chapter four

Anatomical Precedence

This old man, a few hours before his death, told me that he was over one hundred years old…. And thus while sitting on a bed in the hospital…without any movement or other sign of distress, he passed from his life.

And I made an anatomy of him to see the cause of a death so sweet.

LEONARDO DA VINCI, REGARDING HIS DRAWING A DEAD OR MORIBUND MAN IN BUST LENGTH

In beginning the process of cutting apart a human body, we join a long line of medical students—and pioneers in quest of the body’s mysteries—who plunged into this forbidden terrain. The history of human dissection is a long and tortured one, and as I take my place in it, I cannot help but wonder what it must have been like for the first scientists and artists who dared to think of looking beneath a body’s skin. How did they go about their first forays into the dead? I want to know what it was like for these audacious explorers, who were propelled by the same promise of wonder I feel yet who ventured into territory not only forbidden but largely unknown. I want to understand in a deeper way the intensity of the taboo of dissection and the visceral aversion we feel even today to the violation of the human form.

Representations of the human heart and trachea have, it turns out, been found on amulets dating as far back as 2900 B.C. Dissections are not formally documented, however, until two and a half millennia later. In fact, the seminal triumphs and tensions of anatomical discovery took root in the blaze of the Italian Renaissance.

The Italian university town of Padua is the official birthplace of human dissection, and the town’s renowned anatomical theater was built in 1594. Similar theaters were built across Europe, with particularly famous examples in Leiden, Paris, London, and Bologna. Though the theaters were originally built for teaching purposes within university medical schools, the dissections performed in them ignited curiosity first among artists and academics in other fields, and eventually in the community at large. In many cities certain dissections were designated for doctors and anatomists only, but others were open to the public. Tickets were sold, anatomical demonstrations were given, and oftentimes the events were preceded or followed by extravagant meals. Seventeenth-century travel diaries and postcards reveal that attending a dissection was a society event and marked a European traveler as on the progressive edge of culture. In eighteenth-century Bologna, as in many other Italian towns, dissections routinely took place during Carnival. The anatomical theater would be opulently decorated with candles and damask wall hangings. Masked attendees would fill the theater, and the dissecting table was illuminated by waxen torches placed at the head and feet of the cadaver.

The University of Padua, situated in the Palazzo del Bo, boasts a remarkable history, virtually unparalleled in academia. Italy’s original university was founded in Bologna in 1181. In 1222, however, a group of students in Bologna grew frustrated with increasing restrictions on academic exploration—accepted by the university—imposed by the pope and the government. Padua’s university was formed by these students as a place of independent learning, designed to remain unaffected by the ordinances of any pope, emperor, or king. This designation drew to Padua scholars from all across Europe who had felt constricted by regulations imposed upon their work. The list of names is mind-boggling: Copernicus; Galileo Galilei; the great British doctor William Harvey, who discovered the system of circulation of human blood; and many others.

Padua’s university was the professional home of Andreas Vesalius of Brussels, the father of modern anatomy. In the twelve hundred years prior to Vesalius’s seminal sixteenth-century masterpiece, De Humani Corporis Fabrica (literally, On the Fabric of the Human Body), anatomical study relied upon the writings of the second-century Greek physician Galen. Although Galen’s own anatomical knowledge was derived from experimentation and observation, Latin translations of his texts were used in the Middle Ages as substitutes for dissection. When the rare dissection did occur, the anatomy professor would read Galen’s writings, word for word, and would take no part in the dissection itself. In his book Doctors, the physician-writer Sherwin Nuland describes a fifteenth-century illustration of just such an occasion:

The professor sits perched high on what is quite literally his chair, droning along in his recitation of the Latin Galenic text while an ignorant barber-surgeon dissects the cadaver below and a barely better-schooled demonstrator shows the body parts to the only mildly interested students…. Since the professor never descended from his magisterial throne to actually look at the structures being displayed, and neither the surgeon nor the demonstrator really knew what he was doing, the several days devoted to the exercise each year were little more than a walk-through to satisfy a curricular requirement whose advantages were more theoretical than real.

Vesalius, on the other hand, was a master dissector committed to the necessity of direct observation in anatomy. His Fabrica, as it is known, marked the first time in twelve centuries that the investigation of the body’s structures had veered away from Galen’s writings and returned to the body itself. In Padua, Vesalius was comparatively free to disobey the decree of Pope Boniface VIII that forbade desecration of the body and therefore outlawed dissection.

Vesalius’s writings were accompanied by a glorious set of woodcut engravings by Jan Stephan van Calcar, who studied under Titian. In the most famous series of the Vesalian illustrations, called “the muscle men,” male figures stand in classical poses amid the Roman landscape. Their bodies are in various stages of dissection, but their positions and expressions are as lifelike as yours and mine. In some, flayed muscles hang from joints and bones, and yet the men gaze and ponder, stretch out their partially dismembered limbs. The woodcuts are strange and gorgeous, and in them life and death overlap to so great a degree that they collide.

Vesalius was audacious, and a man of insatiable curiosity. This ferocious commitment to elucidating the mysteries of the body is perfectly illustrated in one of my favorite passages in his Fabrica, as he describes his own acquisition of a skeleton. At the time a skeleton was a rare and precious possession, which Vesalius could not afford. In order to obtain one for his own study, Vesalius and his friend Gemma walk “in the hopes of seeing some bones.” Their destination is “the place where, to the great advantage of students, all who have suffered the death penalty are displayed by the public highway,” and there the two come across the skeleton of a condemned man, which had been hanging for more than a year. The criminal, Vesalius writes, “had provided the birds with such a tasty meal that the bones were completely bare and bound together solely by the ligaments.” But, having found a skeleton, “such an unexpected and long-sought opportunity,” Vesalius must now undertake the gruesome—and illegal—task of pulling it down and transporting it back to his home. With the help of Gemma, the anatomist writes that he “climbed the stake and pulled away a femur from the hip bone; and, when I pulled at the upper limbs, the arms and hands came away bringing with them the scapulae.” Vesalius made several trips to and from the corpse, taking the legs and arms home in “several secret journeys,” and, for the retrieval of the trunk and head, he writes:

I allowed myself to be shut outside the city at nightfall; so keen and eager was I to obtain these bones that I did not flinch from going at midnight amongst all those corpses and pulling down what I wanted. I had to climb the stake without any assistance, and it took a great deal of effort and hard work. Having pulled down the bones I took them away a certain distance and hid them in a secret place, and brought them home bit by bit the next day through another of the city gates.

Once in his home with the criminal’s bones, Vesalius softened the ligaments in boiling water, cleaned the bones, and built the skeleton, replacing a missing hand, foot, and patella “with considerable difficulty from another source.” Once finished, he was well pleased with his accomplishment, and brags a little: “I prepared this skeleton so quickly…that everyone was convinced I had brought it from Paris in order to avoid any suspicion of body-snatching.”

Though he may once have legitimately feared the legal ramifications of his research, as his academic status and reputation grew, so did his boldness. Vesalius was invited in 1540 to conduct Carnival dissections in Bologna, the accounts of which marvel at the large supply of subjects made available to him. Six live dogs and the corpses of three executed prisoners were dissected in front of the crowds. The arrangement obviously allowed Vesalius some influence over the legal authorities, because after five days of lessons he confidently announced that “tomorrow we shall have a new subject; I believe they will hang another; indeed this cadaver is now dry and wrinkled.”

 

During my first weeks of medical school, my friends and family phone to see how things are going. They all want to know about my first day in anatomy lab: What was it like? they ask. A mix of curiosity and horror in their voices. Some of them ask whether they can accompany me to the lab: Our friend Welly is an artist. She comes in with me late one night and tearfully sketches in her journal, moved by the matter-of-factness of the cadavers’ mortality. Deborah’s college roommate, Caroline, and her fiancé, Stephan, ask to visit the lab one Sunday. Stephan, who is a philosopher writing on issues of personhood, spends nearly an hour with me in the lab looking closely at the structures we’ve dissected; Caroline, an unflappable optimist and a ceaselessly inquisitive spirit, gets as far as the door, sees the body bags, and bolts out of the building. None of their reactions is unusual among the visitors I bring to see the body I’m dissecting—in fact, all of them are manifestations of the range of feelings that sweep over me from time to time through the course of the semester. But regardless of their reactions, all the visitors say to me at some point that the experience was not at all what they had expected.

Through visiting the lab, my friends and family members become more able to share in and understand this stage of my medical training. As more and more questions arise for me about what Vesalius and his fellow pioneers encountered as they ignored the established Galenic tradition and raced ahead in exploration, I long for this kind of firsthand view of anatomy’s history. What was it like?

Therefore, when a summer break allows me to do so, I decide to travel to Vesalius’s Italy. In search of a different view of gross anatomy from what I have found while working in the lab, I will visit the sites that set the historical precedent for cadaveric dissection and thereby revolutionized the basis of modern medical teaching.

I travel first to Padua and arrive at the Università degli Studi di Padova before it is open to visitors. As I wait, I sit on a bench adjacent to the entrance to read my guidebook and eat a handful of tiny strawberries that I’ve bought from the market for breakfast. At first blush the university does not seem like the serious foundation for anatomical study that it is. Just beyond the portal of Padua’s college palazzo at 10:00 A.M., a twentysomething woman is standing on a public bench in the square. She wears a pair of large white briefs and a black bra, with a small white tank top sliding off her shoulders. She holds a bottle of champagne and reads aloud from a hand-drawn poster with a caricature of herself in the center and text all around it. As she reads, her friends smear her body with butter, wrap her arms and legs in plastic wrap, sprinkle flour in her hair, crack eggs over her head, shove dried pasta down her underwear, drape her with strings of sausages. She laughs. They laugh. At the periphery, middle-aged men and women stand in dressy clothes, giggle, take pictures. Every few minutes they all break into rounds of song. A copy of the poster is taped to the university wall.

Above the caricature, which on closer inspection is the woman, dressed in a bikini, leaning against a giant penis, is a title: Monica, Dottore Filosofia. Monica’s reading goes on, and another woman walks through the portal in a gorgeous long beige skirt and fitted jacket, with stiletto heels. She wears a beribboned wreath around her neck, and her family and friends encircle her, beaming, and applaud. Street musicians strike up the song that Monica’s friends have been singing, and in the portal the woman in the beige suit begins to dance, first with one family member, then another, one friend, then another, and then the crowd forms a bridged passageway with their arms, which she walks through. She is systematically kicked in the rear by everyone. Then she is led, beige skirt and all, to an adjacent bench where she strips down to her underwear, takes hold of a bottle of champagne, and is subjected to a similar fate as her neighbor.

The procession continues like this until lunchtime, until ten or more naughty posters line the university walls and as many young graduates, shaving-cream-clad with lipstick tattoos and bright wigs, leopardskin wraps, and athletic supporters, have led their families out of the square, presumably off to graduation lunches and a day of celebrations.

It is through these festivities that I walk to try to find a third-floor office, to ask about Padua’s historic anatomical theater. As I speak just French and English, along with a few bits of medical Spanish (it is useful only in very specific situations, to ask, “Is there blood in your sputum?” or to say, “We’ll need a sample of excrement”), I thumb through my Italian phrasebook as I climb the stairs. When I find the right door, I knock, and a voice calls out something in Italian that, to me, is equally likely to mean “Come in,” “Wait a minute,” or “Go away.” I turn the handle and open the door, hoping an apologetic smile will compensate for a bad guess if need be.

“Si?” the woman behind the desk asks.

“To write. Book. Anatomy. Please. Permission. Photograph. Theater.”

She looks at me quizzically, then takes my arm, and we cross the hall into a room of computers with two women inside. Italian is exchanged rapidly. For a long time. Then a young woman rises from behind a computer and walks toward me, hand outstretched.

“I’m Anna,” she says. “How can we help you?” Anna, I will learn, is a stroke of great luck for me. Many times over I will make a request, like permission to photograph the anatomical theater. Anna translates this to Eleanora, the first woman I encountered. Then a five-minute conversation ensues in Italian that sounds every bit to me like an argument. Eleanora says numerous things fast, all of which sound like no. Anna responds. They do this for some time. Then they both turn to me and smile.

“It will be okay. Come with us.”

We leave the office space and enter into the Palazzo del Bo. Anna and Eleanora and I climb the stairs of the ancient courtyard where Vesalius once studied, toward the door that will lead us into the “anatomist’s kitchen,” a room adjacent to the anatomical theater, where corpses were once prepared for dissection. The story goes that, despite severe criticism from the Vatican, the University of Padua was given two corpses per year by the liberal Venetian government. But they decayed quickly and were insufficient to support the students’ needs. The students and faculty members therefore stole corpses from cemeteries. Legends of how this thievery was kept secret vary, but most agree that the table at the center of the theater flipped over, so that if inspectors or officials of any kind approached the theater, the table could be quickly turned so that the corpse was hidden, and a flayed animal would appear in its place.

One version of this story holds that the professors and students dug a tunnel under the dissecting table, which led beneath the walls of the city to the river. At night, groups would leave the city walls and paddle rafts to the graveyards, where they would dig up bodies and float them back down the river to the mouth of the tunnel. They would carry the bodies through the tunnel and, using a system of pulleys, lift them up to affix them to the underside of the dissecting table as needed. The lack of corpses was so severe that in the great oratorical hall adjacent to the theater a case holds seven skulls lined up in a row. The skulls are those of anatomy professors, who left their bodies to be dissected.

Unlike the decorated theaters of Carnival, the anatomical theater at Padua, with its rising, concentric circles from which the students observed dissections, is believed to have served a purpose more functional than spectacular. Today it can be visited on an official university tour. You enter the theater at its lowest level. Though it has been recently restored, no one is permitted to enter the levels once occupied by students. Positioned to look up into the rings of railings in the unique anatomical theater in Padua, one occupies the same space so many cadavers did. It is impossible not to imagine the faces of students peering around one another, over shoulders, into the center of this remarkable room.

There were no seats in the theater, so students stood with a rail in front of them and the rail belonging to the higher row behind them, close enough that both rails touched their bodies. For many reasons—reasons far more legitimate than ours on our first day of anatomy lab—students in the Palazzo del Bo’s anatomical theater were likely to faint. The quarters were incredibly tight. The theater is tiny, but anywhere from two to three hundred students are said to have packed into it at a time. However, the small size was effective. It helped students to see as well as possible the corpse being dissected. It also allowed for easy communication and collaboration between students; those on one side of the theater could describe to students on the other what they were seeing.

In addition, there were no windows in the room until 1844, so not only were lectures held by torchlight but the smell of the (often already partially decayed) corpse must have been terribly strong. For many years dissections were held only in the winter, in an attempt to curtail the rapid rot in warmer temperatures. The hope was that the close quarters crammed students into the rows tightly enough so as to prevent them from falling forward into the center of the theater in the event that they should faint. Still, a diary entry from one anatomy professor reports that during a single lecture ten students fainted and fell from the rows. Such an occurrence was not uncommon, and students often injured themselves rather seriously in this way. As a precaution two measures were taken. First, it is said that orchestras were hired to play music for the students, to calm them as they entered the theater. And second, and more practically, that same professor calculated the railing height necessary to keep a body from falling forward and as a result raised all the railings by twenty centimeters.

The precipitous incline and sparse décor that surrounded dissections in the Palazzo del Bo differ from the feel of the anatomical theater in nearby Bologna, built nearly half a century later, in 1637. Rather than having the sharply pitched, circular rows of Bo, the room in Bologna is large and square, and less dramatic. Dark, wooden, backed benches are arranged in rows forming a cantilevered rectangle around the marble dissecting table, one of only two indicators that this is anything other than a picturesque old lecture hall. The other is the stately lecturer’s chair, suspended along one of the room’s walls. The chair is not unlike a throne beneath a wooden canopy. Two famous skinless statues of men, called spellati, effortlessly support the canopy, lifting it above their heads. All the while they demonstrate their own musculature, as if holding a great piece of wood aloft is the most natural thing in the world to do after having been skinned.

Standing in the core of Padua’s restored theater, considering what dissections here must have been like, I realize I might easily have lacked the commitment to anatomy that the students in the sixteenth and seventeenth centuries had to have had. Not only did they engage in grave robbing, but they had to be willing to defy papal edict, either solemnly or with a bit of jest and pretense.

This apparent mockery of church beliefs manifested itself officially in the great hall of the Palazzo del Bo, where to this day a painting above the hall’s entrance designates patron saints for the two original divisions of the university. On the left, Saint Catherine of Alexandria is depicted as the protector of the students of law. On the right, the protector of students of medicine and liberal arts is none other than Jesus Christ, the Redeemer.

Yet despite the brazenness of some university figures, who must have deemed ridiculous the Vatican’s demonization of scientific discovery, I have to believe that for some students this issue caused great personal tension and internal struggle.

In the base of the theater, I snap quick, ill-angled pictures in an attempt to capture the feel of the room that hovers above me, and then Anna and Eleanora look to me as if to say, Is that enough? Not wishing to overstep the limits of their kindness, I accompany them out of the room. Eleanora, smiling, says something fast to Anna and disappears. I call “Grazie!” to her and wave, though she doesn’t turn back to look. Anna guides me around the corner, up a tiny elevator, down a hallway, and into a small room: a library.

“I don’t know how much this will help you,” she says, “because the books are all in Italian, but you are welcome to look.” She leaves me for half an hour to browse, and when she returns, she has photocopied an entire chapter from one book, which she hands to me, along with a bright red hardback, published by the university, on the history and restoration of the anatomical theater. “This book exists also in English,” she says. “It is possible you could buy it.” I tell her that I’d be interested in doing so and ask her how much it would cost.

“Well, we would first have to get permission from the rector,” she explains. I am puzzled. The rector is obviously the equivalent of the university president in the United States, but I am completely unclear on what his role would be in my purchase of this book.

Anna, whom I am starting to think of as Dante’s Beatrice, leading me through the anatomical underworld, now guides me down a back staircase and into a forbidding, high-ceilinged office with dark walls. At a large desk with a cabinet behind her sits a neatly dressed blonde woman. Anna speaks to her at length in Italian, smiles, gestures at me, speaks some more. Eventually the woman rises from her chair, opens the cabinet behind her, and, from a deep space, pulls a copy of the red hardback that appears identical to the one I have seen in the library, except the title of this one is in English.

“Wonderful!” I exclaim, and, having been told that the price of the book would be sixteen euros, I reach into my purse for my wallet. Anna shoots me a strong, fast look. It is the look a mother gives her child as she begins to misbehave in church. Its universal meaning: Stop what you are doing right now, and, for both our sakes, let’s hope that the authority figure hasn’t seen that move of yours. I slowly withdraw my hand from my bag, and the blonde woman leaves the office, with the book under her arm.

Once she is safely beyond hearing range, Anna explains. “The rector has not yet given permission for you to purchase the book. It is important not to presume that he will do so. His secretary has gone in to ask him. She will return in a moment.” When she does, it is without the book. She speaks briefly to Anna, and Anna translates for me.

“The rector is occupied at the moment and will need until tomorrow morning to decide whether to grant permission for the book’s purchase.” Completely baffled, I return to the courtyard and find the way out. As I do, a young man with a wreath around his neck dances with his grandmother and begins to take off his suit jacket. The next morning Anna tells me that the rector has decided to give me a copy of the book, as a gift, which she hands to me, grinning, with her e-mail address tucked inside in case I have any further questions.

Walking through the streets of Padua, I think of how the young men who observed dissections here in the sixteenth century must have felt the same trepidation and awe that I have while looking deeper and deeper into the body of a stranger’s corpse. And though they were physically more distanced from the body than we are, they were actually closer to death. My lab partners and I use our own hands, our own strength to reach into the body, to feel its cold wetness, to pull apart its layers and cut away its packing. We touch and cut the body and change its shape in a way that previous generations of students did not. But we deal with far fewer of the realities of the corpse. Our cadaver hosts no signs of decay. It harbors no timeline of rot, no trace of earth clinging to the skin, harking back to an abandoned grave.

 

My trip to Padua is a sort of pilgrimage, and in that sense I am not at all alone. Because of its Basilica of St. Anthony, Padua has long been considered a holy site for the Catholic faithful. It qualified as such in the days of Vesalius, and the anatomist made good use of Anthony’s relics, which lie in the massive basilica. Today the church—and the relics—receive busloads of visitors daily, who wish to pray to Anthony with requests or with gratitude.

The church named after St. Anthony is enormous and incredibly ornate, seemingly made only of marble and gold. Inside, lines of people swirl around the crypt of the saint. I join the line, and we file behind his tomb. At the back side is a pockmarked granite rectangle—one of the only unadorned spaces in the church. As we wind by, one by one, each person raises a hand to trace the stone.

Past his crypt, in another nave, more lavish and ornamented than any other, is the reliquary. Fragments of Anthony’s tunic. Bits of his handwriting. And, in bejeweled, gilded glass globes, Anthony’s tongue, larynx, and jawbone. Life-size marble cherubs float above them. The ceiling is dazzling gold. The extravagance is much more striking than the black tongue flecked with pink and set on its thick base, pointing upward; the indistinguishable brown furry mass of the “vocal apparatus”; the ghoulish mandible set in a crystal ball and topped by a jeweled crown.

As I leave the basilica and make my way toward the university, I think only of the fact that four hundred years ago Vesalius is said to have stood before those same relics, touched the crypt, and viewed the holy tongue. Local legend purports that Vesalius was a common target of the enforcers of religious law, since his dissections violated the decree of Pope Boniface. Upon hearing of approaching authorities, Vesalius would leave his anatomical study at the University of Padua middissection and run through the narrow streets into the Basilica of St. Anthony. There he would fall to his knees in prayer, confessing the sins of his research, claiming repentance, and begging for forgiveness for his many transgressions. By the time the church officials reached him at the tomb of the saint, Vesalius was unreproachable in the eyes of the church. That he chose to throw himself at the crypt of a saint whose body the church had cut into pieces to display was a detail that was surely not lost on the anatomist.