To the Divine Charles V, the Mightiest and Most Unvanquished
Emperor: Andreas Vesalius’ PREFACE to his books On the Fabric of the Human
Body
However numerous the obstacles to the arts and sciences, hindering
exact learning and the successful application of knowledge, most gracious
emperor Charles, nevertheless I believe it no moderate loss that in addition
there is an excessive scattering of the disciplines that serve the demands of
each art. Worse yet, the distribution of professional skills among various
practitioners has gone so far that those who have set themselves goals of
competency embrace one part of their art to the neglect of others that are
closely related and cannot be separated from it, and they never accomplish
anything notable; never attaining their proposed goal, they constantly fall
short of the true construction of their art.I will pass over the other arts in silence and direct my words for a
while to that which is responsible for the health of mankind; certainly of all
the arts that human genius has discovered, this is by far the most useful,
indispensible, difficult, and laborious. But nothing more calamitous could have
crept in than that at some time, especially after the incursion of the Goths
and after Mansor the king of Persia
(under whom the Arabs, still rightly familiar to us alongside the
Greeks, throve), medicine began to be ravaged by having its primary instrument,
the application of the hand’s work
in healing, so neglected that it seemed to
have been handed over to common folk and to persons completely untrained in the
disciplines that serve the medical art. For though there were once three
medical sects, the Logical, Empiric and Methodist,
still it was the entire scope of their craft which their
adherents directed toward the preservation of health and the ruination of
disease. Applying to this goal everything they considered essential to the art
in their respective sects, they employed three means of aid, of which the first
was a system of diet, the second medication, the third surgery.
The last of these neatly shows even more than the others that
medicine is the addition of things that are lacking and the removal of what is
superfluous; surgery never fails to aid the treatment of a condition whenever
in medicine we encounter means by which time and experience have shown this to
be the healthiest procedure for people. This triple approach to medicine was
equally familiar to physicians of every sect, and as they applied their own
hands to this treatment according to the nature of the symptoms, they expended
no less effort in working with their hands than in establishing a dietary
regimen, or knowing and compounding medications. The point is clearly made in a
number of the books of the divine Hippocrates, especially in his masterpieces
On the Function of the Doctor, On Fractures, On Dislocations of Joints, and
books on similar injuries.
Moreover, Galen, the first man of medicine after
Hippocrates, besides repeatedly boasting that the medical care of the Pergamene
gladiators was entrusted to him alone,
and even as
his age increased was unwilling to have apes skinned for him by slaves prior to
dissection,
frequently repeats how much he enjoyed working with his hands and
how zealously he did so with the other doctors of Asia.
Indeed, none of the ancients is seen to have handed on to posterity what
treatment is performed by hand less attentively than what is accomplished by
diet and medication.
But it was especially after the Gothic devastation, when all of the
sciences previously in their prime and fittingly practiced went to ruin, that
first in Italy the more fashionable doctors behaved as if they were ancient
Romans and scorned working with their hands; they began to order their servants
to perform what they thought should be done by hand for the sick, while they
only stood by as if they were architects. Soon, when little by little still
more practitioners declined the inconveniences of true medicine without
refusing any of the profit and prestige, they quickly degenerated from the
standard of ancient physicians, abandoning the technique of cooking and food
preparation to those attending the sick, the composition of medicine to
druggists, and surgery to barbers. And so in the passage of time the science of
healing has been so sadly torn asunder that certain doctors, peddling
themselves as physicians, have taken for themselves exclusively the
prescription of medication and diet for hidden conditions;
other branches
of medicine they relegated to those whom
they call
surgeons and scarcely respect as servants, disgracefully spurning what is a
principal and most ancient branch of medicine, one preeminently reliant (if
anything is) upon the investigation of nature: what is today in India the
particular work of kings, what the Persians pass along to their children by
hereditary right just as the whole art of the Asclepiads was once passed on,
and which the Thracians supremely cultivate and revere with many other nations,
all but forgetting that portion of the art which the Romans once outlawed from
their republic as if it were invented to deceive people and kill them.
For without Nature’s aid, medication has
no deep effect, but instead while eager to help Nature as she is hard pressed
to extricate herself from disease, it often destroys her entirely and renders
her completely useless.
To this we chiefly owe it
that so many aspersions are cast on doctors and this most sacred art is mocked,
while the branch of medicine which men educated in the liberal disciplines
cravenly allow to be torn from their grasp, constantly makes it shine with
special praise. When Homer, the fount of genius, affirms that a medical man is
more eminent than many,
and with all the poets of Greece celebrates Podalirius
and Machaon, these are not called the divine sons of Æsculapius because they
removed a small fever and things which Nature alone heals without the aid of a
doctor more easily than if he were put to the task, or because they pandered to
the palate of men in obscure and hopeless diseases, but because they were
primarily responsible for treating dislocations, fractures, wounds, other
lesions of continuity,
and the flow of blood, and they freed
the noblest of Agamemnon’s warriors from arrowheads, spears, and other such
afflictions (which happen chiefly in war and always demand the careful work of
a doctor).
Yet, most august emperor Charles,
I have not by any means proposed to prefer one instrument of
medicine over the others, since the triple system of healing that I mentioned
is all but inseparable and pertains as a whole to a single practitioner, and
for its proper attainment all branches of medicine are so equally constituted
and provided that each one is more effectively used the better one combines it
with the others. Rarely does any disease occur that does not from the start
require the threefold application of remedies: an appropriate diet must be
established, medications employed, and finally manual work applied; therefore,
students of this art must be urged in every way to discount the whispers of
those (if it please the gods) physicians, and apply their hands like the Greeks
to whatever treatment the nature of their craft thoroughly instructs, lest they
in turn direct a mutilated system of medicine to the disadvantage of all human
life. They must be the more diligently urged, the more fully trained in
medicine the people we see today abstaining from surgery as from the plague,
chiefly to avoid having the high priests of the profession
libel them before the untutored public as barbers, and
lest they receive less gain, honor, or prestige from the ignorant mob
than these less-than-half-doctors.
It is chiefly this detestable public
attitude that hampers us from acquiring the complete art of healing even in our
time, and makes us learn only the treatment of internal disorders: we study to
be doctors only partially, at great harm (to tell the truth for once) to
mankind. As soon as all preparation of medicine was relegated to druggists,
doctors soon lost the knowledge of simple medicines that was absolutely
essential to them; it is their fault that the workshops of apothecaries teem
with barbaric words and indeed false drugs, that we lack so many of the best
compounds of the ancients, and that many are still not even known to us.
They have brought about endless labor not only for the
learned men of our age but also for those who came some years before and
applied themselves so tirelessly to the knowledge of simple medications that in
trying to restore it to its pristine splendor they are seen to have contributed
much; proof of which, among so many otherwise famous men, is a rare example of
this age, Gerhard Vueldbik,
privy
councillor to your majesty, highly distinguished as well for his erudition in a
number of disciplines and languages, and the best trained of our people in the
study of botany. This utterly perverse distribution of the means of treatment
to various specialists has brought on a still more damnable calamity and far
more grievous disaster to the particular branch of natural philosophy to which,
since it includes the study of mankind and should rightly be considered the
firmest foundation of the entire medical profession and its first constituent
part, Hippocrates and Plato attached so much importance that they did not doubt
the first place among the parts of medicine should be attributed to it.
Although this branch alone was developed by physicians and they strained every
nerve in acquiring it, in the end it began to collapse pitifully when those
same physicians discarded work of the hands for others to perform and ruined
anatomy. For as long as physicians maintained that only the treatment of
interior diseases was their concern, they believed that knowledge of the
viscera was all they needed, and they neglected the fabric of bones and muscles
and the nerves, veins and arteries that run throughout the bones and muscles,
as if these were irrelevant to them. Moreover, when all operations were
entrusted to barbers, not only did true knowledge of the viscera perish from
the medical profession, but the work of dissection
completely died out. Physicians did not undertake surgery, while those
to whom the manual craft was entrusted were too uneducated to understand what
professors of dissection had written. So far this class of men is from
preserving for us the difficult and abstruse art handed down to them, and so
far has this pernicious dispersal of the healing art failed to avoid importing
the vile ritual in the universities by which some perform dissections of the
human body while others recite the anatomical information. While the latter in
their egregious conceit squawk like jackdaws from their lofty professorial
chairs things they have never done but only memorize from the books of others
or see written down, the former are so ignorant of languages that they are
unable to explain dissections to an audience and they butcher the things they
are meant to demonstrate, following the instructions of a physician who in a
haughty manner navigates out of a manual alone matters he has never subjected
to dissection by hand.
And as everything is being thus wrongly taught in the universities
and as days pass in silly questions, fewer things are placed before the
spectators in all that confusion than a butcher in a market could teach a
doctor. I pass over any number of schools where dissecting the structure of the
human body is scarcely ever considered; so far has the ancient art of medicine
fallen from its early glory many years past. But when in the great felicity of
this century (which the gods wish to be wisely governed by your genius)
medicine had now for some time begun to revive along with all studies and raise
its head from the deepest shadows, so that in many academies it seemed without
doubt nearly to have regained its ancient radiance, and still required nothing
more urgently than the altogether dead science
of the parts of the human body, I was challenged by the example
of so many outstanding men and decided that aid must be brought on my part to
this cause by whatever means I could.
Not wishing to be the only one to fall idle while all others are
applying themselves with such success to some common topic of interest, or to
be unworthy of my ancestors,
it was my thought that this branch of natural philosophy should
be recalled from the dead so that even if we treated it less perfectly than the
ancient professors of anatomy, it should be good enough that no one would ever
be ashamed to declare that our science of anatomy could be compared with the
ancient one; and that in this present era nothing so fallen to ruin had been so
soon restored to health as Anatomy.
But this project would never have gone forward if when I was
studying medicine at Paris I had not personally set my hand to Anatomy at a
time when my fellow students and I had to content ourselves with a few internal
parts being superficially displayed at one or two public dissections by the
most ignorant barbers. So perfunctorily was Anatomy treated in the place where
we first saw medicine successfully revive, that I myself, trained in a few
dissections of animals under the famous and never sufficiently praised Jacob
Sylvius,
at
the urging of friends and instructors conducted a better than usual public
dissection
— the third anatomy I ever attended. When I
made my second attempt (barbers having been relieved of the task), I tried to
demonstrate the muscles of the hand along with a more accurate dissection of
the viscera. Except for eight abdominal muscles which had been disgracefully
mangled and presented in a perverse sequence, no one (to tell the truth)
had ever before demonstrated to me a single muscle or a single
bone, much less a correct series of nerves, veins, or arteries.
Soon after at Louvain, to which I had had to return because of the
disruptions of war,
because for the last eighteen years the doctors there had not even
dreamt of Anatomy,
and in order to do the students at the Academy a good turn and
make myself more proficient in a completely unknown subject that was to me of
the greatest importance in medicine, I conducted lecture demonstrations of the
human fabric—a little more accurately than in Paris—with the result that the
younger professors at the Academy are now seen to devote substantial, serious,
and diligent work to identifying the parts of the human body, understanding
clearly what an extraordinary instrument of philosophy this knowledge provides
them.
Later in Padua, at the most famous university in the entire world,
because the study of Anatomy pertains also to the profession of surgical
medicine (on which, so as not to dissociate myself from the rest of medicine, I
give lectures, having been employed for five years under a stipend from the
illustrious Senate of Venice,
which is by far the most generous in its support of higher
learning), I plied this task while inquiring into the structure of man. My hope
has been that I might more often practice Anatomy here in Padua and in Bologna,
and by rejecting the silly habits of the schools so demonstrate and teach, that
by this anatomical method we would be deprived of nothing that comes down to us
from the ancients and would not still be trying to find out the construction of
any part that exists.
But the indolence of doctors has been too eager to
prevent the writings of Eudemus,
Herophilus,
Marinus,
Andreas,
Lycus,
and other luminaries of dissection from
being preserved for us, since not even a fragment of a page survives of so many
illustrious authors of whom Galen records more than twenty in the second book
of his commentary on Hippocrates’ book On the Nature of Man —indeed, scarcely
half of Galen’s anatomical books have been saved from extinction.
As
for those who followed him, among whom I count Oribasius,
Theophilus,
the Arabs,
and as many of our own authors as it has so far been
possible for me to read, if they have passed down anything that is worth
reading, [page *3v] they all have borrowed it (if they will forgive me for
saying so) from Galen. By Jove, to a serious dissector, there is nothing they
seem less likely ever to have done than dissect a human body; so tenaciously
have the most prominent of these writers, trusting in their own foppish style
of writing and the careless dissection of others, perversely condensed Galen
into overpriced digests, never departing so much as an fingernail’s width in
their emulation of Galen’s views — indeed, they add to the prefaces of their
books the claim that their writings are completely patched together out of the
opinions of Galen and that everything of theirs is Galen’s, even going on to
say that if anyone should find fault with their views, he would thereby be
judging Galen himself guilty of error.
To this man they have all so entrusted their faith that no doctor
has been found who believes he has ever discovered even the slightest error in
all the anatomical volumes of Galen, much less that such a discovery is
possible: even though (notwithstanding that Galen often corrects himself, that
more than once after learning better he points out in some books a careless
error he has made in others, and that he often contradicts himself)—even though
it is just now known to us from the reborn art of dissection, from the careful
reading of Galen’s books, and from the welcome restoration of many portions
thereof, that he himself never dissected a human body, but in fact was deceived
by his monkeys
(granted a couple of dried-up human cadavers came his way)
and often wrongly disputed
ancient doctors who had trained themselves in human dissections. In fact, you
will find many things in Galen which he misunderstood even in monkeys, not to
mention the most astonishing fact that among the many and infinite differences
between the organs of the human body and the monkey Galen noticed only those in
the fingers and the flexion of the knee;
he would no doubt have missed these as well, had they not
been obvious to him without dissecting a human.
But for the present, I have decided not to criticize the false
doctrines of Galen, who is easily the greatest of the professors of dissection;
much less would I wish at the very beginning to be held impious toward the very
author of all good things, and disrespectful of his authority. For I am not
ignorant how doctors (quite unlike the followers of Aristotle) tend to become
agitated when it comes to their attention nowadays in the course of a single
anatomical demonstration
that Galen has departed much more
than two hundred times from a true description of the harmony, use, and
function of the human parts, and they grimly puzzle over the dissected pieces
with the utmost determination to defend him. But let even these men gradually
soften their position out of a love of truth, and let them trust their not
ineffectual eyes and powers of reason more than the writings of Galen; let them
carefully write out these unexpected truths which are not cadged from other
authors and not verified merely by a collection of authorities, and send them
to friends hither and yon, both for their examination and finally for the
knowledge of true Anatomy, exhorting them in such an earnest and friendly
manner that there will be hope that this kind of Anatomy will soon be
cultivated in all the academies just as it was once regularly practiced at
Alexandria in the age of Herophilus, Andreas, Marinus,
and the other
foremost masters of dissection.
To further the success of this hope as much as is in me with the
happier auspices of the Muses, I have added to the works in this vein which I
have previously published—and which certain plagiarists produced as their own
work, thinking I was far from Germany.
I have now freshly organized knowledge about the parts of
the human body into seven books, in the same order which I am accustomed to use
in this city and in the assemblage of learned men at Bologna.
Thus, those who were present at one of my dissections will
have notes of what was demonstrated, and will demonstrate anatomy to others
with little trouble. Yet the books should be far from useless at some other
place to those unable to view an anatomy first-hand, since they explain in
sufficient detail the number, location, shape, size, makeup, connection to
other parts, use, function, and many such features of each part of the human
body whose nature we are accustomed to investigate as we dissect. They also
describe the technique of dissection and vivisection, and they include pictures
of all the parts inserted in the text in such a way that they place the
dissected body, as it were, before the eyes of those studying the works of
Nature.
In the first book I have described the nature of all the bones and
cartilages, which because the other parts are supported and stabilized by them
and are described in accordance with them, are the first to be learned by
students of Anatomy.The second book records the ligaments by which bones and cartilages
are connected to each other, and then the muscles, producers of voluntary
motion.
The third includes the highly complex series of veins which carry
familiar blood
to the muscles, bones, and other parts for their
nourishment, and of the arteries that regulate the mixture of innate heat and
vital spirit.
The fourth explains not only the distribution of nerves that go to
the muscles,
but the branches of the others
as well.
The fifth tells about the construction of the organs that assist
nutrition, which is accomplished by food and drink. In addition, because of
their proximity, it also contains the instruments fashioned by the supreme
Maker of things for the succession of the species.The sixth is devoted to the heart, fomenter
of the
vital faculty, and to the parts that assist it.
The seventh examines the harmony of the brain and the organs of
sense in such a way that the series of nerves taking their origin from the
brain, explained in the fourth book, is not repeated.In arranging the order of these books, I have followed
the opinion of Galen, who believed that after an
account of the muscles, the Anatomy of the veins, arteries, nerves, and finally
of the inner organs must be explained.
Someone will quite rightly maintain that, particularly for the
novice in this science, a rough knowledge of the inner organs should accompany
the distribution of vessels, just as I have provided in the Epitome,
which I prepared as a kind of path through these books and an index of the
items shown. It is honored by the radiance and protected by the authority of
the most serene Prince Philip,
your Majesty’s son, a living
model of his father’s virtues (from whom whatever things can be wished for in
the finest ruler in all the world are expected in the greatest abundance).
But at this point there comes to mind the judgement of certain
persons who bitterly condemn the practice of putting even the most detailed
imaginable illustrations, not just of plants but also of parts of the human
body, in front of students of the natural sciences: such things, they say,
should be learned not from pictures but by painstaking dissection and
observation of the things themselves — as if I had illustrated my narrative
with the most authentic anatomical images (never, I hope, destined to be
spoiled by the printers), with the intention that students would depend on them
and refrain from dissecting cadavers, and as if I had not rather joined Galen
in urging medical students by every means possible to take on dissections with
their own hands.
Assuredly, if the habit of the ancients, who trained their boys at
home in the methods of dissection just as they did in writing and reading, had
continued to the present day, I should readily dispense with not just the
pictures but also all commentaries, just like those ancients who did not begin
writing about techniques of dissection until they believed it was honorable to
communicate the art not only to their children but also to unrelated adults
whom they esteemed for their ability.
As soon as the custom ended of training boys in dissection, as an
immediate and inevitable consequence they learned less well, since the training
they were accustomed to commence in childhood was abolished. Consequently, when
the art of medicine left the family of the Asclepiads
and declined for many generations, there was a need for books
to preserve a view of it intact.
How much pictures aid the understanding of these things and place a
subject before the eyes more precisely than the most explicit language, no one
knows who has not had this experience in geometry and other branches of
mathematics. Our pictures of the body’s parts will especially satisfy those who
do not always have the opportunity to dissect a human body, or if they do, have
a nature so delicate and unsuitable in a doctor that though they are obviously
captivated by a knowledge of humankind that is most pleasant to them and
attests the wisdom (if anything does) of the infinite Creator of things, they
cannot bring themselves actually to attend an occasional dissection.
However that may be, I have made every effort for
a single purpose: to be of use to as many people as possible in an extremely
abstruse and no less arduous enterprise, and to provide as truthful and
complete an account as possible of the fabric of the human body, which is made
not of ten or twelve different parts (as it seems to the casual observer), but
of some thousand. For the understanding of those books of Galen still preserved
for posterity which among the other monuments of this divine man
require the assistance of a teacher, I aim also
to bring no unwelcome profit to students of medicine.
At the same time it does not escape me how little authority this
effort of mine will have on account of my age, as I have not yet passed beyond
my twenty-eighth year, and, because of my frequent indications of Galen’s
untrue beliefs, how unprotected my work will be from the attacks of those who
have not attended my anatomy instruction or have not themselves made a serious
study of anatomy and at first sight will contrive various theories in defense
of Galen,
unless it come to light auspiciously, duly approved by
the great patronage of some godlike power. Because it can never be more safely
protected or more splendidly honored by any immortal name greater than that of
the divine Charles, the most invincible, greatest Emperor, I again and again
beseech your imperial Majesty with all reverence on bended knee
to permit this
youthful work of mine, which is answerable for many flaws and deficiencies, to
remain in the hands of mankind under your leadership, splendor, and protection
until such time as through experience, the judgement that grows with age, and
learning, I make this labor of mine worthier of the greatest and best ruler, or
until I offer a tribute not to be rejected, another gift on another subject
derived from our art.
Yet I surmise that out of the entire Apolline discipline of
medicine, and indeed all natural philosophy, nothing could be produced more
pleasing or welcome to your Majesty than research in which we recognize the
body and the spirit, as well as a certain divinity that issues from a harmony
of the two, and finally our own selves (which is the true study of mankind).
I gather this for many reasons, chief among them my
conjecture that in that crowd of books that were dedicated to your grandfather
Maximilian of happy memory, the supreme emperor of the Romans, no book more
pleasing ever existed than a little book on the present topic.
Nor shall I ever forget with what
pleasure you looked at my Tabulae anatomicae, and with what interest you
lingered over each table that my father Andreas, chief and most trusted
pharmacist to your majesty, would bring to your attention from time to time. I
will not dwell on that astonishing love of yours for all learned disciplines,
but most especially mathematics, particularly the branch that deals in
knowledge of the earth and stars, and an understanding of it that is admirable
in so great a hero.
So as it is inescapable that [page *4v] you are uniquely interested
in the science of the universe, so you would sometimes be delighted to ponder
the construction of the most perfect of all creatures, and take pleasure in
considering the lodging place and instrument of the immortal soul—a domicile
which, because it admirably resembles the universe in many of its names, was
fitly called a microcosm by the ancients.
Though a knowledge of our own bodily structure is most worthy of
mankind and extremely commendable for its own sake, and gave such pleasure even
to the greatest men of Rome, leaders both in affairs of state and the
philosophic disciplines, to expend their efforts upon, I did not think it
required my praise here. By the same token, I am rightly mindful of Alexander
the Great, who did not wish to be painted except by Apelles, cast in bronze
except by Lysippus, or sculpted except by Pyrgoteles,
and I have thought it still less proper for me to
enumerate any of your praises here, lest I pour darkness instead of light on
them by my meager and unpracticed style—especially since the hackneyed ritual
of prefaces is altogether to be condemned in which indiscriminately and with
little regard to merit, as if in accordance with some standard formula
and for the sake of some cheap gratuity,
everyone is routinely credited with admirable learning, singular prudence,
remarkable clemency, keen judgement, untiring generosity, remarkable love for
men of letters and scholarship, supreme dispatch in the conduct of business,
and the entire chorus of virtues, in which everybody knows perfectly well
(though the words are not mine) your majesty exceeds all mortals no less than
in dignity, success, and triumphant achievements. For this you will be
venerated in your own lifetime as if you were the greatest divinity, whom I
pray the gods may not begrudge to science and all the world, but most
abundantly preserve and protect for mortals unharmed and forever
successful.
PaduaAugust 1, A. D. 1542
