“Dispel from your mind the thought that an understanding of the human body in every aspect of its structure can be given in words” –Leonardo da Vinci
**This is part 1 of 6 in a series of articles chronicling medical illustration from antiquity.
A picture is worth a thousand words. The value sought within medical illustration however extends beyond words. In medicine, the human anatomy may render one initially speechless, whether by astonishment of beauty or pure shock. When cataloging the extensive network within the body, a systematic approach is often favored, but on occasion fails to describe its complexity. The moment when words escape the tongue, medical illustration proves its value.
Medicine today is considered “modern,” but all medicine in its day was progressive. Traditions established millennia ago remain as the cornerstone of medicine today. Within this time, languages have been retired and texts translated, but medical illustrations have served as the thread weaving our epochs together. The human body remains perpetual, despite a world in flux, and we can connect to the oldest of medical images. Much of our basic understanding of medicine derives from the past. Through timeworn pictures, we learn of anatomical features or surgical procedures, improving upon them each generation. Open an aged incunabulum and look upon its yellowed pages, the language will often be incomprehensible to those without advanced degrees in classics. However, within some pages will be images that are interpretable with identifiable structures. Medical illustrations are thus timeless.
Our focus in the following sections will be to highlight three major advancements to the field of medical illustrating. Also, emphasis will be placed on the state of medical illustrating in the twenty-first century, and the future of the field on its present course. Moreover, the perspective from contemporary illustrators will provide personal familiarity on these issues. Finally, to appreciate the present and future of medical illustrating there must be a glimpse into its past: it is in the past where we begin.
Illustrating the Greeks to the Italians
The timeline of medical illustration retracts far before JENNER developed a smallpox vaccine and GALEN put pen to paper. While modern illustrators enjoy the ease of digital manipulation, basic luxuries, such as monochromatic printing, were a far cry from the tools available to the early anatomists.
The initial spark of medical illustration in the Western World dates to the Greeks, who began dissecting the human body in Alexandria during the Hellenistic period. As early as 300 BCE, anatomists HEROPHILUS and ERASISTRATUS incorporated images of the body derived from their observations. Their intent was to clarify structures and present the anatomy in digestible forms to students.
GALEN of Pergamon (c.129-199 CE) revived the field of medicine during the second century through codification of medical knowledge from the Hellenistic period, supplementing with his own commentary. The large body of writing Galen produced led to nine books on anatomy, two major works being De anatomicis administrationibus and De usu partium corporis humani. His education in anatomy was ascertained in Alexandria, and, according to GALEN, Alexandria was the only place teaching anatomy directly from human bones.
One may possess strong artistic skill, but as we will see later, direct observation of the human body is significant to developing accurate anatomical diagrams. On an important note, Rome decreed a prohibition on human dissection in 150 BCE. Thus, GALEN would not have dissected human bodies, opting for animals. VESALIUS will make the claim refuting GALEN’S accuracy of the human body based on his own dissections, resigning from his post at the University of Padua.
After GALEN, and the Visigoth invasion of Rome in 410 CE, medical knowledge would pass onto the Arabs, and later re-translated to Latin during the Renaissance. Prior to the Renaissance, the Catholic Church administered medicine in Europe during the Middle Ages, who proclaimed JESUS as the savior of souls, superseding AESCULAPIUS. However, painters of this time were afforded the freedom to depict the sick in very graphic detail, most commonly those suffering from Hansen’s disease (leprosy) with JESUS as their healer. In the third century, Saint LUKE and the brother Saints COSMAS and DAMIAN accompany JESUS as healers in Christianity.
Much of the medicine practiced within the circles of physicians in Europe during the Middle Ages was under the knowledge prescribed by GALEN. The value of illustrations from this period is debated. Those against their significance to medicine assign responsibility to the Church. However, the Catholic Church was not as limiting as presupposed. The Church did not issue a comprehensive ban on human dissection. The Ecclesia Abhorret a Sanguine, issued by the Council of Tours in 1163 CE, has been misidentified as a scapegoat for prohibiting the dissection of human bodies. Later bans on surgery and dissection under Pope BONIFCACE VIII (1294-1303 CE) would not represent an encompassing prohibition on all dissection. These edicts represent the Church’s response to a widespread, unlawful practice, namely the dissecting of Crusaders and rendering their remains to acquire bones. However, Europe interprets the Ecclesia as a moratorium on all bodies, not just of the Crusaders.
Sources label the Catholic Church responsible for diminutive medical innovation using the above edicts as the golden evidence. However, we can speculate and attribute the misconstruction of the Ecclesia as a result of low literacy rates in Europe, leading to misguided analysis of the edicts, and to Galenists, who did not want the anatomy of their prophet challenged, which we will see with VESALIUS. Regardless the cause, stagnant innovation in medical ideas during the Middle Ages remains unattested. However, the Papacy in Rome does not deserve full culpability. Once more, Pope INNOCENT III (1198-1216 CE) issued orders to dissect the body of those who died in suspicion. In addition, European hospitals between the years 1200 to 1350 CE experienced tremendous growth.
The Catholic Church appears retrospectively as more open to the expansion of anatomy than the Roman Empire based on the issued laws explained above. Another significant result of the Ecclesia was the transition of monastic medicine to medicine controlled by lay doctors, as well as the separation of medicine and surgery. Canonical law stipulated if a cleric’s action resulted in a person’s death, their religious authority would be revoked. Essentially, losing their license to practice Christianity. One man during the Middle Age was able to take advantage of this opportunity to dissect the body.
MONDINO DE’LUZZI (c. 1275-1326 CE), professor of surgery in Bologna, published the first anatomical textbook, Anathomia corporis humani, in 1316 CE that incorporated new knowledge from direct human dissection. MONDINO conducts the first public dissection at Bologna in 1315 CE, attended by medical students and others. The dissection was sanctioned by the Pope; involved the examining of the corpse of an executed female criminal; and was accompanied by the reading an anatomy text.
The Anathomia is one of the few innovative texts to rise from the ashes of the Middle Ages and yield many editions over the next few centuries. The woodcut illustrations detail more than just human anatomy, they detail the first known hierarchy of the dissection. The earliest editions of Anathomia, illustrated by two surgeons HENRI DE MONDEVILLE and GUIDO DA VIGEVANO, incorporate fresh knowledge distinct from the Alexandrian model.
The illustrations of MONDEVILLE and VIGEVANO, both educated in Bologna, express the primitiveness indicative of medieval artwork. The viewer is presented flat figures devoid of depth and shadow. These simple, outlined drawings may appear absent of useful anatomical information today; however, the principles behind their conception represent the utility these images served. These images were not intended to adorn the walls of patrons, but rather used in the dissection theater. Images from Anathomia show simple outlines with definite contrast, which guide the viewer to the most high yield information. Shadowing is absent, and shading is kept to a minimum. This permits the main structure being highlighted on the figure to remain uncluttered and easily identified. [Figure 1].
While the Renaissance will usher in a new age of artistic representation of the human form, images from Anathomia demonstrate the urge to educate using illustrations rather than text alone.
Medical education during this age is visualized by woodcuts used as cover images for later editions of Anathomia. In JOHANNES DE KETHAM’S 1495 CE edition of the Anathomia, Fasciculus Medicinae, the viewer witnesses an idealized depiction of the dissection. [Figure 2]. Many figures in the scene are vertical with the stark exception being the male corpse, laying horizontally. The men to the left of the image appear to transition seamlessly from erect to supine, guiding the viewer to the cadaver. This transition could possibly represent the inevitability of our fate, a memento mori. The verticality of the living people in the scene may allude to a vertical hierarchy in medicine at the time. At the top of the woodcut is a man in robes sitting on an ornate throne with intricate detailing. This man, the professor, is the focus of the image, and represents the knowledge of anatomy. Another figure, the demonstrator, hovers over the corpse with a knife in hand looking at the cadaver, ready to dissect. Another man points to the corpse with a probe. This man, the ostensor, was present to identify the structures the demonstrator was carving. The corpse, which remains inert and unclothed, remains divided from the other members of the scene due to the supine position. The three men in this image (demonstrator, ostensor, and corpse) form a triangular circuit that guides the viewer. The corpse focuses the viewer to the professor, who is looking directly at the viewer, asserting his omnipotence over the events unfolding below.
The accomplishments of the Greeks, GALEN, and MONDINO hammered the framework for an anatomical birthing to occur. The Greeks introduced illustration to the classroom, and the leniency of the Catholic Church permitted the first public dissections of human corpses, advancing the field. Illustrations from the Middle Age serve more than just primitive examples of early anatomical study, but an insightful look into the educational model in medicine of Italy. Italy will serve as the nucleus of a much larger event about to occur in the history of medicine and of the world, the Renaissance.
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