Vesalius

Portrait of Andreas Vesalius (1514-1564) at age twenty-eight years. It appeared in the Fabrica and the Epitome of 1543, and the China-Root Epistle of 1546. C.D. O'Malley, who wrote the definitive biography of Vesalius, credits this image as the only authentic portrait of Vesalius. Source: James Moores Ball.

Andreas Vesalius (1514-1564),       a Belgian (Flemish) Renaissance physician/surgeon, anatomist and physiologist, revolutionized the study and story of human anatomy and, as a consequence, the practice of medicine. He accomplished that feat (a) in virtue of the results of his dissections of human cadavers never previously performed and described with the factual accuracy of Vesalius's extraordinarily meticulous systematic detail and extensive documentation; (b) in virtue of the fluent writing [in Latin] of lucid descriptions of his anatomical and physiological findings precisely integrated with the accompanying illustrations; (c) in virtue of his gift for visualization and understanding of the importance of illustration for teaching anatomy, resulting in his having his anatomical findings exquisitely illustrated by his artist collaborators, including Jan Steven van Calcar and likely other pupils of the artist, Titian; and, (d) in virtue of his insistence on employing the findings of dissection of the human body as the arbiter of human anatomy, as opposed to accepting the reports of anatomists of antiquity.  

Fabrica

In 1543, at the age of 28 years, Vesalius published De Humani Corporis Fabrica (On the Workings of the Human Body.) — generally referred to as the Fabrica — a work of many years of observations and illustrations of human dissections that not only laid the foundation for a realistic human anatomy but also demonstrated numerous errors in the anatomical assertions of the self-proclaimed heir of Hippocrates (460-360 BCE), Galen (129-216 CE) of Pergamum, the Greek physician/surgeon who based his description of human anatomy on extrapolations of dissections of animals and observations of the wounds of gladiators in Rome and Pergamum. Vesalius's contemporaries, having unquestionably accepted Galen's conclusions about human anatomy, found themselves in turmoil, stunned and even outraged at what eventuated as one of the most important contributions to the evolution of biology and medicine.

In his book on the evolution of medicine, Sir William Osler considered the Fabrica "....one of the great books of the world", asserting as follows:

The worth of a book, as of a man, must be judged by results, and, so judged, the "Fabrica" is one of the great books of the world, and would come in any century of volumes which embraced the richest harvest of the human mind. In medicine, it represents the full flower of the Renaissance. As a book it is a sumptuous tome—a worthy setting of his jewel—paper, type and illustration to match...the chef d'œuvre of any medical library.

The U.S. National Library of Medicine offers an online gray-scale reproduction of some forty pages of the Fabrica, prepared in such a way that the reader can turn the pages, pause on any page to zoom on any section, read explanatory commentaries, and print pages.

Medicine's intertwining with science began when physicians finally realized that universalizing, all-explaining theories about human biology served only to foster the misinterpretation of observed phenomena. Until then, a conflict between what was actually experienced and what the grand conceptual scheme told a physician he should be experiencing was always resolved in favor of the latter. —Sherwin B. Nuland

The year that saw publication of the Fabrica, 1543, also saw publication of Nicholas Copernicus's (1473-1543) De revolutionibus orbium coelestium libri vi (Six Books Concerning the Revolutions of the Heavenly Orbs) — the two books published a week apart. A memorable year, and a memorable pair of scholars who jump-started two revolutions, one on interpretations of the structure and function of the human body, the other on interpretations of the structure and movements of the earth and the sun. Those revolutions challenged ancient wisdom that had dominated thinking in medicine and astronomy. These new ideas represent an anno mirabile in the history of science.

Vesalius' observations challenged some misconceptions of Christendom about the human body, and provoked opposition. Even Vesalius' teacher Sylvius denounced him to Charles V as a monster of impiety. During the Middle Ages there was a widely held belief known as the Apostles' Creed that the flesh of the body would be resurrected in the future, and some thought the nucleus of the resurrected body took the form of a bone, which Vesalius failed to discover. Another disproved idea was the "missing rib" used to create Eve. Some speculate that the Fabrica was sent to Basel for publication, instead of a much more convenient and easily supervised publication in Venice, to avoid anticipated censorship (the Roman Inquisition was formed in 1543, the year the Fabrica was published). However, O'Malley considers the reason unknown (p. 430).

Vesalius was forced to steal his "materials" from the gallows and from tombs to perform his work, because he was unable to obtain enough cadavers legally for dissection. According to O'Malley:

Nor should we overlook Vesalius's own initiative in the procurement of cadavers — of course illegally — as he became more confident of his position. Yet even with such assistance as he received, he must always have suffered from a shortage of dissection material, especially when we recall that there were no satisfactory preservatives. (p. 113)

Vesalius himself describes the illegal source of several of his cadavers in the Fabrica as translated by Richardson and Carman.

The history of Western science recognizes Vesalius's century as a turning point in the progress of science, a significant transition period straddling medieval science and the scientific revolution of the 1600s. Historian C. B. Schmitt states that one of the major growth points for scientific studies during the sixteenth and early seventeenth centuries lay in developments within biological science. While many contributed to that growth, and did so in what biologists would now assign to many different disciplines of biology, Vesalius remains a key contributor, in pedagogical and scientific method, in knowledge, and in influence.

Chronology of Vesalius's life

Vesalius entered the world in Brussels, Belgium, late on the last day of 1514 or early on the first day of 1515, the newest member of a wealthy family of many generations of physicians. His father served as apothecary — preparer and dispenser of medications — in the royal court (Holy Roman Emperor Charles V (1500-1558)). Father's duties apparently forced leaving the upbringing of Vesalius and his two brothers and a sister to the mother. Vesalius had access to his family's library of books. As a child Vesalius often visited a nearby site (Gallows Hill) where the authorities left criminals hanging until they rotted. Vesalius thus could begin to teach himself aspects of human anatomy at an early age. He continued to satisfy his curiosity of anatomy with the dissection of small animals, concentrating on both structure and function at a macroscopic level — the microscope not invented until after Vesalius's death.

At age 15, Vesalius began studying at the University of Louvain, where he learned, between 1530 and 1533, the subjects of rhetoric, logic, philosophy, and Latin. The University of Louvain stressed the Latin of the ancient Romans and attempted to inculcate a high degree of literary skill in reading and writing.

After Louvain, Vesalius moved to study at the most prestigious center of medical science at the time, the University of Paris, attending from 1533 to 1536. As little information has emerged of Vesalius's activities during those three years, his biographer, C. D. O'Malley, offers an educated argument from information on the workings of medical education at that time there. Near concluding, he writes:

It would be incorrect to liken the Vesalius of Paris to the later author of the Fabrica, and it is important to remember that although Vesalius in Paris may have been extraordinarily inquisitive, and he had acquired unusual skill in the technique of dissection, his vision was still considerably clouded by Galenism if, indeed, he was not a completely devoted Galenist.

Subsequently Vesalius moved to Italy, to the central hub of Renaissance culture and learning, Padua, where at the University there he quickly earned his medical degree (1537) and soon after a professorship in anatomy. Vesalius received his medical degree on 5 December 1537, and the “following day Vesalius took over the chair of surgery and anatomy, although there appears to be no official document that records his appointment….the fact is found only in the document that records his reappointment in October 1539…[t]he only other possible explanations for his appointment are the impression he may have made during the few months in which he was a candidate for the degree, and the quality of his examination, plus the fact that the chair to which he was appointed was not at that time of great significance, as the list of his predecessors indicates. Whatever the reason, Vesalius was appointed professor of surgery to succeed Paolo Colombo of Cremona”.

Following publication of Fabrica Vesalius resigned his chair in Padua and became the physician to the royal household of Emperor Charles V in Brussels. In 1555 Charles V abdicated and Vesalius entered the service of Charles' son Philip II, the new ruler of Spain, and moved to Madrid.

In the spring of 1564 Vesalius undertook a pilgrimage to Jerusalem. Apparently, upon his return he intended to resume his chair in Padua. The reasons for this trip are not documented, but among the possibilities the most likely is that he ran afoul of the significant opposition to his dissections, and the trip was a penance imposed by the Inquisition in place of a judicial penalty. On his return journey from the Holy Land later that year, a storm forced Vesalius' ship to the Greek island of Zakinthos (Zante) in the Ionian Sea, where he died.

Timeline

(PD) Image: John R. Brews

The image at right shows the timeline of Vesalius's life in relation to that of William Harvey, who advanced physiology as Vesalius did anatomy, and Marcello Malpighi, who completed the circuit of Harvey's circulation of the blood by his discovery of the capillaries. Each segment of years is one century.

Vesalius's work

(PD) Image: Andreas Vesalius, Fabrica (1543)
The Fabrica illustration of the human cortex. Top panel: Figure 2 of Book 7; Bottom panel: Figure 3 of Book 7.

(PD) Image: Andreas Vesalius, Fabrica (1543)
Figure accompanying Table 2 in Book 2 of the Fabrica. An image in color can be found here.

Vesalius’ major work was the Fabrica, printed by Johannes Oporinus of Basel in 1543. The letter of instructions submitting this work to the printer is available in English translation.

As samples of the Fabrica, two gray-tone versions of Fabrica illustrations are shown. The figure at left provides two of twelve figures from Book 7: The brain and organs of sense that display the human brain. Vesalius describes in his figure captions the procedures used to obtain these views, and provides detailed observations upon the brain's construction. The figure at right shows one of many depictions of human musculature in Book 2: Ligaments and muscles. Although not obvious in the figure at this size, tiny labels identify individual muscles and are elaborated upon in the table accompanying the figure. As the figures progress, layers of muscle are peeled away (flayed) to show structure at all levels.

The Metropolitan Museum of Art website says about the posed figures in the illustrations: “In addition to demonstrating the physical structures of the body, they imply concern for more elusive aspects of the human condition.”

Nuland summarizes Vesalius and his work in the following outline, presented verbatim:

“A.  Fabrica has been interpreted to mean not just "structure" but "workings." Vesalius was as interested in the functions of the human body as he was in the anatomy itself.

B.  Published in 1543, Fabrica gave the world its first accurate knowledge of anatomy and a method by which it could be studied.

C.  Vesalius provided directions by which anyone with appropriate instruments and access to cadavers could perform dissections.

D.  Vesalius's book began the process of debunking Galen, though this would take centuries.

E.  Although Vesalius's text brought about the change, the work of its artist, Jan van Calcar, a protege of Titian, is what is most commented on today.

F.  The story of this book and of Vesalius himself is also the story of a series of events representative of the Renaissance, including:

1.  A return to interest in the human body

2.  A return to Greek learning

G.  The rise of the universities, which were the focus of Renaissance thought.”

In regard to point D, the influence of Galen on the description of human anatomy before and during Vesalius's time cannot be underestimated:

Indeed, when the young Vesalius began his study of human anatomy, the authority of the ancient anatomist had grown so weighty that anatomists tended to explain away discrepancies between his descriptions and their own observations in terms of individual abnormalities or changes in the human body that had occurred since the time of Galen. For example, Jacobus Sylvius (1478-1555) defended Galen's description of the human sternum as made up of seven bones on the grounds that human beings in a more heroic age might have had more bones than their degenerate descendants.

In the practice of medicine, the Renaissance saw the classic medical scholars of antiquity deified and staunchly deemed infallible and irreproachable. Like the enchanting songs of the sirens, their authoritative voices were so deafening that even one’s eyes could be fooled into believing that they could see what was not truly there.

Point E seems a bit exaggerated, possibly undervaluing historical and other scholarly commentary. The suggested involvement of Jan Steven van Calcar is supported by Guerra, but is admittedly not iron clad. Guerra also points out the importance of the wood engraver and well-known publisher, Francesco Marcolini da Forlí. O'Malley, in his exhaustive biography of Vesalius, devotes seven pages specifically to a consideration of the illustrator(s) of the Fabrica, interpreting the documentary evidence as providing no definitive conclusion as to who prepared the illustrations, and no evidence with certainty that Calcar participated. O'Malley suggests that some of the illustrations were prepared by Vesalius himself and others by students of the studio of Titian. In any case, the art work is extraordinary: to quote Nutton,

"...its artwork, the co-production of anatomist, artist, block-cutter and printer, solved at a stroke many of the difficulties involved in representing a three-dimensional object on the printed page." –from the Conclusion of Nutton's Introduction to Fabrica.

The universal assessment of Fabrica today is summarized as:

"The result is, without question, the finest medical book ever published and one of the most beautiful books of all time." –Chauncey D. Leake.

Vesalius as Galen resurrected

According to historian, Andrew Cunningham, in his book, The Anatomical Renaissance, Vesalius exceeded Galen, surpassed him, went far beyond him, not by pointing out the erroneous conclusions Galen made about human anatony—the consequence of Galen's dissections performed not on human corpses but on those of apes and other non-human animals, of necessity, because of the proscription dictated by custom and law—nor did Vesalius surpass Galen by upbraiding him or holding him up for disrespect as dissector or anatomist—rather, Vesalius revived Galen, continuing Galen's anatomical project, in a metaphorical sense, by a metamorphosis of himself into another Galen, an extension or reincarnation of Galen.

For some 200 years before Vesalius, medievalists dissected human corpses, dissections for the most part motivated to demonstrate and confirm the anatomy of Galen, regarded as the infallible, the supreme authority on human anatomy[ pp. 11-17] [ p. 118].  The lecturer read from the text of Galen from an elevated lectern removed from the corpse, a surgeon dissector cut to reveal the Galenic truths, and a demonstrator with a pointing device pointed to the Galenic revelations—the latter two individuals performing their contributions sometimes days after the lecture. None had thought to repeat Galen's work, to dissect meticulously the human body and accept the evidence of the very images presented to their eyes and the feelings informing their hands, as Galen had done with non-human bodies. None, that is, until Vesalius, the "born dissector", came along and did just that, and so "taught the world to see a different Galenic body; and...taught anatomists, physicians and philosophers to adopt a new ambition with respect to the Ancients of anatomy".

After receiving his doctor of medicine degree in Padua and taking up his teaching duties, Vesalius quickly grew impatient with the traditional ritual of performing 'anatomies', as the three-person lecturer-dissector demonstrator ritual described above was called. He himself lectured as he dissected, at the same time demonstrating the parts and their relationships, encouraging students to come to the corpse and see and feel for themselves, roughly sketching at the dissection table the findings for the students to view and copy, sometimes bringing to the sessions illustrations he had made from previous dissections. In revealing where the Galenic texts were incorrect, he was not castigating Galen, he was being Galen, doing what Galen could not do because Galen could not dissect the human body. He even followed the sequence of dissecting the body as Galen did, in contrast to the traditional sequence that the pre-Vesalian anatomists employed. His ambition was "to redo the whole of Galen's anatomy, but on the human body, the body it was supposedly about. In order properly to be Galen, Vesalius had to do what had not been available to Galen to do". Thus, the Fabrica.

References

Many citations here include blue links that open variously to full-text or to a publisher's description of the work. Links to Google books often offer an extensive preview of the text.

Notes

Included among the Notes below are annotations to several of the references.