Andreas Vesalius On The Fabric Of The Human Body

Just as Copernicus and Galileo revolutionized ideas about the motions of the earth and the heavens, Andreas Vesalius (1514-1564) transformed Western concepts of the structure of the human body. Vesalius' great treatise, The Fabric of the Human Body (De humani corporis fabrica), appeared in 1543, the year in which Nicolaus Copernicus (1473-1543) published the text that placed the sun, rather than the earth, at the center of the universe (On the Revolutions of the Heavenly Spheres). Vesalius was heir to the humanist medical tradition that had rediscovered the original writings of Hippocrates and Galen. He was a member of the first generation of scholars to enjoy access to the complete works of Galen. The Fabrica, which is considered the first anatomical treatise based on direct observation of the human body, is still regarded as a milestone in the history of anatomy. In honor of its place in the history of Western medicine, in 1998, scholars began publishing a five-volume English translation of the first edition of the Fabrica.

Given the scope of his work, Vesalius can be considered a classical scholar and humanist, as well as a physician, anatomist, and artist. Unlike Linacre and Caius, however, Vesalius was able to renounce

Vesalius With Cadaver
Andreas Vesalius, on the fabric of the human body.

the errors of the ancients clearly and publicly. Through his scholarship and his own observations, he came to realize that human anatomy must be read from the ''book of the human body,'' not from the pages of Galen. With all due modesty, Vesalius regarded his work as the first real advance in anatomical knowledge since the time of Galen.

A horoscope cast by Girolamo Cardano, a Milanese physician, fixes the birth of Andreas Vesalius in Brussels, Belgium, on December 31, 1514, at 5:45 a.m. Vesalius was born into a world of physicians, pharmacists, and royal patronage. His father was imperial pharmacist to Charles V and often accompanied the Emperor on his travels. As a youth, Vesalius began to teach himself anatomy by dissecting mice and other small animals. Although he studied at both the University of Paris and Louvain, institutions notable for their extreme conservatism, his innate curiosity was not destroyed by the benefits of higher education.

While a student at the University of Paris, Vesalius served as assistant to Jacobus Sylvius (1478-1555), an archconservative who saw human dissection only as a means of pursuing Galenic studies. Unfortunately, the atmosphere in Paris became so threatening that Vesalius found it necessary to leave without a degree. In the fall of 1537, he enrolled in the medical school of the University of Padua, a venerable, but relatively enlightened institution. He was awarded the M.D. in December 1537, and appointed lecturer-demonstrator in anatomy and surgery. Abandoning the traditional professorial role, Vesalius lectured and dissected simultaneously. These dissection-lectures occupied the anatomist and his audience from morning to night for three weeks at a time. To minimize the problem of putrefaction, anatomies were scheduled for the winter term. Several bodies were used simultaneously so that different parts could be clearly demonstrated. Anatomies began with a study of the skeleton, and then proceeded to the muscles, blood vessels, nerves, organs of the abdomen and chest, and the brain.

By 1538, Vesalius was beginning to recognize differences between Galenic anatomy and his own observations, but when the young anatomist publicly challenged Galen, Sylvius denounced his former student as "Vesanus" (madman), purveyor of filth and sewage, pimp, liar, and various epithets unprintable even in our own permissive era. Vesalius in turn told his students that they could learn more at a butcher shop than at the lectures of certain blockhead professors. Referring to the dissection skills of his former teacher, Vesalius said that Sylvius and his knife were more at home at the banquet table than the dissecting room. In 1539, Marcantonio Contarini, a judge in Padua's criminal court, became so interested in Vesalius's work that he awarded the bodies of executed criminals to the university and obligingly set the time of execution to suit the anatomist's convenience.

Finally, to mark his independence from Galen, Vesalius arranged a public dissection lecture in which he demonstrated over two hundred differences between the skeletons of apes and humans, while reminding his audience that Galen's work was based on the dissection of apes. Hostile reactions from outraged Galenists were inevitable. Vesalian anatomists were vilified as the ''Lutherans of Physic'' on the grounds that the heresies of such medical innovators were as dangerous as Martin Luther's

(1483-1546) effect on religion. Tired of the controversy, Vesalius became court physician to Charles V, Holy Roman Emperor and King of Spain, to whom he dedicated the Fabrica. Soon Vesalius discovered that imperial service was almost as unpleasant as the stormy academic world.

The patronage of a king, pope, or wealthy nobleman might allow a scientist to continue his research, but such patrons were often difficult and demanding patients. Charles V suffered from gout, asthma, and a variety of vague complaints exacerbated by his predilection for quack remedies. Moreover, kings often loaned their physicians to other royal courts. Thus, when Henry II of France was injured while jousting, Vesalius and the French surgeon Ambroise Pare were among the medical consultants. Using the heads of four recently decapitated criminals, Pare and Vesalius carried out experiments to ascertain the nature of the injuries. They correctly predicted that the wound would be fatal. According to a doubtful, but persistent tradition, Vesalius went on a pilgrimage to the Holy Land to extricate himself from the Emperor's service, or as a penance for initiating a premature autopsy. Vesalius may have used the excuse of a pilgrimage to explore the possibility of returning to a professorship at Padua. Unfortunately, he died on the return voyage.

Despite being steeped in the conservative academic scholarship of his time, Vesalius confronted and rejected Galen's authority and demanded that anatomists study only the ''completely trustworthy book of man.'' Vesalius attributed his own disillusionment with Galen to his discovery that Galen had never dissected the human body. However, a minor work, known as the ''Bloodletting Letter,'' suggests that practical problems concerning venesection forced Vesalius to question Galenic dogma. Venesection was the subject of violent controversy among sixteenth-century physicians. No one suggested abandoning bloodletting; rather, the medical humanists attacked what they called corrupt Arabist methods and demanded a return to the pure teachings of Hippocrates and Galen.

Unfortunately, even after ''purification,'' Galen's teachings on the venous system remained ambiguous. When Hippocratic texts contradicted each other and Galen, which authority could tell the physician how to select the site for venesection, how much blood to take, how rapidly bleeding should proceed, and how often to repeat the procedure? Struggling with these questions, Vesalius began to ask whether facts established by anatomical investigation could be used to test the validity of hypotheses. Unable to ignore the implications of his anatomical studies and clinical experience, Vesalius became increasingly critical of the medical humanists. He could not tolerate the way they ignored the true workings of the human body while they debated ''horse-feathers and trifles.''

The Fabric of the Human Body was a revolutionary attempt to describe the human body as it really is without deferring to Galen when the truth could be learned through dissection. Vesalius also demonstrated how well anatomical truths could be conveyed in words and illustrations. About 250 woodblocks were painstakingly prepared and incorporation into the text where their placement complemented and clarified matters described in the text. Ironically, critics of Vesalian anatomy attacked the Fabrica on the grounds that the illustrations were false and misleading and would seduce students away from direct observation. Actually, the importance of dissection is emphasized throughout the text and careful instructions were given on the preparation of bodies for dissection and the instruments needed for precise work on specific anatomical materials.

The Fabrica was intended for serious anatomists, but Vesalius also prepared a shorter, less expensive text, known as the Epitome, so that even medical students could appreciate the ''harmony of the human body.'' The Epitome contained eleven plates showing the bones, muscles, external parts, nerves, veins, and arteries, and pictures of organs that were meant to be traced, cut out, and assembled by the reader. The Vesalian texts and illustrations were widely plagiarized and disseminated, often in the form of inferior translations and abstracts that failed to credit the originals.

In response to his critics, Vesalius denounced the ''self-styled Prometheans'' who claimed that Galen was always right and argued that the alleged errors in his works were proof that the human body had degenerated since the classical era. Galenists, Vesalius declared, could not distinguish between the fourth carpal bone and a chickpea, but they wanted to destroy his work just as their predecessors had destroyed the works of Herophilus and Erasistratus. Recalling how he had once been under Galen's influence, Vesalius admitted that he used to keep the head of an ox handy to demonstrate the rete mirabile, a network of blood vessels that Galen had placed at the base of the human brain. Unable to find the rete mirabile in human cadavers, anatomists rationalized this inconsistency by asserting that, in humans, the structure disappeared very soon after death. When Vesalius finally came to terms with Galen's fallibility, he openly declared that such a network was not present in humans.

In contrast to his revolutionary treatment of anatomy, Vesalius did not go much further than Galen and Aristotle in physiology and embryology. He gave an exhaustive description of the structure of the heart, arteries, and veins, and was skeptical of the Galenic claim that the blood moved from right heart to left heart through pores in the septum, but the motion of the blood remained obscure. Thus, while Galen was challenged on anatomical details, his overall anatomical and physiological doctrines remained intact. For example, having ruled out the presence of the rete mirabile in humans, Vesalius had to find an alternative site for the generation of the animal spirits. By interpreting Galen's various

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