Introduction by Vivian Nutton

The Book
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.

Introduction by Vivian Nutton