Why is Vesalius important in the history of anatomy? In what ways does he continue Galenic anatomical notions? In what way does he depart?

Introduction

Vesalius (1514-1564), working in the anatomical renaissance of the sixteenth century, is regarded by medical historians as being the “father of modern anatomy.”[1] Ranked alongside Hippocrates, Galen, and William Harvey, Vesalius is among the greatest physicians and discovers in the history of medicine.[2] Valeria Finucci goes so far as to say that Vesalius’ anatomical work paved the way for “a stunning series of advances and lab breakthroughs that followed in physiology, cell biology, biochemistry, epidemiology, immunology and genetics.”[3] Born into a medical family at Brussels, Vesalius dissected the bodies of animals as a boy, and, “like any other young student of the time, naturally accepted the Galenic anatomy” during his formal medical training in Louvain and Pairs.[4] Vesalius is undoubtably a product of his age, having been brought up by the imposing Galenic Science and nurtured by “that fair creature, the new Art.”[5] This upbringing allowed him to become instrumental in transforming anatomy into an empirical science, presenting the results in an innovative way in his most famous works, De Humani Corporis Fabrica.[6] Prior to this, the foundations for anatomy were still located in the writings of Roman physician Galen (born 129 AD, Pergamum), whose ideas  had dominated for over 1300 years without being questioned.[7] It can be argued that “no figures loom larger than the ancient medical authority Galen and the master dissector Vesalius;” It is therefore apt that we compare the works of these two great anatomists when evaluating the importance of Vesalius’s work. [8] I will firstly discuss the significance of Vesalius’s De Humani Corporis Fabrica in terms of his anatomical thinking and illustrations. I will then discuss Vesalius’ research methods – namely the subjects his dissections – and compare these to Galen’s earlier demonstrations. I will finally discuss Vesalius’ general methodology and his supposed divergence from Galen.

Main Text

The Duffinsargue that “if there is one book from the remarkable time of the medical Renaissance that physicians ought know, it is [Vesalius’ Fabrica] … a magnificent anatomical work.”[9] Medical historians Saunders and O’Malleynot only agree with this statement but extend their admiration, believing this works to be “without doubt the greatest single contribution to the medical sciences” in their totality, as opposed to their praise being confined to the Renaissance period – or indeed the field of anatomy.[10]  Certainly, the book is deservedly famous for being the first modern book of anatomy, incorporating both written findings from dissections and illustrations depicting them; this consequently revolutionized the way the human body was seen.[11] However, it is important to note that a works of this magnitude was only made possible with the development of the printing press which allowed for images of the human body to be reproduced for multiple publications, suggesting that Vesalius may not have been so significant to the history of anatomy had he lived even a century earlier.[12] The illustrative element of the Fabrica deems it one of the “most noble and magnificent volumes in the history of printing.”[13] Published in 1543 and divided into seven volumes, the Fabrica established a dialogue between the verbal and the visual, using images to explain the written word, and text to expand on anatomical illustrations.[14] This multidisciplinary approach was used in his teaching career, whereby he used his own drawings and those of others to supplement or clarify the oral, including diagrams to explain the meaning of phrases in Galen’s discussion of bloodletting.[15] Often he displayed articulated skeletons, alongside a dissected form and his drawings, in order to pursue topics previously considered impractical; these innovative methods of explanation often led to critical insights.[16] It is important to note that Vesalius was not the first professor to use his own drawings to illustrate knowledge, however it was unusual for the time.[17] It is Vesalius’ equal attention to the visual and the verbal which ultimately determined the significance of his Fabrica.[18] Although historian of science, technology and medicine, Charles Singer, believes that “the greatest glories of his book are the three exquisite cuts of complete skeletons drawn in dramatic attitudes,” it is the frontispiece that I will discuss as this provides us with an insight into the messages Vesalius intended to convey to his readers.[19] The cover page of the Fabrica (Figure 1)

gives us a commentary on previous methods of obtaining anatomical knowledge, alongside a statement on how anatomic research should be conducted by
anatomists of the future.[20] Vesalius can be seen in the centre of the piece, performing a dissection himself. Practical work for anatomists, until the early sixteenth century, had previously been delegated to the hands of barber assistants whilst the lecturer read excerpts from the likes of Galen and never touched the corpse in front of them.[21] The fact that Vesalius presents this new and more professional approach to dissection and the teaching of anatomy, instantly tells the reader that they, as the anatomist, should be conducting hands-on research themselves just as he has done.[22] Within the same illustration, Vesalius indicates another way in which anatomical knowledge can advance, by side-lining the monkey and dog for the human body.[23] Furthermore, the skeleton dominates over the rest of the characters, which is said to represent an “intermediary between the past and present:” Galen’s vivisection and Vesalius’s human dissection.[24] This implies that Vesalius wanted to tell the reader, immediately, that it is possible to go beyond Galen’s discoveries. Although some medical historians, including Vivian Nutton, believe that Vesalius “broke decisively with his predecessors” on publishing this revolutionary book, the presence of the skeleton in this frontispiece suggests that Galen’s work was not been completely rejected but was in fact respected as one would respect the dead.[25] I would argue that Vesalius merely recognised the fact that medical advancement could be prevented by blindly accepting what has previously been written. This can be supported by over a thousand annotations, corrections, deletions, additions and marginal notes that Vesalius made to his own copy of the 1555 edition of the Fabrica, in preparation for what is assumed to be a third edition that was never published.[26] Although there was little new anatomic material added, these notes suggest that Vesalius continued to think about what he had previously discovered, and was not opposed to revising his work if he later saw error in it.[27] Certainly, Vesalius appreciated the possibility that printing offered for publishing revised versions of the same work, telling us that he was never satisfied with what he had published.[28] This only highlights how quickly his anatomical thinking was developing as he conducted further practical work on the human body.[29]

Both Vesalius and Galen placed a great deal of emphasis on their public demonstrations and learning.[30] Anatomy had, in the past, suffered from certain disadvantages which ultimately hindered the progress of the likes of Galen, namely due to the prejudice against the dissection of the human body.[31] Vesalius was able to advance his anatomical knowledge primarily through having access to limited human corpse, something which had not previously been available to Galen. He is therefore significant to the history of anatomy for stressing the message that human anatomy should only be studied on basis of human anatomy.[32] In December 1537, Vesalius was given a teaching post in surgery which would also require him to teach anatomy; for the benefit of his students he began dissecting an 18-year-old man in order to solidify his knowledge, after which he assembled a complete skeleton.[33] There are at least five skeletons that are believed to be his handiwork: in 1539 he skeletonised a French priest with an abnormal spleen which was compared to the skeleton of an ape in  Bologna where he was a guest lecturer; a skeleton of a six-year-old girl was assembled in Padua; in Pisa skeletons were assembled of a thirty-six-year-old nun, and a seventeen-year-old deformed girl whose body was stolen from a cemetery by Vesalius’ students.[34] From what we have seen in the frontispiece of the Fabrica, we would assume that Vesalius had completely discarded the use of animals for the purpose of dissection, though this is not the case. Certainly, Vesalius – unlike Galen – had access to the corpses of criminals, worn out paupers and bodies wasted by disease.[35] Although bodies for public demonstrations were supplied by the local authorities from the ranks of executed criminals, there was still an issue with the lack of supply.[36] Animals were still more readily available for dissection and experimentation than the human body, and Singer states that there can be no doubt that, not infrequently, [Vesalius] availed himself of them rather than the human subject for anatomical description”.[37]Finucci therefore, is wrong to state that “the Barbary apes, monkeys, dogs, pigs, cows, goats & cocks of Galen” were “no longer.”[38] Indeed, animal and human dissections appear interchangeable depending on availability of corpses and the purpose of the dissection.[39] In an account of a dissection that Vesalius held at Padua in 1537, there is a reference to the use of a dog, with the intention of preserving the human heart as cutting the body for examination of one area often rendered others destroyed and unfit for further examination.[40] Furthermore, it was sometimes difficult to fully understand anatomy inside the human body due to its intricacies – or because they had been ‘damaged’ during their execution.[41] When provided a hanged corpse who suffered a crushed neck, Vesalius used the head of an ox to show his audience the larynx.[42] On another occasion, he used a sheep’s head to show the brain as it was easier to see its structures.[43] Although Vesalius’ use of animals for dissection may suggest that he has done little to advance anatomical knowledge, one could argue that this gave him a comparative eye that allowed him to notice differences between animal and human anatomy.[44] With this in mind, Vesalius was highly critical of Galen and his reliance on apes for having failed to recognise the difference between human and animal anatomy on a number of occasions.[45] Vesalius on the other hand, through regular visits to Paris’ Saints-Innocents cemetery to between 1533-1536, realised after studying exhumed bones that the lower human jaw was in fact a single bone, in contrast to that of other animals.[46] One could argue as Shotwell does, that the continuation of animal dissection alongside the human body was not a hindrance, but rather an “innovative strategy” that helped him to overcome the limitations faced by Galen who did not have both types of corpses at his disposal.[47]

Vesalius’ progress with dissection can be seen in terms of his wider reform of scientific methodology and teaching. Singerargues that “Vesalius has always been regarded as the first modern anatomist to place his study on a firm foundation of observation” and practical work; this approach was not confined to the medical sciences. [48] Explorer Christopher Columbus, after his first voyage to the Indies (1429-3), stated that “although there was much talk and writing of these lands, all was conjectural, without ocular evidence. In fact, those who accepted the stories judged by hearsay rather than any tangible information.”[49] The idea that one must see the evidence for themselves before reaching a conclusion is echoed in the writings of Vesalius who stressed the importance of ocular evidence in the exploration of the body.[50]  There is much debate about whether in doing this, Vesalius was decisively breaking from his predecessor, Galen. The fact that this debate exists is to an extent, unsurprising as the tone of Vesalius’ criticism of Galen was initially quite derogatory; on page eighteen of the Fabrica for example, Vesalius said “I don’t know what came into Galen’s mind… ,” however this was later changed to “I don’t know why Galen… .”[51] However, in practice, the methods adopted by Vesalius largely kept the recognizably Galenic framework.[52] Galen was an empiricist, believing theoretical understanding to be inferior to practical experience, particularly in the field of anatomy where he stressed the importance of dissection.[53]  Vesalius held this in similar regard, believing medical knowledge to “no longer to be gained by pouring over the books of revered past physicians…but by uncovering with one’s hands.”[54] This is not to say that the study of books was completely disregarded, only that it became secondary to the interaction between anatomist and corpse.[55] Amanda Taylor argues that Vesalius presented himself as Galen’s heir by using his own hands to skin the subjects he was working with, just as Galen had previously done with his apes, in order to prove that he had the authority to refine Galenism.[56] Furthermore, there are numberless references to Galen in the Fabrica, showing the respect of the “Reformer of Anatomy” for the opinion of the “Prince of Physicians.”[57] As historian Jonathan Sawday correctly states, “the history of this discovery of the body is above all, a cumulative project, with each generation of observers standing metaphorically on the shoulders of the previous generation.”[58] Like Galen, Vesalius dedicated a significant portion of his literary output to critiquing the work of other theorists.[59]  By following in Galen’s footsteps, he encountered Galen’s mistakes, ultimately because unlike Galen, he had seen a human body with his own eyes.[60] As a result, Vesalius was able to identify errors in Galen’s text which was based on the dissection of animals yet concluded as being true of the human body also.[61] Vesalius himself was aware that “many [were] hostile to [him] because [he had] held in contempt the authority of Galen…because [he had] not indiscriminately accepted all of his opinions; and in short, because [he had] demonstrated that some fault is actually discernible in his books.”[62] Whilst his contemporaries and some historians regarded his criticism a sign of his complete “anti-Galenism”, others saw it as him continuing to use the empirical and experimental methodology that Galen advocated, but was unable to sufficiently put into practice due to the restrictions on dissection at the time.[63] Just as Galen was allowed to move beyond Hippocrates because of historical circumstance, so was Vesalius; therefore, it can be argued that Vesalius never opposed himself completely to the Galenical system, “but rather attempted to reconcile or correct the anatomical descriptions of Galen whenever they were found not to agree with observation.”[64] Galen, the empiricist, would have advocated this, particularly as he used anatomical knowledge as the “hallmark of the complete physician.”[65] Vesalius is therefore significant in the history of anatomy for challenging the authority of Galen and questioning his wisdom by testing his writings against the experience of the body.[66] Ultimately however, even if his conclusions updated those of Galen, Vesalius used the same method of investigation that Galen did, suggesting, as Saunders and O’Malley do, that Vesalian anti-Galenism has been grossly exaggerated and is a complete misunderstanding of Vesalius’ work.[67] Vesalius merely set out to discover the truth of the human body, and was known for being willing to correct himself (supported by the multiple editions and annotations of the Fabrica), in addition to his predecessors and contemporaries, “if his knife had uncovered novelties that challenged his understanding.”[68] The idea that “touch has the power to contest written authority” ultimately redefined the conception of knowledge, whereby for the first time in 1300 years, personal experience was valued total acceptance of the ancient works.[69]

Conclusion

In conclusion, Vesalius is significant in the history of anatomy largely as a result of his perfectionism and attention to detail, seen both in his illustrative work and in his determination to correct both his own and his predecessor’s findings if he finds them to be previously misled; his Fabrica, a prime example of this hard work, is one of the most magnificent pieces of anatomical works. His multidisciplinary approach allowed him to become successful as an anatomist, through both utilising technology such as the printing press, and using his strengths as an artist to better explain his findings. Vesalius emphasised gaining knowledge from one’s own observations, incorporating the practical element of anatomy that had previously been delegated. In practicing this himself, Vesalius was able to prove that Galen had been wrong about some of his conclusions after 1300 years of acceptance of his text. This emphasis on observation allowed for anatomical knowledge to develop when it had previously been held at a standstill, opening several doors for future anatomists and physicians as the foundations of critiquing and exploring had already been laid down by him. Whilst Vesalius can be seen to criticise Galen’s findings, it is important to note that his methodology is undeniably Galenic – as is, ironically, his critical nature. Whilst Vesalius had the novelty of dissecting the human body, he did not completely reject the use of animals in his experiments; this allowed him to develop a comparative eye which provided new insights and proved Galen’s previous anatomical thinking – based solely on animals – to be incorrect. Vesalius is therefore significant in the history of anatomy for being able to do what Galen was unable to, due to the restrictions on dissection at the time. Ultimately, whilst his contemporaries may have seen the divergence from Galen’s conclusions as disrespect for his authority, Vesalius’ empiricism certainly shows that his methodological beliefs and goals were in line with Galen’s.

Bibliography

Allbutt, Clifford. ‘Andreas Vesalius the Reformer of Anatomy’, in The American Historical Review, 1911, Vol.17(1), pp.125-127.

Biesbrouck, Maurtis; Steeno, Omer. ‘Andreas Vesalius’ Corpses’, in Acta Medico-historica Adratica, 2014, Vol.12(1), pp.9-26.

Dominiczak, Marek. ‘Andreas Vesalius, His Science, Teaching & exceptional Books’, in Clinical Chemistry, 2013, Vol. 59(11), pp.1687-1689.

Duffin, Jacalyn; Duffin, Jessica. ‘The Annotated Vesalius’, in Canadian Medical Association Journal, 2014, Vol.186(11), pp.856-857. 

Finucci, Valeria. ‘Vesalius and the Languages of Anatomy’, in Journal of Medieval and Early Modern Studies, 2018, Vol.48(1), pp.1-9.

Flemming, Rebecca. Medicine and the Making of Roman Women (Oxford: Oxford University Press, 2000).

Nutton, Vivian. Ancient Medicine (London and New York: Routledge, 2004).

Nutton, Vivian. ‘Vesalius Revised. His Annotations to the 1555 Fabrica 1’, in Medical History, 2012, Vol.56(4), pp.415-443.

Nutton, Vivian. ‘1538, A year of Vesalian Innovation’, in Journal of Medieval and Early Modern Studies, 2018, Vol.48(1), pp.41-59.

R. J. Hankinson (ed.) The Cambridge Companion to Galen (Cambridge: Cambridge University Press, 2008).

Saunders, J. B. de C. M.; O’Malley, Charles, D .. The Illustrations from the Works of Andreas Vesalius of Brussels, (Cleveland: Dover, 1973).

Sawday, Jonathan. The Body Emblazoned (New York: Routledge, 1996).

Shotwell, R. Allen. ‘Animals, Pictures & Skeletons’, in Journal of the History of Medicine and Allied Sciences, 2016, Vol.71(1), pp.1-18.

Singer, Charles. A Short History of Anatomy from the Greeks to Harvey (New York: Dover, 1957).

Taylor, Amanda. ‘The Compounded Body: Bodily Knowledge Production in the Works of Andreas Vesalius and Edmund Spenser’, in Journal of Medieval and Early Modern Studies, 2018, Vol.48(1), pp. 153-183.

Vesalius, Andreas. De Humani Corporis Fabrica Libri Septem (Basel: J. Oporini, 1543)


[1] Valeria Finucci, ‘Vesalius and the Languages of Anatomy’, in Journal of Medieval and Early Modern Studies, 2018, Vol.48(1), p.8; Charles Singer, A Short History of Anatomy from the Greeks to Harvey (New York: Dover, 1957),p.111; Jonathan Sawday, The Body Emblazoned (New York: Routledge, 1996), p.39.

[2] J.B. de C. M. Saunders and Charles D. O’Malley, The Illustrations from the Works of Andreas Vesalius of Brussels, (Cleveland: Dover, 1973), p.9.

[3] Finucci, p.2.

[4] Saunders and O’Malley, p.13; Singer, p.111-112.

[5] Singer, p.111.

[6] Marek Dominiczak, ‘Andreas Vesalius, His Science, Teaching & exceptional Books’, in Clinical Chemistry, 2013, Vol. 59(11), p.1687.

[7] R. J Hankinson, ‘The Man and his Work’, in The Cambridge Companion to Galen, ed. by R.J. Hankinson (Cambridge: Cambridge University Press, 2008), p.1; Dominiczak, p.1687.

[8] Amanda Taylor, ‘The Compounded Body: Bodily Knowledge Production in the Works of Andreas Vesalius and Edmund Spenser’, in Journal of Medieval and Early Modern Studies, 2018, Vol.48(1), p.155.

[9] Jacalyn Duffin and Jessica Duffin, ‘The Annotated Vesalius’, in Canadian Medical Association Journal, 2014, Vol.186(11), p.856.

[10] Saunders and O’Malley, p.19.

[11] Vivian Nutton, ‘Vesalius Revised. His Annotations to the 1555 Fabrica 1’, in Medical History, 2012, Vol.56(4), p.415; Duffin and Duffin, p.856.

[12] Nutton, ‘Vesalius Revised’, p.416.

[13] Saunders and O’Malley, p.9.

[14] Jonathan Sawday, The Body Emblazoned (New York: Routledge, 1996), p.66; Nutton, ‘Vesalius Revised’, p.416.

[15] Vivian Nutton, ‘Vesalius Revised’, p.426; Vivian Nutton. ‘1538, A year of Vesalian Innovation’, in Journal of Medieval and Early Modern Studies, 2018, Vol.48(1), p.42.

[16] R. Allen Shotwell. ‘Animals, Pictures & Skeletons’, in Journal of the History of Medicine and Allied Sciences, 2016, Vol.71(1), p.3.

[17] Nutton, ‘1538’, p.42.

[18] Nutton, ‘Vesalius Revised’, p.426.

[19] Singer, p.125.

[20] Sawday, p.66; Andreas Vesalius, De Humani Corporis Fabrica Libri Septem (Basel: J. Oporini, 1543), frontispiece.

[21] Duffin and Duffin, p.856.

[22] Duffin and Duffin, p.856.

[23] Sawday, p.68.

[24] Taylor, p.156.

[25] Nutton, ‘Vesalius Revised’, p.416.

[26] Nutton, ‘Vesalius Revised’, p.415, p.421.

[27] Nutton, ‘Vesalius Revised’, p.415, p.442; Duffin and Duffin, p.857.

[28] Nutton, ‘1538’, p.46.

[29] Nutton. ‘1538’, p.41.

[30] Shotwell, p.2.

[31] Clifford Allbutt. ‘Andreas Vesalius the Reformer of Anatomy’, in The American Historical Review, 1911, Vol.17(1), pp.125-6.

[32] Nutton, ‘Vesalius Revised’, p.416.

[33] Maurtis Biesbrouck; Omer Steeno. ‘Andreas Vesalius’ Corpses’, in Acta Medico-historica Adratica, 2014, Vol.12(1), p.12.

[34] Biesbrouck and Steeno, pp.13-14.

[35] Singer, p.116.

[36] Shotwell, p.4.

[37] Singer, p.114.

[38] Finucci, p.4.

[39] Shotwell, p.8.

[40] Shotwell, p.4, p.10.

[41] Shotwell, p.8, p.11.

[42] Shotwell, p.11.

[43] Shotwell, p.11.

[44] Biesbrouck and Steeno, p.9.

[45] Nutton, ‘Vesalius Revised’, p.432; Singer, p.57; Shotwell, p.8.

[46] Biesbrouck and Steeno, p.10; Shotwell, p.8; Singer, p.57.

[47] Shotwell, p.1.

[48] Singer, p.119.

[49] Sawday, p.26.

[50] Sawday, p.26.

[51] Nutton, ‘Vesalius Revised’, p.432.

[52] Vivian Nutton, ‘1538’, p.46.

[53] Vivian Nutton, Ancient Medicine (London and New York: Routledge, 2004), p.236.

[54] Finucci, p.1.

[55] Sawday, p.65.

[56] Taylor, p.155.

[57] Singer, p.119.

[58] Sawday, p.39.

[59] G.E.R. Lloyd, ‘Galen and his Contemporaries’, in The Cambridge Companion to Galen, p.34; Singer, p.117.

[60] Shotwell, p.18; Sawday, p.26.

[61] Dominiczak, p.1687.

[62] Saunders and O’Malley, p.13.

[63] Nutton, ‘Vesalius Revised’, p.417.

[64] Rebecca Flemming, Medicine and the Making of Roman Women (Oxford: Oxford University Press, 2000), p.278; Saunders and O’Malley, p.13; Taylor, p.156.

[65] Julius Rocca, ‘Anatomy’, in The Cambridge Companion to Galen, p.257.

[66] Sawday, p.39.

[67] Saunders and O’Malley, p.13; Taylor, p.156.

[68] Finucci, p.6.

[69] Sawday, p.64; Finucci, p.4.

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