Chapter IV: Introduction (3)

For a period of two centuries the Vesalian pictures were ascribed to Titian, but on insufficient grounds. The famous Venetian painter was over sixty years of age at the time of the publication of the _Fabrica_; his services were much in demand, and he was signally honored by the Spanish emperor, Charles the Fifth. His powers remained undiminished until shortly before his death, which occurred in 1576. He had the ability to make the Vesalian illustrations, but it is doubtful if he had the time. Although Titian may have taken an interest in these anatomical plates, it is not now believed that he drew them.

The Vesalian pictures have been attributed to Christoforo Coriolano; but he could not have been the artist, since his earliest work dates from 1568. He is known to have furnished the drawings for Jerome Mercurialis’s _De Arte Gymnastica_, and for Vasari’s _Lives of the Painters_. Roth is of the opinion that Vesalius himself made most of the illustrations; but such a view would credit the comparatively short and busy life of the great anatomist with too much accomplishment.

I conclude that the illustrations for the _Fabrica_, like the osseous figures in the _Tabulae Anatomicae_, which Vesalius issued in 1538, were made by Jan Stephan van Calcar (+1546), the favorite pupil of Titian. Sandrart[23] states that van Calcar made the drawings for the _Fabrica_; that he went to Venice in 1536 or 1537; that he studied under Titian; and that his paintings were of such merit that they were often mistaken for those of Titian, Raphael, and Rubens.

Van Calcar was a Fleming, a native of Kalcker in the Duchy of Cleves. The date of his birth is not known. His death occurred at Naples in 1546. He was highly esteemed by Vesalius who speaks of him as ranking “with the divine and happy wits of Italy”. The anatomical plates which Vesalius issued in 1538 were made, he states, by van Calcar:—_sumptibus Joannis Stephani Calcarensis_. These plates, which appeared in the form of pictorial broad sheets, or _Fliegende Blätter_, may be likened to the Herald who goes in advance to announce the coming of the King. They were engraved on wood, and, like their companion pictures in the _Fabrica_, they were unprecedented in magnitude and in minuteness.

The Vesalian plates vary greatly in merit. The most satisfactory ones are those depicting the undissected body and the bones and muscles. The artist was not at his best in drawing the nervous system, although it is claimed that Vesalius had prepared his neurologic specimens with great care. For the use of artists, the best plates are the three skeletons and the four entire myologic figures in the _Fabrica_. The first myologic figure, showing a man who has been divested of all skin, fat, and superficial fascia, presents the muscles of the anterior portion of the body beautifully delineated. Vesalius took much pride in this plate, and directed the attention of artists to it. The second plate, which is constructed along similar lines, shows the body in its lateral aspect. The head is thrown slightly backward, the right hand pointing to the earth and the left raised towards the horizon, and the whole attitude of the subject calls to mind the position which an orator would assume when addressing an audience. The third myologic plate is similar to the first one, but the muscles of the face are exhibited to better advantage and the aponeuroses, absent in the first plate, are here present. The fourth plate, which is the ninth in Vesalius’s work (_nona musculorum tabula_), presents the muscles of the posterior part of the body. The other myologic figures show the deeper muscles, layer by layer, and are of value to an artist who wishes to study the effect of their action upon the superficial parts of the body. Hence many of these figures have been reproduced in works on art-anatomy. The artist who studies these plates should remember that the figures in question are divested of skin, fat, and superficial veins—all of which must be supplied, in order to avoid giving too great prominence to the muscles. The two naked figures contained in the _Epitome_ are properly clothed in skin and are of great artistic merit. They also are to be seen in numerous works on art-anatomy. Thus, in one of the earliest books on anatomy for the use of artists (_Abrégé d’anatomie accommodé aux arts de peinture et de sculpture._ Paris, 1667, 1668), Rogers de Piles and François Tortebat have used the three skeletons and seven myologic figures taken from the _Fabrica_ and the _Epitome_. In the preface of his book, de Piles says that he does not think it is possible to produce better figures than those found in the works of Vesalius. That he was not alone in this opinion is shown by the fact that many other artists, who have composed treatises on art-anatomy, have drawn freely from the Vesalian storehouse. An Italian, Giacomo Moro, in his anatomy for the use of artists, (_Anatomia ridotta ad uso de’ pittori e scultore._ Venice 1679), reproduced nineteen of Vesalius’s figures in copperplate.

The popularity of Vesalius’s anatomical figures among painters was due, not only to the intrinsic worth of these illustrations, but also to the erroneous belief that the original drawings were the work of Titian. This opinion found expression on the title-pages of several works on art-anatomy. For example, in 1706, Moschenbauer, of Augsburg, issued a folio volume illustrated with Vesalian figures cut in wood, with this title:—_Andreae Vesalii, Bruxellensis, des ersten besten Anatomici, Zergliederung des menschlichen Körpers auf Mahlerey, and Bildhauer-Kunst gerichtet, die Figuren von Titian gezeichnet_. An anonymous book, _Notomia di Titanio_, appeared in Italy about the year 1670.

The Vesalian figures of the skeleton were also issued in single sheets with moralistic verses appended. Moehsen cites one of these with the inscription printed in French:

“De cet objet affreux tu parois rebutté,
Est c’est ce que dans peu cependant tu dois étre:
Apprens, mortel, a te connoître
Ce miroir est le seul, ou tu n’est point flatté”.

Another legend reminds the reader that he is only dust, and to dust he must return:—“_Vous estes poudre, & vous retournéres en poudre_”.

CHAPTER TENTH
Publication of the Epitome

Upon the thirteenth day of August, 1542, Vesalius finished the _Epitome_ of his great book. The text and illustrations for it were forwarded to Basel by the same merchant who conveyed the manuscript and drawings of the _Fabrica_. The title of the lesser work is as follows:—

_Andreae Vesalii Bruxellensis, Scholae medicorum
Patavinae professoris, suorum de Humani corporis
fabrica librorum Epitome. Basil., et officina
Joannis Oporini, Anno, 1543, mense Junio._

This work is extremely rare. It belonged to the class of _Fliegende Blätter_ and was issued unbound. Perfect copies of it are rarely found. The first twelve sheets are printed on both sides; the two last leaves are printed on one side only, in order that they might be cut out and pasted together to show two complete figures. Hence these sheets are often lacking. The _Epitome_ appeared in the same year and in the same month as the _Fabrica_, but the latter work was printed first.

The _Epitome_ is dedicated to Philip, the son of Charles the Fifth, who, after his father’s abdication, was known as Philip the Second of Spain. The title-page is printed from the same plate as the larger work; and Vesalius’s portrait also is present. From the fact that the dedication bears the inscription: _Patavii, idibus Augusti 1542_, the erroneous opinion arose that this work preceded the _Fabrica_.

Among the illustrations found in the _Epitome_ are seven that are not in the large book; namely, five myologic plates, and the figure of a naked man and one of a woman. The myologic figures in the _Epitome_ differ from those in the _Fabrica_ in this respect: the muscles are drawn in their natural position, group, and order, so that the surgeon, in treating wounds and in performing operations, may have the correct relations of the parts in mind. Also, the one side of the figure differs from the other: the one showing the superficial muscles, while the other exhibits the deeper musculature. The muscles in the _Fabrica_, with the exception of four complete myologic figures, are represented as they appear in anatomical demonstrations, particular attention being given to their origins and insertions. For the purpose of the artist, the best figures are the three skeletons and the four complete myologic figures which are found in the _Fabrica_.

Two beautiful copies of the _Epitome_, printed on vellum, are in existence. One is in the British Museum and is thought to be the copy which was owned by the celebrated Dr. Richard Mead; the other one is in the possession of the University of Louvain.

Vesalius speaks modestly of the _Epitome_, which he regards as an index or appendix of the _Fabrica_, and is for the use of beginners in anatomy.

CHAPTER ELEVENTH
Contents of the Fabrica

The reputation of Vesalius rests securely upon the _Fabrica_. This grand book, which is dedicated to Charles the Fifth, consists of six hundred and fifty-nine folio pages of text; thirty-four pages of index, disposed in three columns to the page; six pages of preface; and two pages of a letter which is addressed to “Joannes Oporinus, the renowned professor of Greek letters in Basel”. The work is printed in excellent style. The printed page measures 8 by 12½ inches, including the marginal notes. There are fifty-seven lines to a page, averaging twelve words to a line, or approximately seven hundred words to a page. This was written, amid many duties and distractions, in the short period of three years. It is truly a monument of diligence.

The text of the _Fabrica_ is clear and concise; it describes what has to be described and does it well. The errors which Vesalius rectified, and the improvements which he made in anatomy, are so numerous that references can be made to only a few of them. His anatomical writings are of such bulk that they cannot be reviewed adequately within the limits of the present chapter. As regards the _Fabrica_, we may say, with Richardson, that “The dissections and the plates are the book”.

The _Fabrica_ contains the rudiments of anthropology as well as the first illustrations of comparative anatomy. Vesalius portrays a human skull resting upon the skull of a dog. He also shows a simian and a canine sacrum and coccyx, to prove his contention that Galen’s anatomy was derived from dissection of the lower animals. The _Fabrica_ is more than an anatomy. Throughout the work physiology goes hand in hand with the anatomical description. The use and function of each part of the body is given in short, clear sentences.

The _Fabrica_ is built upon a practical plan. It treats of anatomy in a logical manner and is composed of seven books, which deal with the following subjects: (1)—Bones and Cartilages; (2)—Ligaments and Muscles; (3)—Veins and Arteries; (4)—Nerves; (5)—Organs of Nutrition and Generation; (6)—Heart and Lungs; and (7)—Brain and Organs of Sense.

The First Book

Vesalius devotes one hundred and sixty-eight pages to the bones and cartilages, treating these structures with a thoroughness that amazed his contemporaries. He was the first author who correctly described the osseous system as a whole. In numerous instances Vesalius places himself in direct opposition to the opinions of Galen. He denied the existence of the intermaxillary bone in adults, and showed that the inferior maxilla does not consist of two pieces, as has been asserted by Galen. The seven bones of the sternum were reduced to three by Vesalius. He denied Galen’s statement that the bones of the symphysis pubis separate during parturition. He was the first anatomist to give an accurate description of the sphenoid bone. A small aperture at the root of the pterygoid process of the sphenoid bone is called _foramen Vesalii_. Vesalius proved the existence of marrow in the bones of the hand, which had been denied by Galen. In all respects, he wrote more intelligently of the bones than any anatomist who had preceded him.

The Second Book

Vesalius devotes one hundred and eighty-eight pages to a description of the ligaments and the muscles. This part of his treatise, while it contains a few errors and does not reach the high plane of the first book, is superior to any work of its kind that had preceded it. Vesalius was the first writer to describe the internal pterygoid muscle. He denied the existence of a general muscle of the skin, and stated that the intercostal muscles merely separate the ribs without expanding or contracting the thorax. He held the view that nerves and muscles do not stand in any relation of proportionate strength to one another, large nerves often being distributed to small muscles. He also held that the tendons are similar in structure to the ligaments.

Vesalius’s plates of the superficial muscles are among the most beautiful that have ever appeared. They have been copied in practically all later treatises on anatomy, and have been used extensively by art-anatomists. His plates of the deeper muscles, while naturally not so pleasing to the eye, are wonderfully near accuracy. The different muscles are drawn to show function as well as structure.

The Third Book

The third part of the _Fabrica_, comprising sixty pages, is devoted to the veins and arteries. Vesalius begins with the definition of a vein, and describes the structure of these vessels in general. The term “artery” is treated in like manner. He introduces several small illustrations which serve to elucidate this part of the text. His first large plate in this section is devoted to the venae portae. This is followed by a full-page picture of the entire venous system. The arterial system is fully described and elaborately illustrated. To these is added another plate, in which both arteries and veins are represented in their natural order. In other plates he shows the special circulations—cerebral, portal, and pulmonary.

Vesalius described the valve which guards the foramen ovale in the foetus, and also noticed the valve-like fold which guards the entrance of each hepatic vein into the inferior vena cava. He also gave an admirable description of the vena azygos. Blinded by the ancient theory of the movement of the blood—a sort of flux and reflux in the veins, he overlooked the function of the venous valves. He described them as eminences, or projections, or accidental rugosities, which in no way interfere with the flux and reflux of the blood.

The Fourth Book

Vesalius devotes forty pages to the cerebral and spinal nerves. The anatomy of the brain is treated in the seventh book. His representations of the nerves are very creditable. He mentions eleven pairs of cranial nerves: the olfactory, the optic, the motores oculorum, the trifacial, the abducens, the portio dura, the portio mollis, the glosso-pharyngeal, the pneumogastric, and the spinal accessory.

His account of the brain—contained in the seventh book—is elaborately minute considering the time when it was written. His illustrations and description of this organ surpass those of scores of later authors. Vesalius fully describes the position of the brain; the membranes which cover it; the cavities, or ventricles, within it; the divisions of cerebrum, cerebellum, and medulla; the anatomy of the base, and the origins of the cerebral nerves. These structures are illustrated from different points of view.

The Fifth Book

The fifth book, comprising more than one hundred pages, is devoted to the organs of nutrition. Here we find an admirable account of the peritoneum, the mesentery, the omentum, the stomach and intestines, the liver, the spleen, and the genito-urinary tract—all of which structures are described and fully illustrated. In this book Vesalius also describes the foetus in utero.

The Sixth Book

In less than fifty pages Vesalius describes the contents of the thorax. He writes intelligently of the membrane lining the thorax, and then gives an account of the arteria aspera, as the trachea was formerly named. Passing on to the lungs, he next takes up the anatomy of the heart. He describes its position, form, and structure in better terms than had been done by preceding anatomists. The auricles, ventricles, and valves are carefully examined. His illustrations of both lungs and heart are excellent.

In the 1543 edition of the _Fabrica_, Vesalius adopts the erroneous view of Galen that openings exist in the septum of the heart. In the second edition of his book, published in 1555, he says that influenced by the views of Galen, he believed that the blood passes from the right to the left ventricle of the heart, through the septum, by means of the pores. Vesalius immediately adds that the septum of the heart is as dense and compact as the rest of this organ, and that not the smallest quantity of blood passes through the septum.

His account of this subject is best given in his own words:—“In recounting as above the structure of the heart, and the use of its different parts, I have followed in the main the doctrines of Galen; not that I regard them in all particulars as consonant with the truth, but because, in attributing new functions and uses to a number of parts, I am still distrustful of myself, and not long ago should hardly have ventured to differ from that Prince of Physicians by so much as a finger’s breadth. As for the dividing wall, or septum, between the ventricles forming the right side of the left cavity, the student of anatomy should consider carefully that it is equally thick, compact, and dense, with all the rest of the cardiac substance enclosing the left ventricle. And accordingly, notwithstanding what I have said about the pits in this situation, and at the same time not forgetting the absorption by the portal vein from the stomach and intestines, I still do not see how even the smallest quantity of blood can be transfused, through the substance of the septum, from the right ventricle to the left”.

Vesalius and other anatomists knew of the hepatic circulation, or at least believed in some communication between the portal and hepatic veins:—“The branches of this vein”—vena cava—“distributed through the body of the liver, come in contact with those of the portal vein; and the extreme ramifications of these veins inosculate with each other, and in many places appear to unite and be continuous”.

Vesalius knew that in several particulars the accepted physiology of the vascular system was wrong. If he could have lived a few years longer, it is possible that he might have solved the great problem which was made clear by William Harvey. In the light of our present knowledge some of Vesalius’s words are suggestive:

“When these matters are taken into account, many things at once present themselves in regard to the arterial system, which deserve careful consideration; especially the fact that there is hardly a single vein going to the stomach, the intestines, or even the spleen, without its accompanying artery, and that nearly every member of the portal system has a companion artery associated with it in its course. Again, the arteries going to the kidneys are of such size that they can by no means be affirmed to serve merely for regulating the heat of these organs; and still less can we assert that so many arteries are distributed to the stomach, intestines and spleen for that purpose alone. And there is, furthermore, the fact, which we must for many reasons admit, that there is through the arteries and veins a mutual flux and reflux of materials, and that within these vessels the weight and gravitation of their contents has no effect”.

The Seventh Book.

In the seventh book, consisting of less than sixty pages, Vesalius fully describes the anatomy of the brain, of the cranial nerves, and of the organs of sense. His description of the eye is not as near accuracy as might be expected. He places the crystalline lens in the centre of the globe. His description of the organ of vision was only slightly better than that which was given by Galen. Vesalius showed, however, that the optic nerve is not a hollow tube, and that it does not enter the eyeball exactly in the antero-posterior axis.

Conclusion

Considering the time in which he lived, Vesalius was remarkably free from errors. Although to him the arteries were carriers of vital spirits, the veins were the true blood vessels, and, according to the first edition of his great book, the septum of the heart was filled with foramina; yet, we must say with Baas, “these are all mere shadows necessary to the brilliancy of the picture”.

Vesalius was more than an anatomist. As a practical physician he had the highest reputation among his contemporaries. He was an accomplished scholar and was thoroughly conversant with the weaknesses of human nature, as is evident from many satirical touches in his writings. Although his great work contains many errors that a tyro of the present day would laugh at, it laid the foundations of our knowledge. Vesalius overthrew the idol of authority in anatomy and taught us to look at Nature with our own eyes.

Portal[24] has paid a splendid tribute to Vesalius. “Vesalius”, he says, “appears to me one of the greatest men who ever existed. Let the astronomers vaunt their Copernicus, the natural philosophers their Galileo and Torricelli, the mathematicians their Pascal, the geographers their Columbus, I shall always place Vesalius above all their heroes. The first study of man is man. Vesalius has this noble object in view, and has admirably attained it; he has made on himself and his fellows such discoveries as Columbus could make only by travelling to the extremity of the world. The discoveries of Vesalius are of direct importance to man; by acquiring fresh knowledge of his own structure, man seems to enlarge his existence; while discoveries in geography or astronomy affect him but in a very indirect manner”.

Like Harvey, Vesalius was obliged to defend his writings from fierce attacks. The most desperate of his opponents was his old master, Jacobus Sylvius, who was so wedded to the Galenic teachings that he asserted that since Galen’s time the thigh bones had changed their shape. He spoke of Vesalius as a “madman, Vesanus, whose pestilential breath poisons Europe”. Ponderous discussions were carried on between the friends and opponents of the great anatomist. The complete overthrow of the Galenists resulted.

If Vesalius had remained professor of anatomy in Padua, instead of being appointed physician to Charles the Fifth, at Madrid, in 1544, it is probable that the circulation of the blood would have been discovered by him.

In recent years attempts have been made to show that it was not Vesalius, but Leonardo da Vinci, who was the founder of modern anatomy. A considerable amount of controversial literature has accumulated on this subject. For our purpose it may suffice to quote the conclusions of McMurrich[25]:—“Leonardo was the first to create a new anatomy, but he created it for himself alone; Vesalius demonstrated a new anatomy to the world. It was the publication of Vesalius’s _Fabrica_ that revolutionized anatomy, while Leonardo’s drawings were lying unpublished, at first the cherished possessions of his favorite pupil Melzi, later in the Ambrosian Library in Milan, and still later forgotten in the Royal Library at Windsor. We must credit Leonardo as being the forerunner of the new anatomy, but Vesalius must be recognized as its founder”.

CHAPTER TWELFTH
Contemporary Anatomists

Shortly after the publication of the _Fabrica_, great activity was manifested in anatomic research, and numerous opponents and critics of Vesalius appeared in the arena of science. The criticism of such men as Jacobus Sylvius and John Dryander, while it was of a violent type, was of much less importance than was that of Eustachius, Columbus and Fallopius. Vesalius was not without his partisans, of whom Ingrassias and Cannanus are worthy of mention.

Bartholomeus Eustachius

Eustachius was born at San Severino, a small city near Salernum, about the year 1520. He studied anatomy in Rome and made remarkable progress in this science. In the year 1562, as he informs us in his _Opuscula Anatomica_, he was professor of medicine in the Collegio della Sapienza at Rome. Like many other men of genius, Eustachius died in poverty. In August, 1574, having been called by the illness of Cardinal Rovere to Fossombrone, Eustachius died upon the journey.

To Eustachius posterity is indebted for a series of splendid copperplate engravings which were designed to illustrate the anatomy of the human body. These plates, the handiwork of Eustachius, and the first anatomical illustrations wrought in copper, were completed in 1552, only nine years after the first impression of the book of Vesalius. Unfortunately for himself, and worse for medical science, Eustachius was unable to publish them. If this magnificent atlas of anatomy could have been published when completed, the anatomical discoveries of the eighteenth century would have come two hundred years earlier. Unfortunately the entire text of the work is lost. For one hundred and thirty-eight years the Eustachian plates remained either in the family of Pinus, an intimate friend of the anatomist, or were buried in the Papal Library at Rome. When discovered they were presented by Pope Clement XI. to his physician, Lancisi, who published them with notes of his own, at Rome, in 1714. In 1740 they were issued under the direction of Cajetan Petrioli. Four years later the edition by Albinus appeared, which was republished in 1761. The anatomical writings of Eustachius were published during his lifetime, in 1564. It is upon his _Tabulae Anatomicae_ that the fame of this wonderful man is founded. If this work had been published in 1552, Eustachius would have divided with Vesalius the honor of founding human anatomy. The victim of circumstances, his name has been overshadowed by that of Vesalius, to whom in some respects he was superior. Deprived during life of his merited honors, Eustachius has been awarded a goodly share of posthumous fame.

Eustachius was the first anatomist to describe, with any degree of accuracy, the tube which bears his name. We can truly say he discovered it, since Alcmaeon dissected only the lower animals, and was not an accurate observer, as his view that goats breathe through the ears, amply testifies. Eustachius discovered the tensor tympani and stapedius muscles, the modiolus and membranous cochlea, and the stapes. The honor of the discovery of the stapes is claimed for no less than five renowned anatomists, namely, Fallopius, Ingrassias, Columbus, Colladus, and Eustachius. It is unnecessary to discuss this disputed claim to priority. The truth seems to be that the stapes was discovered by both Ingrassias and Eustachius, each independently of the other. In 1546 Ingrassias publicly demonstrated the little bone of the ear in his lectures at Naples. Fallopius, after learning from an eyewitness that Ingrassias had actually discovered and named the ossicle, relinquished his claim to the discovery. Columbus and Colladus filed their information at too late a date. Eustachius, as previously stated, finished his anatomical plates in 1552. His seventh plate shows, among other subjects, the auditory ossicles—malleus, incus and stapes—and tensor tympani muscle. These objects are delineated as taken from a human subject, and also from a dog.

Eustachius discovered the origin of the optic nerves, and the sixth cerebral nerves. He gives excellent pictures of the corpora olivaria and corpora pyramidalia; of the stylo-hyoid muscle; of the deep muscles of the neck and throat; of the suprarenal capsules, and of the thoracic duct. He also described the ciliary muscle. Eustachius was the first anatomist who accurately studied the teeth and the phenomena of the first and second dentition. In his researches he employed magnifying glasses, maceration, exsiccation, and various methods of injection.

Realdus Columbus

The first anatomical treatise containing an account of the lesser, or pulmonary circulation, was the monumental work, _De Re Anatomica, libri xv._, written by Realdus Columbus and sumptuously published at Venice in the year 1559. This, however, was not the first printed account of the lesser circulation. Six years prior to the publication of the book of Columbus, the unfortunate Servetus, in a theological treatise, described correctly the course of the blood in its transit through the lungs. Tried for heresy, Servetus was burned, together with all obtainable copies of his book. Although it had been printed, the work was suppressed; hence it follows that Columbus was the first to publish the great discovery. Of the life of this anatomist we know but little. Born at Cremona, a small Milanese village, the year of his birth is unknown. He died in 1559, while his book was being printed. A few copies were finished before his demise, since a copy belonging to the late Dr. George Jackson Fisher, of Sing Sing, N.Y., contains the author’s own dedication to Pope Paul IV., while in other exemplars, the dedication has been written by the two sons of Columbus, and is addressed to “_Pio IIII., Pont. Max_”. This prelate, on the death of Paul IV., on August 18, 1559, became the head of the Church.

Some writers have held that the discovery of the lesser circulation was not made by Columbus independently of Servetus, but that a copy of the book of Servetus had drifted into Italy and had been read by Columbus. There is no direct evidence to support this view. When Vesalius was called to Madrid as physician to Charles the Fifth, Columbus, in 1544, succeeded him in the University of Padua; two years later he filled the anatomical chair at Pisa, and in 1546, Pope Paul IV. called him to Rome. Here he spent the later years of his life, engaged in teaching anatomy and in writing his book. For forty years Columbus pursued his anatomical studies, and in that period he dissected an unusually large number of bodies. Fourteen subjects passed under his scalpel in a single year.

Columbus frequently made experiments upon living animals. He was the first to use dogs for such purposes, preferring them to swine. Book XIIII. of the work of Columbus is upon the subject of vivisection, _De viva sectione_. In this he tells us how to employ living dogs in demonstrating the movements of the heart and brain, the action of the lungs, etc. Columbus was the first anatomist who demonstrated experimentally that the blood passes from the lungs into the pulmonary veins. “When the heart dilates”, says Columbus, “it draws natural blood from the vena cava into the right ventricle, and prepared blood from the pulmonary vein into the left; the valves being so disposed that they collapse and permit its ingress; but when the heart contracts, they become tense, and close the apertures, so that nothing can return by the way it came. The valves of the aorta and pulmonary artery opening, on the contrary, at the same moment, give passage to the spirituous blood for distribution to the body at large, and to the natural blood for transference to the lungs”.

Like Servetus, Columbus held to the idea of “spiritus”. Harvey was the first physiologist who recognized the circulation as purely a movement of blood. All before him assumed the existence of a mixture of air and blood. Columbus, pupil and prosector of Vesalius, like his great master, denied the existence of foramina in the cardiac septum.

Gabriel Fallopius

Gabriel Fallopius (1523-1562), of Modena, was a noted Italian anatomist. In his twenty-fifth year he was made professor of anatomy at Pisa. Although the span of his life was short, he will be remembered always as the discoverer of the tubes which bear his name. According to Fisher, Fallopius “described the ear more minutely than had ever before been done. He discovered the little canal along which the facial nerve passes after leaving the auditory; it is still called the _aquaeductus Fallopii_. He demonstrated the fact of the communication of the mastoid cells with the cavity of the tympanum; and also described the fenestrae rotunda and ovalis. In the treatment of diseases of the ear, he used an aural speculum, and employed sulphuric acid for the removal of polypi from the meatus. In some of his supposed discoveries he had long been anticipated; for example, the tubes which bear his name were known and accurately described by Herophilus, over three hundred years before the Christian era, and also by Rufus of Ephesus, of whom Galen speaks as the best anatomist of the second century. Rufus refers to two varicose and tortuous vessels passing from the testes (as the ovaries were called) to the cavity of the uterus. Fallopius, however, gave a full account of their course, position, size and structure. He cut into them and found them hollow, gave them the name of tubae seminales, and posterity attached his name to them, and in time came to a better comprehension of their true function. This is not the only instance in the history of anatomical discovery where the name of a person, not its discoverer, has been given to an organ. Allusion has been made to Fallopius as a botanist; a genus of plants, _Fallopia_, has been named in honor of him”.

Fallopius was appointed professor of anatomy at Pisa, in the year 1548; and later, at the instance of the Grand Duke of Tuscany, Cosimo I., he received a professorship at Padua, as successor to Vesalius. Besides the chair of anatomy and surgery and of botany, he also held the office of superintendent of the new botanic garden in that city. Fallopius remained in Padua to the day of his death, which occurred in 1562. He was very properly succeeded by his favorite pupil, Fabricius ab Aquapendente, who had been for some time previously his anatomical demonstrator. His collected works, as published in Venice, 1606, embrace twenty-four treatises distributed in three folio volumes. Only one of his works was published during his lifetime, namely, his _Observationes Anatomicae_, Venice, 1561, which is considered one of his most valuable books, containing, as it does, most of his discoveries and his animadversions on the works of other anatomists.

This was written as a supplement to the anatomy of Vesalius, for it follows the same order, passes upon the same subjects, corrects the inaccuracies of the Vesalian treatise, and supplies what is wanting. Throughout the work Fallopius treats Vesalius with great respect, and never mentions him without an honorable title. Vesalius wrote an answer to this work, entitled, _Observationum Fallopii examen_, in which he acknowledges the courtesy of Fallopius, but, as argument progresses, appears to be out of temper.

After the death of Fallopius it was thought that no successor except Vesalius could be found competent to fill his place. Accordingly Vesalius was chosen. The news of his appointment reached him while he was returning from a pilgrimage to Jerusalem. Unfortunately he was shipwrecked and perished, otherwise history would have afforded an example of the master filling the chair of the pupil.

John Philip Ingrassias

Ingrassias, who lived between the years 1510-1580, was a graduate of the celebrated Paduan School. He described minutely the anatomy of the ear, including the tympanum, fenestrae rotunda and ovalis, the cochlea, the semi-circular canals, and the tensor tympani muscle. His admiring pupils caused his portrait to be painted and placed in the Neapolitan School, with this inscription:—“To Philip Ingrassias, of Sicily, who, by his lectures, restored the science of true Medicine and Anatomy in Naples, his pupils have suspended this portrait as a mark of grateful remembrance”. Ingrassias was a voluminous writer, his chief work being a treatise on osteology, which was published twenty-three years after his death. When the plague depopulated Palermo, in 1575, his devotion was such as to earn for him the title of the Sicilian Hippocrates. Few men have been more earnest workers in medical science. If his fame as an anatomist has not equalled that of others, the cause is to be sought in the multiplicity of competitors, not in lack of zeal and ability.

CHAPTER THIRTEENTH
Commentators and Plagiarists

Medical history furnishes numerous examples of literary theft. In many instances an entire set of anatomical plates has been pirated by unscrupulous publishers. In a few cases both text and plates have been appropriated by medical authors. The most notorious example of this form of theft was furnished by William Cowper (1666-1709), an English surgeon and anatomist, who, having secured three hundred copies of Bidloo’s set of one hundred and five anatomical plates, in 1697 issued the work[26] as his own. Cowper added a few original illustrations to the book.

Vesalius suffered severely at the hands of the plagiarists. Pirated editions of the _Tabulae Anatomicae_ were printed in several cities, chiefly in Germany. As regards the _Fabrica_, we may say that it has been the fountain from which many anatomical writers have derived practically all of their illustrations and much of their text.

The fame of the _Fabrica_ soon spread throughout Europe. It was published in Germany, in Holland and in England. An epitome of its contents was issued in Latin, in 1545, by Thomas Geminus, or Gemini, under the title:—_Compendiosa totius Anatomiae delineatio, aere exaratum per Thomam. Geminum._ It contained forty of the Vesalian plates, cut in copper, and was the first book issued in England in which the roller printing process was employed. It was dedicated to Henry the Eighth, and was embellished with “one of the earliest and most curious of all extant engraved title-pages”.

In 1553, Geminus issued a second edition, in which the text was translated into English. This edition was dedicated to Edward the Sixth, with a commendatory note, “To the gentill readers and Surgeons of Englande”. Six years later the third English edition appeared, which was inscribed to Queen Elizabeth. It contains the first published portrait of the Queen. She is shown upon the engraved title-page, and, strange to say, above her is another queenly figure, with a pen in her right hand, a wreath on her left, her foot resting on the globe, and styled _Victoria_.

Another English work on anatomy, which is filled with poor imitations of Vesalius’s illustrations, is the _Microcosmographia_ of Helkiah Crooke, or Crocus, who was “Professor in Anatomy and Chirurgery”. Its chief value rests in an elaborately engraved title-page, a part of which shows Crooke giving a demonstration in anatomy in the presence of the “Worshipfull Company of Barber-Chirurgeons”, in London, early in the seventeenth century.

John Banister of Nottingham, in 1578, borrowed a few Vesalian woodcuts for use in _The Historie of Man, sucked from the sappe of the most approved Anatomists and published for the Utilitie of all Godly Chirurgians within this Realme_.

Most of the host of translators, epitomizers, commentators and imitators of Vesalius have passed into oblivion. A few of these persons have possessed enough of individuality to deserve recognition.

Juan Valverde di Hamusco, a Spaniard who was born about the year 1500, studied anatomy at Padua and later at Rome. His book, _Historia de la Composicion del Cuerpo Humano_, was published at Rome in 1556. It contains forty-two copperplates and an engraved title-page. Although the author says he has used only the Vesalian plates, his work contains several plates which are not to be found in Vesalius’s writings. For example, Valverde shows a _muskelmann_ with his skin held in his right hand, the left grasping a dagger which may have been used in the skinning process. Other original drawings show the abdomen and intestines, a pregnant woman with the abdomen opened, and illustrations of the superficial veins.

Valverde was physician to Cardinal Juan de Toledo, Archbishop of Santiago, to whom the work is dedicated. The illustrations were drawn by Gaspar Becerra and were engraved by Nicholas Beatrizet. Valverde’s book went through several editions. It forms a landmark in the medical history of Spain—a country which, for many years, was behind other states of Europe in matters of science.

To name the list of anatomical writers who have derived their artistic inspiration from the _Fabrica_ would require much more space than is at our disposal. It must suffice to say, that, for a period of two centuries, nearly all treatises on anatomy contained illustrations which were taken from the writings of Vesalius. With few exceptions, these reproductions were little better than caricatures of the original figures.

Of the numerous editions of the _Fabrica_ there are three which are highly prized, namely, the first one, 1543; the second, issued in 1555, containing eight hundred and twenty-four pages, with many changes in the text; and the 1725 edition of the collected writings of Vesalius. The last named is a huge volume which was published at Leyden under the supervision of Boerhaave and Albinus, with the illustrations cut in copper by Jan Wandelaar[27].

It contains the _Fabrica_, the _Epitome_, the _Epistola de Radicis Chynae_, various anatomical treatises of a controversial character, and the _Chirurgia Magna_ which has been wrongly attributed to Vesalius. Morley says of this book:—“After his death a great work on surgery appeared, in seven books, signed with his name, and commonly included among his writings. There is reason, however, to believe that his name was stolen to give value to the book, which was compiled and published by a Venetian, Prosper Bogarucci, a literary crow, who fed himself upon the dead man’s reputation”.

CHAPTER FOURTEENTH
The Court Physician

Vesalius, having finished the _Fabrica_, intended to write a work on the practice of medicine which should be based on pathology. He makes mention of this in the preface of the _Fabrica_, and in numerous places in the body of the book he describes the pathologic appearances which he found in dissection.

Returning to Padua after a year’s absence, he found that the University for which he had strenuously labored was a very hotbed of opposition. His former pupil and friend, Realdus Columbus, who was now lecturing on anatomy at Padua, had turned against him. How deeply Vesalius was wounded by the man whom he had made, can be appreciated only by those who have been placed in similar circumstances. The controversy between Columbus and Vesalius was of a bitter and personal character.

On all sides the views of Vesalius were attacked, and the defenders of Galen joined hands with men like Columbus in an effort to besmirch the great anatomist. Disgusted with such treatment, Vesalius, early in 1544, went to Pisa. Here he conducted a course in anatomy. Leaving Pisa, he went to Bologna where he made some special dissections upon two bodies. About this time he declined a chair in the University of Pisa which was tendered to him by direction of Cosimo de’ Medici. Tired of the apparently useless effort to make men see the truth, sick of disputes and arguments, persecuted by members of his own profession, in a fit of passion Vesalius threw his manuscripts into the fire and ended his career as a scientist. “Thus”, says Morley, “he destroyed a huge volume of annotations upon Galen; a whole book of Medical Formulae; many original notes upon drugs; the copy of Galen from which he lectured, covered with marginal notes of new observations that had occurred to him while demonstrating; and the paraphrase of the books of Rhazes, in which the knowledge of the Arabians was collated with that of the Greeks and others”.

While in this frame of mind it is not surprising that he should have accepted the appointment of Archiatrus to Charles the Fifth of Spain.

The great Emperor was now at the zenith of his fame. His kingdom, which reached from South America to the Zuyder Zee, was well under control, but the monarch already contemplated the abdication of the throne in favor of his son Philip, who is known in history as Philip the Second.

Vesalius left Italy and took up his residence at Madrid. He was now in his thirtieth year. As Archiatrus he accompanied the Emperor in the fourth French war, in which he gained his first experience as a military surgeon. He also acted as physician to Charles and to the members of the imperial household. The war ended in September 1544. In January, 1545, Charles went to Brussels, and remained in the Netherlands for many months. Vesalius was now in his native country, and in April, 1546, he visited the graves of his ancestors at Nymwegen and Wesel. In the same year he published a new edition of his treatise on the China root.

On the twenty-fifth day of October, 1555, amid a scene of pomp and splendor, in the presence of the assembled representatives of the Netherlands, Charles formally surrendered to his son all his territories, jurisdiction and authority in the Low-Countries. This was the first of a series of acts by which the Emperor gradually relinquished the reins of power, in order to spend his remaining days in a cloister. Philip thus became the heir to a vast dominion. Vesalius was continued in office as Archiatrus by the new Emperor. From both Charles and Philip, Vesalius received many marks of honor. It was he who rescued Charles from what was thought to be a mortal disease. At a later date, when Philip’s unfortunate son, Don Carlos, received a severe injury to the head, and after the treatment of the Spanish physicians had failed, it was Vesalius who saved his life by an operation. These cures, and the accurate prediction of the death-day of Maximilian d’Egmont, placed the fame of Vesalius at high tide.

CHAPTER FIFTEENTH
Pilgrimage and Death

Suddenly, early in the year 1564, for a reason which has never been explained satisfactorily, Vesalius left Madrid. Apparently he was at the height of success. He was famous as a physician and surgeon; he was a favorite at the Spanish court; he had amassed a fortune; and seemingly he was destined to pass his remaining days under the most favorable surroundings. As occurs to all great men, he had excited the jealous animosity of many of the members of his profession. The efforts of the Madrid physicians to ignore the talents of one whom they regarded as a foreigner, long since had reacted to the advantage of the Archiatrus.

During the twenty years that he had filled the post of Archiatrus, the scalpel of Vesalius was rusting: but the controversy concerning the infallibility of Galen was still raging. The violent criticisms of Sylvius upon the _Fabrica_ had been silenced by death, but others took up the cause of Galen where Sylvius had left it. But the passing years had brought a new coterie of professors, who, like Fallopius at Padua; Rondelet at Montpellier; Massa at Venice; and Fuchs at Tübingen, were boldly teaching many things that were contrary to Galen.

Life at the Spanish court was not favorable to the study of science. “The hand of the Church”, says Foster[28], “was heavy on the land; the dagger of the Inquisition was stabbing at all mental life, and its torch was a sterilizing flame sweeping over all intellectual activity. The pursuit of natural knowledge had become a crime, and to search with the scalpel into the secrets of the body of man was accounted sacrilege. It was for a life in priest-ridden, ignorant, superstitious Madrid that Vesalius had forsaken the freedom of the Venetian Republic and the bright academic circles of Padua; in Madrid, where, as he himself has said, ‘he could not lay his hand on so much as a dried skull, much less have the chance of making a dissection’. Moreover, he must have felt the loss of Charles, who, whatever his faults, recognized the worth of intellectual efforts, and in many ways had shown his sympathy with Vesalius’s love of knowledge. Such sympathy could not be looked for in the narrow and bigoted Philip”.

About this time Vesalius received a copy of the _Observationes Anatomicae_ of his pupil Fallopius, who, having learned all that his master had taught of anatomy, continued his studies with great skill and industry. Such a book, coming at an opportune time, must have seemed like a voice calling the Archiatrus back to the intellectual life, bringing to his mind’s eye the recollection of his happy days in Italy.

Vesalius travelled to Venice by way of Perpignan. While in Venice he visited the printer, Francesco Sanese, and discussed the publication of a new book which should contain his reply to Fallopius. In a short time he started for Cyprus in company with Jacobo Malatesta, the commander of the Venetian forces in that island. Thence he passed to Jerusalem on a pilgrimage to the Holy Land. Vesalius never returned from that journey. Information of his death reached Brussels towards the end of that year—1564.

What was the reason for this pilgrimage? Various alleged authorities have given different versions, many of which are evidently fictitious. The most reasonable account, which emanates from Spanish-French sources, dates from a letter written January 1, 1565, to the physician Caspar Peucer by Hubert Languer, or Hubertus Languetus, the Huguenot friend of Philip Sidney, which says:—“They say that Vesalius is dead. Doubtless you have heard that he went to Jerusalem. That journey had, as they tell us from Spain, an odd reason. Vesalius, believing a young Spanish nobleman whom he had attended to be dead, obtained leave of the parents to open the body for the sake of inquiring into the cause of the illness, which he had not rightly comprehended. This was granted; but he had no sooner made an incision into the body than he perceived the symptoms of life, and opening the breast, saw the heart beat. The parents coming afterwards to the knowledge of this, were not satisfied with prosecuting him for murder, but accused him to the Inquisition of impiety, in hopes that he would be punished with greater rigor by the judges of that tribunal than by those of the common law. But the King of Spain interposed, and saved him on condition that by way of atoning for the error he should undertake a pilgrimage to the Holy Land”.

The pilgrimage was made, the Holy Sepulcher was visited, and the weary wanderer had started for Padua to take the chair which was made vacant by the death of Fallopius. A violent storm swept the Ionian Sea. Vesalius’s ship was wrecked upon the island of Zakynthos, where, on the fifteenth day of October, 1564, the Archiatrus died of exhaustion.

Such was the miserable end of Andreas Vesalius of Brussels, a man, who, before he had attained his thirtieth year, had become the greatest anatomist that the world has ever seen.

FOOTNOTES

[1]Théorie de la figure humaine. Paris, 1773.

[2]Moehsen: Verzeichnis einer Sammlung von Bildnissen. Berlin, 1771;
page 59.

[3]Bell: Observations on Italy. Edinburgh, 1825; page 257.

[4]Galen: De Anatomicis Adininistrationibus. Lib. II.

[5]Celsus: De Medicina. Lib. I.

[6]Fisher: Claudius Galenus. Annals of Anatomy and Surgery, Vol. IV.,
page 216.

[7]Saint Basil, in his maturer years, deeply regretted that he had
studied classical literature in his youth. Jerome regarded the
reading of the writings of antiquity as a terrible crime. Gregory
the Great declared a knowledge of grammar even for a layman to be
indelicate.—Fort: Medical Economy during the Middle Ages. N. Y.,
1883; pages 102, 103.

[8]Meryon: History of Medicine. London, 1861; vol. I, page 479.

[9]Adam; Vitae Germanorum Medicorum. Haidelbergae, 1620: page 224.

[10]Zwinger: Theatrum Vitae Humanae. Basileae, 1571.

[11]Vesalius: Fabrica, 1543, preface.

[12]Sylvius: Ordo et Ordinis Ratio in Legendis Hippocratis et Galeni
Libris, 1539.

[13]The Collége Royal de France was founded by Francis the First. This
enlightened patron of the sciences and arts recognized the merits of
scientific men and rewarded them with his money and his friendship.
He established the Collége de France with twelve richly-endowed
professorships, one of which was devoted to medicine. The lectures
were free to all who desired to attend. The first incumbent of the
chair of medicine was Vidus Vidius, Guido Guidi, of Florence, who
filled this position from 1542 to 1548. Such success followed his
labors that, on his return to Italy, his experience in Paris was the
subject of this witticism: _Vidus venit, Vidius vidit, Vidus vicit_.

[14]Northcote: History of Anatomy. London, 1772; page 56.

[15]Portal: Histoire de l’Anatomie et de la Chirurgie. Paris, 1770; vol.
I, page 365.

[16]Moreau: Vita Sylvii, in Sylvii Opera Medica. Geneva, 1635.

[17]Vesalius: De radice Chinae epistola, 1546; pages 151, 152.

[18]Archives Curieuses de l’Histoire de France.

[19]Guinterius: Anatomicarum Institutionum, 1539.

[20]Paraphrasis in nonum librum Rhazae medici Arabis clariss. ad Regem
Almansorem, de singularum corporis partium affectuum curatione,
autore Andrea Wesalio Bruxellensi Medicinae candidato. Lovanii ex
officina Rutgeri Resii. mense Februar. 1537.

[21]Radicis Chinae usus, Andrea Vesalio autore. Lugd., 1547; page 278.

[22]Moehsen: Verzeichnis einer Sammlung von Bildnissen. Berlin, 1771;
page 82.

[23]Sandrart: Teutsche Academie. Nürnberg, 1685: vol. II., page 243.

[24]Portal: Histoire de l’anatomie et de la chirurgie. Paris, 1770; vol.
I., page 399.

[25]McMurrich: Medical Library and Historical Journal, December, 1906.

[26]Cowper: The Anatomy of Human Bodies. Oxford, 1697.

[27]Andreae Vesalii Opera Omnia Anatomica et Chirurgica in duos tomos
distributa cura Hermanni Boerhaave et Bernhardi Siegfried Albini.
Lugduni Batavorum, 1725.

[28]Foster: Lectures on the History of Physiology. Cambridge, 1901, page
17.

INDEX

INDEX