Vesalius: spirit of excellence and inquiry

JMS Pearce 
Hull Royal Infirmary, United Kingdom (Spring 2014)

 

An image from De Fabrica

This brief sketch is offered to commemorate the 500th birthday of Andreas Vesalius and the beginnings of post-Renaissance anatomy. Few men are more deserving of lasting fame than Vesalius. The prime importance of his anatomy is irrefutable. The current decline in anatomy teaching has provoked trenchant criticism.1 But Vesalius was not the first to advance the subject. Herophilus of Chalcedon (325-255 BC)2, with his contemporary, Erasistratus (c. 325 -250 BC), performed human cadaveric dissections over a period of 30-40 years.

Andreas Vesalius, son of an apothecary to Emperor Maximillian and to Charles V, was born in Brussels on December 31, 1514.3 He studied in Paris and worked in Louvain, Basle, and Padua. He was trained in the received medical wisdom pioneered by Galen. A passionate, assiduous scholar, his anatomical dissections yielded observations at odds with Galenic traditions. These he recorded in 1543 in De humani corporis Fabrica,* dedicated to Charles V, the Holy Roman Emperor. It comprised seven books (see appendix) written in Latin.

Predictably controversial, De Fabrica4,5 and its companion the Epitome6 quickly became what The Oxford Medical Companion calls “probably the most influential of all medical works.” Its magic lies both in the marvelous dissections and illustrations, and in revealing that this one man invented modern anatomy.True, Leonardo da Vinci (1452-1519), Marcantonio della Torre (c. 1481-1511), and Bartholomeo Eustachius (c. 1500-1574) had illustrated human dissections, but they were less comprehensive.

Not only is De Fabrica a singular, original work,8 but also one of beauty, bearing 272 woodcuts and copper plate illustrations—attributed to the “studio of Titian” possibly including Jan van Calcar, illustrator of Vesalius’s earlier tracts.9 Importantly, Vesalius insisted that anatomy could be studied only by of human dissection: “The negligence of those who stupidly transcribe from the books of others things which they have never seen for themselves.” (Fabrica, I 18:191)

Though devoted to Galen—quoting many of his passages on function,12—he challenged his sacrosanct authority on several Galenic observations made in apes, oxen, and sheep. A second edition with stylistic amendments was published in 1555. Recent translations and commentaries3,10,11 show that Vesalius was at times captious of his contemporaries’ publications. Vivian Nutton describes Fabrica as a masterpiece of rhetoric, printing, and art.9

Fabrica notably corrected many inaccuracies of earlier tracts translated from Greek, Syrian, Arabic, and Latin, and laid the groundwork for all subsequent anatomy. For Vesalius anatomy was essential for rational surgery. Yet surgeons’ dissections13 constituted a lowly job whereas anatomists were learned physicians seated (in cathedra) above the cadaver with a demonstrator who indicated body parts. Autopsies lasted about three days.14 Though anatomical material was scarce, Vesalius performed his own dissections. Fortunately, in 1539 a Paduan judge decreed that he could dissect bodies of executed criminals.

Examples of difficulties with nomenclature
In his time, arteries, veins, and nerves were a ‘threesome of vessels’. This concept troubled Vesalius, because he failed to find a lumen in nerves (vide infra) whereas arteries and veins contained hollow channels. Vesalius reappraised many of Erasistratus’s notions.15 He named the pulmonary artery vena arterialis, and the pulmonary vein arteria venalis. But in Book III, he explained that this contradiction related to function rather than structure of these vessels. This exemplifies the many difficulties in confusing terminology.

Vesalius also challenged Galen’s rete mirabile of the brain’s circulation at his public dissections: “I was so keen not to gain the reputation of having been unable to find the plexus … that I imposed upon my audience by demonstrating from a sheep’s head something I had never found in a human one.”

Only Vesalius’s largest arterial and venous trunks were named: he had no names for peripheral branches. We have eight cervical nerve roots, Vesalius had seven: thus our C8 equates with Vesalius’s T1. Seven cranial nerves figure in Fabrica do not correspond to modern conventions. The optic nerves were until Vesalius hollow channels (poroi optikoi), but Vesalius stated: “I have never found such a channel, though I have operated with this sole end in mind.”

With few human bodies to examine, anatomical variations were underestimated. But Fabrica’s astonishing detail is exemplified by a huge illustration of veins and arteries at the end of Book III.

After De Fabrica

Little is known of Vesalius after 1555 when largely abandoning anatomy he became physician to Emperor Charles V and attended Philip II of Spain. Returning from a pilgrimage to the Holy Land he died, possibly of scurvy,16 in October 1564 on the Greek island of Zakynthos. Harvey Cushing included Vesalius with Hippocrates, Galen, Harvey, and Lister as the five greatest contributors to medicine.6

Notes

*Traditionally abbreviated to De Fabrica or Fabrica

 

References

  1. Korfa HW, Wicht H. Snipes RL, Timmermans JP, Paulsen F, Rune G, Baumgart-Vogt E. The dissection course – necessary and indispensable for teaching anatomy to medical students. Ann Anat 2008;190 16—22.
  2. Pearce JMS. The Neuroanatomy of Herophilus Eur Neurol 2013;69:292-295
  3. O’Malley  CD. Andreas Vesalius of Brussels, 1514-1564. (Berkeley: University of California Press, 1964.
  4. Vesalius A.  De humani corporis Fabrica libri septem’. Basel, 1543.. annotated translation of the complete book, see Garrison et al. (2003), http://vesalius.northwestern.edu/.
  5. Vesalius, Andreas. On the Fabric of the Human Body, translated by W. F. Richardson and J. B. Carman. 5 vols. San Francisco and Novato: Norman Publishing, 1998-2009. http://books.google.co.uk/books?hl=en&lr=&id=-CjZIlnq78QC&oi=fnd&pg=PR9&dq=vesalius&ots=brhzY5aCsL&sig=VtjnUdutpiHE6eC93aOcYY5q5X8#v=snippet&q=De%20Fabrica&f=false
  6. Cushing H. A Bio-Bibliography Of Andreas Vesalius. Schuman’s. New York, 1943.
  7. Pearce JMS. Andreas Vesalius: the origins of anatomy. In: Fragments of Neurological History. London, Imperial College Press. 2003. pp. 3 – 13.
  8. Menzoian JO. Lest we forget: the contributions of Andreas Vesalius and Ambroise Pare to my surgical practice. Am J Surg 1999;178:85-91. Hunter. J Biocommun 1998;25:2-7
  9. Rudakewich M. The recognition of the anatomical artists in the works of Vesalius, Albinus, and Hunter.  J Biocommun 1998;25: 2-7.
  10. Garrison DH. Hast M H. Andreas Vesalius, The Fabric of the Human Body (2003). Book I is available on line at http://vesalius.northwestern.edu; the complete version will be published by S. Karger at Basle in 2014.
  11. Pearce JMS. On the Fabric of the Human Body, Books III and IV J R Soc Med. 2003 ; 96(9): 467–468.
  12. Nutton V. Vesalius Revised. His Annotations to the 1555 Fabrica  Medical History 2012; 56, pp. 415-443.
  13. Singer C. Brain dissections before Vesalius. J Hist Med 1956; 11: 261-5.
  14. Hart Davies A. Vesalius. BBC Online, Local heroes, biography. www.bbc.co.uk/history/programmes/local_heroes/biogs/biogindex.shtml
  15. Pearce JMS.  The Neurology of Erasistratus. Neurol Disord 2013, 1:1. doi: 10.4172/2329-6895.1000111
  16. The causes of the enigmatic death of Vesalius in Zante in 1564. http://pampalaia.blogspot.com/2012/03/causes-of-enigmatic-death-of-vesalius.html

Appendix
Book I – The things that sustain and support the entire body, and what braces and attaches them all [the bones and the ligaments that interconnect them]
Book II – All the ligaments and muscles, instruments of voluntary and deliberate motion
Book III – The series of veins and arteries throughout the body
Book IV – The nerves
Book V – The organs of nutrition and generation
Book VI – The heart and organs serving the heart [chiefly the heart and lungs]
Book VII – The brain and organs of sense

 


 

J.M.S. PEARCE, MD, FRCP (London) is emeritus consultant neurologist in the Department of Neurology at the Hull Royal Infirmary, England. All correspondence to: 304 Beverley Road, Anlaby, East Yorkshire, HU10 7BG, England.