THE birth of Andreas Vesalius took place on the last day of 1514 or early on the following morning. This uncertainty about the origins of so famous an anatomist exemplifies much about his career, his aims, and his intellectual debts to others. His eventual appointment as personal physician to the most powerful monarch in Europe has been regularly viewed as an aberration or as a decision he came ultimately to regret. The very success of his programme for the revival of human dissection has obscured what others were doing, or had already done. The fame of his most important book, De humani corporis fabrica, On the fabric of the human body, a prized possession of more than a hundred libraries worldwide, has often led it to be seen as a typical product of the renaissance genius, although it is almost alone as a medical book in the elegance of its printing and in the beauty of its illustrations. This introduction will attempt a more nuanced view by placing Vesalius into a broad context, looking in turn at his life, his great book, and his impact on his contemporaries.
Andreas Vesalius came from a medical family which had had links with the court at Brussels and with the University of Louvain for almost a century. His father, also called Andreas, although illegitimate, became an apothecary to the Emperor Charles V, and married the daughter of a wealthy councillor and revenue agent, Isabel Crabbe. Of the childhood of young Andreas, his two brothers and his sister, almost nothing is known, except that their father was often away with the emperor, and that he owed much to his mother and his neighbours, the Stern family. In 1529, he left Brussels to study at the Castle School of the University of Louvain, where he embarked on the arts course. His path was that followed by many a wealthy young man, studying rhetoric, philosophy and logic, at a University that, for a brief moment, was in the very forefront of the new humanist movement in education. Its new “Trilingual College,” whose lectures were open to all, offered instruction not only in Latin, the staple of all medieval teaching, but also in Classical Greek and Hebrew. Like the greatest of all Netherlands humanists, Erasmus, its professors wished to inculcate an understanding of the foundations of scripture, in Hebrew and Greek, and of the classical authors of Greece and Rome. They aimed to revive a Latin style of writing that avoided what they saw as the linguistic solecisms of the Middle Ages and instead used the Latin of the ancient Romans. They stressed the need for a variety of expressions for the same activity or object, complex sentences that would encompass in an architectural whole a series of interlinked statements, and a flowing rhetoric that would add an elegant literary polish to any theme. Vesalius’ Latin is a tribute to his teachers, although its variations, its periodic structure, and its orotundity are not always to the taste of modern readers, accustomed to a more straightforward manner of expression.
While at Louvain, if not earlier, Vesalius turned his mind to medicine, and in 1533 he planned to take lodgings in Paris with a great humanist-to-be, the future Strasbourg teacher Jean Sturm. Paris had long been the leading medical school North of the Alps, both in the number of its students, although they were extremely small by modern standards, and in the reputation of its professors. The Paris printers, like Simon de Colines, were also keen to publish the very latest works on medicine, and the presence of the French court also drew to the metropolis doctors and surgeons from all over France and beyond. Relations between the University, the physicians, the surgeons, and the barber-surgeons in Paris were not always harmonious, especially as the physicians wished to impose their writ and their privileges on all other medical groups, but during Vesalius’ stay, there were none of the great battles that characterised the early years of the century. Teaching took the form of lectures on particular texts in Latin, especially Hippocrates, Galen, Avicenna, and Rhazes, which expounded the meaning of these often obscure treatises and showed the principles of medical theory and practice that they contained. The faculty library was filled with manuscripts of these authors in Latin. Practical instruction was rarer, and a dissection of a corpse before the student body was a relatively recent and infrequent innovation. Anatomy was primarily learned from a book, especially the Introduction to Anatomy of Mondino de’ Liuzzi, a Bolognese professor who had lived and taught two centuries earlier. When an anatomy did take place, the body was cut up by a surgeon or an assistant, while the teacher expounded the words of Mondino, attempting to set his instruction into a broad context of medical and philosophical knowledge. Practical experience, by contrast, was gained by working with a master or, as with anatomy, carrying out independent investigations. Vesalius was not alone in visiting the Parisian cemeteries to look for bones and skeletons, and, like other students, he not only attended but was asked to take part in the actual process of a public dissection.
Intellectually, Paris was a continuation of Louvain in being at the forefront of the new humanist movement, not least in medicine. While in Oxford, Cambridge or Cologne, medical teaching remained heavily focussed on medieval Latin translations or treatises, the Paris faculty of the 1530s was deeply involved in the move towards a better understanding of the principles behind these medieval productions through a return to purer sources, the words of the Greek and Latin authors on whom subsequent authors depended. It was a movement begun in Italy, in Ferrara in the 1480s, and then in Bologna, Padua, Pavia and other universities, from where it spread over the Alps to affect all Western Europe by the 1540s. Its leaders, like Niccolò Leoniceno or the Englishman Thomas Linacre, the founder of the London College of Physicians, thought of themselves as being progressive — and they were right. They argued that many of the texts of medieval medicine, and especially those derived from the Arabic, were filled with errors that derived from a misunderstanding or miscopying of the original words of the Greeks, especially Galen and Hippocrates. If one could return to the original sources, understand them correctly, and even add to their number by bringing to light treatises that had remained for centuries unnoticed in Greek manuscripts, then one would have a much clearer and sounder basis for the principles of medicine. Confusion would be swept away through philological exactitude, and one would indeed have brought about a rebirth of medicine. These new standards, enforced throughout medicine through colleges of graduate physicians, would ultimately benefit all mankind.
Such a programme could not but appeal to Vesalius, who had been well trained in the classical languages, and at Paris he found some of its leading exponents. Throughout the medical faculty, from the lecturer in surgery, Jean Tagault, to its Dean, Jean Vasses, scholars were eagerly translating, commenting upon, and putting to wider use the newly rediscovered riches of the Ancients. The arrival in print of the works of Galen in Greek in 1525, of Hippocrates in 1526, and of several other Greek writers in the next decade, led to a flood of new translations in Latin, and occasionally into French, and to a reorganisation of the texts chosen for comment. By the 1550s, Paris was the place to come and learn Hippocratic medicine based on the writings in the Hippocratic Corpus, but in the 1530s it was the works of Galen than dominated. Some Parisians, like Jean Fernel, sought a new synthesis that would develop insights provided by the Greeks, but others, notably the two Faculty members who most influenced Vesalius, Jean Dubois (Sylvius) and Johann Guinther von Andernach, were heavily involved in the actual production and dissemination of translations of works unknown for centuries.
Sylvius (1478-1555) was the older man. Trained in the classical languages, as well as in Hebrew and mathematics, he came to medicine with a strongly philological bent. But he had a practical side to him that is often forgotten. He had spent some years travelling to learn practical botany and pharmacology, subjects revived by the humanists under the influence of Galen and Dioscorides, and a later pupil in the 1540s refers to him refusing to let others dissect for him and bringing in under his robes a mouldly arm or thigh of a dissected criminal. In the 1520s and 1530s he had translated many of the newly published works of Galen, but he did not begin to lecture within the medical Faculty until 1536. At least until 1542 Vesalius always spoke of him with respect, and his recollections of his teaching do not depict the ferocious Galenist of his last years. Guinther (1505-1574) was the rising star of the Faculty. He had travelled widely, including a period at Leipzig studying medicine, before he came to Paris in 1527. He quickly gained his degrees in medicine, becoming Professor in 1534. He was a phenomenal translator of Galen — a joke had him translating while standing on one leg — and of other Greek medical authors, and, at this period in his life, he was a vigorous and outspoken Galenist, attacking his colleagues for their ignorance of the true meaning of Galen, despite their claims to be his adherents.
Both Sylvius and Guinther were proponents of the new Galenic anatomy. Guinther’s translation of Galen’s Anatomical Procedures effectively for the first time made Galen’s most important practical treatise on anatomy accessible to a wide audience, and easily outsold the rival (and slightly earlier) translation of the work by Chalcondylas and Berengario. Both men were keen on anatomy, publishing their own little guides to anatomy to supersede that of Mondino. Sylvius’ combines a Galenic method of dissection and some of his own discoveries with an exposition of the anatomy of man in Galenic terms, athough he was aware that Galen had largely dissected animals. Guinther’s book was far more literary, and his lectures on anatomy more bookishly Galenic. Yet he was aware of his limitations, and he employed his students to carry out the actual dissections for him. One of them was Vesalius, who is praised for his technical expertise in his dissection of the spermatic vessels. Clearly the young Vesalius, after his practice on bones, skeletons, and a variety of animals, was already famous for the quality of his work with the knife.
The outbreak of war between France and the Emperor put an end to Vesalius’ stay in Paris. He returned to Louvain, inspired by the new medical humanism. The medical faculty at Louvain he found old-fashioned defenders of the indefensible, and even its most up-to-date member, Drivère (1504–1554), was unsympathetic to many of the views of Paris or the Italians. Vesalius’ MB thesis, published in February 1537, is an uneasy compromise, a Paraphrase of one of the staples of medieval medical teaching, Book IX of the Liber ad Almansorem, a Latin version of a medical handbook by the Arab physician Rhazes. Vesalius’ paraphrase makes more explicit its therapeutics, in a more elegant Latin, while his notes occasionally point out places where the Arabs had misrepresented their Greek and Latin sources. What he gained at Louvain was greater experience in anatomy, being invited through his contacts with men of wealth and influence to attend autopsies and being protected by the burgomaster when he sought to obtain bodies for his own private dissections. He proudly records how he stole a body hanging from a gibbet outside the town gate, and prepared and mounted it as a demonstration skeleton, supplying the missing hand and leg bones from another corpse.
Between March 1537, when a second edition of his Paraphrase was published in Basle, and December 1 of that year, when he was examined for the MD at Padua in Italy, nothing is known of his movements. As a wealthy man, with pretensions and humanist interests, it is hardly surprising that he should make his way to N. Italy, where the best medical schools were to be found, or to Padua, where the new humanist Galenic medicine found notable exponents in such professors as Giambattista da Monte and Francisco Frigimelica. It was a path followed by many medical students from all over Europe, from England, Spain, Germany, or Poland, and was encouraged by a Venetian government, eager to profit economically from visitors to its university. The rule that no local citizen could hold a chair not only prevented the formation of dull dynasties of teachers, but also allowed the authorities to bring in new talent and ideas. The 1530s, after a period of stagnation and economic uncertainty, saw a marked upswing in the fortunes of the university.
The day after his graduation, the young Vesalius was appointed to a lectureship in surgery and anatomy at a beginner’s salary of 40 florins. Whereas in N. Europe surgery was not taught as a university subject, in Italy it formed a small part of the medical course, usually alongside anatomy, and would-be surgeons could gain some of their training at the university rather than entirely by surgical apprenticeship. Why Vesalius was chosen is not clear — the swiftness of his appointment is not unusual — but he may already have had a reputation for his anatomical skills and have impressed the faculty during the few weeks when he was in Padua preparing for his MD examination.
He began teaching straight away, giving lectures on surgical inflammation and dissecting his first corpse on December 6. Anatomical dissections had for some time been a regular part of medical education at Bologna and Padua, and the, at least annual, demonstration lasted for over three weeks. It was held in winter, and followed the order of Mondino, beginning with the abdominal cavity, thorax, head, brain and and finally the extremities, which reduced the problems caused by putrefaction. One of the student spectators records that Vesalius was lecturer, demonstrator and dissector in one, and that he recommended his students to follow the anatomy texts of Galen and Guinther rather than Mondino, evidence of his new humanism. His other pedagogic innovation, presaging what was to come in the Fabrica, was to introduce drawings and (later) detailed printed sheets as a pictorial exposition to accompany and support his actual anatomy.
Within eighteen months Vesalius had made his mark in Italy, by his dissections and by exploiting the power of the printing press. In 1538, unbeknown to its original author, he published a revision of Guinther’s Introduction to anatomy, claiming that previous editions had been badly in need of correction. This Vesalius provided, altering sentences here and there to incorporate some of his own findings, while at the same time paying regard to his old teacher and to Galen. Guinther was not amused, but Vesalius continued to amass corrections for a possible future edition of what he regarded as an extremely useful small compendium of anatomy in the Galenic tradition. A further aid for students was provided by Vesalius in 1538 with the publication of the Tabulae anatomicae sex, Six anatomical plates, six sheets drawn by the artist Jan van Calcar, in large part on the basis of Vesalius’ own drawings.
These six plates mark a major change in anatomical illustration. Earlier sheets had been intended as an aid to memory, their contents were often crudely drawn, and their anatomy largely fanciful. Here, although still heavily based on Galenic doctrine and incorporating a detailed list of anatomical terms in Greek, Latin, and occasionally Arabic and Hebrew, Vesalius and his artist drew some of the parts of the skeleton, the vascular and the nervous system from life. The general thrust was still Galenic and based on animals, but in both text and illustration Vesalius modified or cast doubt on certain of Galen’s anatomical and physiological conclusions. His choice of a competent artist, and his aim to produce them at an affordable price for students attending his lectures, also are traits that can be seen later in the Fabrica and in its Epitome. He was also, he says, planning a major work on anatomy.
The Tabulae were a commercial success — although Vesalius himself did not always benefit. They were plagiarised by printers in Augsburg, Strasbourg, Frankfurt, Cologne, Paris, and Marburg, thus helping to spread Vesalius’ reputation around N. Europe. They may have stimulated printers in several cities to publish similar sets of anatomical sheets, although not so well drawn or executed. They undoubtedly showed Vesalius’ great skill as an anatomist, and it came as no surprise that he was invited to the equally prestigious and medically distinguished university of Bologna in 1540 to perform a dissection to accompany the anatomy lectures of Professor Corti (1475–1544). Corti, the highest paid medical professor in Italy, had met Vesalius in Bologna once before, in 1538, when they had argued over the existence of fibres in the veins, which Vesalius believed he could show by dissection and thereby prove Galen right. Corti, by contrast, despite being a devoted adherent of Galen, thought Galen had here erred.
Two years later the positions were reversed. Vesalius had been invited by the university students to dissect three human bodies, six dogs and other animals to illustrate Corti’s lectures on Mondino’s Anatomy. He was to deploy his technical expertise while the senior man discoursed on the wider implications of the anatomy, correcting Mondino’s medieval notions by reference to the newly rediscovered anatomical works of Galen. Conscious of his status, Corti suggested that Vesalius was a mere dissector, a little superior to a surgeon but scarcely a respectable physician if he could handle a scalpel. Their confrontation before an audience of almost 200 crowded into the church of San Francesco was certainly a lively one. The two men argued and interrupted one another. Vesalius often let Galenic doctrine pass without comment, but others points, like Galen’s belief in the five lobes of the liver (which he had himself depicted in the Tabulae) or the precise point of insertion of the rectus abdominis muscle, he denounced as contrary to the actual evidence of anatomy. He also used drawings and plates to point out the significance of his visual evidence. When Corti’s lectures were concluded, he stayed on to perform several private dissections, of both animals and humans, and mounted for Professor Bianchi two skeletons, of an ape and a French priest, to compare their articulation.
The significance of the Bologna debate is considerable. Vesalius expressed for the first time his conviction that mere book-learning was not enough and that demonstrable evidence should take precedence over the written. It marked a stage on his move away from a narrow Galenism, but only a stage, and it did not, as yet, distinguish him unduly from those, like Sylvius, Corti, Berengario da Carpi or Niccolò Massa, who were prepared to believe that Galen had made this or that mistake but was still in general correct. Nor were they bothered by Galen’s confession that he was forced to rely largely on animals for his description of the body, for they all, Vesalius included, inspected animals to supplement the supply of human corpses and bones. A general adherence to Galenic theory by Vesalius is clear from his letter on venesection of 1539, in which he supported Galen’s rules on bloodletting against those of his Arabic interpreters, or from the Galenic therapeutics in his case notes from this period. Nor had he qualms about revising in 1540-1541 the Latin versions by others of Galen’s anatomical treatises as part of the complete edition of Galen’s writings published by the Giuntine press under the supervision of his Paduan colleague Da Monte. His English housemate, John Caius, records how they both checked for Galen’s original words in an old Greek manuscript provided for them by the editor-in-chief Agostino Gadaldino. In so doing, by seeking to correct misunderstandings by returning to what they thought were Galen’s own words, they were hoping to find purer springs and a more accurate description of bones, muscles and the like. Progress might be made by removing earlier miscopyings and mistranslations. They were thus improving contemporary anatomical knowledge by retrieving truth from the past: why they should do this, and why Galen was so significant will be described in the second section of this Introduction.
Vesalius’ career in Padua flourished. His salary was increased in 1542 to 200 florins, and he was joined as a lecturer in surgery by his pupil Realdo Colombo. Yet increasingly he was occupied with his big book, the Fabrica, which he began to write perhaps in 1540 and had substantially completed by summer 1542. It was based first on his knowledge of Galenic anatomy and physiology and secondly on the evidence he had gleaned from his many dissections. Some he had carried out in public, like the mistress of a Paduan monk stolen from her tomb by eager students; others he had autopsied, like the oarsman of a papal trireme; still others, with the active encouragement of the local authorities, he had taken home to dissect after a public execution. When human corpses and bones were lacking, he turned to animals. He spoke to midwives and to professors, he visited the butcher’s stalls and the hospitals, he read or re-read his Galen, sometimes in Greek manuscript, he discussed his plans with fellow scholars and with artists. Above all, he wrote, and wrote, free from the distractions of a busy practice and taking advantage of the intellectual climate of Padua and nearby Venice. He was a young man in a hurry, with a career to make. By August 1542, the writing was finished, and the blocks for the illustrations were almost ready to be sent from Venice over the Alps to his printer, Johannes Oporinus, at Basle. Privileges, protecting the Fabrica from unauthorised copying, were obtained from the Venetian Senate and from Charles V, and one was promised from France. Having obtained the university’s permission to go on leave, Vesalius departed for Basle in 1542 to supervise the printing of his masterpiece.
Why he chose Basle and Oporinus remains unknown. Venetian printers were certainly as sophisticated in their typography as the Swiss, and there is no reason to believe that there was a lack of investment potential among Venetian printers or shortages of paper or metal for the fonts. At least two crews of compositors were employed to print the Fabrica, and such numbers could easily have been found near the Rialto. Vesalius’ artist worked in Venice, his wood blocks for the illustrations were cut in Venice, and his closest colleagues were in Padua. Two possibilities suggest themselves; the ambitious Vesalius may have chosen Basle because of its better means of book distribution, down the Rhine to France and Germany or over the Alps to Italy, and he had also published twice before with the firm of Oporinus. Alternatively, Basle was closer than Venice to the greatest potential patron of all, Charles V, to whom he so ostentatiously dedicated the volume. The copy that was sent to the emperor, gloriously coloured and on vellum, represents a huge financial gamble by the young man, or a truly confident belief in his own ability to succeed.
He arrived in Basle in January 1543, perhaps having spent some time with the anatomist Canano at Ferrara. While correcting the proofs and making a few minor changes, he continued to dissect. The skeleton he constructed from the bones of an executed criminal he anatomised is still preserved in Basle, gazed at in wonder by families on Sunday mornings between church and lunch. He also prepared a digest of the Fabrica, the Epitome, for students, a mere six chapters long with nine illustrations, printed on poorer quality paper but of even larger size to make their details clearer. Some were taken over from the Fabrica, others were cut anew, and the text was much simplified to fit the demands of a student audience. At the same time, the Basle professor Alban Thorer was preparing a translation into German of the Latin Epitome, which appeared in print only days after the Epitome in August 1543. Oporinus was the printer for all three works, which between them aimed at three different markets: the Latin Epitome at students with Latin, the German version at non-Latinate surgeons and the general German public, by now a major publishing market covering the whole of central Europe, and the Fabrica itself at wealthy men of learning, connoisseurs as well as physicians.
Vesalius did not stay long in Basle, hurrying north with the presentation copies of the Fabrica and the Epitome to Charles V, who was about to go on campaign in the S. Netherlands. Their meeting was doubly successful. The emperor expressed his pleasure in the gift, and enrolled Vesalius almost at once as one of his household physicians. Vesalius’ eager translation from professor to imperial courtier has often seemed strange to those for whom a major university chair might seem the summit of achievement. Yet family precedent, ties with his home region, wealth, honour, and the prestige of attending the greatest monarch in Europe will all have had their attractions and one should not forget that Vesalius was trained as a physician and that his interests also extended to therapeutics. Royal courts were also major centres of scientific culture and patronage; Galileo, the physician-botanists Matthioli and Clusius, or, among Vesalius’ contemporaries, the prolific Galenist Giulio Alessandrino were courtiers as well as scientists. A decision to enter imperial service was, as Vesalius himself realised, a step that, once taken, was almost irrevocable. Despite the pleas of his friends, and as he came to regret later, he got rid of much of his library, burning his unpublished Paraphrase of the whole of Rhazes’ For Almansor, his notes on Galen, and his own copies of Galen, into whose margins he had written corrections and observations. His scathing comments on the value of such marginalia will have also been directed to such opponents as John Caius, the margins of whose books are filled with copious annotations. Becoming a court physician, Vesalius realised, meant the likely end to all his writing.
Before committing himself full-time to life with the Emperor, Vesalius made a visit to Italy in late 1543-1544 to retrieve his property, for both he and the faculty at Padua had envisaged that he would return after his leave in Basle. It was a triumphant progress, save for a confrontation with Colombo, his successor as anatomist, who had boasted that he had found things in his dissection that were unknown to Vesalius — evidence for the speed with which Vesalius’ ideas became the standard for up-to-date anatomists. Five hundred attended Vesalius’ lectures and demonstrations in Padua, and an anatomical dissection at Bologna continued far into the night, before Vesalius slipped away to Pisa, whose university had been reopened only a few weeks previously. There he carried out a series of dissections on corpses gladly sent from Florence and elsewhere at the behest of Duke Cosimo dei Medici, who would himself have liked to attend at least some of the lectures. He assisted at autopsies in Pisa and Florence, and an attempt was made to persuade Charles V to let his physician remain at Pisa. The request was turned down.
Vesalius returned North to war alongside the Emperor, treating the wounded, not always with total success, and preparing for burial the bodies of nobles and princes. Wherever Charles V went, Vesalius followed, to Ghent, to Brussels, to Cologne, to Nijmegen, to Ratisbon. He treated the Venetian ambassador, the envoy of the Duke of Ferrara, and other courtiers. In 1544 he married Anne van Hamme, the daughter of a rich counsellor of Brussels, who bore him a daughter, also named Anne, in 1545. It was around this time that he became fully aware of the furore that he had created among those whom he had often considered his friends, the Galenists, especially Sylvius. His response was contained in a letter, published in 1546, ostensibly in its first part discussing the so-called china wood, a new discovery that was said to be superior to guaiac as a remedy for nervous disorders, but in its second half mounting a vigorous defence against his detractors and, at the same time, those who had sought to plagiarise his book and its illustrations.
He continued to dissect, especially when performing autopsies, but increasingly he was called in to act as a physician and surgeon. His skill with the knife was widely recognised, even if not all agreed that he was the best surgeon at court. He built a very large house in Brussels, with galleries stables, and its own orchard, next to that of Count Mansfeld, and he was amassing a considerable fortune, made in part from his private practice in the city, where he may have resided almost continually from 1553–1556.
This period of relative stability enabled Vesalius to prepare revisions for a second edition of the Fabrica and its Latin Epitome that had been contemplated perhaps as early as 1551. To what extent, if at all, he had been involved in the reissue by Oporinus around 1548–49 of a variant version, slightly corrected and using in part a different font, is unclear. Vesalius himself never mentions it, and the small number of changes, mainly typographical, could have been made by the printer and his corrector without recourse to the author.
But the revised edition of 1555 was a different matter entirely. Although its frontispiece is somewhat cruder, in almost every other respect the second edition marks a major improvement over its predecessor. Its typography is even more elegant, and the illustrations are better spaced and made more legible. There are many small changes to the Latin, making it even more harmonious, but there are major alterations too, as the notes and accompanying passages to this translation show. Some were imposed of necessity; e.g. the name of Gerard van Veltwyck was removed, because he was by then dead. Others were the result of greater knowledge — or of pique, e.g., the demotion of his teacher Sylvius, by now engaged in a furious quarrel with his pupil. New chapters were added, and the order of others changed, but in general the alterations occur within the chapters. Most obviously they show the results of Vesalius’ continuing experience of dissecting corpses, especially his autopsies. He corrects or amplifies his earlier statements, referring constantly to his own experience and playing down his Galenism. Two areas in particular are worth noting. His experiences with female corpses, including pregnant women, enabled him to rewrite much of his anatomy of the womb and the foetus, and to move away from the animal anatomy that had characterised earlier descriptions. His comments on the heart depart from the Galenic view, from which he had earlier been afraid to dissent, to a stronger insistence on the facts of anatomy, especially when they appeared to prove that, contrary to Galenic doctrine, the intraventricular septum was impermeable. On the conclusions to be drawn from this challenge to Galenic orthodoxy Vesalius was cautious, expressing his doubts about the traditional description of the course of the vena cava, and calling for further investigation into these, to most anatomists, novel findings. Although much within the first edition remains unaltered, the 1555 Fabrica makes substantial changes that go far beyond what most contemporary authors did in their revisions. Its overall message was even more uncompromising: the human body could only be understood by a clear and careful anatomical investigation into human corpses, and the evidence of the senses must take precedence over that of past authorities.
The 1555 revision is a major contribution to anatomical understanding in its own right, and has been unduly neglected as a result of the very success of the 1543 edition. This English translation for the first time makes it possible to see easily the extent of the changes between the two editions. Far from being a mere update, as most scholars have assumed, the revision goes far beyond simple correction and readjustment: it represents both anatomical evidence gathered since 1542 and, more importantly, the results of Vesalius’ continued meditation on what he had discovered.
In 1556 Vesalius, newly created a Count Palatine by Charles V, was among those pensioned off when that monarch abdicated his throne and retired, with a small entourage, to a Spanish monastery. His heir and successor, Philip II, did put Vesalius back onto his own payroll, but his duties do not appear to have been at all onerous. He remained in Brussels, where he was consulted on a wide range of conditions by many notables, including the wife of William the Silent, Prince of Orange, in 1558. The next year, he was involved in an even more famous case. The French King, Henri II, received a lance in his eye during a tournament in Paris to celebrate peace between France and the Holy Roman Empire. Vesalius was immediately sent for (evidence of his international reputation as a surgeon) to join Ambroise Paré, Daza Chacon, and other leading surgeons from France in trying to save the king. They failed, and Vesalius had to conduct the autopsy, giving a very detailed account of the way in which the lance had penetrated the skull, but without causing a fracture.
Shortly after, following a brief return home, Vesalius moved with Philip II to Spain, although perhaps as physician to the Netherlanders at court rather than as personal physician to the Emperor. In Spain he composed his last anatomical essay, a critique of the Anatomical observations of Gabriele Fallopia (1523–1562), who had been the holder of the chair of anatomy at Pisa from 1548 until 1551, when he moved to Padua. Fallopia was a Vesalian anatomist, technically skilled and equally learned. His criticism were greeted courteously by Vesalius, who took the opportunity to remininisce — and to settle a few old scores. Realdo Colombo and another Spanish anatomist (and plagiarist) Valverde de Hamusco come in for particular criticism, being accused of incompetence in dissection and an almost total ignorance of the anatomical works of Galen, unlike Vesalius, who had even examined manuscripts to make sure of the exact meaning of Galen’s Greek.
The last years of Vesalius’ life are difficult to chart. He was one of those involved in the long and difficult cure of the heir to the throne, Don Carlos, in 1562, when the prince fell downstairs and fractured his skull. The same year he treated the French ambassador, and was consulted by letter about the empyema of the Marquis of Terranova, wounded in the chest at a tournament. He recommended surgical intervention to drain blood and pus accumulating in the thoracic cavity, citing several instances where he had successfully operated in Madrid on members of the court.
He left Spain in 1564 in somewhat mysterious circumstances. A letter allegedly dated to January 1565 explains that he had carried out an autopsy in error on a patient who was still alive, and was denounced to the Inquisition. Only the intervention of the Emperor and the court prevented his execution, and he was instead condemned to expiate his crime by going on a pilgrimage to Jerusalem. Although this rumour, or something like it, was circulating at the end of the 1560s, the actual letter itself was not printed until 1620, and may well be a fabrication. The modern version of the story that has Vesalius condemned for being a secret Protestant is equally unlikely: his contacts were with the Catholic court and Catholic aristocrats, and his reference to “the most holy faith by which we gain salvation through pious works” expresses a Catholic, not a reformed, theology. It was prudence, not Lutheranism, that led him, in Book VI, to refuse to draw any conclusions about the location or nature of the soul and in the revised Fabrica to delete a reference to the blood and water flowing from Christ’s wound. Theological positions had hardened, and the activity of the Inquisition had increased; suspicions of crypto-Lutheranism were rife in Catholic Europe, and sweeps by the Inquisition in N. Italy had netted several leading physicians. It would have been foolish of Vesalius, whose relations with some of the Spaniards at court do not appear always to have been of the best, to make any pronouncement on so delicate a matter, whatever his brand of Christianity.
Later Italian admirers asserted that he had been virtually driven out by Spanish hostility, suggesting that the pilgrimage was a polite way of gaining permission to escape from Spain, and there is little doubt that Vesalius retained throughout his life a great love of Padua. Yet another source, claiming to have heard the truth from fellow Netherlanders in Madrid shortly after Vesalius’ departure, declares that the pilgrimage was made in fulfilment of a vow made when recovering from illness.
Whatever the reason, Vesalius left Spain with his wife and daughter on a long and tedious journey. Soon after reaching Provence, the family split up amid much acrimony, the two Annes returning to Brussels, while Vesalius made his way to Venice, where he met and talked with old friends like Gadaldino. He left for the Holy Land in spring 1564, accompanied as far as Cyprus by Signor Malatesta da Rimini, a military commander in Venetian service, and he is recorded by a fellow traveller visiting the plain of Jericho. According to Pietro Bizzari, whose detailed account of the death of Vesalius was published in 1568, it was just after he had set sail from Venice that the Venetian senate appointed him once more to the chair of anatomy at Padua in succession to Fallopia, who had died in 1562, but no documentation remains in the extensive archives to confirm this story.
Even were it true, Vesalius never had the opportunity to take up the chair. His return journey from the Holy Land was a catastrophe. The boat on which he set sail was allegedly driven before a storm for forty days without landfall, provisions ran short, and Vesalius fell ill. The ship finally made land on the island of Zante (now Zakynthos) off the West coast of Greece, and Vesalius came ashore, only to die almost immediately. His end is as mysterious as his beginning. Two alleged eye-witnesses offer different stories. One, a Venetian, has him dying of plague in a remote inn, and being buried by a compassionate Venetian goldsmith; the other, more plausible, has him dying closer to the main town of Zante, where a German erected a monument in his memory. Later antiquarians recorded an inaccurate epitaph from the Catholic church in the main citadel of Zante, but this has long disappeared, if indeed it ever existed.
Vesalius’ wife, having received a pension from Philip II in view of the long and devoted services of her late husband, soon married again, to the Seigneur of Saventhem, and enjoyed a further thirty years of marriage. His daughter, Anne, married and lived comfortably in their old house until 1587, when it passed to their neighbour, Count Mansfeld. The last descendant of her five children died in the mid-nineteenth century in Courtrai, Belgium, having also served an emperor, Napoleon.
The life and career of Andreas Vesalius are typical of a wealthy Renaissance intellectual of the first half of the sixteenth century. They cross boundaries of nations, politics, religion, and language, united by Latin and a common humanist heritage. It is no surprise to find a Fleming teaching at an Italian university alongside an Englishman, a German, or a Spaniard, or that a grand tour of European unversities might take in Paris as well as Pisa, Louvain as well as Ferrara. The investment of money required for such a training was substantial; one need to be wealthy already, or to have subsidies from a wealthy patron. But the rewards in financial terms were themselves great, and a successful university career might be expected to lead to lucrative posts in a major city like Paris or at court. John Caius, from humbler beginnings, became a doctor to the merchant elite of London and wealthy enough to endow his own Cambridge College.
But what of the man himself ? Vesalius is known largely through his books, and the reactions of others to them. Of his personality, we are told only that he was taciturn at times, melancholic (a sure sign of genius), and somewhat tight-fisted. He was, we may be sure, also ambitious and hardworking, if somewhat tactless or unobservant in his dealings with colleagues. Yet students remembered his lectures with enthusiasm, and even John Caius, his old housemate turned adversary, wrote wistfully of their one-time friendship. Three things stand out above all. Two are well-known, his amazing technical skill with the knife, and his readiness to let the evidence of what he observed determine what he was prepared to believe, no matter how unpleasantly radical that might appear. The third is often forgotten; his abundant learning, particularly in the Galenic Corpus, that enabled him also to grasp the significance of his observations and to express them clearly, coherently, and with conviction. Although the first two marked him out from most of his contemporaries, it needed the third to make of the Fabrica one of the greatest of all books.
There are few books so famous and yet so unfamiliar as the Fabrica, not least because it has never yet been fully translated into a modern Western language. Its humanist Latin, with its complex sentences and literary flourishes, is not easy for those brought up on the simple Latin of Caesar’s Gallic Wars — and their numbers have steadily diminished over the last decades. To read to the end of this very large book is an arduous task in itself. Yet both size and language contribute to the message of the book itself. This is no student handbook, easily slipped into the pocket like Guinther’s Introduction, but a major work of learning; it is not meant for small-town surgeons with only a smattering of Latin at best but for European intellectuals who could appreciate the style as well as the content of the book and who could afford to pay for it. How much it cost in 1543 is uncertain, but Oporinus was charging a bookseller in 1547 five florins and three batzen for the Fabrica and Epitome together. In 1573 a copy owned by John Caius was valued at 6 shillings, a price equalled by only two other volumes in his library; by comparison, Vigo’s Surgery and Fracastoro’s On sympathy and On contagious diseases were both valued at 4d. The Fabrica was the most expensive volume in the library of another Cambridge physician, Thomas Lorkyn; and at 7 shillings in 1589 among the top twenty in the largest of all Cambridge libraries of the sixteenth century, the 2585 volumes that belonged to Dr. Perne. Like the large and deservedly famous illustrated herbals of Fuchs, Matthioli or Lobel, its price reflected its quality as an object, not its medical or scientific influence.
The Fabrica is a work of art, in all senses of the term, yet it deals with a subject, anatomy, in which illustration had played at best a minor role. Its message is conveyed in words, but also in images. Its frontispiece not only depicts the author as dissector and expositor before a large crowd of spectators, but emphasises the almost sacral character of what is to come. Demonstrating in front of a large colonnaded exedra, Vesalius points to reveal the innermost secrets of God’s creation, the internal organs of a woman. The initial plan for the frontispiece may have stressed the religious nature of the act still more by depicting Vesalius pointing upwards to heaven, thereby invoking the purposeful divine order of creation. At the same time, a different message is conveyed by the portrait of the author that follows it. In a somewhat exaggerated perspective, Vesalius gazes out at the reader while displaying the muscles of the arm; his scalpel rests on the table, along with a pen and ink, and a Latin scroll. The base of the table carries the date 1542, Vesalius’ age, 28, and a motto. The whole portrait emphasises Vesalius’ learning, with allusions to the Classics; his status, represented by his elegant costume; his debt to his ancient predecessors, not least Galen; and, above all, his practical skills as dissector and demonstrator. Such portraits of the living learned physician begin to appear in printed books from the 1520s on, but Vesalius’ is the first to show the learned anatomist at work.
Form and content, word and image, fit together so neatly throughout the book that the modern reader may easily misunderstand the novelty of the whole enterprise. Familiarity with Vesalius’ achievement also reduces the impact of his new, yet at the same time old, message. It is set out clearly in the preface. It is nothing less than a demand for an anatomy of the human body based on observation and dissection of human bodies, a revival of that once practised at Alexandria in Egypt by a series of distinguished anatomists who were active from the third century BC down to Marinus in the early years of the second century AD. Their human anatomy was subsequently forgotten, submerged under the mass and the overwhelming rhetoric of Galen, who had relied instead on animal dissection and analogies with animals for his description of the human body. Vesalius’ claims are poor history: while Herophilus and Erasistratus around 270 BC did undoubtedly dissect, and possibly even vivisect, human beings, their successors in Alexandria seem to have been restricted to looking at skeletons and surface anatomy. Marinus may have revived an interest in anatomy in the second century AD, but there is no evidence that he performed human dissection. But as a rhetorical appeal, Vesalius’ preface strikes home. It offers a true renaissance of past learning, a reconstruction of the glories of ancient Greece in the modern world, with the dedicatee, the Emperor Charles V, in the role of Ptolemy II as patron and protector.
The key to the understanding of all that follows lies in the ambiguous role of Galen of Pergamum (129–ca. 216) and in Vesalius’ artful representation of his relationship to his great predecessor and to his own contemporaries. To accept what Vesalius says in the Fabrica and to neglect what he omits, to concentrate on the mistakes of Galen rather than on his achievements, and to see Vesalius as a lone figure oppressed and driven out of academe by vociferous Galenists, is to misrepresent the historical situation and to obscure the crucial differences between Vesalius and contemporary anatomists. Galen is both hero and villain of the Fabrica. His errors are carefully noted, yet the substantial borrowings Vesalius made from him are passed over in silence. Large sections of Fabrica, and not only those in which Vesalius talks about function and purpose or the interrelationship between anatomy and physiology, are taken straight from the pages of Galen. Likewise, a few of Vesalius’s friends and colleagues are mentioned, and the occasional enemy, but the work of other renaissance anatomists is passed over, although it is highly unlikely that he would have been unaware of what, say, Benedetti or Berengario had done. Hence Vesalius’ originality is magnified through his failure to acknowledge his predecessors or competitors adequately.
Galen was deeply committed to the pursuit of anatomy, which he saw as one of the foundations of medicine. His own library contained many volumes of writings on anatomy, and his own medical studies, at Pergamum, Smyrna, and, finally, Alexandria itself, had been with teachers who had themselves been trained in the Alexandrian tradition of anatomy. The revival of anatomy which he associated with Marinus was continued into his own day, even if it was no longer carried out on humans. But it was not just book learning that distinguished Galen from other practitioners. He claims to have developed practical skills ever since his childhood days playing with little wooden toys, and his first official employment was as a surgeon to the gladiators at Pergamum. When he came to Rome for the first time in 162 he created a sensation by a series of demonstrations on animals in which he ligated or cut the spinal cord at different levels to identify the various nerves and their functions. Even when the hostility of his competitors forced him to give up these public dissections, he still continued to exercise his skills in private on pigs, goats, sheep, monkeys and even, on one occasion, the emperor’s newly deceased pet elephant. Whether we should believe his statement that he had dissected almost every day throughout his long life, is disputable, but there is no doubt that he considered dissection an essential part of the training of any medical practitioner. It taught the manual dexterity necessary for a surgeon, but it also provided the non-surgeon with an understanding of the body, its function, structure, organisation and purpose. It was for Galen almost a religious duty, as can be seen from the final book of one of his main tracts on anatomy, On the usefulness of parts of the body, and one that he constantly urged on others. As he put it in a quotation taken from his great Alexandrian predecessor, Erasistratus, one progressed rather like an athlete; at first, dissection appeared difficult, if not impossible, but later, with training and practice, one gained in confidence and ability until, in the end, one could compete with the best.
Galen set out a programme for anatomy, yet it was one that he could not himself fulfil. He looked back wistfully to the days of early Alexandria when Herophilus and Erasistratus were allowed to cut up human beings, and recognised that, for the moment, one had to make do with animal dissection and vivisection. He was well aware of the problems in arguing from animals to man: that was one reason for preferring to dissect monkeys, the closest of all animals to man, whose facial expressions as experiments were performed on them could hardly fail to arose compassion. What one might also do was to take advantage of what chance had placed in one's way — a body stripped clean by a mountain torrent, a corpse visible within a broken tomb, dead soldiers left on a battlefield — and he was scathing of those who failed to profit from these opportunities. Surgical experience, too, might help, although he does not mention any medical role in autopsies or police investigation such as we know were carried out in contemporary Egypt. Galen was aware of the limitations of his own anatomy. He had had occasion to look at or into a dead human body, but only rarely, and he endeavoured to combine this scanty information with what he could gain from his surgical cases or from animal dissections. He would have wholeheartedly applauded Vesalius’ preference for evidence derived from the senses over that presented solely in books — those who followed only what was written down he compared to helmsmen navigating solely from a map — and he would have accepted his argument that a proper anatomy of man demanded human dissection.
Galen wrote about anatomy at length and in a variety of treatises. Some were small, introductory guides to bones, muscles, arteries or nerves aimed at students; others were more substantial, like his book on the organ of smell; and some were very large indeed, like his summaries of the doctrines of Marinus. Three in particular demand attention. Galen described his methods of dissection and his results at length in the fifteen books of his Anatomical procedures. This guide to anatomy was first produced in two books around 165, during Galen’s first stay in Rome, but was later extended considerably in three stages. Books 1–5 were written around 172, Books 6–11 around 189, and the remaining books still later, possibly in the early years of the next century. In them Galen concentrated on how to dissect, and on what dissection revealed.
The precise meaning of these discoveries he expounded in two different works. In On the opinions of Hippocrates and Plato, he used his anatomical discoveries to confirm the opinion of Plato that there were three independent systems within the body, centred on the brain, the heart and the liver, and utilising as channels the nerves, the arteries and the veins respectively. These discoveries he took back to the great Hippocrates, who had in some way imparted them to Plato. More significant was his interpretation of his findings in Aristotelian terms, the seventeen books of On the usefulness of parts of the body. Aristotle and his pupil Diocles in the 330s BCE had carried out a whole series of dissections on animals, birds and fishes. Aristotle himself was not only interested in structure, but also, and above all, in purpose or usefulness. Since nature did nothing in vain, every created part of the body had a function and a purpose; it had been made in accordance with the purposefulness and overall care of Nature. Its structures, especially the hand, the arm, and the eye, revealed the technical genius of the Creator who had so perfectly fitted form to function. Galen here reiterated the methods and results of Anatomical procedures for a non-medical, philosophical audience, going over in equal detail the whole structure and organisation of the body, but concentrating less on exposition than on showing the wonderful purpose that lay behind it all. It was an argument that appealed not only to Aristotelians, but also to later Christians, Jews, and Muslims, who could easily transfer the creative foresight of Nature or the divine Creator to their own single God. Galen’s discoveries thus could be easily assimilated into a monotheist universe, and his piety before the Creator's handiwork taken as evidence that he was a virtuous pagan.
The sheer size of the Galenic Corpus, and of these major anatomical treatises, however, brought problems with them. Some of the smaller tracts were lost over the centuries, like On the voice; others, like the introductory texts on anatomy, were often copied as part of the syllabus of formal medicine that developed in fifth- or sixth-century Alexandria and that was then translated into Syriac, Arabic, and other oriental languages. But they could not convey the richness of Galen’s message, being concerned to present his results in a condensed form rather than to explain, justify, or encourage others to investigate for themselves. The fate of the large Galenic tracts was even less happy. Their size meant that they were expensive to copy and it was not always easy to navigate through their many pages. Where they were available, in Greek or in Arabic, they were not always read, and the last six and a half books of Anatomical Procedures became lost entirely in Greek.
Arab physicians who knew Galen’s anatomical writings were few, and they were on the whole content to adhere to what Galen had declared to be the truth, repeating in short summaries at the beginnings of their writings his account of the body and its structures. Criticisms and corrections were rare — the most famous exception in anatomy being the osteological researches of Abd-al Latif al-Baghdadi (d. 1231). The message of Galen as they interpreted it was that the doctor should think philosophically, employing learning and reasoning to understand the little world of the body against the background of the greater world of the created universe. Galen’s equally strong encouragement to practical research was down-played, if it was ever heeded at all. There were also religious reasons why dissection should be frowned upon.
Western Europe in the early Middle Ages lacked the wealth or the intellectual organisations of the contemporary Arab world, and it was only with the rise of the Universities from the end of the twelfth century onwards and the introduction of new translations that enabled Western scholars to equal their equivalents in Baghdad or Cairo. Even so, the introduction of anatomy as part of university teaching was not a foregone conclusion. The major anatomical treatises, perhaps because of their size, their difficult technical vocabulary, and their apparent irrelevance to practice, remained largely unknown. No medieval Latin translation was made of Anatomical Procedures or of On the opinions of Hippocrates and Plato, while On the usefulness of parts was generally consulted only in the form of a somewhat confused summary, De iuuamento membrorum, while the extremely accurate version by Niccolò da Reggio (fl. 1308-1345) was infrequently copied, still less consulted. Any encouragement to perform dissections had to be derived from elsewhere in the Galenic Corpus.
Traditionally, the first university dissections were carried out in Bologna around 1318 by Mondino de’ Liuzzi (d. 1326), although they had been for some time preceded by surgical autopsies, and Mondino himself expresses no awareness of originality in what he is proposing to do. He himself was one of the new Galenists, a pupil of Taddeo Alderotti (d. 1295), who had introduced into Italian university teaching many of the Latin translations of Galen produced in the previous two generations in Spain or the Near East. Taddeo, Mondino, and their confreres were among the first Westerners to feel the effect of Galen’s rhetoric advocating the necessity for the union of hand and brain, of practice and theory. By returning to the sources, they could also gain inspiration for their teaching, which was more freely Galenic than the logically dominated medicine of Avicenna. But at the same time, they were teaching within the system of the medieval university, which imposed its own constraints.
Mondino’s anatomy textbook transferred to the study of the human body many of the techniques of the medical schoolroom. The aim of the teacher was to explain, to describe, but above all to set in context, to relate the evidence of the body to the wider duties of the doctor. Mondino was constrained by circumstance to depart from Galen in many respects. Galen’s anatomical exposition was a composite, based on a succession of animal dissections and moving outwards and upwards from basic structures. Mondino had only one human corpse before him. In his commentary he chose an order for dissection that took account of the speed with which bodies putrefied, even in winter; it also demonstrated more clearly the hierarchy of the divisions of the soul, rising from the nutritive soul in the liver, through the spiritual in the heart, to the animal in the brain. The bones were left till last, and not every anatomist who followed Mondino found time to deal with them in his course. Although Mondino himself dissected and lectured at one and the same time, his very success led to his book being treated like one of Galen’s as an object of commentary, a repertory of agreed information, on which others could pronounce and meditate. The enthusiasm of Galen for dissection — and, indeed, that of Mondino himself — tended to be lost in such a verbal and logical exposition of a text. The corpse was there to illustrate and confirm the words of Mondino, not to inspire an audience to perform practical investigations themselves. It was there to demonstrate truths, about the organisation of the body, and, at least as important, about the wonders of God in creation.
Mondino’s Anatomy was a great success, but it did not bring about a massive renewal of interest in dissection as such. From Bologna and Padua the notion that there should be at least one formal dissection a year spread only spasmodically and slowly, to Pisa, Vienna, and, by the 1470s, if not slightly earlier, Paris. Even when official agreement on at least one anatomy a year had been established, some years passed with none. There might be a shortage of bodies, or a refusal on the part of the authorities to release the bodies of criminals for dissection. The Church’s well-known abhorrence of the shedding of blood was occasionally interpreted by contemporaries (and by many later historians) as antagonism to this new trend, although in fact the Church never took a formal stand on the matter and often approved the introduction of dissections into the medical curriculum when officially approached, provided that the corpse was given a Christian burial afterwards. Above all, one should not underestimate a general repugnance at the idea of cutting up a human body for purposes that were not entirely clear or easily justified. Even when the barrier of acceptability was cleared, medical faculties then worried about the number of spectators who might come along solely for the show, and about the proprieties to be followed in the actual performance of the dissection. Medical students might also wonder of the value of such an exercise if they could scarcely get close enough to see the intimate details of the body that were being described in the book being expounded. Even by 1500, apart from Bologna and Padua, in universities where public dissections had been introduced, often, as in Vienna, by those with Paduan links, they were infrequent, and in most N. European medical faculties they were non-existent.
A second revival of interest can be located at the end of the fifteenth century. Beginning in N. Italy, especially in Ferrara and Venice, humanist scholars, some of them Greek exiles from the former Byzantine Empire, others physicians and administrators who had spent time in Venetian outposts in the Aegean or the Levant, began to collect, read, edit, translate and finally publish the writings of Galen in their original Greek. In doing so they realised that the medieval Latin versions, whether of Galen or Arabic physicians like Avicenna, contained errors of all kinds — wrong translations, miscopyings, and even excisions and interpolations — and they demanded a return to purer founts, to the understanding of what Galen had said through the words of Galen himself. This could be achieved in two ways; by the publication of the Greek texts themselves and, since the great majority of physicians knew no Greek, accurate new Latin translations, or by the preparation of guides incorporating the new information.
The second way was that followed first by the anatomists. Alessandro Benedetti, a physician who had travelled widely around the Venetian colonies, produced in his Anatomice or the History of the human body, 1502, a description of the body that, as its title proclaimed, used Galen’s own Greek nomenclature. A similar procedure was followed by Giorgio Valla, a humanist with medical interests, in his 1501 The parts of the human body. At Bologna, Giacomo Berengario da Carpi (c. 1460–1530), professor of surgery and anatomy, followed a more practice-orientated approach. In his long Commentary on Mondino, 1521, and in his Short Introduction, 1522, 1523, he presented the results, he claimed, of several hundred dissections, criticising earlier authorities where he believed he had seen something different or, more importantly, could find no evidence to in support. Hence he rejected the rete mirabile, a network of veins and arteries said to be located at the base of the skull, and the multicelled uterus of Mondino. He was also in close touch with humanists at Bologna, and, from about 1522 to 1528, was engaged in correcting an earlier and unpublished Latin version of Anatomical procedures prepared by the Greek exile, Demetrius Chalcondylas (1423–1511), some twenty years earlier. When it appeared in print in 1529, it was the first humanist Latin version of any of Galen’s major anatomical treatises.
The reason is not far to seek; their sheer length, and the extreme rarity of Greek manuscripts containing them. Would-be translators had to wait until 1525 when the first edition of the complete works of Galen in Greek issued from the Aldine Press in Venice, and it was effectively not until the 1530s that the Greekless could have access to this most important of Galen’s anatomical works. Berengario’s version was reissued in 1531 as part of the Giuntine edition of the complete works of Galen in Latin, but in the sixth volume of this edition in 1533 a better translation was included, which henceforth was taken as the standard. Its author was the indefatigable Guinther von Andernach, and it had first been published at Paris in 1531. The first Latin version of On the opinions of Hippocrates and Plato appeared in 1534 (by Guinther, but minus Book I, which was published for the first time by John Caius in 1544); Niccolò’s medieval version of On the usefulness of parts in first printed in 1490, was never replaced.
Now for the first time since Galen’s own day scholars could see the essential role that Galen had given to anatomy within medicine, and the extent to which he had devoted himself to this practical pursuit. From the 1520s, anatomy became the new subject for study, and it was vigorously encouraged by all the leading protagonists of humanist medicine. Corti, Sylvius, Guinther, Dryander in Marburg, John Caius in England, to name but a few, saw in this revival of Galenic anatomy an obvious justification for their attitudes towards the past, and in many universities it was the humanists who made anatomy a regular part of medical instruction. For them Galen could do little wrong, although they acknowledged that, for the most part, he had had perforce to rely on animal dissection. They were also confident that, by the preparation of more accurate texts and translations, even that small amount of error could be reduced and shown to be the responsibility of a lazy copyist or an ignorant medieval translator. At the same time, many of them had noticed that, from time to time, Galen’s words did not entirely cohere with what they themselves observed, and they saw no difficulty in criticising this or that particular point, or describing structures that Galen had omitted, e.g. the thymus gland or the trochlear nerve. But they never doubted that Galen had looked at human bodies and performed dissections, or that, overall, he had given a correct picture of the anatomy of the human body.
It is this assumption that Vesalius attacked most vigorously. Following Galen’s own methodology and using his own language at times, Vesalius again and again insisted that what was needed, and what Galen had in no way achieved, was a human anatomy. It was not a question of minor details, but of the whole conception of the subject, and it went far beyond errors of editors and translators. It required a fundamental re-orientation of anatomical thinking, beginning even with the recommended order for studing the body. Whereas Mondino’s order fitted the needs of dissecting, that of Vesalius, which followed that of Galen, was expressed in ways that emphasised the organisation of the human body.
Book I of the Fabrica deals with the bones, unduly neglected by contemporary anatomists, says Vesalius, despite their crucial significance for the whole body by supporting and controlling movement. By leaving the study of bones until the very end of the course, he claims, teachers have confused their pupils and have missed the opportunity to reveal the wondrous workings of the Creator. This teleological approach is shared with Galen, as Vesalius acknowledges when in Chapter 5 he comes to discuss the head. Their universe is one that is made by a Creator or Demiurge; it has been made with a purpose; and the suitability of each part of the body for that purpose is an index of both the skill of its maker and of the whole beauty of the organism. To deny this is close to heresy.
From the skull, with its interesting variations of shape, Vesalius passes to the jaw and the teeth, then to the spine, and downwards through the body, until we reach the foot in Chapter 23. After looking at nails and the cartilages of the eyelids, ears, nose and trachea, Vesalius ends with a chapter detailing how to prepare and mount a skeleton, and with a brief account of the total number of bones in the body (a topic of considerable argument in medieval accounts.)
The second book is devoted to the muscles, tendons and ligaments of the body, a topic that had been considered at length by Berengario. In it Vesalius carefully explains how to dissect the muscles, and how to macerate them in order to show their connective tissues and to distinguish them from tendons. Muscles are greatly varied, in size, shape, origin, insertion, colour, and the arrangement of their fibres. Vesalius’ solution is to treat the muscles topically, site by site, in order also to understand their dynamics. Vesalius here is endeavouring to think of the body in motion, not just as a corpse; even his carefully mounted figures of muscle men appear in their posture to become alive, active despite being stripped of their skin and flesh. He is aware also of the need for animal anatomy and for vivisection to supplement human dissection, and this book ends with a discussion of the role of animal vivisection in modern anatomy teaching. Throughout this book, Vesalius takes great care to explain his techniques of dissection and preparation of his specimens, and his opening chapter defends the teaching value of illustrations such as are displayed in the Fabrica.
The following book is devoted to the arterial and venous systems. This is perhaps the weakest of all the books, for Vesalius’ dissections did not allow him to go much beyond his predecessors, except in his discovery, made in late 1537, that the inferior mesenteric vein entered the portal, not the caval system. Of greater interest is his suggestion that the relative size of the vessels suggested that the caval system did not take its origin from the liver, but from the heart, thus reversing the traditional picture and offering an anatomical reason for doubting the notion of the body’s three parallel systems. If the heart was the source of both arteries and veins, then the role of the liver as the sole organ responsible for the production of blood was called into question. But Vesalius does not develop this criticism further; indeed he refuses to take part in what he sees as a potentially unfruitful argument, regarding his observation as less significant that those he had made on bones, muscles and the arrangement of the vessels. It was left to Realdo Colombo, a decade or so later, to argue for the pulmonary transit of blood from one side of the heart to the other via the lungs.
The illustrations become fewer in Book IV, as the textual description becomes thicker, in part because there are fewer novelties to be found in the account of the brain and nerves that forms the subject of the fourth book. Their investigation and description by Herophilus, Erasistratus, and Galen had been a major achievement of ancient anatomy, and although Vesalius goes far beyond what medieval anatomists described, he is here doing little more than repeat what Galen had said, often in a paraphrase. His major challenge comes in his assertion that despite carefully searching for it in dogs, large animals, and even in the head of a recently decapitated criminal, he had been unable to trace the channel within the large optic nerve, or at any nerve junction, that was believed to carry the animal spirit through the nerves, although he ought to have been able to find it.
The fifth and sixth books deal with the abdominal and thoracic cavities respectively, and with the organs that they contain. Mondino had recommended that these should be investigated first, before the body began to putrefy, and their position late in the description of the Vesalian body is a deliberate reversion to the plan demanded by Galen. Vesalius is concerned to deal with the anatomy of both men and women, but the extreme rarity of occasions on which he could dissect a female corpse, let alone one that was pregnant, militated against his ideal. When he and his students succeeded in securing the body of a priest’s mistress, he had to dissect in extreme haste, which was hardly conducive to accuracy. As he acknowledged in his Letter on the China Root and in his second edition, he made too much use of animals, especially the dog, in delineating what he supposed was a true anatomy of woman. The opened female corpse of the Fabrica’s frontispiece, in its apparent claim to reveal the innermost secrets of the body, is misleading advertising.
Book VI, after disposing briefly of the pleural membranes, the diaphragm, the trachea and the throat, focuses largely on the heart and lungs. The discussion of the heart stresses the fibrous nature of the heart’s substance, although Vesalius denies that it could be described as muscular, for in Galenic physiology muscles performed only voluntary motion, and suggests a model for the action of the fibres on the heart itself. Most interesting are his observations on the septum itself, for he argues that its pits do not, as far as he can see, stretch all the way through the thick membrane. In that case, for blood to pass from one side to the other would require the existence of passages so small as to escape the naked eye, further cause for wonder at the industry of the Creator.
His final book sets up a new, and anatomically well founded, picture of the brain against that of the medieval and contemporary theorists who thought in terms of localized brain function within interlocking ventricles. This view Vesalius dismisses as a worthless delusion, as he does the existence of the rete mirabile, which, he confesses, he had once accepted because of an excessive trust in Galen. His attitude towards the product of final transformation of blood in the Galenic system, animal spirits, is somewhat sceptical, and he wishes to confine it to affecting sensation and motion, not rational thought.
Throughout the Fabrica Vesalius emphasises the art of dissection, passing on useful tips as well as reminiscences from his own experience. His attitude to Galen is critical, but he is more concerned to extend and develop ideas than to indulge in a point by point refutation of individual passages. Over and over again he reiterates the need to investigate human anatomy and, when of necessity dissecting animals, to be aware that there are differences between the two that require careful comparison, not hasty synthesis. He describes the fabrica of the human body in all senses of the Latin word, as the structure that underlies the body, as the created fabric that constitutes it, and as the “workshop” that allows humankind to function properly. Only Berengario in his Commentary on Mondino had written at such length on anatomy, yet his exposition lacked total clarity, and was organised according to the requirements of the lecture room, not those of the enthusiast for anatomy. Vesalius is ostensibly doing something new, an impression strengthened by his near total silence about other N. Italian anatomists. Where they are mentioned, it is to their discredit, and their achievements are left unsaid. Vesalius can hardly have failed to be aware that they had made a discovery here, a Galenic criticism there, and in this sense he can be thought of as depending on what they had discovered and continuing the process of refining and correcting Galenic anatomy. But to see Vesalius in this light, as a better critic of Galen, with more novelties to report, a man, who, as Niccolò Massa complained, gained the credit for what others were already teaching, is to miss the point. It is the wholesale rejection of the very basis of their conclusions, that Galenic anatomy was largely correct and that one should attempt to achieve a general synthesis incorporating Galen’s exposition, that distinguishes Vesalius from his predecessors. The fact that, particularly when talking about function, he often took over large sections directly from Galen should not be allowed to obscure the extent to which, between 1537 and 1542, he had moved away from the orthodox Galenist position. He could still be considered a Galenist, not least because the programme he was putting into effect was that advocated by Galen, but he presented it in an almost revolutionary way, looking forward to new discoveries rather than backwards to the writings of the past.
If the verbal content of the Fabrica was challenging and novel, it was made still more so by the very format in which it was produced, by its typography and by its illustrations. The Fabrica is a very big book, 663 pages long, and 43 centimetres tall, ten centimetres bigger than Zerbi’s Anatomy of 1502, and almost twice the size of Berengario’s books. Its pages have wide, clean margins, and its typography is extremely elegant, with well-formed big letters that sit nicely on the page and with enough space between the individual lines that the eye is not wearied by a continuous mass of type, as in Berengario’s commentary. There are relatively few abbreviations used in the text to cram in more words, as in Vesalius’ revision of Guinther, and the marginal “signposts” are treated with as much care by the typesetter as is the main text. Both Roman and italic fonts are used, where appropriate and in harmony. The paper is finely produced, with no feeling of flimsiness or transparency. As a piece of beautiful printing, it is unprecedented within medicine, rivalled only by the major new volumes of botany such as Leonhard Fuchs’ History of plants, published in Basle only a few months before the Fabrica. In the small world of the Basle printers this was artistic competition on a big scale.
Typography, layout, and finish all contribute to the message; that what Vesalius is producing is no ordinary book for medical students, but a work for wealthy, intellectual connoisseurs, inclusing elite physicians. The human body is transferred from the sordid dissection display to enjoy a reintegration — or a reorganisation of its parts — on the pure white of the printed page. The noblest work of the Creator is given appropriate homage in words and pictures to enlighten the understanding of princes, professors, and other men of talent. Despite his constant advice to dissect and observe for oneself, Vesalius’ book is scarcely to be read while at the dissection table — although it contains a great deal of practical information and some of its successors were so used, propped up on a chair to guide and confirm the discoveries of the anatomist — but one to be pondered and appreciated at leisure. It turned the act of dissection from a manual skill to something to be contemplated and enjoyed by a gentleman. The crowded theatre of dissection, at this period at best a temporary stage structure where spectators would pay to enter, becomes translated to the calm tranquillity of the printed page.
This impression is fostered by the abundance and the quality of the illustrations that grace the Fabrica. Leaving aside the frontispieces, there are 83 plates, containing almost 420 separate illustrations, as well as many historiated initials for books and chapters. These tiny boxes are filled with pictures and stories associated with anatomy, sometimes cleverly dovetailing with the subject of the next section. Putti, cherubs, play in and out of the letters, mimicking in their activities the work of the anatomist. They dissect, they recover corpses, they discuss their findings, they beat an animal to death. They become eager participants in the drama of dissection, which is here literally child’s play. Some have seen whimsy or an unexpected frivolity in this transformation of the initial letters. Better perhaps to see them in an overall context of cultivated learning, whereby the despised activity of dissecting is raised to an art fit for an emperor and others capable of seizing at a glance the allusions and significations of the story in miniature.
But it is the major illustrations, most of them taking up almost the whole page, that have attracted most attention. Indeed, so much have they been seen as the very essence of the Fabrica that they have diverted attention away from the text that surrounds them and have thereby contributed to making the Fabrica an unknown document. That the illustrations were carefully cut in Venice on pearwood before being transported with great care to Basle is well known. Vesalius reveals the name of the manager of the Venetian branch of the merchant house of Bomberg who had helped him pack the blocks, Nicolaus Stopius, and that of the Milanese merchants, the Danoni, who took them over the Alps, but on the name of his artist or his block-cutter he is silent. This has led to considerable debate and considerable confusion. Three possibilities have been put forward for the artist. In the second edition of his Lives of the most excellent painters, published in 1568, Giorgio Vasari declared that the artist was Jan Stephan van Calcar, whom he had known years before in Naples. Calcar was certainly involved in the production of the Tabulae and Vesalius had hoped to engage him for some illustrative work after that. But Vasari’s report is far from accurate, since he refers to “eleven large illustrations,” a number which fits neither the Tabulae nor the skeletons or muscle-men of the Fabrica, and talks of “the anatomy” and “the work” in the singular. But if neither the Tabulae nor the Fabrica was known to Vasari when he prepared his first edition of 1550, the subsequent reputation of the Fabrica could well account for its mention as a single work in a second edition produced by Vasari some years after Calcar’s death around 1547. The criticism of some art historians that Calcar’s style could not have improved so much in the short interval between the production of the Tabulae and that of the Fabrica is also flawed by the lack of suitable other paintings or drawings with which to compare it. Calcar must remain a strong candidate for the unknown artist.
The second possibility is that the artist is unknown, one of the anonymous plurality of designers and engravers about whom Vesalius complains. Charles D. O’Malley, whose biography of Vesalius remains standard in English, even raised the possibility that the great bulk of the drawing could have been done by Vesalius himself, and that the artist merely added the finishing touches. This is an attractive possibility, especially since Vesalius was particularly keen on illustrating his lectures with sketches and drawings, but plays down the remarkable quality of the Fabrica’s plates.
The third candidate for the role of artistic genius is Tiziano Vecelli, Titian, assisted by pupils like Calcar or Domenico Campagnola, whose hand has been seen in the background to the “muscle-men” figures. Given the care that Vesalius took with the printing of the Fabrica, one might well have expected him to seek out the greatest of living Venetian painters, who would have helped with the design, but left the execution to his pupils. The foundation for this notion lies in a reference by a Venetian contemporary and friend of Titian, Annibale Caro, who in his Diceria di Santa Nafissa apparently refers to the “dissection (Notomia) of Vecelli.” This, at first sight conclusive, proof of Titian's involvement melts away under scrutiny. Caro’s book was written in 1538, not in 1543 as many Vesalian scholars assert, and hence cannot be referring to the Fabrica. Besides, so Dr Monique Kornell tells me, only the 1863 printing of the Diceria has the name “Vecelli.” Earlier editions and manuscripts have ‘Vercelli,’ which may well allude to another individual and another incident entirely. No biographer of Titian mentions his involvement, and no contemporary who knew the Fabrica thought it appropriate to associate him with the production of the book.
Whoever he was, the artist, working closely under Vesalius’ supervision, the block-cutter, and the printer together, produced a masterpiece that, almost at a stroke, solved most of the technical questions involved in making the two-dimensional image on the printed page serve as a substitute for three-dimensional reality. The range of techniques — dissection drawings, solid sections, a variety of viewpoints, systems in isolation and then together — are allied with a feeling for the suitability of each for the point in the argument. He balances the conflict between completeness and economy with exemplary skill; the sequences of images is neither monotonous nor exhaustive. The careful cutting of the blocks enabled both contours and differentiation between textures, e.g. muscle and bone, to be made clear, and Vesalius tried, not always successfully, to ensure that the many complicated references set within the figure stand out legibly. The 1555 revision attempted to rectify criticism on this point by reducing the amount of shading in some plates. For visual quality and technical expertise in depicting the human body in all its varied forms on the page, the only parallel to Vesalius is found in the drawings of Leonardo da Vinci, but these were, at this stage, almost entirely unknown, and were not to appear in book-form for several centuries. Vesalius and his artists, by contrast, were aware that they were producing something for public consumption that would take its place among the new genre of books with magnificent illustrations. Fuchs’ equally splendid book on plants had ended with portraits of the author and of his artists, emphasising how all three had contributed to this work of learning and beauty. Vesalius, alas, did not include a portrait of the artist, and his own picture, in two forms, appears right at the start of the book.
Above all, the illustrations are part of a self-consciously direct dialogue with the spectator/reader. Vesalius comments in the text on his illustrations, even apologising if some things are not entirely clear, and constantly refers the reader to points in the figures to confirm or to express better (because the evidence is visual) discoveries made on the human body by the dissector. It is this that marks out the appearance of the Fabrica as a defining moment in the history of illustration, and of anatomical illustration in particular, for it integrates the visual into the whole argument of the book. Both image and text are indispensible.
In the medieval world, manuscript illumination was an indication of wealth and status. A beautiful Book of Hours for private devotion indicated enormous wealth on the part of the commissioner, and even finely ornamented initials and marginalia revealed something of the status of their owner. Illumination in medical books is rare, and falls into three distinct categories. There are, often crude, drawings inserted by an author to exemplify a surgical procedure or a particular flower, and, at the other extreme, manuscripts like the Dresden Galen that include very many illuminated initials telling the story of what is to come in the text, works for display far more than for consultation. In between can be found manuscripts with an opening illumination or with a very limited range of illustration that was constantly repeated in manuscripts all over Europe. Chief among these was the so-called ‘Five-picture series,’ in reality nine pictures, a series of anatomical drawings that illustrate the various systems of the body, veins, arteries, bones, muscles, nerves, and various organs, heart, brain, kidneys, lungs, genitalia, etc. They often accompanied a series of pictures showing the various star signs and constellations that affect the body, the points for bleeding, and the wounds and accidents that the body might suffer, ranging from the bite of a crab to an assault with a shillelagh. These common images survive into the world of print, well into the sixteenth century, and can be found in cheap prints as well as in ostentatious volumes for the rich.
The quality of these images varies widely, from the near cubist anatomy of Oxford, Bodleian, Ashmole 399, to the vivid detail of London, Wellcome 49, and the careful shading of the bones in some of the illustrations in Wellcome 290. But it is less their quality as representational art that marks them off from the Fabrica as the purposes for which they are set. They are primarily mnemonic, visual aids to memory, often keyed into a short summary text listing the parts of the body or the diseases that might befall it, or occasionally to display the stages of dissection. Like many botanical illustrations, they are traditional in content, which ensures their position in the text while at the same time reducing their value as a depiction of this or that organ or plant as set before the artist. They help the written word to become memorable, but they do not necessarily add to it.
Three developments need to be borne in mind if we are to understand properly the significance of the Fabrica as an illustrated book on anatomy: they concern the anatomists, the artists, and the printer-publishers reespectively. The last is the most obscure. Before 1520, print and manuscript cultures coexisted in a system of value that still privileged manuscript as a means of communication among scholars and the wealthy. Luxury copies of printed books were made by hand, and often illustrated, for private use, and as an index of status. By the 1530s printed books might be seen as beautiful works of art in themselves, to be bought and highly prized for that reason. Some were works of literature — the famous example being the Hypnerotomachia Poliphili — or history, like Schedel’s Nuremberg Chronicle; others were scientific, like Brunfels’ or Fuchs’ herbals. That Vesalius’ Fabrica fits into this development is clear, but the precise role within it of author and publisher is not. To produce a book of the quality of the Fabrica required a substantial outlay of money, and the expectation that there would be a market willing to buy at an appropriately high price. Oporinus was in the printing business to make money, not to offer a charitable service to authors.
Artists had also been taking an interest in anatomy and in anatomical drawing, whether from antique models, especially the Apollo Belvedere, or from life. Leonardo was not the first artist who gained access to patients and corpses in the local hospital, although the extent of his involvement is unprecedented. He also planned a work on Galenic anatomy with the Paduan professor Marcantonio della Torre about 1510, which would have illustrated the professor’s lectures with figures drawn from life. Alas, nothing remains of this project, but there are several drawings of dissected or severed limbs done from life by artists of the stature of Michelangelo. Baccio Bandinelli at the end of the 1530s or in the early 1540s was teaching the pupils at his academy to draw skeletons. The realism of contemporary Italian art, especially in its focus on the male nude, also brought the artist’s or draughtsman’s gaze to the bedside or the dissecting table. Anatomy, as we know from Benedetti, was already becoming a public spectacle, a true theatre, in which all who could pay the entrance fee might be admitted. While artists and medical men began to collaborate in looking at the body, it was Vesalius in the Tabulae and, still more, in the Fabrica who first brought the two together in ways that were of more than a merely private concern.
It is a commonplace that the advent of printing brought with it the potential to reproduce images in greater numbers and with far greater consistency than in the age of manuscript. Yet potential is not the same as actuality, and what is striking about the history of visual representation in anatomy is the lateness with which it was expressed in print. Scenes of anatomical dissection had appeared as early as 1493 in the Fasciculus medicinae ascribed to John Ketham, which went through several editions in a variety of languages. They can be found as frontispieces to editions of Galen in Latin translation, as in the 1530 Paris edition of Linacre’s translation of Galen’s Method of healing, which was repeated the next year as the frontispiece for Guinther’s translation of Anatomical procedures. Yet the inclusion of anatomical images themselves was sporadic at best. As in the Spiegel der Arzney of 1517, they were largely traditional and mnemonic in function, only occasionally reworking the medieval images by the inclusion of new material taken from life. The power of the printing press to create a new visual representation of the human body, and the impact that it might have, took a very long time before it was realised in actuality. Indeed, one might argue that an awareness of the forcefulness of the printed image as an instrument of medical education was not to be found before the late 1530s, a possible consequence of the pamphlet wars of religion that set Lutheran propagandists against Catholic in a battle of word and image expressed through the medium of Flugblätter. These were single illustrated sheets intended to have an immediate impact, in which the visual imagery, of Papal corruption or of Lutheran heresy, supplemented (or, for those who could not read, supplanted) the verbal message below.
From 1538 onwards it is possible to trace a whole series of so-called anatomical fugitive sheets, depicting the parts of the body on a single sheet, or, often, as a pair of sheets, one male, one female. Sometime these were provided with the organs of the body arranged down the side of the sheet, so that they could be cut out and then stuck down (not always, alas, in the correct order) on a card beneath the figure. By lifting up the flap representing the trunk, one could then see how the internal organs of the body lay in relation to one another. They were often accompanied by a text describing the particular parts of the body. These were relatively cheap representations, put out by printers in Germany, Italy, France, and England, accessible both as visual imagery and in their verbal message. It is possible that they were aimed at a student market, but many of the early sheets come from cities, like Strasbourg, without a university, and one might think of them rather as satisfying a popular interest in the human body. It is in this context of relatively cheap reproduction that one can set Vesalius’ Tabulae, a similar set of six sheets designed to supplement his lectures, and prepared by an artist, Calcar, in conjunction with the anatomist, although their detail and their text show that they are intended for students, not necessarily for a wider, popular audience.
Two anatomical authors, however, do require special comment for their use of images, which anticipates that of Vesalius in several ways, and also points up the amazing achievement of Vesalius and his colleagues. Berengario in his Commentary on Mondino may be credited with the first deliberate use of anatomical images to go beyond the printed word. As a surgeon, he was aware that some of his predecessors, for example the Arab surgeon Albucasis, had used illustrations of instruments and surgical procedures to illustrate their written works. In his commentary, however, Berengario goes beyond his models by using images for a wider variety of purposes. He himself in his lectures constantly emphasised that anatomy was more than book learning; it was something that involved the senses to reveal the true, sensible, organisation of the human body. Illustration was a printed dissection accessible to view. Where mere words could not express clearly what was visible, as with the ventricles of the brain, a printed image could do the job. A visual representation of the shape of the uterus demonstrated that Mondino had wrongly described it, and served also as a constant memorial of what might have been seen at the dissection table. An illustration of an articulated skeleton or of the bones of the hands might show parts of the body not necessarily reached or discussed in the actual dissection-cum-lecturing process itself. Where to let blood, and how to avoid damaging a muscle when removing a tumour, could also be shown visually better than by words.
Berengario’s sophisticated theoretical understanding of the importance of seeing as well as reading links him with his fellow surgeons rather than those like Corti or Sylvius who approached anatomy from a textual direction. But his programme is weakened by the performance of his artist and block cutter. His illustrations, scattered through his long book, are often too small to be effective, or where they are striking, as in his muscle-men, derive their impact from their heroic poses rather than from the details of the anatomy they display. But, whatever the deficiencies of Berengario’s book or of the images he included in his short guide to dissection, it must be remembered that they formed part of a deliberate programme to demonstrate the human body by visual as well as verbal means. By so doing, he was challenging the traditional strengths of the verbal commentary on Mondino, and insisting on the necessity for illustration to be included in any treatise on dissection. Vesalius’ debt to Berengario in both the Tabulae and the Fabrica is greater than he acknowledges.
Berengario’s commitment to illustration is clear, and its relationship to his own dissections and expositions can easily be traced throughout his long book. By contrast, the circumstances that surround the treatise On the dissection of parts of the human body by Charles Estienne are anything but clear. This Latin work was published in 1545, and was followed by a French translation the next year, but there is strong evidence that it was prepared some time earlier, beginning around 1530, and that printing was interrupted by a lawsuit in 1539. Estienne himself was a humanist, from a famous French humanist family, and his interest in anatomy was largely directed at clarifying its nomenclature, as he was to do later for horticulture and for other aspects of the living world. Were it not for its illustrations, his book might easily be dismissed as a typical production of Sylvius’ circle. These images, however, are of considerable interest, for as the title proclaims, and they themselves reveal, they are derived from life, following dissections carried out by Estienne de la Rivière, a prominent Parisian surgeon. Berengario’s and Vesalius’ demand for a new anatomy based on the visible human body is here put into effect.
Estienne’s illustrations vary considerably in quality. Those in Book I are on the whole traditional in content and design, but from the middle of Book II onwards there is a change. Small wood blocks depicting the detailed results of actual dissections are inserted carefully into already existing larger blocks that show nudes, both male and female, in heroic poses in a variety of classical landscapes, exposed on marble seats or propped up against trees. Whether, as some have suggested, the printer Simone de Colines was simply using a set of blocks originally prepared for a totally different book is far from clear. Others have argued that the classicising background is deliberate, evoking the antiquity of dissection, and transmuting the gruesome horror of the detail of a corpse to the heroic world of the Greeks and Romans or of the gods themselves. The dissected corpse is turned into art: the circumstance of the dissection, often involving the execution and dissection of a criminal, or the unlicensed robbery from a holy grave, is forgotten in a timeless landscape of Elysian peace. The mutilated body is removed as far as possible out of the crowded theatre of dissection. It is given back its dignity, not by a religious rite of burial but by being treated as if it were a noble ancient.
But, it must be admitted, the images are a failure, if their aim is to reveal a true likeness based on new dissection. Their size is pre-determined by that of the woodcut that surrounds them, and their scale is always too small to reveal precise detail. Although the artist and cutter are more accomplished than those of Berengario, they cannot display with clarity in a couple of inches at most the intricate detail visible when the brain is dissected or the womb opened up. Estienne’s book offers a great variety of images of parts of the body, most of them new when they were cut, some even going beyond what Vesalius was to show. But their impact is not as striking as those of Berengario, still less of Vesalius, because they seem not to form part of a coherent argument. They illustrate the words of the text, but they are not related closely to them. In short, their artistic weakness is married to a thematic one: the world of the artist and that of the author do not cohere.
These two examples help to explain why the Fabrica is so successful as a book. From the very start of his lecturing in Padua, if not before, Vesalius was at pains, like Berengario, to include the visual alongside the verbal in his exposition. Both were needed, each complemented the other, and each contributed to strengthen the same overall argument, but in different ways. On the one hand, there is Vesalius the writer; the rhetorician who carefully obscures his debts to others, the passionate advocate of human dissection, and the candid companion breaking up a long description with reminiscences and little stories. The reader is involved in a dialogue with the author: he is instructed what to think, how to dissect, where to look. Recourse to the second person of the verb (“you can see . . . , you may observe. . .”) humanizes what is an inhuman activity.
On the other hand, there is Vesalius the technician; the craftsman with the knife, the observer, the artist who stops in mid-flow to draw an impromptu sketch to make clear a point, and the publicist, who knows the power of the press and the care that must be exercised if that power is to be deployed properly. The full-length figures of muscle-men are placed in an ideal landscape: they are dead, yet by their gestures and situation they are alive. The reader or viewer is allowed to contemplate bones and other bodily structures as it were in the round, from different angles and with subtle shadings denoting changes of bodily texture. He — for Vesalius thinks of a male audience — is also guided carefully as to where he should let fall his gaze. The figures are integrated with the text by a complex, and at times overcomplex, system of lettering, so that the reader needs constantly to become the observer if he is to gain a full understanding of the body.
Reading the text and seeing the images as an integrated whole are made possible in the Fabrica by the sheer size and wealth of its production. The large page allows for large images, far clearer than the cramped inserts of Estienne; the spaces between the lines or between the individual illustrations break up what would otherwise, as in Berengario, be a compact and wearisome mass of type. The overall effect is to lift anatomy out of a subordinate role, in which its teacher at university was among the lowest paid of professors, into a subject worthy of an emperor. Yet, at the same time, through the replication of images in the Epitome and in its various subsequent versions and reprintings the results of dissection are made accessible to the widest possible audience of readers. Vesalius is among the very first medical writers to exploit the ability of the printing press to transport a message safely and quickly to a large audience — and of the printers and booksellers to arrange for its distribution over the whole of Europe.
Paradoxically, the singular importance of the Fabrica is underestimated precisely because it has become familiar. Historians of printing, like Elizabeth Eisenstein, have taken it as typical of what printing could achieve for science, yet, as this section has shown, it is highly untypical. Its written message has equally been distorted. It has been taken to mark the complete overthrow of Galen’s anatomy, when much of Galen’s ideas, especially on the relationship between form and function, remain with Vesalius, and his whole programme can be characterised as putting into effect what Galen had advocated but never achieved. Or, equally misleading, the pre-Vesalian anatomists, like Berengario or Massa, have been seen as anticipating this or that novel observation or Galenic criticism to produce a sort of Kuhnian paradigm, in which the overthrow of Galenic anatomy and its replacement by one based on observation were only a matter of time. If not Vesalius, then Colombo, Fabricius, . . . .
But, as this section has tried to suggest, the differences between Vesalius and his contemporaries are at least as great as their similarities, above all in Vesalius’ awareness of intellectual changes and his exploitation of the effectiveness of the printing press. He had formidable talents, as a scholar, as a dissector, as an artist, and as an expositor, a rare combination acknowledged by those who knew and employed him. He also changed the role and status of anatomy in such a way that the Fabrica itself has achieved iconic status, something to be preserved in a Rare Books Room or behind the glass of an exhibition case. More subtly, Vesalius altered expectations of what an anatomy book should be to such an extent that historians have often taken his standards and his prejudices as normative. Those who preceded him, whether in Antiquity or in the Renaissance, are pitied (or worse) for their failure to be Vesalius, or granted limited approval for anticipating one or two of his discoveries. Those who followed are judged according to whether they followed the Vesalian path that leads inexorably to modernity. In so doing, the unusual strengths (and weaknesses) of his book are both underplayed.
The success of the Fabrica was predicted even before it appeared. Hieronymus Gemusaeus (1505–1544), professor of medicine and a familiar figure around the printing shops of Basle, hinted in March 1543 that Oporinus was about to produce in the Fabrica a work of great significance. More he could not say. On August 1, in a preface to a tract on fevers by Antonio Fumanelli, and only two months after Vesalius had approved the colophon to the Fabrica, he hailed Vesalius as the leading figure in the discipline of anatomy. In his newly published book he had dealt with many passages in Galen that were previously unknown, some he had explained, others he had restored, and, Gemusaeus went on to imply, the author must be given the greatest of respect for his important discoveries.
Gemusaeus’ reaction, although serving as advertising for his friend Oporinus, is interesting for several reasons. He acknowledges immediately that the Fabrica marks a break with the past, although he interprets it, in line with Vesalius’ own rhetoric, as a correction, interpretation, and proper restoration of Galen’s anatomical enterprise. Gemusaeus was a committed Galenist; he had after all been one of the editors of the major 1538 Basle edition of the collected works of Galen in Greek. His comment occurs in a preface to a work almost entirely dependent on Galen’s ideas and even wording. Nonetheless, he welcomes the Fabrica warmly as developing Galen’s anatomical ideas as well as bringing to light Galenic passages that had been previously unknown. His comments, and in particular his classification of Vesalius as a progressive Galenist, can be found elsewhere in sixteenth-century authors whose outlook, especially in therapeutics, remains firmly wedded to Galen. They appreciated that Vesalius had innovated, yet at the same time they could easily accommodate his discoveries within their overall framework. Far from overthrowing Galenism, the Fabrica in their eyes supported the general truths of Galenic medicine.
That the Fabrica could be seen in this way was one of the reasons for its dissemination, both swift and wide, among the medical professors of Europe, and for its general acceptance. Oporinus sent at the end of July 1543 a copy of the Epitome of the Fabrica to his friend Vadianus in St. Gallen, but the messenger fell into a river and the book was allegedly swept away; more likely, thought Oporinus, the man had decided to keep it for himself, preferring to have a damp copy than to send it back. A second copy was then sent to Vadianus by Oporinus, confident that this humanist would be only too delighted by the illustrations. By the end of 1543 all the copies of both Fabrica and Epitome with the booksellers in Leipzig had been sold, and a prospective buyer, the humanist and editor of Galen, George Agricola, had to place his order several days’ journey away in Frankfurt. By 1546 there were at least three copies in circulation in distant Oxford. Philip Melanchthon, the great Lutheran reformer and leader of the University of Wittenberg, read and annotated his copy, now in the National Library of Medicine, Bethesda, Md., from cover almost to cover. He was so delighted that he wrote on the flyleaf of the book a Latin poem praising its and its author's merits. He set to work to incorporate its findings in a revision of his treatise On the soul, published in 1551, that became standard reading in Lutheran schools and universities. Just as he felt it necessary that every good Lutheran should understand the truth about the soul, so he was concerned that they should have the best and most up-to-date information about the body that would, at the Resurrection Day, rise with the soul to heaven.
The same year, the German botanist Leonhard Fuchs, professor of medicine at Tübingen, published the first part of his Epitome of the fabric of the human body taken from Galen and Vesalius. This was avowedly a student text, based to an great extent on Vesalius, who was, in Fuchs’ opinion, divinely inspired to bring to light and make known a part of medicine almost extinct or besmirched with error. Fuchs distances himself from the ultra-Galenists, who sought to defend Galen at every turn, condemning their insolence and ignorance, but at the same time seeking to imply that he had been preaching the same message as Vesalius for many years.
Another early commentator, although somewhat more grudging, was the elderly Venetian doctor and anatomist Niccolò Massa (1485–1569). In 1536 he had published an Introduction to anatomy, claiming to have included in it the results of very many dissections and autopsies, and acknowledging that Galen had made many errors through relying overmuch on animals. But for all its claims to have seen everything that was described, the Introduction, although effective enough as a student guide to be reprinted as late as 1559, still followed Galen and Mondino extremely closely. Massa’s “book review” took the form of two letters, dated 20 and 23 January, 1544. He accepted almost all that Vesalius had said, including his criticisms of Galen, although these seemed to him somewhat exaggerated, but argued that the Fabrica, for all its merits, was doing nothing new. Vesalius had merely put into print what Massa and many others were already teaching — and had been offensive in his criticisms of those from whom he had learned most. Unmarried and ambitious, rich and with few obligations, Vesalius had the time to produce the definitive work on anatomy that a heavy medical practice and a large family denied to Massa and his other competitors. While there is a certain truth in this, no-one who has read Massa’s Introduction or, still more, ploughed through his medical correspondence has felt the need to bemoan a lost masterpiece.
Massa’s reaction was typical of the more pragmatic anatomists. Colombo, to Vesalius’ own disgust, immediately included the teachings of the Fabrica in his Paduan lectures, telling his students where he, Colombo, could improve on this new work. Fallopia also accepted Vesalius’ ideas, but was more honest in acknowledging his debts, even if he then went on to make a large number of criticisms and corrections. Others, like Fuchs, pointed out that Vesalius’ Epitome was too brief to serve as a introductory guide for medical students of anatomy, his Fabrica far too detailed and cumbersome. Hence there was a place for other, modest introductions to anatomy, like his own or that of Massa.
Very different, and far more vociferous, were the feelings of those who had been at the very forefront of introducing the new Galenist anatomy, some of whom, especially Guinther, Caius and Sylvius, had once been Vesalius’ friends and companions. The sense of betrayal must have added to their anger, and Guinther in particular could feel aggrieved at the unasked plagiarism of his own Introduction. Their rage is almost palpable in the furious strokes of the pen with which Cornarius, professor of medicine at Marburg and a leading translator of Galen, scored through the name of Vesalius at every point in his copy of the 1542 Froben reprinting of the collected works of Galen in Latin translation, now in the British Library. Vesalius’ name is expunged from the list of translators and correctors, and his errors are heavily marked down. John Caius went through his copy of the 1538 Greek edition of the collected works of Galen, now at Eton College, carefully recording in its margins the misunderstandings and foolish suggestions of ‘Wesalius’ in his translations and in the Fabrica.
Girolamo Donzellini (d. 1588), in a letter to the physician and botanist Pietro Andrea Matthioli written around 1560, described how Vesalius had angered all the leading physicians of Italy by his “immortal book.” He had provoked them by his language, and still more by his discoveries, and there were still some, almost twenty years later, who were still as hostile to Vesalius as they had ever been. The argument of these diehards, to judge from their criticisms, was expressed in a variety of ways. The first was simply factual: Galen had indeed largely dissected animals, but he had considerable experience of inspecting humans also. This was the primary argument used against Vesalius by Massa in his book review. John Caius listed on the first page of his Galen all the passages where Galen could be shown to have looked at a human body: others pointed to Galen's expressed awareness that he was having to rely on animal dissections for most of his description of the body. To deny this, as Vesalius seemed to do, was to fly in the face of the evidence. Alas for the defenders of Galen; while they were correct in their assertions, they did not appreciate the extent of Galen’s reliance on animals - and even Vesalius underestimated it.
Secondly, they pointed to many errors and misunderstandings of Galen’s Greek on the part of Vesalius. It ill behoved a man to make such damning criticisms of an author whose writings he could not properly translate. Sylvius, Caius and Cornarius eagerly seized on this proof, so they thought, of the incapacity of their opponent. It was compounded, in their view, by his unwillingness to accept fully one of the central tenets of the new Greek-based medical humanism: that the primary cause of alleged errors by Galen lay in the poor textual basis of the early printed editions and translations. By searching in libraries for Greek manuscripts, one could find many passages in which a manuscript preserved more accurate readings that corresponded better to what Galen had said than what had appeared in print. Scribal corruption over the centuries was responsible for making Galen appear more fallible than in fact he was. A good editor like Cornarius, so his Marburg colleague Dryander declared, could easily emend away those passages where Galen himself had been accused of error. This part of the argument had a great deal of plausibility to commend it. Manuscript hunters like Agostino Gadaldino and John Caius did discover older and more accurate manuscripts, and new finds were constantly being made: Galen’s On bones appeared in Greek for the first time only in 1543 and Caius himself published in 1544 the first ever edition of the first Book of On the opinions of Hippocrates and Plato. More investigation and better editing did appear to offer the possibility of a more accurate Galen. Yet, four and a half centuries of manuscript research later, the weaknesses of this approach are clear. Although, thanks in particular to material preserved in Arabic translation and hence unknown in the sixteenth century, modern scholars have at their disposal more extensive and better founded texts on anatomy than had Caius and Vesalius, improvements have been in details rather than in any overall conception or level of accuracy on the part of Galen. A few of Vesalius’ conclusions can be shown to be based on error, but these do not nullify his general contentions.
The third argument to preserve the infallibility of Galen had again a certain justice. Sylvius and, indeed, Fallopia argued that some of the differences between what Galen described and what Vesalius saw were due to a change in the actual body being examined. The noble Romans, a very different breed from modern degenerates, had a slightly different physique from their sixteenth-century successors. Just as one could breed dogs to produce different qualities, and, indeed, changes in their bodily structure, so it was possible to believe that nurture and environment together might combine to bring about alterations in the human body. Renaissance scholars were familiar with the Hippocratic passage in Airs, Waters, and Places, in which the author described how the tight binding of children's heads led first to the artificial production of long heads, and then over time to the generation of a race of long-headed individuals. But Renaissance scholars were not to know the fallibility of this account, or that genetic changes might take generations, and certainly far longer than Vesalius’ opponents assumed. Particularly in Sylvius’ attacks, the contrast between ancient nobility of mind and body and the degenerate present bore the appearance of a shrill reluctance to countenance any error on the part of Galen.
Finally, there were those who attacked Vesalius for his anatomical errors. Sylvius, Corti, and Caius all claimed to have seen structures whose existence had been denied by Vesalius. An anatomy of the senses was thus met by an identical claim to authority. Sylvius reported his experience in very many dissections, Caius likewise; Colombo and Fallopia equally pointed out errors of perception made by Vesalius, both when he failed to notice something and when he still adhered to Galen’s teaching. They rightly drew attention to instances where Vesalius might have mistaken something unusual for the norm, and Vesalius in the second edition of the Fabrica accepted many of these criticisms. But the result was less to discredit Vesalius, whose work was increasingly seen as marking a new epoch in anatomy, than to urge greater care in investigating anomalies, and in using comparative material.
As we have seen, Vesalius was not alone in demanding a leading place for anatomy in medical education; he was contributing to a trend, not setting it. His emphasis on using human corpses, where possible, was also one that was not unique to him, although the impact of the Fabrica undoubtedly inspired many to follow him, and contributed to the general acceptance of human dissection beyond Italy. Dissections drew large crowds in Bologna, Pisa, or Heidelberg; temporary booths, such as had been described by Benedetti, were replaced by permanent anatomical theatres, e.g. in Padua; and condemned criminals, particularly if they came from afar, were likely to end up on the anatomist's table within hours of their execution, a contribution to a public spectacle as well as to medical science.
But one caveat must be entered here. There were never enough bodies to go round to supply all the needs of professors and students. Even when, as at Wittenberg in the second half of the century, the pursuit of human anatomy was strongly encouraged by the authorities of both church, state and university, there were often difficulties in obtaining suitable bodies. There were certainly never enough for students to be able to enjoy the same “hands-on” experience that Vesalius advocated. Two solutions were commonly followed. The first was for the professor to concentrate on skeletal anatomy, where the same bones could be reused for several years in teaching about, for example, the skull. The second was to carry out more and more dissections, but on animals, especially cats and dogs. Provided that one was aware of what one was actually doing, as indeed Galen himself had been, then one could gain an understanding of human anatomy through comparative anatomy. Volcher Coiter’s work on anatomy in the late 1560s and early 1570s and still more, the major series of investigations into individual organs or groups of organs by the Paduan Professor Fabricius of Aquapendente (1533–1619), testify to the sophistication reached by comparativists in response to the methodological challenge laid down by Vesalius. They were still carrying out dissections of both humans and animals, as Vesalius himself had done, but they were now conscious of the pitfalls involved in linking the two together.
To assess the impact of the Fabrica on anatomical drawing is far from straighforward. Although Vesalius’ plates had undoubtedly contributed to the great success of the book, as Massa acknowledged, they brought their own problems, not least that of cost. Few anatomy books for students had more than a few plates, and none were as lavishly illustrated as the Fabrica. But although the illustrations were both clear and beautiful, they carried a visual message that not every anatomist was willing to accept unhesitantingly. Massa was far from alone in identifying the difficulty. Concentrating solely on a sensate anatomy, describing only what one could see or feel, was to minimise the whole purpose of anatomy teaching. As well as description, one needed discussion — of how the bodily part worked and how it related to the other operations of the body. Function was at least as important as form, and that required verbal exposition, not just observation. If the duty of the teacher of anatomy was to explain the body, then Vesalius had left his task only half done. Besides, if, as he had repeated, illustration was required to supplement a verbal description, then greater clarity of exposition would automatically reduce the necessity for a visual image. Not every leading anatomist included plates in his anatomical treatise. Although Realdo Colombo had in 1548, in not earlier, dissected in the presence of an eminent painter, illustrations are absent from the text of his 15-book anatomical treatise of 1559, although his frontispiece shows an artist drawing while he dissects, and a spectator comparing the open viscera of the corpse with a crude full-page drawing in a large folio volume (the Fabrica ?). The unauthorised Lyons re-printing of the Fabrica in 1552 in two volumes with a much smaller format includes only one set of illustrations, those of the skull, on pp. 130–132.
The impact of Vesalius’ illustrations, however, was not entirely beneficial. Their very success as images seems to have driven out competitors. While the new Catholic emphasis on realistic naturalism in art, advocated by the almost contemporary Council of Trent, undoubtedly encouraged young artists to turn to anatomical drawing, for a generation after 1543 it is the Vesalian plates that dominate. Compared with the plurality of images and styles before 1543, this was a regression. Canano’s planned atlas of copperplate engravings did not get beyond the first part, published in 1541–1542; the plates for Eustachius' anatomical textbook, which were ready by 1552, did not appear in print until 1714.
Instead, there came a whole series of plagiarisms or crude copies of the plates to the Fabrica or Epitome. In 1545 Thomas Geminus in England copied the plates from the Fabrica and a version of the text of the Epitome for his Latin Compendium of Anatomy. A Spanish anatomist Bernardino de Monserrate took over some of the plates, crudely drawn and much reduced in size, for his short introductory text on anatomy in 1551, the same year that Geminus’ book was itself copied in Augsburg. The celebrated French surgeon, Ambroise Paré, was another who copied, in this instance much more crudely, Vesalius’ illustrations for his own Anatomy of 1561. Most provocative of all was the takeover of Vesalius’ plates by the Spanish anatomist, Juan Valverde de Hamusco, who was active in Rome and a friend of Colombo. His Historia de la composicion del cuerpo humano appeared in Rome in 1556, but went through several later editions in Italian, Latin and Dutch. His illustrations were much reduced in size, and were crudely drawn, and, according to Vesalius in 1561, accompanied a text written by a man who had never dissected himself and who was ignorant of the very principles of medicine and the liberal arts. It was no more than a pot-boiler, issued solely with an eye to profit. If that was so, Valverde was a shrewd investor. His book was much smaller than the Fabrica, yet much larger than the Epitome. Vesalius considered it superficial, yet others judged it much more favourably. Fallopia, for example, thought it worthy of special praise for its brevity and for its illustrations, which made it ideal for a student market. Its smaller size and weight made it more easily portable than the Fabrica, and subsequent reprints incorporating the Epitome increased its didactic value still further. If the Fabrica was aimed at a wealthy market, it was Valverde's revision that triumphed among the average physician and surgeon, not least because it was published in so many vernaculars.
One further development should be noted, the burgeoning of the fugitive anatomical sheets in various manifestations and languages. This was the way in which anatomical knowledge was most easily transmitted to the widest possible readership. Vesalian anatomy took time to appear in this form, and some of his images, especially the Adam and Eve figures of the Epitome, were more easily assimilated than others. The Wittenberg printer Simon Gronenberg went one step further. In his set of anatomical sheets, “intended for those studying Melanchthon’s On the Soul,” the male figure bears a recognisable likeness to the portrait of Vesalius in the Fabrica. In a trope so characteristic of the sixteenth century, the anatomist is himself anatomized. His final service to his readers is become himself his own subject; it is his body that is laid open, to be peered at by enquirers. He has, in short, become the ultimate anatomical icon.
Vesalius’ De humani corporis fabrica of 1543 is one of the great books of the world, in every sense of the word. As a technical production, it ranks high in terms of quality, and its artwork, the co-production of anatomist, artist, block-cutter and printer, solved at a stroke many of the difficulties involved in representing a three-dimensional object on the printed page. Merely to see its beautiful lettering carefully spaced out on a wide page is to gain the impression that its theme is no ordinary one but something that deserves the closest attention from its choice readership. Its verbal message, although in part not entirely new, was equally striking. Although some of its details might be with justice attacked for exaggeration and error, its overall argument, that the human body could not rightly be understood without a careful and detailed study based on human dissection, carried conviction to his contemporaries. Their objections, for the most part, centred on the secondary premiss of the book, that Galen, whose methodology they and Vesalius claimed to follow, had failed to carry out what he preached: his anatomy of man was animal, not human. Yet, as this Introduction has argued, not all his contemporaries saw Vesalius as an anti-Galenist, nor can the Fabrica be simply characterised as the triumph of observation over the book. Vesalius’ achievement depends in part on his own book learning, and he was far from alone in demanding that one should view and touch a body, not merely read about it. In short, the Fabrica is a typical product of the Renaissance in combining both forward thinking and a desire to recreate anew some of the triumphs of the past.
The impact of Vesalius and his book was equally great. From its appearance in 1543, they were seen as marking a new epoch in anatomy. The ability of the printing press to reproduce its images, and Vesalius’ eagerness to transmit his message via the Epitome and in German translation, also ensured that what he had to say reached a wide audience quickly — unusually quickly, compared with other medical texts. Anatomy was already becoming fashionable before 1543. Public dissections in Italy were attracting large audiences, and the new Galenists, in Italy, France, England, and Germany, saw in the encouragement of anatomy confirmation that their revival of Galenic medicine had something new and positive to bring to modern medicine. Vesalius was thus part of a trend, and, although he gave a new specific direction to that trend, he did not create it entirely on his own, whatever the rhetoric of the Fabrica might suggest. It was a trend that impinged on wider aspects of culture, where by the end of the 16th century the metaphors of anatomy and anatomising became commonplace in booktitles. Robert Burton’s The Anatomy of Melancholy is only the most famous example. In art, the new realism, encouraged both by the Council of Trent and by the example of Vesalius and his artists, placed an added emphasis on the body, especially in suffering. Art, literature, and anatomy thus meet within a wider intellectual culture that brought together, often in the same theatre, men of taste and learning. Anatomy was thus moving upwards, out of the gory hands of lower-class, monoglot surgeons, masters of the knife and human butchers, to a more elevated and elitist plane. Thanks to Vesalius, it could be regarded as something worthy of an educated gentleman, a subject fit for an Emperor.*
* I am glad to acknowledge the helpful criticisms of Dan Garrison, Malcolm Hast, Monique Kornell, Nancy Siraisi, and Andrew Wear. Errors that remain are my own.