Vesalius in Vignettes

It is impossible to underestimate the importance of the uncontested father of modern anatomy, Andreas Vesalius (1514–1564), in its history and evolution. To the present day, pages from his master work, the De humani corporis fabrica libri septem, particularly the ‘Muscle Men,’ are ubiquitous in doctors’ offices and health science institutions around the globe. It is no surprise that a copy of his work is to be found in Edward Worth’s Library, nearly two hundred years after its first publication, as it was on the bookshelves of prominent figures of medicine. Edward Worth’s copy, pages of which are reproduced and discussed in this essay, was published in 1725, under the title Opera omnia anatomica & chirurgica cura Hermanni Boerhaave, & Bernardi Siegfried Albini.^[1] Edited by physicians Herman Boerhaave (1668–1738) and anatomist Bernardi Siegfried Albini (1697–1770), the Opera is the only collection of Vesalius’ works and includes the Fabrica, the Epitome, the China Root letter, and Vesalius’s response to his student, Fallopius (1523–62).

Andreas Vesalius, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi Siegfried Albini (Leiden, 1725), i, portrait of Vesalius.

Andries van Wesel was born in Brussels in 1514, later following the contemporary convention and Latinizing his name to Andreas Vesalius. He studied at the University of Leuven before relocating to Paris in 1533, and studying Galenic anatomy at the University of Paris. Forced to leave Paris because of military conflict between France and the Holy Roman Empire, he returned to the University of Leuven and completed his studies there. Upon his graduation, he was offered a lectureship at the University of Padua. In the following five years he compiled what would become the content of his magnum opus, completing De Humani Corporis Fabrica (On the Fabric of the Human Body) in 1542. He spent the next six months in Basel instructing his printer Johannes Oporinus (1507–68) on precisely how to print the book. While it is believed that several artists lend their hand at illustrating the Fabrica, the most commonly associated is German-born Italian artist Jan Steven van Calcar (c. 1499–1546), who belonged to Titian’s artist circle. In the spring of 1543, the Fabrica was published in an illustrious and expensive volume. In 1546, he wrote the Epistola rationem modumque propinandi radicis Chynae decocti, (the Epistle on the China Root) which contains his evaluation of a popular gout cure, as well as a defence against the criticisms he received following the publication of the Fabrica. Shortly after, he was invited to become the court physician to Emperor Charles V (1500–58), and subsequently he served the court of King Phillip II (1527–98) of Spain. In 1564, he embarked on a pilgrimage to Jerusalem. Upon his return trip, he was shipwrecked and cast ashore the Greek island of Zacynthos, where he passed at age 50.^[2]

Weaving the Fabrica

Vesalius published the Fabrica in 1543 in Basel, at a historical convergence of great discoveries in the world of learning and science. Vesalius took great care in the production of the Fabrica as his communications with his printer Johannes Oporinus show, a letter to which is included in the preface. Taking advantage of the printing innovations of his time, he deliberately instructed his printer on the techniques to use from the layout of each page to the choice of paper it would be printed on.

The Fabrica is divided into seven books, each dedicated to an anatomical system, in which the anatomist meticulously describes each structure and details how he practiced the dissections that led to his observations:

Book 1: The Bones and Cartilages.

Book 2: The Ligaments and Muscles.

Book 3: The Veins and Arteries.

Book 4: The Nerves.

Book 5: The Organs of Nutrition and Generation.

Book 6: The Heart and Associated Organs

Book 7: The Brain.

In its pages, Vesalius describes several groundbreaking discoveries that herald a new era in the history of anatomical study, forever altering its fabric. Namely, he corrects Galen’s description of the sternum and liver, accurately describes voice production^[3] and more famously, mechanical ventilation.

With the second edition of the Fabrica (1555) Vesalius broke new ground. He revised Galen’s assertions about the cardiovascular system, particularly on the role of the permeability of the heart chambers in the circulation of blood, leading William Harvey to accurately describe systemic circulation.^[4] It is believed that Vesalius intended a third edition, a goal  that was never realized.

Deceived by his monkeys

Andreas Vesalius, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi Siegfried Albini (Leiden, 1725), Lib. I, Cap. XII, illustration facing p. 42. A human cranium rests on a human cranium in an example of comparative anatomy.

In this illustration, Vesalius presents a human cranium resting on a canine one, as if to show the absurdity of basing anatomical findings of the human body on the anatomy of dogs.

‘This figure represents the anterior surface of the skull so as to display the bones of the upper maxilla as accurately as possible. We have placed a canine skull below the human so that Galen’s description of the bones of the upper maxilla may be more easily understood by anyone. Also, so that the sockets of the eyes and the bones and sutures appearing within may be seen as well as possible, it was useful for the human skull to rest on its occiput and for its anterior portion [regiones ventrales] to be raised above the dog’s skull’.^[5]

The anatomists of Vesalius’ time closely adhered to the teachings of Galen of Pergamon (129 – c. 216 CE) a learned Greek physician. His contemporaries demonstrated public dissections closely following Galen’s texts without questioning his findings, and their demonstrations were largely based on repetition rather than investigation and discovery. Initially a Galenist, Vesalius discovered Galen’s errors through his own human dissection and close readings of his works, realizing that Galen had never performed a human dissection as the practice was banned in Roman times. Instead, he based his findings on the animal dissections he had performed, famously on Barbary macaques, common pigs, and dogs:

‘…it is just now known to us from the reborn art of dissection, from the careful reading of Galen’s books, and from the welcome restoration of many portions thereof, that he himself never dissected a human body, but in fact was deceived by his monkeys (granted a couple of dried-up human cadavers came his way) and often wrongly disputed ancient doctors who had trained themselves in human dissections. In fact, you will find many things in Galen which he misunderstood even in monkeys, not to mention the most astonishing fact that among the many and infinite differences between the organs of the human body and the monkey Galen noticed only those in the fingers and the flexion of the knee; he would no doubt have missed these as well, had they not been obvious to him without dissecting a human’.^[6]

He derided his fellow anatomists for slavishly following Galen’s works without challenging his claims, even though they were able to perform human dissections themselves. As expected, his statements were viewed as a polemic against Galen, in response to which he defends himself in the China Root Epistle, included in Worth’s 1725 edition of Opera Omnia with the following:

‘So when I regularly demonstrate that we see these things, and do so in a great meeting of the most learned men with cadavers present and meticulously compare them to Galen’s descriptions, I should certainly have deserved that Nature deprive me of my eyes, if I had not protested rather to Galen than to her who is not to be of accused of negligence, and I should have showed myself falsely accusing the exquisite designs of Nature and unworthy of my hands and eyes’.^[7]

Personal observation is of paramount importance to Vesalius; the active seeing of the human body. Throughout the Fabrica, he encourages his readers, who are by extension his students, to pursue their own efforts to dissect cadavers and prepare and articulate skeletons through, detailed procedural instructions. At the same time, he remains cognisant of the value of the study of natural history and comparative anatomy as he notes at the end of Liber 1:

‘Not only the bones of man, but on Galen’s account those of apes and dogs, and for the sake of Aristotle, of birds, fish and reptiles, either articulated or at least disarticulated, should be available for the study of medicine and natural philosophy, unless perhaps we are to regard this branch of philosophy as of no concern to us, and are to convince ourselves that it is sufficient if we can impose on mortals and fill coffins with our syrups and without Anatomy’.^[8]

Tools of the trade

Andreas Vesalius, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi Siegfried Albini (Leiden, 1725), Lib. I, Cap. XLI, p. 138. In this helpful illustration Vesalius lists his preferred dissection tools and offers advice on how to procure them.

As mentioned above, Vesalius embraced a ‘do-it-yourself’ approach in his teachings. He believed that scientific claims should be examined through personal experimentation and encouraged his students to perform their own dissections. In Book II of the Fabrica he includes the above illustration; a butcher’s table with a variety of tools and instruments laid out, and enumerates them along with recommendations for sourcing. His list contains implements that his reader could find without great difficulty; butchering tools like kitchen knives and cleavers, woodcarving chisels and saws, even bookbinder’s thread. Ever the meticulous teacher, Vesalius’s instructions extend to the procurement of cadavers from the gallows, to the de-fleshing of the body, and the preparation and articulation of the skeleton for study, all occasionally peppered with personal anecdotes.

The spectre of death

Andreas Vesalius, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi Siegfried Albini (Leiden, 1725), Lib. I, Cap. XLII, Fig. No. 3, facing p. 141. A weeping skeleton showing posterior skeletal anatomy.

‘Death’s relation to life would now need to be reoriented and become not simply the point of life but also the means, through dissection, to learn about life’.^[9]

Rose Marie San Huan.

As Rose Marie San Huan notes in her essay ‘The Turn of the Skull: Andreas Vesalius and the Early Modern Memento Mori’, Vesalius confronts death and invites his readers to join him, not out of a sense of morbid curiosity, but in the service of health and improvement of life, through the increased understanding of the human body and its workings.

While Vesalius’ posed skeletons evoke ideas of impending mortality and vanitas, they also appear paradoxically animated and lively, despite their stripped state. There is a sense of life triumphing over death in the Fabrica’s pages, usually relegated to religious doctrine.  Still, Vesalius and his contemporaries operated in a somewhat treacherous religious climate that did not welcome the grave robing that anatomical study often entailed. To counteract that, anatomical text was often couched in religious allusions. As Carlino notes:

‘One common textual strategy was to link moral and religious themes to the anatomical discourse-self – knowledge, the transience of human life, the glorification of God through the contemplation of the hidden wonders of the human body – that allowed for a manifold and culturally varied use of the anatomical data present within the printed object’.^[10]

The Ubiquitous Muscle Men

Andreas Vesalius, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi Siegfried Albini (Leiden, 1725), Lib. II, Tab. I, facing p. 145. The seventh of Vesalius’ eight ‘Muscle Men’, a series of male figures showing muscle anatomy posed in front of ruins of Roman baths in a region near Padua.

Arguably, Vesalius’ Muscle Men, particularly the first three, are some of the most reproduced and recognisable illustrations in the history of anatomy. Set against the landscape of the rolling hills near Padua, Vesalius depicts a sequentially dissected man to show the human anatomy from surface musculature to a stripped skeleton. The figure is dramatically animated, as if contemplating his own mortality. Unlike the more practical approach exemplified in most of the illustrations of the Fabrica, the Muscle Men are evocative, even poetic, perhaps denoting Vesalius’ own wonderment and dedication to anatomy. At the same time, Vesalius has carefully selected the poses embodied to allow the reader to view particular muscles. Combining artistry and demonstration, they function as the crowning glory and centrepiece of his opus. He encouraged his readers to page back and forth between the images so they could truly appreciate the position of each muscle in relation to others.^[11]

Vesalius’s Eve

Andreas Vesalius, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi  Siegfried Albini (Leiden, 1725), Lib. V, Cap. XXV, illustration facing p. 407. A dissected female torso showing viscera.

‘It is commonly believed that men lack a rib on one side, and that men have one rib fewer than women. This is plainly absurd, even if Moses did say in the second chapter of Genesis that Eve was created by God out of Adam’s rib. Granted that perhaps Adam’s bones, had someone articulated them into a skeleton, might have lacked a rib on one side, it does not necessarily follow on that account that all men are lacking a rib as well’.^[12]

Vesalius’s main source of cadavers were the gallows, where he and his students would find and retrieve the bodies of executed criminals, under the shield of night. Given those circumstances, access to female bodies to dissect was limited, and the details of female anatomy remained largely mysterious. Furthermore, their understanding was largely based on ‘Galenic sexual isomorphism’, or the ‘one-sex theory’ that purported that reproductive anatomy was essentially functionally homologous between male and female bodies, and originated from the male sex, an idea that reflects the parable of Adam and Eve.

Vesalius perpetuated this idea in his illustrations of the female reproductive system, presenting it as an inversion of the male. However, he took pains to challenge the biblically-derived notion of the missing rib bone, calling it absurd, in contrast to religious doctrine.

Andreas Vesalius paved the way for his successors in the study of anatomy, whose discoveries illustrated in this exhibition would not have been possible without his work.

Text: Ms Evi Numen, Curator of the Old Anatomy Museum, Trinity College Dublin.

Sources:

Ambrose, Charles T., ‘Andreas Vesalius (1514-1564) – an unfinished life’, Acta medico-historica adriatica: AMHA, 12, no. 2 (2014), 217-30.

Brinkman, R. J. and J. J. Hage, ‘Andreas Vesalius’ 500th Anniversary: Initial Integral Understanding of Voice Production.’, J. Voice, 31, no. 1 (Jan 2017).

Carlino, A., ‘Paper bodies: a catalogue of anatomical fugitive sheets 1538-1687’, Medical history. Supplement, 19 (1999), xvi, 352pp; Introduction, p.3.

Ghosh, Sanjib Kumar, ‘Human cadaveric dissection: a historical account from ancient Greece to the modern era’, Anatomy & cell biology, 48, no. 3 (2015), 153–69.

Hast, M H, and D H Garrison (eds),,’ On the Fabric of the Human Body: An annotated translation of the 1543 and 1555 editions of Andreas Vesalius’ De Humani Corporis Fabrica, Northwestern University [online resource] (2003).

Juan, Rose Marie San, ‘The Turn of the Skull: Andreas Vesalius and the Early Modern Memento Mori’, Art History, 35, no. 5 (2012), 958-75.

Keeton, Morris, ‘Andreas Vesalius: His Times, His Life, His Work’, Bios, 7, no. 2 (1936), 97–109.

Kusukawa, Sachiko, Picturing the Book of Nature: Image, Text, and Argument in Sixteenth-Century Human Anatomy and Medical Botany, (London, 2012).

Mandressi, Rafael, ‘Of the Eye and of the Hand: Performance in Early Modern Anatomy’, TDR, 59, no. 3 (2015), 60-76.

Nutton, Vivian, ‘Vesalius revised. His annotations to the 1555 Fabrica’, Medical history, 56, no. 4 (2012), 415-43.

Pagel, Walter, ‘Vesalius and the Pulmonary Transit of Venous Blood’, Journal of the History of Medicine and Allied Sciences, 19, no. 4 (1964), 327–41.

Retsas, Spyros, ‘Galen’s ‘Errors’’, The Lancet, 376, no. 9742 (2010).

Saunders, M. J. B. deC., and O’Malley, Charles D., ‘The Preparation of the human Skeleton by Andreas Vesalius of Brussels: An Annotated Translation of the 39th Chapter of De Humani Corporis Fabrica, 1543’, Bulletin of the History of Medicine, 20, no. 3 (1946), 433–60.

Sims, Michael, ‘Spectacular Bodies: The Art and Science of the Human Body from Leonardo to Now’, Medical Anthropology Quarterly, 16 (2008), 384-85.

Splavski, Bruno, Krešimir Rotim, Goran Lakičević, Andrew J. Gienapp, Frederick A. Boop, and Kenan I. Arnautović, ‘Andreas Vesalius, the Predecessor of Neurosurgery: How His Progressive Scientific Achievements Affected His Professional Life and Destiny’, World Neurosurgery, 129 (2019), 202-09.

Vesalius, Andreas, Vesalius: The China Root Epistle: A New Translation and Critical Edition, edited by Daniel H. Garrison (Cambridge, 2015).

^[1]Vesalius, Andreas, Opera omnia anatomica & chirurgica cura Hermanni Boerhaave …, & Bernardi Siegfried Albini …, (Leiden, 1725).

^[2] Ambrose, Charles T., ‘Andreas Vesalius (1514-1564) – an unfinished life’, Acta medico-historica adriatica: AMHA, 12, no. 2 (2014), 217-30.

^[3] Brinkman, R. J., and J. J. Hage, ‘Andreas Vesalius’ 500th Anniversary: Initial Integral Understanding of Voice Production’, J Voice, 31, no. 1 (Jan 2017).

^[4] Nutton, Vivian, ‘Vesalius revised. His annotations to the 1555 Fabrica’, Medical history, 56, no. 4 (2012), 415-43; Pagel, Walter, ‘Vesalius and the Pulmonary Transit of Venous Blood’, Journal of the History of Medicine and Allied Sciences, 19, no. 4 (1964), 327–41.

^[5] Hast, M H, and D H Garrison,’ On the Fabric of the Human Body: An annotated translation of the 1543 and 1555 editions of Andreas Vesalius’ De Humani Corporis Fabrica, Northwestern University [online resource] (2003), p. 36

^[6] Ibid., 3r: Fabrica, To the Divine Charles V, the Mightiest and Most Unvanquished Emperor: Andreas Vesalius’ PREFACE to his books On the Fabric of the Human Body.

^[7] Vesalius, Andreas, Vesalius: The China Root Epistle: A New Translation and Critical Edition, edited by Daniel H. Garrison (Cambridge, 2015), pp 89–90.

^[8] Saunders, M. J. B. de C., and O’Malley, Charles D., ‘The Preparation of the human Skeleton by Andreas Vesalius of Brussels: An Annotated Translation of the 39th Chapter of De Humani Corporis Fabrica, 1543’, Bulletin of the History of Medicine, 20, no. 3 (1946), 433–60.

^[9] Juan, Rose Marie San, ‘The Turn of the Skull: Andreas Vesalius and the Early Modern Memento Mori’, Art History, 35, no. 5 (2012), 958-75.

^[10] Carlino, A., ‘Paper bodies: a catalogue of anatomical fugitive sheets 1538-1687’, Medical history. Supplement ,19 (1999), Introduction, p.3.

^[11] Kusukawa, Sachiko, Picturing the Book of Nature: Image, Text, and Argument in Sixteenth-Century Human Anatomy and Medical Botany (London, 2012).

^[12]  Fabrica, Bk. I Chapter 19.