supplement No 16 (A/1905), 28 September 1951, Chapter 1, 31.
16. Voyages and Travels in the Levant in the Years 1749, 50, 51, 52, London 1766, p. 147.
17. Olaf Mickelsen and Ancel Keys, The composition of sweat, with special reference to the vitamins, The Journal of Biological Chemistry, 1943, pp. 479 - 490.
18. Adam Melchior, Vitae Germanorum medicorum, Frankfurt Main 1620, p. 133. Also in a manuscript, with the title De morte Vesalii ex letteris Huberti Langueti, scriptis ad D. D. Casparu[m] Peuceru[m], National Library of Medicine, Bethesda, Washington DC (manuscript E 86).
19. According to Felix Faber, who travelled to the Holy Land in the last quarter of the 15th century, food on a pilgrim galley consisted of bread or biscuit, panada, cheese, eggs and mutton or fish; also lettuce with olive oil when they could find it. See Fratris Felicis Fabri Evagatorium in Terrae Sanctae, vol. 1, Stuttgart 1843, pp 136 – 137. In Vesalius’ time travelling in the Mediterranean in a sailing ship rather than a galley had become much more common. Those ships did not need frequent stops for water like the galleys, so fewer chances of lettuce salad. For his desert journey Faber used biscuit, smoked meat, smoked cheese, smoked fish, eggs, rice, almonds, oil, butter, vinegar, salt, wine, live poultry, raisins and onions. Information from the book Once to Sinai: The further pilgrimage of Friar Felix Fabri, by H.F.M. Prescott, New York 1958. Of these only onions contain appreciable quantities of Vitamin C when raw but hardly any if they are sautéed. For obvious reasons boiling was not very popular in the desert.
20. Deglet noor dates contain only 0.4 mg per 100 g. Medjool dates contain nil. Data from the United States Department of Agriculture
21. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
22. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
23. Report of a Committee of the Associate Medical Members of the Sanitary Commission on the Subject of Scurvy with Special Reference to Practice in the Army and Navy, Washington 1862, p. 17.
24. Observations on the Scurvy, 2nd Edition, London 1792, pp. 44 – 45.
25. For example Richard Walter, A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101 and James Lind, A Treatise on the Scurvy, London 1772, p. 132 and p. 281.
26. Thomas Trotter, Observations on the Scurvy, 2nd Edition, London 1792, p. 48.
- Details
- Written by: Pavlos Plessas
Text from the presentation at the 2014 Vesalius Continuum Meeting in Zakyhnthos, Greece by Pavlos Plessas.
Continued from: Powerful indications that Vesalius died from scurvy (1)
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Metellus and Solenander agree on most of the details of the story, to the point that it appears the initial source of their information was the same person, however, their versions are not identical. Metellus claims to have received his information from Georgius Boucherus in person, in the presence of a reliable witness, while we do not know how many times the story was recounted before reaching Solenander. Hence, while Solenander provides some valuable information, it is Metellus’ version, notwithstanding his conjectures, that should be considered more faithful (8).
It is very clear from both versions that, some weeks into the journey, a disease broke out on board the ship. Also, more clear in Metellus than in Solenander, that Vesalius was a victim of the same disease, which was somehow connected to food and water shortages..
(Based on the above) It can be easily concluded that the mysterious outbreak does not appear to have been due to contagion on board the ship. Neither the crew was affected nor Boucherus developed symptoms, either during the voyage or in the following months, in spite of his close proximity with the patients for at least forty days. Consequently, the disease was the result of either a pathogenic factor the pilgrims came in contact with or of some nutrient deficiency.
Contact with a pathogenic factor should have happened before boarding the ship, with the possible exception of the pilgrims consuming contaminated food that was not available to the crew. That way they could have fallen ill with typhoid fever, which has a variable incubation period of up to 30 days. However, complications and death from typhoid usually occur in the third week of the illness, which would have been near the end of the journey. Vesalius would simply not have had the time to get worried, fall ill, develop complications and die by the time they reached land. His sudden collapse and death does not fit in well with typhoid either.
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Looking for pathogenic factors on land we can distinguish between vector borne diseases and poisoning. It is, however, inconceivable that the victims of some 16th century poison would have shown no symptoms for weeks after receiving a lethal dose. Therefore, only vector born diseases need be considered and from those only the ones that are very deadly and present in the region. None of these though agree with what Metellus let us know about the disease.
When considering the various nutritional deficiencies we only need to deal with those that could have led to multiple deaths within six weeks from the onset of obvious physical symptoms, and could conceivably have appeared under the prevailing conditions of the journey and the socioeconomic and cultural traits of the region. As such, only scurvy appears to fulfil the criteria. Many may think that even scurvy is not a good candidate since a six week sailing is not thought sufficient for its appearance.
In fact, very often scurvy did not take long to appear or cause deaths. According to the naval physician Thomas Trotter it was common for an 18th century British warship of the Channel Fleet to lose up to a dozen seamen to scurvy and have another fifty hospitalised during a cruise of just eight weeks (9). A scurvy patient on a ship rarely survived for seven weeks and many died much earlier (10).
Also, it has to be pointed out that Vesalius’ journey did not last only weeks; he left Venice sometime before the 24th of May (11) and died in Zakynthos in the middle of October, a minimum of five months. More than two of these he spent sailing and the remainder in semi-desert or desert conditions. The Holy Land in Vesalius’ time was arid and mostly barren, especially in the high summer. Many pilgrims, shocked by what they saw, believed the area had been cursed by God (12). No vegetables grew at that time of year and only some grapes, grown by Christians, and figs, growing wild, could have been ripe. Both fruit contain very little Vitamin C (13).
Article continued here: Powerful indications that Vesalius died from scurvy (3)
Sources and author's comments:
8. There are additional reasons for this. In Solenander’s version there are efforts to explain certain aspects of the story, which may have been nothing but an intermediate informant’s speculation passed on as reliable information. An example of this is that, according to Solenander, Boucherus met Vesalius and the other pilgrims in Venice, and travelled with them to Cyprus where they separated. He went to Egypt while they continued to Jerusalem. On his return journey he travelled again via Cyprus and by coincidence met the same companions on the same ship. All this is possible but unlikely, especially if he meant that the ship waited for the pilgrims for three months. There is even the suspicion that at least one part of the original story was intentionally “corrected”: Metellus says that Vesalius collapsed and died soon after disembarking, while Solenander says he died on board the anchored ship. Conventional wisdom dictates that a very sick man does not disembark and walk on the shore of Zakynthos but expires on board his ship. This is not always true but the temptation to perform a little cosmetic surgery on the story is understandable.
9. Medicina Nautica: an Essay on the Diseases of Seamen, Volume III, London 1803, p. 387.
10. James Lind, A Treatise on the Scurvy, London 1772, p. 281.
11. This is the publication date of the Examen, in the preface of which Francesco dei Franceschi recalls Vesalius’ visit to Venice.
12. Felix Faber’s description is typical: But even I said secretly in my heart: see, this is the land that is supposed to flow with milk and honey; but I see no fields for bread, no vineyards for wine, no gardens, no green meadows, no orchards, but it is all rocky, burnt by the sun and parched.
13. Figs contain about 2 mg per 100 g; grapes 3.2 mg. Data from the United States Department of Agriculture. A man whose body stores of Vitamin C are very low will need to eat 10 – 12 figs or more than 60 grapes every day just to remain above the threshold of scurvy.