Just as Copernicus and Galileo revolutionized ideas about the motions of the earth and the heavens, Andreas Vesalius (1514–1564) trans- formed Western concepts of the structure of the human body. Vesalius’ great treatise, The Fabric of the Human Body (De humani corporis fabrica), appeared in 1543, the year in which Nicolaus Copernicus (1473–1543) published the text that placed the sun, rather than the earth, at the center of the universe (On the Revolutions of the Heavenly Spheres). Vesalius was heir to the humanist medical tradition that had rediscovered the original writings of Hippocrates and Galen. He was a member of the ﬁrst generation of scholars to enjoy access to the com- plete works of Galen. The Fabrica, which is considered the ﬁrst anato- mical treatise based on direct observation of the human body, is still regarded as a milestone in the history of anatomy. In honor of its place in the history of Western medicine, in 1998, scholars began publishing a ﬁve-volume English translation of the ﬁrst edition of the Fabrica.
Given the scope of his work, Vesalius can be considered a classical scholar and humanist, as well as a physician, anatomist, and artist. Unlike Linacre and Caius, however, Vesalius was able to renounce
Andreas Vesalius, on the fabric of the human body.
the errors of the ancients clearly and publicly. Through his scholarship and his own observations, he came to realize that human anatomy must be read from the ‘‘book of the human body,’’ not from the pages of Galen. With all due modesty, Vesalius regarded his work as the ﬁrst real advance in anatomical knowledge since the time of Galen.
A horoscope cast by Girolamo Cardano, a Milanese physician, ﬁxes the birth of Andreas Vesalius in Brussels, Belgium, on December 31, 1514, at 5:45 a.m. Vesalius was born into a world of physicians, phar-macists, and royal patronage. His father was imperial pharmacist to Charles V and often accompanied the Emperor on his travels. As a youth, Vesalius began to teach himself anatomy by dissecting mice and other small animals. Although he studied at both the University of Paris and Louvain, institutions notable for their extreme conservatism, his innate curiosity was not destroyed by the beneﬁts of higher education.
While a student at the University of Paris, Vesalius served as assistant to Jacobus Sylvius (1478–1555), an archconservative who saw human dissection only as a means of pursuing Galenic studies. Unfortunately, the atmosphere in Paris became so threatening that Vesalius found it necessary to leave without a degree. In the fall of 1537, he enrolled in the medical school of the University of Padua, a vener- able, but relatively enlightened institution. He was awarded the M.D. in December 1537, and appointed lecturer-demonstrator in anatomy and surgery. Abandoning the traditional professorial role, Vesalius lec- tured and dissected simultaneously. These dissection-lectures occupied the anatomist and his audience from morning to night for three weeks at a time. To minimize the problem of putrefaction, anatomies were scheduled for the winter term. Several bodies were used simultaneously so that different parts could be clearly demonstrated. Anatomies began with a study of the skeleton, and then proceeded to the muscles, blood vessels, nerves, organs of the abdomen and chest, and the brain.
By 1538, Vesalius was beginning to recognize differences between Galenic anatomy and his own observations, but when the young anat- omist publicly challenged Galen, Sylvius denounced his former student as ‘‘Vesanus’’ (madman), purveyor of ﬁlth and sewage, pimp, liar, and various epithets unprintable even in our own permissive era. Vesalius in turn told his students that they could learn more at a butcher shop than at the lectures of certain blockhead professors. Referring to the dis- section skills of his former teacher, Vesalius said that Sylvius and his knife were more at home at the banquet table than the dissecting room. In 1539, Marcantonio Contarini, a judge in Padua’s criminal court, became so interested in Vesalius’s work that he awarded the bodies of executed criminals to the university and obligingly set the time of execution to suit the anatomist’s convenience.
Finally, to mark his independence from Galen, Vesalius arranged a public dissection lecture in which he demonstrated over two hundred differences between the skeletons of apes and humans, while reminding his audience that Galen’s work was based on the dissection of apes. Hostile reactions from outraged Galenists were inevitable. Vesalian anat- omists were viliﬁed as the ‘‘Lutherans of Physic’’ on the grounds that the heresies of such medical innovators were as dangerous as Martin Luther’s
(1483–1546) effect on religion. Tired of the controversy, Vesalius became court physician to Charles V, Holy Roman Emperor and King of Spain, to whom he dedicated the Fabrica. Soon Vesalius discovered that imperial service was almost as unpleasant as the stormy academic world.
The patronage of a king, pope, or wealthy nobleman might allow a scientist to continue his research, but such patrons were often difﬁcult and demanding patients. Charles V suffered from gout, asthma, and a variety of vague complaints exacerbated by his predilection for quack remedies. Moreover, kings often loaned their physicians to other royal courts. Thus, when Henry II of France was injured while jousting, Vesalius and the French surgeon Ambroise Pare´ were among the medical consultants. Using the heads of four recently decapitated criminals, Pare´ and Vesalius carried out experiments to ascertain the nature of the inju- ries. They correctly predicted that the wound would be fatal. According to a doubtful, but persistent tradition, Vesalius went on a pilgrimage to the Holy Land to extricate himself from the Emperor’s service, or as a penance for initiating a premature autopsy. Vesalius may have used the excuse of a pilgrimage to explore the possibility of returning to a professorship at Padua. Unfortunately, he died on the return voyage.
Despite being steeped in the conservative academic scholarship of his time, Vesalius confronted and rejected Galen’s authority and demanded that anatomists study only the ‘‘completely trustworthy book of man.’’ Vesalius attributed his own disillusionment with Galen to his discovery that Galen had never dissected the human body. However, a minor work, known as the ‘‘Bloodletting Letter,’’ suggests that practical problems concerning venesection forced Vesalius to question Galenic dogma. Venesection was the subject of violent controversy among sixteenth-century physicians. No one suggested abandoning bloodlet- ting; rather, the medical humanists attacked what they called corrupt Arabist methods and demanded a return to the pure teachings of Hippocrates and Galen.
Unfortunately, even after ‘‘puriﬁcation,’’ Galen’s teachings on the venous system remained ambiguous. When Hippocratic texts contra- dicted each other and Galen, which authority could tell the physician how to select the site for venesection, how much blood to take, how rapidly bleeding should proceed, and how often to repeat the proce- dure? Struggling with these questions, Vesalius began to ask whether facts established by anatomical investigation could be used to test the validity of hypotheses. Unable to ignore the implications of his anatom- ical studies and clinical experience, Vesalius became increasingly criti- cal of the medical humanists. He could not tolerate the way they ignored the true workings of the human body while they debated ‘‘horse-feathers and triﬂes.’’ The Fabric of the Human Body was a revolutionary attempt to describe the human body as it really is without deferring to Galen when
the truth could be learned through dissection. Vesalius also demon- strated how well anatomical truths could be conveyed in words and illustrations. About 250 woodblocks were painstakingly prepared and incorporation into the text where their placement complemented and clariﬁed matters described in the text. Ironically, critics of Vesalian anatomy attacked the Fabrica on the grounds that the illustrations were false and misleading and would seduce students away from direct observation. Actually, the importance of dissection is emphasized throughout the text and careful instructions were given on the pre- paration of bodies for dissection and the instruments needed for precise work on speciﬁc anatomical materials.
The Fabrica was intended for serious anatomists, but Vesalius also
prepared a shorter, less expensive text, known as the Epitome, so that even medical students could appreciate the ‘‘harmony of the human body.’’ The Epitome contained eleven plates showing the bones, mus- cles, external parts, nerves, veins, and arteries, and pictures of organs that were meant to be traced, cut out, and assembled by the reader. The Vesalian texts and illustrations were widely plagiarized and dissemi- nated, often in the form of inferior translations and abstracts that failed to credit the originals.
In response to his critics, Vesalius denounced the ‘‘self-styled Prometheans’’ who claimed that Galen was always right and argued that the alleged errors in his works were proof that the human body had degenerated since the classical era. Galenists, Vesalius declared, could not distinguish between the fourth carpal bone and a chickpea, but they wanted to destroy his work just as their predecessors had destroyed the works of Herophilus and Erasistratus. Recalling how he had once been under Galen’s inﬂuence, Vesalius admitted that he used to keep the head of an ox handy to demonstrate the rete mirabile, a network of blood vessels that Galen had placed at the base of the human brain. Unable to ﬁnd the rete mirabile in human cadavers, anatomists rationalized this inconsistency by asserting that, in humans, the structure disappeared very soon after death. When Vesalius ﬁnally came to terms with Galen’s fallibility, he openly declared that such a network was not present in humans.
In contrast to his revolutionary treatment of anatomy, Vesalius did not go much further than Galen and Aristotle in physiology and embry- ology. He gave an exhaustive description of the structure of the heart, arteries, and veins, and was skeptical of the Galenic claim that the blood moved from right heart to left heart through pores in the septum, but the motion of the blood remained obscure. Thus, while Galen was chal- lenged on anatomical details, his overall anatomical and physiological doctrines remained intact. For example, having ruled out the presence of the rete mirabile in humans, Vesalius had to ﬁnd an alternative site for the generation of the animal spirits. By interpreting Galen’s various
Inferior view of the cerebellum as depicted in De Humani Corporis Fabrica, 1543.
accounts of the process that generated them, Vesalius concluded that Galen thought that only part of this process occurred in the rete mira- bile; the ﬁnal modiﬁcations may have involved the brain and its ventri- cles. Vesalius could, therefore, ascribe the function of the nonexistent rete mirabile to the general vicinity of the cerebral arteries.
Historians generally agree that anatomical research has been the cornerstone of Western medicine since the sixteenth century. Inspired by the new Vesalian anatomy, physicians focused on direct observation of the body as the only means of generating valid anatomical knowl- edge. But anatomical knowledge and the right to perform human dissection also served as a means of establishing a unique professional identity and asserting power over life and death. The emphasis on human dissection as an essential aspect of medical education, however, led to increasing tension between the apparently insatiable need for cadavers and the widespread prejudice against human dissection. Until recent times, anatomists were often forced into dangerous and illegal methods of obtaining human bodies. As a medical student in Paris, Vesalius fought off savage dogs while collecting human bones from the Cemetery of the Innocents. In Louvain, he stole the remains of a robber chained to the gallows and brought the bones back into the city hidden under his coat. Grave-robbing incidents were reported wherever Vesalius conducted his famous lecture-demonstrations. One ingenious group of medical students reportedly obtained a corpse, dressed it, and walked their prize into the dissecting room as if it were just another drunken student being dragged into class. Despite anecdotes that fea- ture the bravado of enterprising anatomists, being associated in the popular mind with hangmen and grave robbers was humiliating and dangerous to anatomists. When anatomists were fortunate enough to obtain cadavers, they faced grave dangers during routine dissections, because even the smallest cut could result in a fatal infection.
Long after most European nations had made legal provisions for anatomical studies, body snatching provided the bulk of the teaching material for gross anatomy in Great Britain, Canada, and the United States. Anatomists too timid to obtain cadavers themselves turned to entrepreneurs known as ‘‘Resurrectionists’’ or ‘‘Sack-Em-Up Men,’’ who procured bodies by grave robbing, extortion, and murder. In England, under the Murder Act of George II, the bodies of criminals considered vile enough to be worthy of death and dissection were awarded to the Royal College of Surgeons as a ‘‘peculiar mark of Infamy added to the Punishment.’’ When England’s 1832 Anatomy Act allowed the state to give the unclaimed bodies of paupers to medical schools, poverty became virtually as deeply stigmatized as criminality. It is interesting to note that the Visible Human Project began with the use of a 39-year-old criminal executed by lethal injection in 1993. The body was frozen, sectioned, and transformed into the ﬁrst fully digitized human being. Today, the National Library of Medicine’s Visible Human Project provides invaluable radiological scans and digitalized photographs of cross-sections of a male and a female cadaver.
American physicians also attempted to establish a professional identity through anatomical knowledge. This created an infamous black market for cadavers. Following the example set in England, physicians successfully lobbied for laws that allocated paupers’ bodies to medical schools. But scandalous stories of body snatching and dissection-room pranks continued to inﬂame the public. Advocates of improved medical and surgical training were obliged to remind legislators and laymen that
if doctors did not practice on cadavers, they would have to learn the art at the expense of their patients. The Latin motto used by Medical Examiners and Pathology Departments around the world—‘‘Hic locus est ubi mors gaudet succurrere vitae’’ (This is the place where death delights to help the living)—stresses the insights physicians and researchers gain through human dissection.
By the beginning of the twentieth century, gross anatomy had become an essential part of the curriculum at every American medical school. By the end of that century, the hours devoted to formal anatomy training had sharply declined and the shortage of instructors had become more signiﬁcant than the problem of obtaining cadavers. Many medical educators argued that computerized scans and three-dimensional repre- sentations of the human body provided better teaching tools than traditional dissections, although standardizing models ignores the variability of human anatomy. Others insist that human dissection is an essential aspect of conveying the lesson of human mortality and the meaning of being a doctor. The French anatomist Marie Franc¸ois Xavier Bichat (1771–1802) stressed the importance of conducting autop- sies. ‘‘Open up a few corpses,’’ he wrote, ‘‘you will dissipate at once the darkness that observation alone could not dissipate.’’