I stare at the bookshelf of my parents’ library, trying to decide which volume of the World Book Encyclopedia I want to explore next. My dad is an academic veterinarian, and although we don’t have a lot of money, my family, like so many in 1976, has decided to “invest in the future” and buy a home encyclopedia. It’s the greatest invention in the world to me: twenty-two inches of information, alphabetized and condensed, containing, as advertised, a world of knowledge at my fingertips. In the days since the treasured series arrived, I’ve spent hours leafing through the books, reading about the Appalachian Trail, the Congressional Medal of Honor, and flags of the world.
I reach for Volume 8, with the letter H on the spine. I’m not looking for anything in particular, just waiting for something to grab my attention. As I plop down on our sunflower-festooned canvas couch, I thumb the pages to survey the topics. Letting the pages fall open near the back of the book I am arrested with wonder. Unlike all the other shiny paper pages, here are four clear plastic acetate sheets, each representing a layer of the human body.
The first human form has no skin, and gazes left. The right side of his body, closest to the book’s spine, has the muscles intact over the chest, abdomen, right arm, and leg. His left side bears only the rib cage painted on the first sheet, and I linger over his lungs and guts, enthralled. Turning the page, I see inside the front of his body, its entire rib cage and muscles visible. The front of the second sheet shows only the muscles of the left arm, but reveals the lungs, liver, stomach, and intestines, all glistening and moist. Every organ is numbered, and the corresponding legend makes a light blue column along the edges. Turning the second page, to my great pleasure, I find the brain, visible within its bony home, the skull.
The third plastic page reveals lungs, heart, large blood vessels, pancreas, and kidneys. I flip back and forth, memorizing the numbered organs and their habitations, not sure if they are interconnected, but riveted by the thought that the guts and organs all have their own purpose. The last sheet is mostly skeleton and nerves, and as I turn it, I see the back side of the body. To my boyish glee, I find muscle number 159, gluteus maximus, which sounds like a forbidden term.
As I stare at the images I can’t see how food gets from the mouth to the stomach, but the accompanying text tells me the esophagus serves as the conduit for liquids and chewed-up bits, and the small intestine absorbs the food particles, which are further broken down by the digestive enzymes from the pancreas. Whatever isn’t broken down and absorbed moves on to the large intestine, where water is drawn away, leaving “waste.” My grade school mind wonders, is “waste” the same thing as “poop?”
Nowhere else in this encyclopedia is there such a specialized set of illustrations, and the message is clear to me: the human body is the most important subject in all these volumes. Other topics still pique my interest, but these anatomical drawings will always be my greatest fascination. In fact, I can’t drift too far away from them; returning often to these acetate sheets.
In the 1400s, Gutenberg invented the printing press, Constantinople fell to the Turks, Jan Hus and Joan of Arc were burned at the stake, the Medici rose to power, Columbus sailed to the New World, the Jews were expelled from Spain during the Inquisition, and the word “discovery” was coined.
When Columbus stumbled upon the New World in October 1492, he had no word to describe the action of “encountering an unknown world.” Columbus recorded the accounts of his voyage in Spanish and Latin, but only Portuguese had the word, discobrir. Prior to the late 1400s, authors struggled to convey the concept of invention or discovery, and would rely upon paraphrases such as, “a new technique that never existed previously.”1
David Wootton, in The Invention of Science, posits:
The discovery of America in 1492 created a new enterprise that intellectuals could engage in: the discovery of new knowledge. This enterprise required that certain social and technical preconditions be met: the existence of reliable methods of communication, a common body of expert knowledge, and an acknowledged group of experts able to adjudicate disputes. First cartographers, then mathematicians, then anatomists, and then astronomers …2
Therefore, the idea of discovery is inseparably linked with ideas of “exploration, progress, originality, authenticity, and novelty. It is a characteristic product of the late Renaissance.”3
Copernicus (1473–1543), the Prussian astronomer who discovered heliocentrism (placing the sun at the center of our solar system), was fortunate to live during “the very decades when a great many changes, now barely visible to modern eyes, were transforming the ‘data available’ to all book readers. A closer study of these changes could help to explain why systems of charting the planets, mapping the earth, synchronizing chronologies, codifying laws, and compiling bibliographies were all revolutionized before the end of the 16th century.”4 The starwatchers comprehended that the heavens could be described with charts and tables; the early anatomists—cartographers of the body—would similarly map the intricate and predictable anatomy of humankind.
While it took a full century for print culture to assimilate scribal records of the ancient philosophers into coherently presented books, the simultaneous distribution of well-made figures and charts enhanced the works. It was one thing for a Florentine publisher to present, say, the philosophical works of Aristotle, it would be quite another for a 16th-century savant to revisit the works of Galen, the most authoritative physician-author in human history. The year 1543 witnessed the publication of two of the greatest books in human history: Copernicus’s groundbreaking manuscript, published in Nuremberg in the year of his death, and an anatomy book by a twenty-nine-year-old, Andreas Vesalius, who would dare to challenge the great Galen. His book, De Humani Corporis Fabrica (On the Fabric of the Human Body), a tour de force folio, would set the stage for a renaissance in medical education.
During the Sack of Constantinople, in 1204, crusaders (inspired by Pope Innocent and supplied by Venice) pillaged and purged the ancient city of its treasures, and carried them back to the Italian peninsula. These included works of art, sculptures, precious metals, and ancient manuscripts. The works of the philosophers of antiquity from Constantinople and other conquered lands “caused some to understand that there had once been an age that far outshone their own, one that emphasized the humanity of humankind, rather than its spirituality. As a result, there was now a new humanism in the air, which began to emphasize freedom of thought, rather than the selfless submission demanded by medieval philosopher-theologians. This humanism encouraged the exploration of human potential, and the expression of humanity, especially in literature, philosophy, and all forms of art.”5
Constantinople surrendered to the Turks in 1453; the mass westward emigration of the eastern Christians was an important factor in the reawakening of Europe. The translation centers in Italy and Spain had their new Latin works (from Arabic), but the Byzantines brought their Greek manuscripts with them to the Italian city-states just as Gutenberg was perfecting movable type printing.
A small group of 15th-century craftsmen fled Constantinople and made their way to Venice; the Venetians had been major power brokers for decades in Byzantium, with their sophisticated ships, trading networks, accounting systems, and banking erudition. The artists and technicians who sailed for Venice included a group of glassmakers who found themselves in one of the greatest commercial trading hubs in the world. The making of colored glass had been around since Roman times, but the Byzantine workers had elevated their craft to previously unseen heights, and a new luxury good was introduced. In the Venetian marshlands, however, the glassmakers had an unappealing habit of “burning down the neighborhood,”6 and were moved across the lagoon to the island of Murano. An “innovation hub” was created, and the “Isle of Glass” (which still produces exquisite glass today) became the paragon of the craft.
Steven Johnson describes the big breakthrough:
After years of trial and error, experimenting with different chemical compositions, the Murano glassmaker Angelo Barovier took seaweed, rich in potassium oxide and manganese, burned it to create ash, and then added these ingredients to molten glass. When the mixture cooled, it created an extraordinary clear type of glass. Struck by its resemblance to the clearest rock crystals of quartz, Barovier called it cristallo. This was the birth of modern glass.7
Surprisingly, modern, clear glass would enable several of the key innovations that empowered the birth of modern science and would define the birth of the Renaissance. The accidental making of clear glass would be followed by the (almost) accidental manufacture of mirrored and curved glass, and the possession of mirrors and small curved lenses would revolutionize medicine and science in unimaginable ways over the course of the next century.
Once the Venetians had discovered the technique of making cristallo, the next major challenge was making a larger flat piece of glass, not an easy task when you consider that glassmaking always started with a glass-blown bubble that had to be rapidly flattened while cooling. Additional experimenting with basic ingredients from faraway lands yielded ever superior glass, including herbs from Egypt and sand from Mediterranean trading partners. In an effort to make larger, flat panes of glass, they adapted a method of blowing glass into cylinders, slicing the molten glass lengthwise and laying it flat. Early mirrors had been made with a technique of adding silver flakes on the back of cooling glass, but the differential coefficient of contraction between the glass and metal made the glass fracture. The Muranese innovated an amalgam of mercury and tin, which resulted in less breakage of glass and yielded a shiny and highly reflective surface.8 While still a relative luxury good, mirrors became commonplace enough that they became part of the fabric of everyday life in the early Renaissance in Venice and Florence. “This was a revelation on the most intimate of levels: before mirrors came along, the average person went through life without ever seeing a truly accurate representation of his or her face, just fragmentary, distorted glances in pools of water or polished metals.”9
Therefore, a combination of developments occurred in the mid-1400s that set the stage for a seismic sociological change. Within a few decades, Lucretius’s poem “On the Nature of Things” was discovered in a German monastery, crystal clear glass and advanced mirrors were invented in Venice, Constantinople fell to the Turks—with the original Greek manuscripts flowing into Italy—and the movable type printing press was invented. Conventional wisdom holds that individualism was born in 1500 C.E.,10 and it is no accident that the refinement of mirrors and the appearance of the first self-portraits are coincident. “Self-consciousness, introspection, mirror-conversation developed with the new object itself,” writes Lewis Mumford in Technics and Civilization.11 Man could see himself for the first time, and as the personage came into focus, property rights and legal customs began to revolve around the individual, rather than the former collective units of family, tribe, city, or kingdom.12 The new individualism and humanism of the mid–15th century would compel prodigies to turn their gaze inward, to explore the motives of the mind and the corpus, and, following Columbus’s example, to discobrir the fabric of the human body. Our interior thoughts and our physical makeup became fertile ground for exploration at the fading of the Dark Ages, and the surveyors who sharpened their gaze on the human body had no idea about the new continents that lay before them.
The decline of human dissection in Alexandria at about 150 B.C.E., at the time of Herophilus and Erasistratus, presaged the extinction of the medical school in what had been the most advanced center of scientific study in the world. The incorporation of Alexandria into the Roman Empire in 30 B.C.E. further codified the opposition to human dissection, both by statute and general pagan religious sentiment.13 As we have seen, it was Galen (129–199 C.E.) who became the unquestioned anatomical authority, even without ever dissecting a human cadaver or performing an autopsy. His investigations were animal-based, including barnyard animals and Barbary apes.
The prohibition of human dissection continued through the Muslim epoch of intellectual leadership from the 8th to the 13th centuries, with only scattered original anatomic investigations. “The anatomical knowledge of Islam was merely that of Galen in Moslem dress,”14 and the great Arabic translators were merely recapitulating what Galen had claimed. Curiously, it may have been the practice of dismemberment, boiling, and cleansing of bones of crusaders who had died in the distant East for easier transport back home that laid the foundation for the revival of human dissection.
The renewed interest in medical learning in the Italian Peninsula, first in Salerno, and later in Bologna and Padua, inspired young researchers to ignore the prohibitory bull of Boniface VIII of 1299 and perform the first human dissections. The bull was “directed not against human dissection but against the practice of boiling dead bodies of those far from home [for burial in their own homeland] … the papacy never issued any statement specifically opposing dissection although there seem to have been instances in which overzealous local ecclesiastical authorities, by interpretation or misinterpretation, did oppose the practice.”15 It is simply not true to claim that the church forbade dissection; ironically it was the Roman pagans who enacted these laws that had lasting power until the 1300s, and it was their Italian descendants who most powerfully challenged and reversed the laws.
Mondino de Luzzi, a physician from Bologna, Italy, became the first important dissector of the Middle Ages, publishing the classic Anatomia, in 1316. This was the first modern book devoted solely to anatomy, and while it appears that Mondino relied heavily upon Galen’s writings, it is clear that much of the book was based upon his own anatomic dissections. Anatomia is simple, concise, and systematic, and would be the guide to anatomists for two hundred years, helping spark medical curiosity across Europe. The University of Bologna was, therefore, the first home of the revived practice of dissection and study of the human body16; the revival would soon spread to Padua, Venice, and Florence throughout the 1300s, and later to Siena, Perugia, Genoa, and Pisa by 1501. Again, while the sins of the Catholic Church, particularly in the 14th and 15th centuries, were legion, the prohibition of human dissection was not one of them, as is commonly claimed.
It is no coincidence that the rise of anatomical understanding, humanistic self-awareness, and enriched artistic representation occurred simultaneously in the Italian Renaissance. In the early 16th century, Botticelli, Leonardo da Vinci, Michelangelo, Raphael, Dürer, and Titian coexisted, competed, and, occasionally, cooperated. In 1502, Giacomo Berengario was appointed chair of surgery and anatomy at the University of Bologna (situated halfway between Florence and Venice) and would become Mondino’s successor, writing Commentaria (1521), an extensive work of almost a thousand pages (possible only because of the printing revolution). Berengario was the first physician “not constantly overwhelmed by earlier authorities, either Galenic or Moslem [sic]”17 and put considerable trust in his own vision of the human body and its function. Importantly, he had a sincere interest in art, even owning Raphael’s John the Baptist. Commentaria would be the first anatomy book to integrate (although crudely) text and illustration, and Berengario was the “first anatomist to have a fairly good idea of the true significance of anatomical illustration.”18
Although surgery was still limited to the lancing of boils and rudimentary battlefield triage and temporization, the tide was swelling for an improved understanding of how the body works. With the advent of the printing press, the refinement of woodcut printmaking, and a new, scientific approach to investigation, the stage was set for a young anatomist/surgeon who would write one of the greatest books ever written.
Andreas Vesalius was born in Brussels, Belgium, in 1514, to a family well positioned in society, with a father (Andries) who was the imperial pharmacist and a grandfather who was a physician to the Archduke Maximilian. In a time when royalty was often on the move, the ambulations of the imperial train compelled Andreas’s father rarely to be home. Andreas benefitted from an elite education, first in Brussels, and then as an adolescent in nearby Louvain. At the Castle School at the University of Louvain, the teenage Vesalius studied philosophy, including Aristotle, and the arts, and was thoroughly versed in Hebrew, Greek, and Latin. With a family tradition of medical studies, it is not surprising that he opted for medical school, and by 1533, Vesalius was on his way to Paris.
Vesalius enrolled in the medical school in Paris, with the expectation that he would earn his degree within four years. In retrospect, it seems amazing that a medical baccalaureate degree demanded four academic years’ work. A modern surgeon asks, what were they studying and how did the program take so long? There was no such thing as a microscope, the concepts of physiology (the study of the dynamic functions of the body), pathology (the study of diseases of the organs and cells), and microbiology (the study of bacteria and viruses) were completely undiscovered, and surgery was as primitive as we may find in a stone age village in Borneo today. We must conjecture that they learned Galenic and Hellenistic medicine, replete with philosophy and misinformation. Vesalius was in Paris for three years, but was forced to leave before being granted a medical degree, as we shall see.
Prior to the arrival of Andreas Vesalius to the City of Light, barbers, surgeons, and physicians continued to wrangle for prestige and recognition. The longstanding prohibition against human dissection had contributed to physicians’ disinterest in anatomical study of any kind. Because the study of anatomy was so strongly linked to surgery, there was little incentive for physicians to engage in serious scholarship of the body and certainly not to touch a corpse. Modern readers understand that today, all physicians and surgeons, whatever their specialty, started out as classmates in the same medical schools. But in medieval times, physicians and surgeons did not train together. The guild of surgeons trained independently from the faculty of medicine; the barbers were far below, with no schooling in Latin (and certainly not in Greek), and only occasionally benefitting from instruction by physicians and surgeons. Barbers first organized around monasteries, where they performed the tonsure haircut we associate with medieval monks; over the preceding millennium, barbers became expert with knives while providing haircuts, shaves, and Hippocratic bloodletting. In England, the barbers melded with surgeons from 1540 to 1745, eventually becoming irrelevant except for a shave and a haircut. The striped barber pole is the only reminder of their former job as bleeding patrons.
Like medieval priests exercising control over parishioners, “the employment of Latin seems to have been in the ancient tradition of power and control … through its possession of the keys to the esoteric mysteries.”19 After years of simmering tensions, an agreement was finally reached in Paris in 1516 that resolved the medical hierarchy, with physicians preserving their vaunted position and surgeons accepting a subservient station. Instead of the Parisians emulating the more advanced Bolognese and Paduans, who rolled up their sleeves, dissecting and investigating for themselves, the French physicians eschewed touching cadavers, instead lecturing high from their cathedra (high chair) while the surgeon performed the actual dissection.
Whereas surgery had achieved some measure of respect in Italian cities by the 1400s, in Northern European countries like France, Germany, and England, esteem for surgeons languished far behind that enjoyed by physicians. Guilds (like modern-day trade unions) were formed by both surgeons and barbers, and were critical in establishing membership rules and standards. The craft of barber-surgery would have resembled the “surgery” of Greek and Roman times, limited to basic trauma stabilization of broken bones, sword and knife wounds, and the new injuries associated with gunpowder’s arrival from China.
The battlefields of 14th and 15th century Europe would bear witness to the new power of gunpowder, and the “blast injuries” seen from guns and cannons represented much greater trauma than had ever been seen. Ambroise Paré (1510–1590), himself the son of a barber-surgeon, never attended formal medical school but would rise to become surgeon to four French monarchs. Paré, the first great French surgeon, revolutionized the treatment of war injuries, becoming influential through his writing—in French and not Latin. Physicians in the early Renaissance found themselves helpless to treat patients whose gunshot wounds were dramatically worse than any injuries humankind had ever faced. Therefore, care was left to barber/surgeons, and in the pre-Newtonian age, it was difficult to understand that it was the energy imparted by the gunpowder-propelled shrapnel, and not some “poison” within the fragments, that imparted such significant injury. Giovanni da Vigo (1450–1525), surgeon to Pope Julius II, theorized in his publications in 1514 and 1517 that gunshot wounds were “poisoned by the effects of gunpowder,” and should be cauterized with hot oil to counteract the poison, mimicking the ancient treatment of gladiatorial battle wounds. As one can imagine, the searing effects of hot oil might staunch bleeding, falsely leading the traumatologist to conclude that care has been rendered, when in actuality the “zone of injury” has perversely been enlarged and further trauma has been introduced. Unfortunately, Vigo’s writings had influence, leading battlefield surgeons to obediently pour hot oil on blast injuries.
In his famous 1575 book, Oeuvres, Paré elegantly described his crisis during the Siege of Turin of 1536. Late one night following a horrific battle, Paré’s ration of oil had been extinguished. He recorded:
At last I ran out of oil and was constrained to apply a digestive made of egg yolk, oil of roses and turpentine. That night I could not sleep easily thinking that by the default in cautery I would find the wounded to whom I had failed to apply the said oil dead of poisoning; and this made me get up at first light to visit them. Beyond my hopes I found those on whom I had put the digestive dressing feeling little pain from their wounds which were not swollen or inflamed, and having spent quite a restful night. But the others, to whom the said oil had been applied, I found fevered, with great pain and swelling around their wounds. From then I resolved never again so cruelly to burn poor men wounded with arquebus [gun] shot.
Paré had serendipitously discovered a better way, accidentally performing a comparative study. More importantly, he published his results, contradicting the established academic authority of his time. He would significantly influence early surgery, advocating ligatures (sutures) in tying of blood vessels, the use of prosthetic limbs following amputations, and important changes in the management of childbirth. The advent of book printing had arrived just in time for Paré to publish his works, and, as will be seen repeatedly, war has been fertile ground for medical advancement.
Andreas Vesalius started medical school in 1533 (the same year that Paré arrived at the Hôtel-Dieu de Paris, the oldest hospital in the world, located next to Notre-Dame Cathedral) and his training was typical for the day. Galenic teaching was in its ascendancy, and Vesalius’s anatomical instruction was rudimentary at best. Here, Vesalius first showed his supreme curiosity (if not his morbid oddity, on display throughout his life), when he struck out on his own, admitting that he would not have been successful under his professors’ tutelage, “if when I was studying medicine in Paris I had not put my hand to the matter but had accepted without question the several casual and superficial demonstrations of a few organs presented to me and to my fellow students … by unskilled barbers.”20 As will be seen again and again, the invention of surgery was crafted by tinkerers, oddballs, lonely geniuses, inspiring mentors, and stubborn misfits; Vesalius was all these things. He visited the Cemetery of the Innocents in Paris on many occasions, picking through the decaying corpses and maggot-cleaned bones, later recalling his long hours in the cemetery “gravely imperiled by the many savage dogs.”21
With the outbreak of war between Emperor Charles V of the Holy Roman Empire and Francis I of France, Andreas Vesalius was forced to return to Brussels, given his identity of a Flemish enemy-alien living in Paris. He quickly installed himself in the medical school at Louvain (outside Brussels), and was soon scouting the locale for bodies. Outside the walled city of Louvain, while searching for the bones of executed criminals, Vesalius and a physician friend stumbled upon a cadaver, hanging upon a gibbet (the upside-down L-shaped frame used to hang criminals). He inspected the cadaver, concluding that the body had initially been burned and roasted over a fire of straw, but had been “freed of flesh” by the birds. Observing that the bones were now held together only by the dried ligaments, he recalled:
Observing the body to be dry and nowhere moist or rotten, I took advantage of this unexpected but welcome opportunity and, with the help of [my friend], I climbed the stake and pulled the femur away from the hipbone. Upon my tugging, the scapulae with the arms and hands also came away, although the fingers of one hand and both patellae as well as one foot were missing. After I had surreptitiously brought the legs and arms home in successive trips—leaving the head and trunk behind—I allowed myself to be shut out of the city in the evening so that I might obtain the thorax, which was held securely by a chain. So great was my desire to possess those bones that in the middle of the night, alone and in the midst of all those corpses, I climbed the stake with considerable effort and did not hesitate to snatch away that which I so desired.
Vesalius finished cutting away the ligaments and soft tissues after softening them with boiling water. He continued:
Finally and secretly I cooked all the bones to render them more suitable for my purpose. When they had been cleansed I constructed the skeleton that is preserved at Louvain.22
After a brief stint in Louvain, Vesalius was on his way to Padua, Italy, home to the most distinguished medical school in the world, and it was at the University of Padua where Vesalius would take his final examinations. The almost four-hundred-year-old academic documents at the University of Padua inform us that he “conducted himself very well in this, his rigorous examination … he was approved unanimously.”23 Amazingly, the following day, Vesalius was named the chair of surgery and anatomy. Despite his meanderings through three schools in four years, he had distinguished himself among his professors, and it was clear that something special was brewing in Padua.
A day after graduating, in December 1537, the new chair of anatomy and surgery started his first anatomical dissection, on an eighteen-year-old male, and the dissection would last for eighteen days. Vesalius would follow the traditional protocol established by Mondino: abdominal cavity first, then thorax, head and neck, brain, and then extremities. The greatest change witnessed by the audience was that Vesalius performed every role: lecturer, demonstrator, and dissector. The prestigious physician, acting as surgeon, had dismounted from his cathedra chair and positioned himself, knife in hand, over the body. He didn’t have to read from Mondino or Galen, he knew their works verbatim. Just shy of his twenty-third birthday, Vesalius also introduced a new pedagogical device of posting illustrations, or charts, for his students. Here was a man who was obsessed with true knowledge transfer, and within a year he would publish his first book, the Tabulae Anatomicae. The drawings were nontraditional, reflecting what Vesalius observed and was trying to convey, with high mnemonic value. The Tabulae Anatomicae was printed in Venice, with six large woodcut illustrations of anatomy, measuring 19 by 13½ inches. In this 1538 book, there are the first hints at Galen’s fallibility. Vesalius discovered inconsistent findings in Galen’s descriptions, and the young anatomist was beginning his program of refusing to accept past authority until his own research proved it to be true.
Two years later, Vesalius published a revised edition of another anatomist’s book, Johann Guinter’s Institutiones Anatomicae, which would serve as a text to accompany the lectures and demonstrations in anatomy. In a sense, much of the book was plagiarized, with Vesalius revising the work of the primary author, yet adding content throughout. While it seems odd that Vesalius would publish a revised edition of another author’s work, worse would happen to Vesalius when his words and illustrations would be entirely plagiarized verbatim by other publishers.
In the late 1530s, Vesalius began a program of comprehensive analysis of Galen, with Greek interpretation and scholarly evaluation of his anatomical descriptions. It was becoming obvious to Vesalius that Galen was not infallible, and emboldened by some of his professors in Paris and Louvain, he began preparations for a monumental work to challenge Galen’s authority, while taking advantage of the new printing press technology and vastly improved artistry of early Renaissance northern Italy. During this investigation, Vesalius was housemates with the Englishman John Caius, who was also in his twenties, and had journeyed to Padua to study medicine. Caius had studied at the University of Cambridge, matriculating at Gonville College. It appears that Caius assisted Vesalius in his Greek translations, but maintained greater loyalty to Galen than Vesalius was willing to pledge. Historian C. D. O’Malley says, “Despite the fact that Caius belonged physically to the generation of Vesalius in which the dissection of human specimens was under way and the scientific treatment of anatomy had begun, he belonged spiritually to that previous generation in which the medical humanists had believed that Galen held the key to all medical problems and that accurate Latin translations from sound Greek texts were the greatest boon they could offer to the medical world.”24 Caius would return to London, succeeding enough to financially rescue Gonville College and lend his name in 1557 to the now renowned Gonville & Caius College at the University of Cambridge.
Vesalius was busy in both Padua and neighboring Bologna, entrancing students with his flair for teaching and dissection ability. “It is significant that wherever Vesalius traveled to give extramural lectures a wave of body snatching ensued.”25 Newly buried citizens and criminals were fodder for Vesalius and his “anatomies.” A contemporaneous report states, “The mistress of a certain monk [in Padua] died suddenly … and was snatched from her tomb by the Paduan students and carried off for public dissection. By their remarkable industry they flayed off the whole skin from the cadaver lest it be recognized by the monk.”26
Challenging the conventional wisdom with which he had been indoctrinated, Vesalius became the man who knew more about the human body than anyone who had ever lived. In the Age of Exploration and Discovery, voyagers had mapped the coastlines of South America, Africa, India, and East Asia; Vesalius had a similar program of exploration, and much to the betterment of mankind, an urge to convey that knowledge in a most excellent way.
The project of writing De humani corporis fabrica, hereafter referred to as De fabrica, began in earnest in early 1540, just after his twenty-fifth birthday. Vesalius intended for De fabrica to be a guide for dissection and to understand the human body. This was not simply a book about the body that could be read by a gentleman in isolation. This was an instruction manual for physicians (a later condensed book, Epitome, was intended for medical students), with step-by-step descriptions (and pictures) of the tools needed for dissection, the technique for boiling and cleaning bones, and the dissection process for each muscle, joint, organ, and nerve. He would sometimes spend weeks by himself in his Paduan home, writing and reflecting. Vesalius probably spent at least a year writing the text for De fabrica. His earliest publication had woodcut prints of drawings from his own hand, but in the end all the illustrations in De fabrica were drawn by professional artists. The printing revolution had given Vesalius and his team of illustrators the power of multiplication when all his predecessors were writing “one-off” books whose text had to be scribed by hand but whose drawings, redrawn one at a time, rapidly denigrated in quality with successive reproductions.
Vesalius, in his earlier works, had hinted at Galen’s inconsistencies and the problem of his lack of human dissection. In De fabrica, there was no more hinting and only slight nuance regarding the master. In the introduction of De fabrica, Vesalius affirmed:
At Padua, in that most famous university of the whole world … I gave lectures on surgical medicine, and because anatomy is related to this, I devoted myself to the investigation of man’s structure. Thus I have already conducted anatomy very often here and in Bologna, and, discarding the ridiculous fashion of the schools, I demonstrated and taught in such a way that there was nothing in my procedure that varied from the tradition of the ancients.
He then referenced the gods of anatomy, including Galen, and then criticized their followers:
To one earnestly concerned with dissection there is nothing in which they [earlier anatomists] seem to have had less interest than in the dissection of the human body. They are so firmly dependent upon I-know-not-what-quality in the writing of their leader [Galen] that, coupled with the failure of others to dissect, they have shamefully reduced Galen into brief compendia and never depart from him—if ever they understood his meaning—by the breadth of a nail.
Powerful words from the twenty-eight-year-old, but later in the introduction, he softened:
At present I do not intend to criticize the false teachings of Galen, easily prince of professors of dissection; much less do I wish to be considered as disloyal from the start to the author of all good things and as paying no heed to his authority.27
In the words of Mark Antony, “I come to bury Caesar not to praise him.” Vesalius went on to reference over two hundred instances in which Galen was wrong regarding “human structure and its use and function.” The message was becoming clear: The king is dead, long live the king.
Earlier in this chapter, mention was made of Ambroise Paré, who some consider the first great surgeon. An argument can be made that Vesalius is the luminary that elevated surgery from the lowly barber/surgeons by his emphasis on the skillful use of the hands. In De fabrica, Vesalius mourned that man had neglected “that primary instrument, the hand, so that [the manual aspects of medicine] were relegated to ordinary persons wholly untrained in the disciplines subserving the art of medicine.”28 Whereas in ancient times, the early physicians used the three methods of the regimen of the diet, the use of drugs, and the use of hands, by degrees physicians of Vesalius’s time had “promptly degenerated from the earlier physicians, leaving the method of cooking and all the preparation of the patients’ diet to nurses, the composition of drugs to apothecaries, and the use of the hands to the barbers.”29 Vesalius, wellborn into a proper family, was making the case for intimate contact with patients, which would require getting dirty and smelly. Physicians in ancient times “devoted themselves especially to the treatment of luxations [joint dislocations], fractures, wounds, and … freed warriors of javelins, darts, and other evils … of war.”30 Vesalius wanted physicians to still use their hands to treat patients, “if it please the gods, [to be] like the Greeks, to scorn the whisperings of those physicians,”31 who had disdained the art of using the hands to make dissections and treat patients. While Paré is rightly credited with wiser treatment of war injuries, and more elegant treatment of severed blood vessels, Vesalius’s simultaneous reinvigoration of the study of the human body and exaltation of the use of the hands makes him one of the most important figures in the history of surgery.
With his anatomical text prepared, final planning was made on the illustrations. The magnificent drawings commissioned by Vesalius, transmitted via woodcut blocks onto massive pieces of paper, are recognizable to most of us. The master artist Titian (1490–1576) was born, lived, and died in the Republic of Venice. In his many productive years, Titian maintained a studio in Venice, and it is thought that the superlative illustrations in De fabrica likely emanated from a young genius in that studio. The illustrations fall into four general groups: the introductory illustrations, the muscle men, the historiated initials, and the sublime anatomical figures. All of the refined artwork would have first been drawn on paper, and then came the arduous task of converting the drawings into reverse images on identical-size woodblocks. The woodblocks were made of pearwood, sawed with the grain, rubbed with hot linseed oil, and then meticulously carved by the cutters with extreme delicacy. Following completion of the blocks, Vesalius wrote a letter to the printer in Basel, Switzerland. He had chosen Johannes Oporinus, a professor of Greek in Basel, who was well known to scholars for his attention to detail and extremely high production values. The letter and all the woodblocks arrived in Basel in September, 1542, following a transalpine cartage from Venice. Oporinus and his team (along with the help of Vesalius) then spent months organizing the manuscript and woodcuts, and by the summer of 1543, finished books were emerging. (While most woodblocks used for printing were recycled or thrown away, the De fabrica blocks survived for centuries, at times being lost for decades. There were whispers that the blocks were hidden at the University of Munich library, and after some investigation, they were discovered in pristine condition in a large trunk in the library attic in 1936.32 Tragically, they were all destroyed during World War II bombings and none survive today.)
In De fabrica, there are two large, introductory images. The first is the title page and the second image is that of Vesalius himself. The title page image is one of the greatest woodcut images ever produced; its perspective, clarity, composition, and technical mastery would be wonders to behold if it were a mere drawing. To realize that a master cutter carved this image in relief is mindboggling. The scene is a public dissection, with a throng of people (at least eighty-five, by my count, not including the corpse, a dog, and a monkey) crowded around the dissection table with Vesalius demonstrating the innards of a cadaver. It recalls Raphael’s The School of Athens, completed in 1511, and in fact, there is a figure on the right side of the image that resembles Raphael’s Plato (by tradition, modeled after Leonardo da Vinci, who died in 1519), but here he is not pointing heavenward, as Plato did, but motioning toward the body. Is this Vesalius’s ideal? If astronomers were mapping the heavens, was our anatomist mapping our bodies?
The muscle men encompass entire sheets of paper, and in fact, in the few remaining original copies of De fabrica, the sheets are larger than folio size, unfolding to become another one-third larger. These large drawings are macabre representations of the corpses in action, skinless, yet not lifeless, their faces contorted in agony. Successive illustrations show increasing degrees of dissection, with less and less muscle still attached. The muscle men are situated in a pastoral scene, perched high on a hill with the Venetian countryside in the background, with churches and village buildings dotting the horizon.
The historiated initials throughout the book offer a whimsical, if not ghastly, interlude between sections of the writing. The large capital letter that starts a new passage was formerly decorated by hand but after the advent of printing could be efficiently printed from woodblocks. Two-thirds of the letters of the alphabet are used, and all include putti, or angels, mischievously participating in bodysnatching, boiling bones, setting fractures, and more gruesomely, experimenting on a live pig.33 All are a reminder of the dreadful epoch that our ancestors endured but from which all future generations greatly benefitted.
The anatomical figures themselves are the main attraction. In his letter to Oporinus, Vesalius exhorted him to print everything as “handsomely and swiftly” as possible and to use the woodblocks as “correctly and elegantly” as he could. For the first time ever, the figures were inscribed with letters that correlated with the text. The reader could follow Vesalius in the text, encountering the letters that guided him to the specifics in the illustrations. Additionally, in the margins, there were numbers and letters that cross-referenced other drawings. Vesalius was breaking ground in many ways, presenting a visually stunning, didactic tour de force that, on occasion, challenged 1,500 years of authority. Through hundreds of pages and illustrations, the human body and its functions are presented in stunning, comprehensible figures; Vesalius on occasion opines about the physiology, the function of the organs, at times, challenging Galen. Noticeably absent, of course, is conjecture about the gods, evil spirits, and the seat of the soul; however, it would take several hundred years for advanced microscopy to reveal the secrets of the cells and their functions.
Vesalius stated: “I am aware that by reason of my age—I am at present twenty-eight years old—my efforts will have little authority, and that, because of my frequent indication of the falsity of Galen’s teachings, they will find little shelter from the attacks of those who were not at my anatomical demonstrations.”34 To the contrary, his masterpiece was hailed immediately, and his renown as an anatomist and surgeon became unrivaled, perhaps for two hundred years.
I will admit it: I am an unrepentant book lover. The privilege of holding a rare priceless book in my own hands is extraordinary indeed. After months of communication to establish my credentials with archivist librarians, and after completing the requisite forms granting me access to the special archives room at the Wellcome Library in London, the day has finally arrived for me to investigate a 1543 copy of De humani corporis fabrica. I stow my backpack and pens (no pens are ever allowed in rare book rooms) in a locker, and after scanning my scholar’s ID through the security checkpoint, I make my way to the top floor of the building in one of the greatest medical libraries in the world. I do have some trepidation—despite all my preparations, I have concerns that I will have come all the way to London, only to be turned back at the last moment. My last email exchanges were with the archivist named Ross, and he approaches me immediately after I pass through the last security doors into the inner sanctum. “Dr. Schneider? Welcome to the Wellcome Archives. How ’bout having a look at De fabrica?”
I take a seat, realizing he has done his own homework, investigating me online and ensuring that I am not some imposter who will come to the holy of holies and disrespect these inestimably valuable tomes. Ross reappears, carrying a massive 16-by-11-inch rich green book. I am gobsmacked by its size—it’s really true—it’s a beast of a book. The lustrous green leather exterior must certainly be less than a hundred years old, and I instantly wonder what the original binding looked like. The book is set down on the archive table, and before opening it, a religious rite of sorts takes place, of purification, solemnity, and homage. As Ross and I have not encountered a rare book together before, I sense he wants to ensure that I will appropriately care for this treasure. There are only about one hundred De fabrica copies in the world, and this one is in pristine condition.
De fabrica lies next to me, unopened. Ross and I start to build a small mountain of foam blocks and white canvas bean bags. The goal with archival books is gentle handling of individual sheets of paper, assiduous care of the spine, minimal handling, and no accidents. Again and again, Ross places the book in the center of the angled black foam wedges and starts to let the book naturally fall open. Still sensing not enough support on the right side, the librarian adds another bean bag to the wedge. After several minutes of tinkering and adjusting, the book is ready for inspection.
Staring at a page, I am struck by faint, colored lines that delineate the margins. They appear hand drawn, and are on almost every page. The particular book in my hands is from the original 1543 publication run, meaning that Vesalius himself may have handled this book. The four-hundred-year-old paper is in wonderful condition, with no foxing and no edge wear.
I want to see one of the large illustrations, and turning to the back half of the book, I see a folded sheet. Shocked, I see that this is an extra-large sheet of paper that is completely filled with a detailed illustration of veins and arteries of the body. I unfold it partway, and then again along the bottom. Considering that this diagram of veins and arteries to the entire body came from one wood carving is stunning. There are scores of letters and numbers labeled on the structures, and the remainder of the sheet is filled with the names of the vessels, all in Latin. I am spellbound.
Returning to the front of the book I encounter the famous muscle men, and in sheet after sheet, I see the progression of dissection. With each sequence, less and less muscle is depicted. It’s like the acetate overlays in my beloved World Book Encyclopedia. It all started here, with this book, the masterpiece of instruction and artistry that dared to criticize Galen, and Vesalius had thrown down the gauntlet and proclaimed, I will see for myself and prove to myself through investigation what is true. Over the next one hundred years, this resolve took root and ignited a scientific revolution.