Few men mentioned prior command the significance that ANDREAS VESALIUS (1514-1564 CE) has been favored through medical history. Physicians in the early twentieth century, and probably even today, consider VESALIUS as magnanimous as GALEN and HIPPOCRATES. Earlier comments made in this series allude that the techniques used in VESALIUS’S illustrations were not unilaterally original. However, his publications serve as the cornerstone to any historical medical library.
Born in Brussels just five years before the death of LEONARDO, VESALIUS embarked throughout Europe, pursuing study in Leyden, Louvain and then Paris. Between 1533 to 1536 CE, VESALIUS lived in Paris and was a student of JACOBUS SYLVIUS (1478-1555 CE), a proponent of GALEN.
During VESALIUS’S tenure in Paris, another text of anatomy was in development. CHARLES ESTIENNE (1504-1564 CE) set out to publish De dissectione partium corporis humani as early as 1530 CE, which is when the earliest plates date. ESTIENNE returned to Paris to continue his studies from Padua, and was a pupil of SYLVIUS, along with VESALIUS. De dissectione was complete around 1539 CE. However a lawsuit between ESTIENNE and the surgeon who dissected and sketched the corpses, ETIENNE DE LA RIVIÈRE, pushed the release to 1545 CE, two years after VESALIUS’S De humani corporis fabrica libri septem.
War between France and Germany encouraged VESALIUS to move to Italy, where in 1537 CE he settled in Padua and would assume the role as lecturer of surgery at the university. Prior to his arrival in Padua, VESALIUS passed through the city of Venice, where he would meet a fellow compatriot, and his future illustrator, JOHANN STEPHAN VAN CALCAR (1499-1546 CE). He also encountered GIAN PIETRO CARAFFA (later Pope PAUL IV) and IGNATIUS of LOYOLA, founder of the Jesuits, who both helped care for those afflicted with Hansen’s disease (leprosy) in Venice.
In 1538 CE, VESALIUS and CALCAR printed their first anatomical text, Tabulae sex, a series of six illustrations used by VESALIUS’S students and spectators of dissections. In comparison to De dissectione, skeletal details in Tabulae sex are of less quality, while myology is designed very comparably. Modern historians assert contemporaries of VESALIUS plagiarized his work. This statement is true to an extent for some illustrators. However, ESTIENNE is not likely to be one of those plagiarists, given the observations between VESALIUS’S early work and the older plates of ESTIENNE. The possibility has arisen that VESALIUS was exposed to ESTIENNE’S plates while in Paris, and even went so far as to be inspired by those early illustrations.
Between the periods of Tabulae sex and De fabrica, VESALIUS encounters the inconsistencies with GALEN, like his predecessors, and these fallacies encourage the conception of De fabrica. Around 1540 CE, while compiling an edition of GALEN, VESALIUS discovers a vertebral process described by GALEN found in a species of primate but not man. This changed VESALIUS and he wrote, “I cannot wonder enough at my stupidity and trust in GALEN which prevented me from seeing this before.” Fully resolved, the release of De fabrica was only a matter of time.
VESALIUS celebrated his twenty-eighth birthday the same year he published De fabrica in Basel, 1543 CE. In its first printing, De fabrica was a large volume of 663 pages and over 300 illustrations. VESALIUS acknowledged that his students may be unable to carry, or even afford, such a magnanimous folio, and later that year published Epitome. The Epitome was VESALIUS’S response to De fabrica not being an anatomical atlas. Surprisingly, the Epitome, being much cheaper, sold much better than the larger De fabrica, but locating editions today is a challenge.
De fabrica collates the spectrum of medical illustration available to VESALIUS at the time. As stated above, De fabrica shares many features found in older volumes: such as full-figured illustrations against landscape, cast shadowing, articulating subjects and placing other anatomical objects in their grasp, momento mori, and the printing of a smaller volume after the original.
One area between VESALIUS and ESTIENNE that differs is the identification of structures on illustrations. While unbeknownst to the viewer, the method by which an illustration is labeled has definitive consequences on the final image. In comparison, ESTIENNE opts for lines to be drawn from a specific area whereas VESALIUS prefers to place letters within the structure. [Figure 8]. Neither man pioneered these methods. The use of lines had been employed as far back as editions of MONDINO. Placing letters in the figure was used by LEONARDO, as well as DRYANDER, and enhances the aesthetics of the image without the appearance of the subject being impaled by a wave of lines. Contrast between the letter and surroundings is important for clarity, and some labels in the first edition copies of De fabrica fall victim to illegible typeface. These problems are reconciled in the second edition.
Similar to editions of MONDINO, the cover for De fabrica introduces a different view of education. On the cover, VESALIUS is the man dissecting and instructing, serving as the professor, dissector, and ostensor. [Figure 9]. In addition, we see VESALIUS dissecting a female corpse oriented in the same plane, vertical, as the rest of the largely male audience. This composition is not accidental. VESALIUS was making a statement about the role of physicians. In the forward to De fabrica, VESALIUS claims physicians have abdicated the use of their hands, having pawned off the role of dissecting to others, losing their familiarity of anatomy in the process. Not mentioned by VESALIUS explicitly, is his view on the role of cadavers. By placing the cadaver in the same plane as the audience, it becomes an equal among the men. Perhaps using this symbolism VESALIUS argues that a physician is uninformed without the cadaver, and the cadaver earns as much respect, if not more, than the dissector. After all, the cadaver rests central and, on quick glance, more prominently viewed than VESALIUS. Also, VESALIUS and the cadaver are placed almost at the bottom of the image, an implicit rejection of MONDINO’S vertical hierarchy. In this golden age of medical humanists, VESALIUS certainly rose above his contemporaries.
As presented, VESALIUS and the artists who illustrated De fabrica did not invent the techniques found in the text. Instead, these methods were used in full-effect to present the first, and for many the best, medical textbook on modern medicine. [Figure 10].
The same year De fabrica is printed, another former student of Padua, NICOLAS COPERNICUS (1473-1543 CE), released a book, De revolutionibus orbium coelestium, which would stir controversy in religious circles. While COPERNICUS died prior to facing pressure from the Catholic Church on his theories, VESALIUS lived on to encounter accusations from those adherent to the church of GALEN. As previously stated, VESALIUS began work on De fabrica in direct response to the errors he encountered in GALEN. Unfortunate for VESALIUS, Galenists were rampant in academic medicine at the time, and repeated accusations against De fabrica led to VESALIUS’S resignation from Padua. To add misery, one of VESALIUS’S close illustrators, CALCAR, a pupil of Titian, died just a few years after De fabrica.
Where there is one item of highest quality adored by many, there will be those who naturally want to recreate and undersell that item. For VESALIUS, the next major hurdle would be plagiarists. VESALIUS himself was aware of the problem of plagiarizing and wrote chastising letters on the subject. For a more complete analysis of these accused illustrators, the reader is encouraged to look at CUSHING or HERRLINGER. One such artist to be discussed is DRYANDER.
Around 1541 CE, DRYANDER had been involved with the printing of Anathomia Mundini, which used illustrations from other sources, namely Tabulae sex. There was a professional relationship between DRYANDER and VESALIUS via letters exchanged in 1542 CE, and culminated in VESALIUS including DRYANDER’S name among accomplished anatomists in the first edition of De fabrica. VESALIUS was unaware at the time of the first printing of De fabrica of DRYANDER’S involvement in the Anathomia Mundini; however, through a mutual friend, VESALIUS was informed of DRYANDER’S role and omitted DRYANDER from the second edition of De fabrica in 1555 CE. DRYANDER did not just exploit VESALIUS’S work, in 1542 CE, before De fabrica, he utilized illustrations from ESTIENNE’S De dissectionae for another medical text. On the surface, DRYANDER in his later career appears to us today as thief of intellectual property and copyright. However, there was no governing body protecting the illustrations of these anatomists. In addition, to turn the tables on VESALIUS, De fabrica employs the same example of momento mori as DRYANDER, namely a skull resting on an hourglass with an inscription stating Inevitabile fatum (inevitable fate).
The legacy VESALIUS has impressed upon medicine still echoes into our generation. While evidence has been presented that asserts VESALIUS did not invent the field of medical illustration, his woodcuts would set a new standard among his contemporaries and future illustrators. De fabrica is the quintessential text that defines an historical library, and Sir William Osler even went as far to name De fabrica “the greatest medical work ever printed.”
Not every medical illustrator after VESALIUS adopted his mentality. Naturally, those who could disprove VESALIUS would reap the same fame. One such example is BARTOLOMEO EUSTACHIO (1520-1574 CE). In 1552 CE, EUSTACHIO completes the plates for his Tabulae anatomicae clarissimi viri, which in design and theory could not be more opposite than De fabrica. EUSTACHIO defended GALEN, and would have known of VESALIUS while studying medicine in Padua. The same fate of LEONARDO’S work would beset EUSTACHIO to a lesser extent. Only eight of the thirty-nine plates EUSTACHIO produced were published in his lifetime as the Opuscula anatomica in 1564 CE. Pope CLEMENT XI’S physician, GIOVANNI LANCISI, would publish all of EUSTACHIO’S plates with color in 1714 CE. One look at EUSTACHIO’S plates and you can see a great departure from VESALIUS and all illustrators before him. One of the most fascinating departures is EUSTACHIO’S use of a grid system to identify structures. There are no lines, or letters. EUSTACHIO employs a technique similar to cartography, in which a surrounding border becomes a coordinate grid. [Figure 11]. In addition, in contrast to VESALIUS, EUSTACHIO aimed to generate a composite of the human form, a summation of observations into one, standard map of the human body. VESALIUS aimed for the reader to be able to study anatomy without a cadaver, whereas EUSTACHIO places greater demand upon the reader.
Technologically, EUSTACHIO employed copperplates for his illustrations. This divide from woodcuts would prove the victor visually and economically. A student of EUSTACHIO in Padua, JUAN VALVERDE (c. 1525 -1588 CE) would not only denounce VESALIUS, but use the illustrations of De fabrica to advance his Galenist opinion with higher-quality, low-cost copperplates. [Figure 12]. VALVERDE’S Historia de la composicion del cuerpo published in 1556 CE would prove successful in disseminating VESALIUS’S illustrations because its copperplates were easy and cheap to print. Thus, more people would study from VESALIUS’S images in VALVERDE’S text. In fact, only four illustrations of the forty-two used by VALVERDE were of his own creation.
The Renaissance was more than just a movement in art. Medicine changed, and departed on a new course. For the first time, the human body was presented as it never had been before in two-dimensions. Students, academics, and lay people who were unable to study from cadavers had the opportunity to learn anatomy via dissection. The introduction of copperplates would enhance the clarity of these illustrations, and lower printing costs made these books more accessible.
The relationship between the artist and the anatomist accelerated the field of medical illustration. Many of the anatomists described above have identified human structures that today bear their name. However, the artists, printers, and engravers who pressed these anatomists into history have remained either unknown or shadowed by the magnanimity of the anatomist. These volumes were not the product of any one man, but the collective work of a team.
There is no doubt that the success of these anatomists was dependent upon the invention of the printing press. The printing press changed the world, and would serve as an efficacious catalyst to advance new theories in medicine. Without the printing press, the pioneering work of these illustrators would have remained in very few circles, with similar fate as LEONARDO.
From the Renaissance moving forward, improvements in printing, including the use of color, would enhance our understanding and visualization of the human body. Each century after the Renaissance would contribute to the evolution in medical illustration. The seventeenth century showed improvements in engraving as well as more detailed, scientific illustration; color printing started to trend in the eighteenth century, well embraced by educators and students; and the nineteenth century would introduce even better printing methods, such as lithography. One of the major shifts to occur in medical illustration during the twentieth century would occur in the United States.
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