Berengario Da Carpi Giacomo

(b. Carpi, Italy, ca. 1460; d. Ferrara, Italy, 24 November 1530 [?])

medicine.

Giacomo Berengario (or correctly, Barigazzi) was one of the five children of Faustino Barigazzi, surgeon of Carpi. He received rudimentary training in anatomy and surgery from his father and possibly some classical education from Aldus Manutius, who was in Carpi between 1469 and 1477 as tutor to the children of Lionello Pio, prince of Carpi. Berengario apparently studied more systematically, perhaps in Ferrara or Bologna, before entering the medical school of the University of Bologna. He studied there under Girolamo Manfredi, Lionello dei Vittori, Gabriele Zerbi, and Alessandro Achillini, and received his degree on 4 August 1489.

Nothing definite is known of Berengario’s activities from the time he left the university until his appointment as a member of its faculty of medicine in the early sixteenth century. It is likely, however, that he returned to Carpi, at least for a time, to assist his father in his surgical practice; and he probably practiced surgery independently during the wars that plagued ltaly at this time and were further aggravated by the French invasion of 1494. That Berengario had acquired considerable distinction as a surgeon, very possibly as a military surgeon, is indicated by his appointment in the latter part of 1502 as lecturer in surgery at Bologna, where he was one of the four “foreign” member of the faculty chosen for their achievements and designated the eminenti. in 1506 he became a Bolognese citizen through the mediation of Pope Julius II, and in 1508 the goverment of Bologna placed him in charge of treating victims of the plague epidemic.

Berengario enjoyed great popularity as a teacher, despite a somewhat fiery and quarrelsome nature. In 1511, for reasons not now known, he developed a bitter enmity toward one of his colleagues; armed and accompanied by his servant and sixteen other companions, he searched for the luckless colleague in order to do him bodily harm. Thwarted in this, he incited his companions with the cry “To his home.let us kill his father and mother,” which the group seemed not loath to do. Happily, they could not get into the house, and had to be content with smashing its exterior. The university authorities seem to have been willing to put up with several such violent incidents, partly because of Berengarioés support by powerful individuals and families, notably the Medici, and partly because of his popularity with the students. Indeed, a record in the university archives reveals Berengario’s success by a comparison of the numbers in his class with the much smaller numbers in the class of the second lecturer in surgery.

At some time during the pontificate of Julius II, Berengario was called to Rome for medical consultation. In 1513, Pope Leo X, a Medici, was directly responsible for Berengario’s leave of absence from his academic duties, thus enabling him to go to Florence and take over the medical care of Alessandro Soderini, who was related to the pope by marriage. On several occasions thereafter Berengario was of service to the Medici, who repaid him with their patronage and protection.

In 1514 Berengario produced an edition of Mondino da Luzzi’s early fourteenth-century Galenicomedieval dissection manual, Anothomia Mundini noviter impressa ac per Carpum castigata. Presumably the work was prepared as an aid for his students. but its publication also suggests that Berengario had by this time begun to give greater prominence to anatomical investigation, which in his original appointment as surgical lecturer was merely an ancillary discipline.

In 1517 Berengario was one of the physicians called to attend Lorenzo de’ Medici, who had received a gunshot wound and an occipital skull fracture in battle. Although he was not responsible for the immediate treatment and trepanation of Lorenzo’s skull. Berengario was placed in charge of the postoperative care; this assignment led to his second book. Tractatus de fractura calvae sive cranei(1518). The Tractatus was written in little more than two months, soon after Berengario’s return to Bologna, and dedicated to Lorenzo de’ Medici. It opens with a short discussion of various sorts of skull fractures, followed by a grouping of the consequent lesions according to their symptoms. This is the most interesting and valuable portion of the work, for Berengario was able to cite from contemporary knowledge or from his own direct observation the relationship between the location of the lesions and the resulting neurological effects. Next, he discusses prognosis, diagnosis, treatment, the instruments to be employed, and the technique of craniotomy. Berengario’s book was the most original neurosurgical treatise until then and was not surpassed until the appearance of Ambroise Paré’s similar work in 1562, in which Paré expressed his appreciation of his predecessor’s efforts and made use of them.

In 1520 Berengario was called to Cremona as one of the medical consultants for Marchese Galeazzo Pallavicine, who, according to Berengario, died in that same year of a renal complaint.

Although Berengario was officially lecturer in surgery, he was also responsible for instruction in anatomy, which, in the course of time, appears to have become his major interest. In his Isagogae breves(1522) he declares that by that time he had dissected several hundred bodies, and in the Commentaria (1521) he refers to a number of specific dissections he had performed on adult cadavers and on fetuses. It is not known when Berengario’s interest in anatomy became predominant. although this may be marked by his edition of Mondino’s Anothomia in 1514; and somewhere toward the close of the second decade of the sixteenth century his dissatisfaction with traditional accounts of the human body became strong enought to cause him to wrtite his own treatise. It seems to have been produced very quickly, in approximately two years, and was published under the title Commentaria cum amplissimis additionibus super anatomia Mundini cum textu eiusdem in pristimum &verum nitorem redacto, with a dedication to Cardinal Giulio de’ Medici, later, later Pope Clement VII.

The Commentaria, consisting of slightly more than a thousand pages, is so arranged that each topic is introduced by the appropriate section of Mondino’s Anothomia and followed by Berengario’s critical commentary. The commentary presents the opinions of ancient and medieval writers, as well as those of Berengario’s contemporaries, and finally his own judgment of the problem ; sometimes these judgments are illustrated from his own cases or from other, contemporary ones known to him. As one who had an unusually great knowledge of human anatomy, as well as a considerable degree of intellectual independence and an argumentative and even pugnacious spirit, Berengario not only extended the knowledge of human anatomy but also opposed traditional, often Galenic, beliefs and sought to replace them with his own. The Commentaria was the first work since the time of Galen to display any considerable amount of anatomical information based upon personal investigation and observation, and although Berengario’s antitraditional attitude was not the result of a consistent principle of independent investigation, his Commentaria nevertheless must be considered the most important forerunner of Vesalius’ Fabrica.

After a brief discussion of the value of anatomical studies, Berengario, following the sequence of Mondino’s text, systematically describes the general characteristics of the major structures and divisions of the body and the properties of fat, membrane, flesh, fiber, ligament, sinew and tendon, nerve, and muscle. This description, more extensive than any until then, is followed by a fairly extensive account of the abdominal muscles. In accordance with Mondino’s arrangement, the abdominal organs, the most susceptible to putrefaction, are next considered. The account begins with mention of the peritoneum, but only the visceral portion is described ; and Berengario erroneously criticizes Gentile da Foligno for referring to a muscular portion as well. The description of the intestines contains the first mention of the vermiform appendix; the yellow staining of the duodenum, caused by bile, is noted; and attention is called to the fact that the common biliary duct opens into the duodenum. The stomach is described as being formed of three intrinsic coats, to which a fourth, arising from the peritoneum, is added, although Berengario mentions only two intrinsic coats in the Isagogae breves of 1522. In his description of the kidneys Berengario denies that they contain a filter or sieve for straining off the urine, and is especially critical of his former teacher Gabriele Zerbi, who had claimed actual observation of such a filter. During a public dissection in 1521, but too late for mention in the Commentaria, Berengario observed a fused kidney with horseshoe configuration, which he described in the Isagogae breves.

The description of the male and female reproductive organs, of reproduction itself, and of the fetus is much more extensive than any earlier account. In the course of this description Berengario for the first time called attention to the greater proportional capacity of the female pelvis than the male pelvis. and elsewhere he noted the proportionately larger size of the male chest. He also denied the medieval belief in the seven-celled uterus, and in direct opposition to Galen he declared that the umbilical cord carried a single vein rather than two.

Turning his attention to the neck and thorax, Berengario recognized five cartilages in the larynx, describing the two arytenoid cartilages for the first time, and provided the first good account of the thymus. He declared that the lungs were a single organ, although he admitted that some said they were plural. He did, however, note the existence of three right lobes, in contrast with two on the left. He remarked upon the oblique position of the heart, described the pericardium in some detail, and declared that it contained pericardial fluid at all times. In his description of the ventricles of the heart he sought a compromise between the Aristotelian description of a three-chambered heart and the Galenic description of a two-chambered one by declaring that the third ventricle posited by Aristotle was in the traditionally accepted Galenic pores of the cardiac septum. Although erroneous, this assertion was of some significance, for Niccolo Massa answered it in 1536 with the declaration that the heart’s midwall was solid. Although Massa seems not to have realized the implication of his statement, he and Berengario unwittingly preluded the dispute that developed later in the century over the correct course of the blood from the right to the left side of the heart. In addition, although Berengario correctly described the aorta as arising from the left ventricle, he displayed some confusion regarding the position and structure of the pulmonary artery (which he called vena arterialis) and pulmonary vein (which he called arteria venalis).

In his description of the skull and its contents, Berengario was the first to describe the sphenoidal sinus, which he considered to be the source of catarrh, but he declared that the ethmoid plate was impervious to the passage of cerebral fluids. He also called attention to two of the ossicles of the ear, the mallcus and incur, although he did not provide them with these names or claim the discovery. In his description of the brain, the account of the ventricles is relatively clear and extensive. Contrary to the then common practice of locating the mental faculties in the four ventricles, however, he placed them all in the first two, or lateral, ventricles and thereby reduced the significance of the remainder. He considered the third ventricle as being merely a passage through which excess cerebral fluids were transported to the infundibulum for ultimate excretion; it also served as a route for the transmission of a portion of the animal spirit into the fourth ventricle. The fourth ventricle served only as the receptacle for that portion of the animal spirit which served to operate the spinal nerves.

Of the other cerebral structures, Berengario noted the corpus striatum, declared that the choroid plexus was formed of veins and arteries, and described the pituitary and pineal glands. His most noteworthy anti-Galenic heresy was denial of the existence of the rete mirabile in the human brain, for the excellent reason that he had never been able to find it. However, since the accepted theory of the day would not permit him to deny the existence of animal spirit, the motive force of the nervous system until then asserted to be manufactured in the rete mirabile, Berengario declared that the spirit was manufactured in the very small branches of the arteries dispersed throughout the pia mater. Consequently, it was Berengario who began the movement to give greater importance to the entire brain substance.

Despite the significance of Berengario’s anatomical findings and his correction of traditional errors, as well as his citations, which reflect wide reading in classical and contemporary literature, his literary style was more medieval than Renaissance. Whatever his merits or deficiencies as a stylist, he was greatly hindered by the absence of any standard anatomical vocabulary. Numerous medieval Latin translations from the Arabic by a number of different translators, often not really familiar with the subject matter of their translations, had produced a confusion of terminology; an anatomical structure might have several names or a single term might apply to several different structures. Berengario was well aware of this problem, and on one occasion described it in respect to the graphic illustration of a vein:

In these figures can be seen the course of the salvatella of Mondino and Rhazes, the sceylen of Avicenna, the salubris of Haly, and that branch of the basilica which ends between the little and ring finger which Rhazes [also] calls salvatella . It can furthermore be seen how the vein called funis brachii by Avicenna ends around the middle finger in a branch called sceylen by Avicenna and salubris by Haly and how also the funis brachii is a branch of the cephalic and terminates between the index finger and thumb [lsagogae breves, 1522, fol. 65 r].

Such conditions recommend visual assistance, and Berengario appears to have been the first anatomist to recognize the significance of anatomical illustrations properly related to the text. The Commentaria contains twenty-one pages of illustrations, some of them with the names of the significant structures written on the figures, with a brief explanation of the meaning of the particular illustration printed along its border. The figures are rather crude woodcuts, but the crudity does not greatly impede the explanation of anatomical terminology. Infrequently there is reference from the main text to the illustration. The illustrations are less successful when, as in those of the uterus, the purpose is to reveal details of structure rather than to explain terminology. It is particularly apparent in these figures that Berengario had not completely broken away from the older idea that illustrations must serve a decorative purpose, an idea that interfered with the presentation of anatomical detail. One figure, presumably displaying the abdominal muscles (actually plagiarized from Pietro d’Abano’s Conciliator of 1496), is utterly worthless because the muscles are wholly imaginary. However, the remaining sequence of figures in which the successive muscle layers of the abdomen are displayed, dimly suggests, despite anatomical errors, the later Vesalian “muscle men .”Berengario’s results, however, were more important for the direction they took than for their achievement.

In 1521 there also appeared an edition of Ulrich von Hutten’s small treatise of 1519 on the use of guaiac wood in the treatment of syphilis, Ulrichi de Hutten Eq. de guaiaci medicina et morbo gallico liber units. It is uncertain whether the publication was primarily a publisher’s speculation, since guaiac wood had gained sudden and very considerable popularity as a specific, or occurred at the urging of Berengario, whose name, however, appears only on the final page in the colophon. Berengario himself preferred to treat syphilis with mercury. In 1522 he was responsible for publishing an edition of Galen’s work on medical prognostication, Habes in hoc volumine candide lector magni Galeni Pergamensis medicorum principis libros tres de crisi. i. de judicationibus interprete Laurentiano medico Florentino, and dedicated it to one of his students, Ochoa Gonzales. Despite his intermittent criticisms of Galenic anatomy, Berengario remained a supporter of the “prince of physicians,” who was not opposed for basing human anatomy on that of animals until 1543.

A much more important publication, in 1522, was the compendium of the Commentaria, entitled Isagogae breves perlucide ac uberrime in anatomia humani corporis a communi medicorum academia usitatam a Carpo in almo Bononiensi Gymnasio ordinariam chirurgiae public docente ad suorum scholasticorum preces in lucem datae and dedicated to Alberto Pio, prince of Carpi. As a condensed version of the more extensive Commentaria, but with the same arrangement of contents, the Isagogae breves was intended by Berengario as a manual for his students and a replacement of his edition of Mondino’s Anothomia, which he had made obsolete. If we may believe the title, it was prepared at his students’ request. Its success is indicated by the fact that a second edition was published in 1523, with some alteration and increase in the number of illustrations, emphasizing the anatomy of the heart and brain.

In 1525, at the command of Pope Clement VII, Berengario went to Piacenza to assist in the care of Giovanni dalle Bande Nere, a member of the Medici family, who had suffered a wound of the right leg in battle. During 1526 Berengario spent several months in Rome as physician to the ailing Cardinal Pompeo Colonna, and, according to Vasari, in lieu of his fee accepted a “St. John in the Desert” painted by Raphael. It was also at this time that he met the sculptor and goldsmith Benvenuto Cellini, who described Bedengario as a clever surgeon and a man of much learning whose services were sought on a permanent basis by Clement VII. Cellini also referred to Berengario’s lucrative but ultimately disastrous practice of venerology, declaring that “he was a person of great sagacity and did wisely to get out of Rome.” since through the excessive use of mercurial fumigations in the treatment of syphilis, “all the patients...grew so ill... that he would certainly have been murdered if he had remained.”

Berengario’s return to Bologna was brief, however, since he was dismissed from his position in the medical faculty. According to Gabriele Falloppia, he was charged with numan vivisection, of which, however, there is no documentary evidence. Whatever the reason, Berengario retired to Ferrara, where he edited a collection of Latin translations of Galen:Libri anatomici, horum indicem versa pagina indicabit. De motu musculorum liber primus. Nicolao Leoniceno vicentino interprete. Anatomicarum aggressionum interprete Demetrio Chalcondylo. De arteriarum et venarum dissectione, interprete Antonio Fortolo Ioseriensi. De hirudinibus, revulsione etc., interprete Ferdinando Balamio Siculo (1529). The date of Berengario’s death is uncertain and the place of his burial is unknown, although possibly it is the church of San Francesco in Ferrara.

BIBLIOGRAPHY

Berengario’s writings include his edition of Mondino da Luzzi’s Anothomia Mundini noviter impressa ac per Carpum castigata (Bologna, 1514; Venice, 1529, ca. 1530, 1538, ca. 1575); Tractatus de fractura calvae sive cranei (Bologna, 1518; Venice, 1535; Leiden, 1629, 1651, 1715, 1728); Commentaria cum amplissimis additionibus super anatomia Mundini cum textu eiusdem in pristinum & verum nitorem redacto (Bologna, 1521); his edition of Galen’s Habes in hoc volumine candide lector magni Galeni Pergamensis medicorum principis libros tres de c risi. i. de judicationibus interprete Laurentiano medico Florentino (Bologna, 1522); Isagogae breves perlucide ac uberrime in anatomia humani corporis a communi medicorum academia usitatam a Cmpo in almo Bononiensi Gymnasio ordinariam chirurgiae publice docente ad suorum scholasticorrnn preces in lucem datae Bologna, 1522, 1523; Strasbourg, 1530; Venice, 1535); and his edition of a collection of Latin translations of Galen, Libri anatomici, horum indicem versa pagina indicabit. De motu musculorum Tiber primus, Nicolao Leoniceno vicentino interprete. Anatomicarum aggression um interprete Demetrio Chalcondylo. De arteriarum et venarum dissectione, interprete Antonio Fortolo Ioseriensi. De hirudinibus, revulsione etc ., interprete Ferdinando Balamio Siculo (Bologna, 1529).

All editions of the above works are very rare, and none has been published since the lat date given for each. there is, however, an Italian tanslation of De fractura calvae in Vittorio Putt, Berengario Da Carpi saggio biografico e bibliografico (Bologna, 1937). There is also an English translation of the Isagogae breves(London, 1660, 1664) and in Jacopo Berengario da Carpi. A Short Introduction to Anatomy (Isagogae breves), translated with indroduction and historical notes by L.R. Lind and with anatomical notes by Paul G. Roofe (Chicago, 1959), pp. 3–29; it suffers, however, from aome misunderstanding of Berengario’s original text.

The best biographical account, including the pertinent documents and records, is in Putti’s work cited above. The introduction to Lind’s translation contains a brief biographical account drawn from Putti.

C. D. O’Malley