Andreas Vesalius, or Anatomy Revisted



Vanessa Schmitt, PhD

Federal University of Rio Grande do Sul,

Porto Alegre, Brazil



Abstract

This essay aims to show that the Renaissance period had a profound effect on the field of medicine. In order to demonstrate this assertion, I will examine Renaissance advancements in the study of anatomy, largely drawing from changes provoked in this branch of medicine during the sixteenth century by the brilliant work of Andreas Vesalius. To achieve this goal, three main topics will be presented. First, I will investigate the substantive meaning of the Renaissance and its importance for people of time. Second, a short biography of Vesalius — his background and the ways it influenced his career — along with a description of the teaching of anatomy in his time will be presented. Finally, I will discuss how Vesalius's attitudes and published works created a significant change in the field of medical science, permanently struck by the Renaissance anthropocentric thought.

 

Keywords: Renaissance; anatomy; Vesalius (Andreas)


Introduction

This essay will argue that medicine was deeply and irremediably affected by the Renaissance. In order to demonstrate this assertion, I will examine Renaissance advancements in the study of anatomy, largely drawing from changes provoked in this field during the sixteenth century by the work of the physician Andreas Vesalius. To achieve that goal, three main topics will be presented. First the substantive meaning of the Renaissance and its importance for people of time are discussed. I also present a brief biography of Vesalius — his background and the ways it influenced his career — along with a description of the teaching of anatomy in his time. At last, I analyze how Vesalius's attitudes and published works left a permanent and profound impact on the conception of medical science.

 

Defining the Renaissance 

It is wise to practice prudence when defining the meaning of certain terms, and Renaissance is no exception. First, there is much controversy surrounding the term; according to some scholars, as highlighted by the historian Paul Oskar Kristeller, the Renaissance cannot be considered a historical period at all. (1) These scholars uphold that conceiving History as a timeline — i.e. divided into segments according to common characteristics — is difficult. The last work published by the French medievalist Jacques Le Goff discusses this topic adopting a very thoughtful perspective. (2) For this article’s purpose, I will use Kristeller's definition of Renaissance, for whom it is "the period of Western European history which extends approximately from 1300 to 1600, without any preconception as to the characteristics or merits of that period, or of those periods preceding and following it." (3) Kristeller also emphasizes, judiciously, that the "inability of historians to find a simple and satisfactory definition for it [the Renaissance] does not entitle us to doubt its existence." (4) 


It was the French historian Jules Michelet who introduced, in the 19th century, the term Renaissance (with capital letter) within the context of historical terminology (that was the title of his work published in 1855). Five years later, in Die Kultur der Renaissance in Italien (The Civilization of the Renaissance in Italy, 1860), Jakob Burckhardt made its use well established. According to the historian Jean Delumeau, one of the most respected Renaissance experts, Michelet and Burckhardt gave to the word Renaissance a much broader meaning than that one which was given by humanists. (5) 


The Renaissance would be, in the sense of the individual, the turning point between the medieval man idea and the rediscovered man, as the rising anthropocentric perspective understands it. This effervescent period would be identified, by some coetaneous philosophers and artists — that is the Italian intellectual elite — as a "cultural rebirth". (6) For Delumeau, this would be evidenced by the use of the term renaissance (rinascita), which means rebirth. (7) Therefore the Renaissance man, driven by the desire to overcome those of the Antiquity, has "souvent la conscience d’y avoir réussi” [has often the awareness of having achieved this goal]. (8) 


We must also be cautious with humanism, a term intrinsic to the logic as well as to the definition of the Renaissance. Humanism has been interpreted in many ways and its meaning may be considered as controversial as the Renaissance itself. Kristeller highlights: "Renaissance humanism was understood and studied by most historians of the nineteenth and early twentieth century as the broad concern with the study and imitation of classical antiquity which was characteristic of the period and found its expression in scholarship and education and in many other areas, including the arts and sciences." (9) Thus, humanism went further than simply giving another meaning to classical studies: instead, this new way of understanding the world (from an anthropocentric perspective) should be considered responsible for rising science and its knowledge to the status of reflection of God. Only in this context of "emphasis on man,” in which the idea of the individual is unceasingly promoted, the Renaissance man could be able to elaborate his own thinking. (10) This new perception of the world as a microcosm inhabited by men, whose authority was seen as God's blessing, allowed the flourishing of science. Thus, we can understand the emergence of medical humanism more clearly as a renewed search for the essence of God in man on the physical, rather than metaphysical plane. 


Anatomy Before Vesalius

Today, anatomy is a scientific study based largely on observation. However, for centuries there was no direct correlation between the dissection of the corpse and the observation of the structure of the human body. As highlighted by the historian of science Marie Boas Hall, "progress in anatomy before the sixteenth century is as mysteriously slow as its development after 1500 is startlingly rapid." (11) Although some assumptions in this sense could be made, there is no obvious explanation to justify these phenomena. Unfortunately, a detailed examination of the study of anatomy before the Renaissance is not within the scope of this paper. 


In the fourteenth century, one of the major impediments to the study of anatomy was the absence of an accurate guide. Despite being widely available, most sections of the anatomical texts of Galen's monumental work were not translated (aside from some extracts of his treatise De Juvamentis Membrorum). Further, there was not a great interest in anatomy at the time, and even surgeons had knowledge only of superficial anatomy. The first major step towards a more significant degree of anatomical knowledge has been linked to the emergence of Mondino de'Luzzi's Anathomia (1316). As reported by Nancy Siraisi, Mondino's treatise begins "by a paean of praise to the superiority of man (that is, humankind), to all other animals. Man, according to Mondino, is distinguished by his upright stature, his intellect, his power of judgement and his tool-making abilities. The implication of the passage is that the body of so noble creature is a subject specially meriting study." (12) In Mondino's time, this was considered good reason. 


Up until the fifteenth century, anatomy was understood quite differently than it is today; anatomical concepts were essentially visual associations that symbolized physical concepts without closely resembling them. Although scattered references to poor graphic representations exist (usually erroneous), establishing visual correlations was not the purpose of anatomical studies. Analysis of the human body could only be justified through philosophical and theological reasoning. Firstly, anatomy might lead to an understanding of how and why man was given his mortal involucre. Answers to these inquiries were sought by Aristotle and Galen. (13) Thus, according to Roger French, "anatomy was also central to the enduring question of whether reason or sensory observation was more important in medicine, and we shall see that the sensory component enabled anatomy to survive the crisis of philosophy." (14) 


Manuscripts and, in a very reduced range when it became available, printed books were one of the main sources of education and knowledge (anatomical as well as physiological) for physicians and medical students during the Renaissance. Near the beginning of the fourteenth century, Galen became increasingly studied in recent Latin translations in the renowned medicine schools of Bologna, Paris, Montpellier and also in other educational centres. (15) It is important to note that in the early Renaissance, most professors of anatomy were actually experts in philosophy, philology and theology who acquired medical authority on the merits of their outstanding translations and compilations of medical texts. For example, Johann Guinther of Andernach (1487-1574), professor in the Faculty of Medicine of Paris, first taught Greek at Louvain and then anatomy in Paris, where he translated and published Galen's Anatomicis Administrationibus in 1531. There is no evidence that he ever dissected a corpse. (16) In this context, where anatomical knowledge was accepted as completely dissociated from observation, the practice of dissection seemed to have nothing valuable to add, which could explain its rarity. According to Siraisi, "in this context, dissection seldom functioned as a means of controlling or correcting the written word and certainly not as an independent research tool [...]. Rather, the practice of dissection served primarily as a visual aid to the understanding of physiological and anatomical doctrines found in texts.” (17) 


Nevertheless, it is known that through the fifteenth century, dissections were regularly performed in universities, and constituted an essential part of the curriculum. Marie Boas Hall highlights, "the cadaver was laid on a table, around which the students clustered closely; the actual dissection was performed by a demonstrator (often a surgeon) while the professor on his high lecture platform read the prescribed text which was Mondino or sometimes, later, Galen's Use of the Parts.” (18) Upon closer examination of this historical backdrop, the reasons that Vesalius's work eclipsed the pale attempts of others to form a Renaissance corpus of human anatomy become apparent.




The Changes Vesalius Provoked

Despite the temptation to sketch a detailed biography of Vesalius's life (which was short yet fascinating, ending tragically in a shipwreck), I will attempt to point out a few major moments which seem important to understanding the overwhelming impact of Vesalius's work in his own time. Born into a family with a medical tradition who served the royal house of Netherlands, Andreas Vesalius of Brussels (1514-1564) first studied in the very conservative Faculty of Medicine in Paris under teachers such as Vasses Meaux, Jean Fernel, Guinther of Andernach and Jacobus Sylvius. 


At Paris, as related by Marie B. Hall, Guinther of Andernach, who was a "medical humanist, rather than a practising anatomist", introduced Galen's On Anatomical Procedures (recently translated to Latin and commented by him) to Vesalius. Though he accused his teachers — including Guinther and Sylvius — of ignorance in practical anatomy, "he was profoundly influenced by the tremendous interest in Galen displayed by the medical faculty and the printers of Paris." (19) Vesalius's technical improvement is also attributed to his frequent visits to the cimetière des Innocents (which provided him specific notions of osteology). At Louvain, where he reinitiated his studies after leaving Paris due to war, his reputation seems to have preceded him and he was invited to lead the first dissection performed in eighteen years. In 1537, he published his thesis, Paraphrasis in nonum librum Razhae medici arabis clariss ad Regem Almansorem, in which he confronted several theories of disease and therapeutics by Arab physicians, particularly those of the Persian Rhazes (854-923). (20) In the same year, Vesalius went to Padua, the most esteemed medical school at the time, as stated by Daniel Boorstein, and where education was strongly influenced by humanism. On December 5th, 1537, the Faculty of Medicine in Padua granted him the title of Doctor of Medicine magna cum laude. (21) The next day, he was assigned chair of surgery at the same university, a position that allowed him to begin transforming the concept of anatomy. (22)


De Humanis Corporis Fabrica

Vesalius's first anatomy at Padua became famous. It was conducted over nearly three weeks in the body of an eighteen-year-old man. Vesalius's procedure was still indebted to Galen and the Galenists; however, from his first dissections he showed a particular concern for anatomical findings. As a result of his teaching and dissection experiences in Padua, in 1538 Vesalius published Tabulae Anatomicae Sex, a work that inaugurated a new trend in anatomical textbooks where drawing and diagrams were successfully associated to anatomical terms. This text provides evidence to distinguish Vesalius from his predecessors and from the others anatomists of his time: 

1) The illustrations added a new dimension to the study of anatomy. Until then considered "useful merely as a mnemonic device rather than an explanatory source," Vesalius's illustrations transcended their prior meaning and could be considered an authentic way to represent reality. (23) More specifically, the body and the human being; 

2) The illustrations had an undeniable and innovative aesthetic appeal. In this work, Vesalius drew the three plates devoted to the veins and arteries, "the first interested in the liver, spleen, the portal vein and genitals, the second giving the appearance of the entire system venous and one third of the aorta and the heart," while the other three plates, designed by Jan van Kalkar (a pupil of Titian), are dedicated to the skeleton, in frontal, sagittal and posterior views. (24)

 3) Most important among the aspects we could highlight to demonstrate the strength and originality of Vesalius's work, as mentioned earlier, is that Vesalius included his personal evaluation of the work, which was completely new and unexpected at the time. This signified a move away from the speculative world toward the realm of empirical evidence. Considering this, the Tabulae  became one of the most important medical references of the time.


Albeit well done, the drawings of the Tabulae perpetuated some inaccuracies; which Vesalius, to his credit, did not ignore. Thus, in the following years, he "lectured and dissected furiously, until he felt satisfied that he had solved the major problems in anatomy and was competent to present the results of his work to the public." (25) In 1543, in Basel, he published his masterpiece, De Humani Corporis Fabrica Libri Septem —more commonly known as Fabrica — by the printer Johannes Oporinus. In this beautifully illustrated and printed edition, Vesalius described the structure of the human body in detail using more than two hundred woodcuts. 


According to Saunders and O'Malley, the Fabrica can be considered the most overwhelming individual contribution to the medical sciences. (26) The identity of the real author of the Fabrica's amazing illustrations remains uncertain. It may have been Jan van Kalkar, another (or several) of Titian's pupils, Vesalius himself, or even someone else in collaboration with him. What is essential here however is not the illustrator's identity but rather that the Fabrica is recognized as a landmark for its time. I will attempt to emphasize why. 


Foremost, the Fabrica is recognized as the original anatomical atlas: for the first time, a huge amount of anatomical findings were shown graphically and textually, in an accurate representation of the human body. In this work, Vesalius far surpasses his achievements of the Tabulae. By the sixteenth century, anatomical nomenclature was not yet standardized and for this reason Vesalius used images to illustrate his work and to avoid the possible ambiguity of words. In addition, he included a glossary as well as an index with names of structures in Greek as well as Latin, Arabic and Hebrew. (27) 


Secondly, Vesalius's understanding of anatomy was grounded in his own observations and he did not hesitate to report when his own descriptions differed from Galen's. In his boldness, he claimed that Galen's anatomical conceptions were based on animal dissections, especially on the anatomy of the ape, and hence divergent from that of humans. Vesalius's allegations unleashed fierce controversy, in particular among professors of the Faculty of Medicine of Paris (Jacobus Sylvius particularly was offended). Undoubtedly, this revolution was Vesalius's greatest achievement. As Stephen N. Joffe highlights in his Vesalius' biography, "no previous publication had so extensively or critically outlined Galen's anatomy [...]." (28) This could be considered the biggest attack on dogmatism in the history of medical science. 


Third, the aesthetic appeal of the Fabrica established a new paradigm in art as well as science. The set of illustrations showing the skeleton and the échorchés set against Paduan landscapes astonished the world. Beyond its pedagogical significance, the Fabrica can be considered poetical and even thanatological. 


Finally, it can also be noted that in publishing the Fabrica, Vesalius made anatomical knowledge accessible to all. Artists, surgeons, barbers, even those belonging to la rica borghesia cittadina who were looking for distraction and, a whole generation of scholars found in Vesalius's work a trusted source of medical knowledge. Thus, anatomy became — more than a set of vague descriptions — a visually comprehensible and powerful pedagogical tool. 


Conclusion

Vesalius aimed to prove he was greater than the greatest of masters, otherwise his work would not be considered noteworthy. Therefore, although on the surface Vesalius's work appears as an incredible innovation, without Galen it would have been impossible for him to achieve his goal and give the world the Fabrica. As Marie Boas Hall rightly notes: "there is a real sense in which Vesalius began with Galen rather than the human body, in the same way in which Copernicus began with Ptolemy rather than with the physical world. Neither Copernicus nor Vesalius was any the less original for that."  (29) 


One of Vesalius's greatest merits is undoubtedly the volume of material he examined and his ability to combine, as much as was possible in his time, the knowledge he inherited (from Galen, Avicenna, Aristotle, the old school of Paris and the progressive school of Padua) with the results of his own observations. 


The De Humani Corporis Fabrica has earned a place as a landmark in human history. Remembered for its considerable impact, intelligent contents and arguments, aesthetic beauty, and for the boldness of its author, the Fabrica pushed many generations of medical students and doctors towards science. The Fabrica's exceptional woodcut engravings were reproduced and inspired the work of others such as Realdo Colombo, Felix Platter, Gabrielle Faloppio and Leonardo Fuchs. Vesalius's anatomical drawings and descriptions influenced artists and were even responsible for a new poetic of death. 


Vesalius is unarguably a key figure in the history of medicine. Through his love of science and of art he created important changes in the field. With his great courage, he challenged long-held beliefs, and overturned the status quo of his art. Vesalius showed that there was a whole world to discover, a long pathway where difficulties and inconsistencies could persist. But his anatomical discoveries were just the beginning of a journey towards a more comprehensive understanding of the human machine. For one, they laid the groundwork for the important physiological findings of the seventeenth century. Vesalius reinvented our conception of man: nothing could be more consonant with the significance of the Renaissance.


References

1. Kristeler, Paul. Renaissance thought and its sources. New York: Columbia University Press, 1979, 17.
2. Le Goff, Jacques. Faut-il couper l'histoire en tranches? Paris: Seuil, 2014.
3. Kristeler, Renaissance thought, 17.
4. Kristeler, Renaissance thought, 17.
5. Delumeau, Jean. La Civilisation de la Renaissance. Paris: Arthaud, 1984, 495
6. Johnson, Paul. The Renaissance: a short history. New York: The Modern Library, 2000, 3.
7. Delumeau, La Civilisation, 82. 
8. Delumeau, La Civilisation, 111.
9. Kristeler, Paul. "Humanism". In The Cambridge history of Renaissance philosophy, edited by C. Schmitt, and Q. Skinner. (Cambridge: Cambridge University Press, 1988), 113.
10. Kristeler, Renaissance thought, 30.
11. Hall, Marie B. The Scientific Renaissance, 1450-1630. New York: Dover, 1994, 130.
12. Siraisi, Nancy. Medieval and early Renaissance medicine: an introduction to knowledge and practice (Chicago: University of Chicago Press, 1990), Kindle edition.
13. French, Roger. Medicine before science: the business of medicine from the Middle Ages to the Enlightenment. Cambridge: Cambridge University Press, 2003, 113.
14. French, Medicine before science, 114.
15. Siraisi, Medieval and early Renaissance
16. Saunders, JB and O’Malley Charles. The Illustrations from the works of Andreas Vesalius of Brussels: A Discussion of the plates, and a biographical sketch of Vesalius. With annotations and translation. Cleveland: World Publishing Company, 1950.
17. Siraisi, Medieval and early Renaissance
18. Hall, The Scientific Renaissance, 133.
19. Hall, The Scientific Renaissance, 144.
20. Drèze, Charles. 1998. "André Vésale et De Humani Corporis Fabrica Libri Septem". Louvain Medicine 117: 273-274
21. Drèze, Charles. "André Vésale", 273
22. Saunders and O’Malley, 21.
23. Joffe S. Andreas Vesalius: The making, the madman, and the myth (Bloomington: Authorhouse, 2014), Kindle edition.
24. Drèze, "André Vésale", 273.
25. Hall, The Scientific Renaissance, 145.
26. Saunders and O’Malley, 24.
27. Boorstin, Daniel. The Discoverers (New York: Vintage Books, 1985, Kindle Edition.
28. Joffe, Andreas Vesalius.
29. Hall, The Scientific Renaissance, 146.


Vanessa Schmitt has a graduate degree in Dental Surgery, a Master of Arts and a PhD in French and Francophone Literature, all of them awarded by the Federal University of Rio Grande do Sul, Porto Alegre, Brazil. During the 2013-2014 academic year, she was an affiliate of the University of Geneva as a postdoc fellow. Her project explored the dialogue between literature and science in the nineteenth century French novel, particularly the Goncourt brothers' work. 


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Historia Medicinae Editor,
Aug 14, 2015, 1:55 PM
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