Introduction by Vivian Nutton

The Man
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.

Introduction by Vivian Nutton