Vesalius And Dissection

Ten years ago my daughter went to medical school. In her first week, they introduced her to a corpse, and asked her to start cutting it up. As it happens, she is a vegetarian, and if they had asked her to cut up a raw leg of lamb I am not sure she could have coped. There were six on her dissecting table, one of whom dropped out. My daughter is now a psychiatrist: raw flesh is not for her.

Since the nineteenth century, dissection has been a rite of passage, the beginning of a medical education. If you cannot face cutting up the dead, how will you be able to slice into the living? For centuries (until computer imaging made it possible to move around and through a body) dissection was the only reliable way to learn anatomy, and the dead body the only place you could afford to make mistakes. In this tradition of medical education, the great hero is Vesalius (1514—64), who is regarded as the founder of modern medicine. The beginning of modern medicine can then be dated to a day in 1536 when Vesalius, walking outside the city walls of Louvain, came across the body of an executed criminal chained to a gibbet. Only the bones remained, 'held together by the ligaments alone'. Vesalius at once made offwith the arms and legs, but came back that night (defying the curfew) to climb the gibbet, smash the chain and carry off the trunk. Out of these parts he constructed his first skeleton em;boiling them up secretly, and then pretending that he had brought them with him from Paris. 'I was burning with so great a desire to possess those bones,' he wrote seven years later, 'that I did not hesitate to snatch in the middle of the night that which I so desired.' Vesalius had no name for his desire, and I can think of none either. The love of knowledge certainly formed part of it. So did a burning desire to imitate Galen, who describes coming across a rather similar skeleton in his On Anatomical Procedures, a work which had only recently been rediscovered, and a translation of which had been published by Vesalius's teacher, Guinter of Andernach, in 1531. But so too did a delight in doing what no one else dared do, what was forbidden. At night restless spirits walk, and Vesalius was one of them.

In Northern Europe dissection was a relative rarity, and Vesalius went on to conduct the first dissection in Louvain for eighteen years. Vesalius complained that his own education at the University of Paris had been so pathetic that, despite being a medical student who had practised only on the bodies of animals, he had had to take over from the instructor during the dissection of a human being in order to show how it ought to be done. In Italy, however, dissections had been routine for over two hundred years. In 1315 Mondino de' Luzzi, at the University of Bologna, conducted the first comprehensive dissection of a human corpse for over a thousand years, perhaps even since Herophilus and Erasistratus, and the next year he published a manual on the subject. Mondino believed himself to be following in the footsteps of Galen, although there is no conclusive evidence that Galen ever actually dissected human beings.

Mondino established a new norm for medical education in Italy (where the distinction between medicine and surgery was less sharp than in Northern Europe): doctors were expected, as part of their university education, to be present at dissections. Dissections were carried out in the winter months and the bodies used were those of recently executed criminals. No more than one or two dissections were normally conducted in a year, and the audience consisted of a small group of twenty or so. As these dissections became routine, they were brought within a conventional academic framework, that of the lecture. The professor read from a textbook, usually that of Mondino, while his assistant, frequently a practising surgeon, carried out the dissection. The real object of study was the book; the body was only there to illustrate what was being described in the book. Such academic dissection was quite separate from the occasional opening up of a body to establish the cause of death, the post mortem, a process which goes back before 1315 and has a continuous history thereafter.

8. Anatomy Lesson,from Johannes de Ketham, Fasciculus Mediciniae (Venice, 1522). This illustration stands at the beginning of an edition of Mondino's Anothomia. In the first two editions of this collection the image is slightly different — the lecturer has no book in front of him, and is presumably intended to be Mondino himself. This reworked image first appears in 1495, and shows a lecturer reading from Mondino's text — it thus shows how anatomy was taught prior to Vesalius.

With Vesalius and his immediate predecessors (in Italy, from 1490 or so) everything changes. Dissections become much more frequent— in 1522 Jacopo Berengario da Carpi (c. 1460—c. 1530) claimed to have dissected hundreds of bodies. The result was a crisis in the supply of bodies. Dissections also became immensely popular. Tiered seating would be erected in a church or a square so that a very large audience could get a good view—audiences of five hundred were not unknown. The frontispiece of Vesalius's great work, the De Humani Corporis Fabrica or The Construction of the Human Body (1543), shows the crowds gathered to watch 'an anatomy' (as a dissection was called by contemporary Englishmen). Moreover such audiences consisted not just of doctors and medical students, but of philosophers, theologians, gentlemen and their servants, though, if Vesalius's frontispiece is to be trusted, there were no women amongst them. Attending a dissection was now a fashionable entertainment. By the early seventeenth century special anatomical theatres were being built in Italy and Holland for the public performance of dissections (and there were women in the audience in Holland).

Above all, the focus of dissection was now not on the book but the body: Vesalius used no book, but displayed the parts of the body himself. In the preface to the Fabrica he laid great stress on the need to step down from the cathedra, the pulpit or great chair from which professors lectured, and work with one's own hands, and the Fabrica contains a portrait of Vesalius dissecting an arm. The anatomy lecturer was now expected to lecture from what Vesalius called the book of nature (thus indirectly acknowledging the traditional authority of books), and this involved, quite literally, getting his hands dirty.

Why was there such public interest in anatomy in the sixteenth century? Vesalius was proud to be doing exactly what Galen had done em;Galen had not trusted his slaves to prepare bodies (in his case, the bodies of apes), but had worked on them with his own hands, and had conducted dissections in public. The new anatomy fitted in with a much larger enterprise of recovering the culture of classical Rome, an enterprise that embraced literature, philosophy, and art. Vesalius, though, was convinced (quite possibly correctly) that Galen had dissected only apes, dogs, pigs, and other animals, not humans. This was

9- The titlepage to the 1st edition of Vesalius's De Humani Corporis Fabrica.

78 revolution postponed the only feasible explanation for his numerous mistakes: in the Fabrica Vesalius set out to demonstrate more than three hundred of them. At his public dissections he may well have compared dogs and monkeys with humans (both a monkey and a rather strange-looking dog appear in the frontispiece) so that people could see for themselves the source of Galen's misconceptions, but such animals were probably primarily to hand so that they could be vivisected. Anatomy thus represented new knowledge in a world where the assumption had long been that there could be no progress beyond the achievements of the ancients.

Anatomy was seen as being of central importance. It was man's knowledge of himself, through which the anatomist learnt about his own body. But at the same time man was a microcosm, a little universe, an epitome of the macrocosm or larger universe, so that all knowledge was to be found reflected and summarized in him. And man had, the Bible said, been made in the image of God, so the study of anatomy was also the study of the divine. Moreover anatomy gave onlookers the opportunity to meditate on death and the transience of life, a theme both philosophical and religious. Finally, the Renaissance did not see minds and bodies as distinct in the way that we (since Descartes) do: hair colour, for example, reflected the balance of the humours, and this determined the psychology of the individual. To study someone's body was also to study their mind. All this served to give the messy and disturbing task of cutting up bodies an extraordinary dignity.

Renaissance art had already trained people to look at the body in a new way, and from the beginning the great artists of the Renaissance had practised anatomy. Donatello (1386—1466) attended anatomical dissections (he illustrates one in a bronze, 'The Heart of the Miser') and made a bronze sculpture of the skeleton of a horse; Antonio Pollaiuolo (1432—98) 'removed the skin from many corpses in order to see the anatomy underneath'. To portray weight, balance, movement, tension, and strength the artist had to have a direct knowledge of the structure of the bones and the shape of the muscles. In 1435 Alberti advised anyone painting a human figure to imagine the bones beneath the skin and to build up from them the muscles and the surface appearance, and there is a sketch by Raphael in which he can be seen doing exactly that. The great Leonardo (1452—1519) was so interested in the structure of the human body that he planned a book on human anatomy, perhaps to be written in conjunction with a famous Florentine doctor of the day, Marcantonio della Torre. A generation later, the artists crowded round Vesalius at dissections.

On such occasions the artist and the anatomist had more in common than just an interest in bodies. At the same time that the anatomist was getting down from his podium to get his hands dirty, the artist, who had always been considered of low social class because he worked with his hands, was laying claim to a new social status, a right to mix with intellectuals and nobles. Both had an investment in dignifying manual dexterity. The anatomist was demonstrating his newfound knowledge, but the human body was interesting partly because artists had trained the public to look at it with an anatomist's eye. The anatomists and the artists, by giving manual work a new status, made possible the scientific revolution, which itself depended on the educated learning from artisans and doing things for themselves with their own hands. The anatomy theatre is the first laboratory, the cadaver the first experimental apparatus. Galileo, Boyle, and Newton followed in the footsteps of Leonardo and Vesalius, and the crowds who gathered to watch Vesalius were giving their support to the first modern scientific enterprise.

Without three technical developments Vesalius could never have accomplished what he did: the printing press using movable type; the woodcut; and perspectival representation. In order to claim that he knew more than Galen had done, Vesalius had to direct his audience to reliable editions of Galen. He himself edited, for the great Giunta edition of Galen's Opera Omnia that appeared in 1541—2 and included many new translations from the best Greek manuscripts, the key anatomical text of Galen, the one that had inspired his own bone-stealing in 1536. An anatomist like Mondino, in the fourteenth century, could not read the full range of Galen's writings, or be sure that the copies he had were reliable (even Vesalius complained that he could not get sight of crucial Greek manuscripts that he needed to check the accuracy of the Latin translations). By 1542 any educated person with access to a decent library could trace the full range of Galen's views on any topic, and could be confident that the texts at his disposal were generally accurate. He could now claim to be sure of what Galen thought and consequently to be in a position to judge whether he was wrong or right. The printing press and the new scholarly editions that it made possible were fundamental to Vesalius's enterprise of surpassing Galen.

In addition, before the printing press medical books had had either no illustrations or only very rudimentary ones. Manuscripts were copied by hand and so only the crudest of illustrations could be employed. With anything complicated the quality was bound to degenerate as one copy was made from another. With the printing press came a new emphasis on illustration; woodcuts and (even better) copper plates could be employed to provide complex and detailed information. Leonardo saw clearly the possibilities that this opened up. Beside one of his anatomical drawings of a heart he wrote:

O writer what words of yours could describe this whole organism as perfectly as this drawing does? Because you have no true knowledge of it you write confusedly, and convey little understanding of the true form of things . . . How could you describe this heart in words without filling a whole book? And the more minutely you try to write of it the more you confuse the mind of the listener.

Vesalius invented the process of labelling parts of illustrations with letters keyed to an accompanying text, so that readers could turn back and forth from text to illustration using each as a commentary on the other.

Vesalius was also able to draw on the great discovery of Renaissance art, perspectival representation, to produce images that created the illusion of being three-dimensional, without which it would have been impossible to represent the interrelationship of the different parts of the human body. Raised in Brussels and Louvain, educated in Paris, by 1537 Vesalius was teaching in Padua, and to illustrate his great work, the Fabric of the Human Body, he turned to the nearby city of Venice, to the artists in Titian's studio. The first scientific drawings employed the skills of the most highly trained artists of the day.

10 and 11. These two medieval illustrations of skeletons, one from the fourteenth and one from the mid-fifteenth centuries, give an indication of the very varying quality of the illustrations accompanying medieval medical manuscripts — but even the finer of the two, an exceptionally detailed image for a medieval manuscript, falls far short of the standard of accuracy established by Vesalius.

10 and 11. These two medieval illustrations of skeletons, one from the fourteenth and one from the mid-fifteenth centuries, give an indication of the very varying quality of the illustrations accompanying medieval medical manuscripts — but even the finer of the two, an exceptionally detailed image for a medieval manuscript, falls far short of the standard of accuracy established by Vesalius.

Vesalius was the first to bring together anatomy, art, and the printing press. In principle, Leonardo could have beaten him to it; but the enterprise would have been impossible before 1500, when a lavishly illustrated book would have been hopelessly expensive (the first anatomical drawing made from direct observation had appeared in print as recently as 1493), and eccentric before 1531, for up until then the task of catching up with the knowledge of the ancient Romans was still incomplete. Before Vesalius, the most important work to pioneer anatomical illustration was Berengario da Carpi's Commentaria of 1521; Vesalius published his first illustrated medical text, the Tabulae Anatomicae in 1538, in collaboration with an artist, Joannes Stephanus of Calcar: he must have begun work on the Tabulae almost immediately on arrival in Padua. He was clearly determined to waste no time.

Illustration, of the quality pioneered in the Fabrica, enabled the anatomist to make manifest exactly what it was that he thought he had seen. His successors could compare both his words and his plates with what they found on the dissecting table, and if there was a discrepancy they could be certain that they had found something new. Leonardo carried out a number of dissections, and in his drawings we can trace the development of his anatomical understanding. At first he held all sorts of mythical beliefs derived from ancient authors: for example, that there was a duct connecting the penis to the brain, so that semen contained not only matter from the testicles, but spirit from the brain. The great English anatomist, Thomas Willis, was still looking for such a duct in the 1660s. As time passed, Leonardo made ever more exact observations of the human body, although occasionally it is clear from his drawings that he has more experience of dissecting cows than humans, so that bovine features appear in his illustrations of human anatomy! Still, his new knowledge, confined to his private notebooks, had no impact on his contemporaries. Vesalius's discoveries, by contrast, were a public record of the extent (and the limits) of his knowledge.

In the Fabrica Vesalius set out to illustrate the human body logically, which meant ignoring the sequence of an actual dissection. A dissection started with the abdomen, which was where putrefaction began first, and then proceeded to remove the skin, and work down through the layers of the flesh, ending with the bare bones. As a result the normal name for a skeleton in sixteenth-century English was 'an anatomy', since a skeleton was the end product of the anatomical enterprise. But Vesalius begins the Fabrica with the bones and they, at the end of the first book, are then assembled into a series of three elegant skeletons, viewed from front, side, and rear. He then works from the surface of the body inwards, and only finally does he turn to the abdomen. One can see at once the pedagogical advantages of such an approach, but it was also a symbolic choice on Vesalius's part: the skeleton represented the beginning of his own career as an anatomist.

Only having introduced you to the skeleton does he begin to work with the whole body.

The skeleton was Vesalius's trademark, and it became the trademark of the new anatomy. Hippocrates may have given a statue representing a skeleton to the temple of Asclepius. Galen had stressed the importance of trying to find a body where the flesh had rotted away and all the bones were in place, though there is no evidence that he ever went on, as Vesalius did, to assemble a skeleton by tying the bones together with thread and wire. There are images of skeletons on late Roman tombs and drinking cups, reminders of the shortness of life; and in the later Middle Ages there are often images of death as an emaciated creature with the bones showing through, or even as a mere skeleton. And Donatello's bronze horse's skeleton shows how natural it was for any Renaissance artist to think in terms of skeletons. There was nothing new, then, about the idea of a skeleton. Vesalius however turned the articulated skeleton into a central pedagogical aid: he had one hanging by the body being dissected as he lectured and cut, and, in imitation of him, generations of anatomists furnished every anatomy theatre with its skeleton.

Vesalius could use skeletons as pedagogic aids because he had a new method for producing them. He implies he is following the example of Galen, but the reference he gives to Galen is false, and perhaps deliberately misleading. He tells us, in the opening pages of the Fabrica, that his predecessors had put bodies in coffins, covered them in quick lime, and then, after a few days, cut holes in the sides of the coffins and put them in a stream. After a while, the coffins were removed from the running water and opened; the flesh had washed away, leaving the bones, still tied together by ligaments. But the dark ligaments concealed much of what needed to be seen.

Vesalius's method was very different. In his kitchen, he boiled up a large vat of water. He carved up a body, removing as much flesh as possible, and carefully putting aside loose pieces of cartilage, including the cartilage in the tip of the nose and the eyelids. He then boiled up the body until it fell apart, pouring off the fat and straining the liquid so that nothing was lost. He was left with beautiful clean bones that could be wired together to create an almost perfect representation of

12. The lateral view of the skeleton from the De Fabrica of 1543.

the 'living' skeleton. Those little bits of cartilage which could not be reattached (the tip of the nose, the stiffening to the eyelid, the ears) he strung together on a necklace to decorate his teaching aid, which was then made portable by being mounted on a folding stand and encased in a box—one of Vesalius's skeletons survives to this day in Basle.

There is something profoundly alarming about the story of how to make a skeleton: Vesalius is boiling bones as if he was making beef stock; he is chopping up bodies in his own kitchen as if he were about to eat them. By beginning with bones, and with his recipe for producing skeletons, Vesalius was inevitably reminding his readers that there was something shocking about dissection. As already noted, a papal bull of 1299 had specifically forbidden the boiling up of bodies (a method used for the bones of Crusaders), and Mondino had acknowledged that there were some bones in the skull that could only properly be exposed by boiling them up: these, Mondino said, he was accustomed (a slippery word) to leave alone, in order to avoid committing a sin. Readers of Vesalius naturally concentrate on the large and elaborate scientific illustrations; but each book and then each chapter begins with an illustrated initial letter—a larger letter for the first letter of each book, a smaller one for the first letter of every chapter after the first. Naturally the first letter of the preface is a large initial V, illustrated by a picture of an anatomist cutting into a body positioned so that it seems strangely alive. The first letter of book I, facing the portrait of Vesalius himself, shows putti (naked children) boiling up bones in a kitchen to make a skeleton. The innocence of the putti contrasts sharply with the cooking of human beings. This, as much as the portrait of himself, is Vesalius's chosen self-representation.

It is sometimes said that the very act of looking inside the body was disturbing. This is certainly wrong, as in Italy it was normal to embalm bodies to help preserve them between death and the funeral. Italian funerals were 'open casket' events; no body that had been dissected could be buried in the normal way. But worse still, no body that had been turned into a skeleton could be buried at all. At the very heart of the new practice of dissection, where it ended in the production of a skeleton, was a truly shocking act: the denial of burial to the dead. Theologically speaking, one did not need to be buried in order to be resurrected to eternal life: Vesalius's skeletons, bones in a box, with the flesh torn away and boiled off, were in no worse a position as far as resurrection was concerned than fishermen drowned at sea, and Italian cemeteries contained ossuaries where old bones were collected when plots were reused for fresh burials. Still, the burying of the dead was a fundamental gesture of respect, and if the remains of the dissected sometimes ended up in a tomb, they often ended up on display.

Vesalius was engaged in a strangely contradictory activity. On the one hand he employed the finest artists to turn his cadavers into aesthetic objects. He carefully posed his dead bodies so that they could be represented as though still alive. He had them illustrated in landscapes, as if walking about. When he came to illustrate the viscera, where it was clearly impossible to make a corpse look alive with its guts hanging out, he created the illusion that an antique statue was being opened up to discover flesh-and-blood organs within. But then, he provides an illustration to show just how his bodies were posed: a corpse held up by a rope, hanging from a pulley, bits of flesh dangling from the bones. When he dissects the brain, he allows you to see (after the idealized anonymity of the 'muscle men') the moustache and facial characteristics of the corpse: his friends would be able to recognize him. And he provides an illustration of the lower torso, with legs splayed and dangling penis, which makes it look like a hunk of meat on a butcher's slab. At one moment he is a magician, beautifying death; at the next he is telling you it was only a trick, and showing you how terrible the dead body can be.

We find the same contradiction in the text. At one moment Vesalius is writing of anatomy as a divine calling, at another he is boiling human bodies in a vat. It is Vesalius who tells us that he obtained the first body he worked on by pulling it down off a gibbet and carrying it home in pieces under cover of darkness; Vesalius who tells us that his students stole the unburied body of a woman who had recently died, and quickly flayed it so that those who knew her would not recognize her; Vesalius who tells us that one of the bodies he dissected was that of a recently buried prostitute famous for her

13. The first illustration of the muscles from the 1543 De Fabrica.
14. The seventh illustration of the muscles from the 1543 De Fabrica.

373 andre ae vesalii brvxellensis

Q^Qj-lti characleribmfiitiflrx later is metnbrana ttoMur, qua: till correfoondet, ftam nuptr 0, O indicctrunt*

jiyS Vteri ccruicis anteriorp,irsfititer R. er S ea rfdftwc obdticla tunka f tju,amperitonei partes if !i offcTutsqui? ipji'uaja cxporri^untfdcducuiit^:,itc ilium perkonaoadneShtnt. Co-term inter u,ilium inter R&S confijlens,uteri ccrufcis timplitudinem quoddinmodofynifieat, Rugxvc robicconfpicuceyillrfuntquas uteri ccrutxin fccollapjk,tiap alias dtjlenta¿inter fccaadm commonflntt.

T jfejiea}cuiuspojlcriorfaciei hicpotiftmtm[pcflatnr.itd etiitn inftgur* huius delincotionc oat km dircximusy acfi in corporeproflmto^pofhriorem uefciefedem qua- uterum\fpc8at,potift tittw cemerc tioluijjemtts. St cnim pretjew mulicbre corpus ita uti id quodmodojubfequcttir^ rcflum -trbitmreris-.ttidm/ecus att£ resfc habctjucrijundum muko dittos ipfa uefica debut* turn ejje tili perfuaderes.

Jf Vmbilici cfl portio r a peritonea inter fecadum 1iberatdr & una cum oafisfattui pccuh'aricus bk dtorfum reflcxa. JST Portio iicnx ab umbilico t'ecur pet etuis.

y Meat in ducjiaejwtdi clafifiimajedc ad umbilicum pertinens}acfatus urinam interjecundtm CT tntimttm ipfhis ittuolticrum dedueenj. r2Lietz3" Duaf arteri* db umbilico bucfccuiidum ucjicar Lttera prorcpctitcs, afp hacfedc rnqgitxattts rtx ramispubis ofiumforaminapottjiimuni adcutttibtis infert(Cyfcu continue.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Responses

  • myrtle
    How id vesalius record the different parts of the body?
    16 days ago

Post a comment