Andreas Vesalius, 1555, his annotated copy

Arguing with the Ancients

The state of medical knowledge in Europe when Andreas Vesalius began his academic training was one of rapidly expanding horizons. As Vivian Nutton notes in his Renaissance Medicine, “it was an exciting time to be a student, especially as the new information offered a great range of alternatives to the dogmatic Galenism of the Later Middle Ages. It was now possible to be both modern and traditional at the same time.”

The discovery by Europeans of the Americas and previously unknown parts of Africa introduced not only new plants, potential medicines, and new diseases—but also new ideas about and orientations towards received knowledge. The texts of medical authorities from antiquity, such as Hippocrates and Galen, were equally subject to the new humanist revival of ancient learning. Western European physicians were meeting their august heroes in their original languages for the first time, sometimes to great surprise.

While Galen had been a respected medical authority for over a thousand years, his incredibly prolific writings—making up almost half of all Greek literature surviving from antiquity—were not transmitted smoothly through the Medieval period, when very few scholars in the Latin West were able to read Greek. His translated work was available only in dribs and drabs during this time, with periodic infusions of new translations via the Arabic and Syriac traditions. By 1490, when the first printed edition of Galen’s collected works appeared at Venice, edited by Diomedes Bonardus, European physicians had inherited a vast corpus of translations, mistranslations, and pseudonymous works waiting to be untangled.

Galen (129-c.216 C.E.) was a native of Pergamon who served as a medic to gladiators and as the personal physician to several Roman emperors. A philosopher, physician, and anatomist, he was known to his contemporaries for his sharp observational skills as well as his eloquence of argument. His gigantic corpus basically aimed to communicate the entirety of the Greek medical tradition, and included commentaries on his illustrious and semi-legendary predecessor Hippocrates as well as his own innovative treatises. He was a dedicated dissector and proponent of empirical observation; his treatise De usu partium provided a guide to dissection so readers could see for themselves the workings of the body. Due to Roman regulations and lack of supply of human cadavers, however, most of his dissections were performed on animals, which had some obvious limitations.

When manuscripts of his original Greek texts began to be collected and examined in Western Europe, a new and different Galen from the one handed over by the Medieval tradition began to emerge. More eloquent, more open to change and innovation, more committed to the idea of empirical observation even when it was not directly available to him—and overall, just more. It became apparent that the study and understanding of this new Galen was going to play an important role in the future of European medicine. Making the Greek texts accessible was, however, a major challenge. Greek printing was expensive and the market still small. Efforts to incorporate Greek into the standard medical curriculum were not successful.

The first collected edition of Galen in Greek came out from the Aldine press in 1525, but it was rushed and full of errors, and still included many texts which were merely attributed to Galen and unlikely to be truly his work. Nevertheless, it provided the raw material for scholars to get to work at making Galen’s contributions widely accessible to the Latin-speaking world. After 1525, an average of 12 translations a year began to be produced, starting with no less than Erasmus of Rotterdam, followed by Aldine collaborator Thomas Linacre. A 1538 Basel edition made an effort to groom the corpus into something more usable, and the 1540s saw editions from both Giunta at Venice and Froben at Basel.

Into the midst of this Renaissance, the ambitious and talented young Andreas Vesalius, from a long line of illustrious physicians, arrived in 1533 at the University of Paris. Both the newly-invigorated study of the ancient medical tradition and the first-hand experience of human dissection played major roles in his education, and he excelled across the board. At the time, it was the custom at dissections for the faculty to lecture while a “cutter” did the dirty work with the cadaver, and Vesalius assisted as a cutter at both public and private dissections for the student community of his teacher, the Greek-reading Galenist Johann Guenther of Andernach. He also attended the wildly popular lectures of Jacobus Sylvius on Galen and Hippocrates. Charles V’s invasion of France cut short his time in Paris, however, forcing Vesalius to return to Belgium. At Louvain, he wrote a dissertation on book IX of 10^th-century Persian physician Abu Bakr al-Razi’s Ad almansorem, a standard Medieval handbook on disease, providing updated humanist terminology. Afterwards, he set out for Padua to complete his medical education.

His experiences at the University of Paris allowed him to accelerate his medical degree at Padua, taking his final examinations almost immediately upon arriving. The faculty were so impressed that after being granted his degree, Vesalius was made a professor of surgery there at the tender age of 23. He earned notoriety for lecturing and dissecting at the same time, eschewing the assistance of a cutter, and students recorded the delight and enthusiasm that greeted his public presentations. It is clear that he was thinking deeply both about the state of anatomical knowledge and how to communicate it most effectively to his students—and his colleagues.

During this time, Vesalius wrote and published his first post-dissertation work, the Tabulae anatomicae sex, which was an innovative set of illustrations aimed at supplementing dissection work. More audaciously, he also produced his own “corrected” version of his former teacher Guenther’s anatomical textbook. He had earned himself a glowing acknowledgement from Guenther based on his work for him in his Paris dissections—but once teaching his own students, he felt the need for an updated version (to the dismay of his former mentor). In 1539, he was invited to be a contributing editor to the new Giunta translation of the Galenic corpus. This reveals the degree to which he was seen as an expert in his field even in the earliest years of his professional career—as well as the pattern of difficulties with his elder colleagues which would emerge as a major trend in his life.

In the course of all this scholarship and teaching, he began to conceive of what would be his legacy: his own wholly original contribution to the literature of anatomical study. Sometime in late 1542 or early 1543, he left Padua for Basel to oversee the printing of his magnum opus: the De humani corporis fabrica.


Learning to Read the Human Body

The book which would crown Vesalius’s reputation also laid the foundations of Western anatomical study for the next several hundred years. The printer with whom he chose to collaborate on the job was Johannes Oporinus, a professor of Greek who had only a year prior left his university position to pursue printing full time. Oporinus had studied law with the son of Johannes Amerbach and worked as a proof-reader at the Froben press before joining in a consortium with other printers, including his brother-in-law Robert Winter, and then eventually setting out on his own. He had also pursued medical studies, including a period of time as an assistant to the notorious Swiss iatrochemist Paracelsus. This made him the perhaps unexpected, yet ideal candidate for the job of creating the most groundbreaking medical book of the Renaissance.

Although Oporinus was already a respected scholar and an accomplished and well-connected printer at the time he began work on the Fabrica, the choice was still something of a risk, as “he had published nothing on this scale and no extensively illustrated books” (Gaskell). Vesalius had worked with Oporinus’s partner Robert Winter on the publication of his Louvain thesis, which is likely how they met. The fact that Oporinus’s father had been a painter may also have provided some indication that the two men would work well together, sharing similar sensibilities about the importance of visual representation.

Vesalius’s fluent understanding of Galen and of the human body in realia, as well as the practical desire to assist his students, enabled him to create an unprecedented map of the human body. The Fabrica is deeply engaged with the ancient medical tradition while also correcting and improving it. It became the most complete description of the human body published to date, and a watershed in the development of the medical sciences. And completely, to his mind, in the spirit of Galen, whom he calls “divine” and the “prince of Medicine”—even as it corrected and critiqued the ancient authority’s conclusions.

The Fabrica is organized into seven books, each addressing a different system of the body. Vesalius was certainly not the first person to point out inaccuracies in Galen, but he was the first to pursue them systematically, coming from the specific perspective that Galen’s lack of experience with human cadavers had led him to many errors that needed to be corrected through direct observation.

Vesalius had an unusual degree of artistic control over the layout and design of the book, which he discusses in a letter to Oporinus that the printer included in a prefatory text entitled Typographicus lectori—The Printer to the Reader. It provides an explanation of his thinking and a guide to navigating his complex treatise through the thoughtful use of typography and hypertextual labels and notes. In the 1543 first edition, the main body text is set in 15.5 point roman type. Within it, superscript references refer the reader to a running commentary on the illustrations. This commentary text is set in italic type, in a slightly larger point size which gives the compressed italic an equal visual weight to the roman type. The result is an elegant page which allows the reader to navigate the book in any number of ways. The main text can be read straight through without any engagement with the illustrations, but can also be departed from at any given point to study a topic in more detail through the accompanying images and their captions.

The aspect of the Fabrica which has attracted the most attention over the last 400 and more years has been its large and uncannily beautiful illustrations. They are rivaled only by the unpublished anatomical illustrations of Leonardo da Vinci—of which there is no evidence Vesalius had any knowledge. But while artists had long been aware of the value of anatomical knowledge to their own work (Alberti and Cellini both discuss this in their treatises on painting), anatomists were slightly slower to seriously recognize the importance of art, or to be more specific, visual representation, to the development of their own field.

Jacopo Berengario da Carpi, who also had a commitment to human dissection and a willingness to disagree with Galen, provided something of a forerunner to the Fabrica with his illustrated 1522 Isagoge Breves. Charles Estienne’s 1545 De dissectione partium corporis humani also provided some inspiration to Vesalius and Oporinus. According to Roger Gaskell, its “division between text and illustration is remarkably similar to the Fabrica. The narrative text is set in roman and has no internal references to the illustrations, while the illustrations have keys and some explanatory text set in italics. There is a difference, though, in that Estienne’s text is devoid of marginal references … It seems that Vesalius took over Estienne’s plan and improved on it.” Although not the first to unite text and image for anatomical purposes, Vesalius’s effort blew the rest away in scope, using larger and better images in a more sophisticated way.

In the Fabrica’s dedication to Charles V, Vesalius writes that illustrations can create a more exact picture in the mind of the reader than even the most precise language, giving as an example the diagrams which accompany mathematical texts. As Monique Kornell writes, he was “the first author to explore fully the potential of a book to describe with word and image what was an unavoidably ephemeral subject—the dissected human body.”

The Musclemen

To that end, Vesalius not only seems to have thoughtfully designed the layout for his book, but closely overseen the creation of the woodblocks. The identity of the actual artist(s) of the Fabrica remains controversial. The woodcuts are often attributed to Jan Stephan van Calcar, a student of Titian who had illustrated the Tabulae anatomicae sex and with whom Vesalius mentions wanting to work on a future project. But although he may well have worked on some of the images in the Fabrica, Calcar is not named anywhere by Vesalius as their creator. Vesalius was himself an artist, known for sketching at the dissecting table to help students understand what they were seeing, and would have contributed some of his own drawings. Other artists working in Padua or Venice may have been involved as well. Guerra attributes the cutting of the blocks—its own virtuosic effort—to the workshop of Francesco Marcolini and his manager Johann Britt based on comments by Vasari and other suggestive historical evidence.

The images were drawn from life—or rather, death. Vesalius describes how he suspended cadavers using ropes and arranged them to create the striking compositions. It was not only accuracy that was paramount, but clarity and size. The woodcuts employ a combination of realism and diagrammatic visualization aimed at maximizing the information they could communicate. Many previous anatomical books had illustrations which functioned mainly as an aid to memory of the text, but in the Fabrica both illustration and text are fully integrated as a way of encoding knowledge.

The apotheosis of artistic achievement and visual expression in the Fabrica is the famous musclemen series. These fourteen large woodcuts exemplify what Martin Kemp calls a “remarkable system of continuous revelation.” Living corpses in balletic poses progressively reveal more and more of the interior of the human body. The pastoral backgrounds are not random fantasies, but when joined together reveal a continuous panorama of the Euganean Hills between Padua and Vicenza.

When complete, the woodblocks were packed and transported from Venice to Basel for use in Oporinus’s print shop. In Vesalius’s letter to Oporinus, he describes how he sent the blocks along with proof prints of each illustration which contained his detailed notes on their placement. The resulting book, first printed in 1543, was “the first comprehensive attempt to present the human body through the medium of images” (Margócsy). The images themselves had a long afterlife and, like the images of his earlier Tabulae, they were frequently plagiarized. Many later writers who copied the images commented that they were so accurate, there was no point in going through the effort of attempting to create new compositions.

Although one of the main intellectual arguments of the Fabrica, and indeed of Vesalius’s career, was for the importance of first-hand observation of human dissection for anatomical knowledge, his book paradoxically in some ways had an opposite effect. Legally obtained cadavers were hard to come by, and most physicians simply did not have access to enough bodies to conduct first-hand anatomical research by means of dissection. Marginalia in extant copies of both the first and second editions of the Fabrica reveal that many of his readers used the book as a substitute for dissection, relying on its images and descriptions to provide a clear and accurate simulacrum of the human body.


Vesalius on Vesalius

The Fabrica is a remarkable book, both of its time and ahead of its time. It excited readers immediately—but some were not quite sure what to make of it. Reception was divided, with even some of the teachers and mentors whom Vesalius explicitly praises and acknowledges reacting with fury to what they perceived to be his disrespect for tradition and lack of courtesy to his elders. He fared better outside his immediate orbit. The first edition sold out in Leipzig before the end of the year and Melanchthon wrote a poem about it. A hand-colored presentation copy to the dedicatee, Charles V, earned Vesalius a court appointment and praise from Charles that it was “without question the greatest of all books which have been written about anatomy.”

Vesalius was an ambitious thinker, however, and he did not spare himself the treatment he had given Galen. When a new edition was called for, he did not just reprint the text of the 1543 edition. The 1555 second edition, while re-using almost all the masterful woodcuts created for the first, contains almost 160 pages of additional text—answering his critics, making corrections, and incorporating new information gleaned from dissections performed in the intervening years.

The prefatory matter was also edited to protect Vesalius after the rocky reception of his colleagues to the first, with many names of former friends removed and Galen demoted from divine status. A new large initial “V” was cut depicting the story of the flaying of Marsyas from Ovid. Not only a classic anatomical scene, it perhaps suggests Vesalius’s own feelings on his treatment by his elder contemporaries.

In addition to corrections of content and reworkings of style, the second edition is entirely reset, with new types. The body text is in slightly larger roman type and the illustrations given more space. The italic commentary, on the other hand, was set in a new “French style” italic and slightly smaller point size—more trendy and elegant, but slightly narrower and perhaps less legible. While Vesalius had overseen the printing of the first edition in person, he was not physically present for the second edition, and many of these stylistic changes seem to have been the work of Oporinus. The result is a publication regarded as “even more lavish than the first” (Heirs of Hippocrates). The famous woodcut frontispiece is the only major illustration that is recut, with a few compositional changes, although Vesalius did make some changes to his meticulous labels to increase their legibility, which in the first edition had not always come out as intended.

Towards a Third Edition

The 1543 and 1555 publications were the only editions edited and corrected by Vesalius himself. But he never stopped refining his ideas and their expression. The present volume, discovered and identified only in the last two decades, contains over a thousand annotations, corrections, deletions, and editorial notes in Vesalius’s own hand. His intention was clear: to prepare a never-realized third edition which would surpass the first two. Vivian Nutton, writing about this volume, speculates that it was perhaps left behind in Brussels in the summer of 1559, when Vesalius set out for Spain, based on the lack of references to important new works by fellow anatomists.

In addition to a hand matching his few extant letters and writings and a very particular habit of notational practice, some of the textual emendations refer to and update comments specifically relating to Vesalius’s own life experiences, including a discussion of witnessing the practice of circumcision in Venice and Padua. In the preface, he deletes his father’s name, perhaps having found it redundant or confusing (he was also Andreas). It is clear that no one but the original author would have treated the text in this way.

Nutton suggests that these pages comprise the sheets sent by Oporinus in Basel to Vesalius in Brussels at the time of publication, before the printing of the post-lim text. It was Oporinus’s practice to send a proof copy to authors not resident in Basel after the main text was printed, so that they could produce the errata list while he worked on the index. He proposes the following sequence of events:

According to Martin Steinmann, if an author was not resident in Basle, then the proof copy of the text was read by Oporinus and his staff before it was printed and sent, often in small sections, to the author. He would then send a list of Errata back to Basle, which would then be printed along with the preface, title page and index before the book went on sale. Many of these stages are visible here. The text of the Fabrica ended on p.824 on the last side of a gathering, Aa, that was unusually long presumably so all the text could be fitted in. This was then sent to Vesalius, along with the frontispiece and prefatory material, for his consideration … an examination of the volume reveals no indication that the last gatherings with the index, sigg. Bb-Ee, were ever included. The grubbiness of the last page, p.824, contrasts markedly with the near pristine p.823, showing that it must have been exposed to the elements for some time.

Judging from the placement and angle of the annotations, Vesalius appears to have left the sheets unbound, making them more convenient to work with. The annotations were probably made over the course of several years. When he was finally ready to begin printing the new edition, he could just send the sheets off to Oporinus. The missing bifolium mm3.4 was likely lost later, perhaps during the rebinding process, when some of the annotations were also trimmed.

About two thirds of the changes are stylistic, revealing Vesalius’s continued and indeed perhaps deepened interest in Latin prose and the best way to communicate information to his readers. He refines his phrasing, rethinks word choice, and improves the clarity of his sentences. He was a devoted humanist, which included a commitment to elegance of Latin expression—as well as to the demonstration of wide learning outside even the medical sphere.

To one passage, discussing genitals, he adds an interesting long note on the religious practice of female genital cutting among the “Scevani,” identified as residents of Ethiopia (and subjects of the legendary Prester John), which he seems to have taken from Paolo Giovio’s 1550 work Historiae sui Temporis. According to Nutton, this manuscript note is probably the first discussion in a medical context of non-medical female genital mutilation.

In addition to changes to phrasing and additions, Vesalius has crossed out passages, rearranged information, corrected marginal headings, and even adjusted the labels on some of the woodblocks. He uses classic printer’s marks to express these changes, and sometimes re-writes more legibly longer explanations in the margin where his original comments came out somewhat crabbed. In some places, he tempers his criticisms of Galen (something he had come under fire for), making statements of correction more gentle or just deleting passages altogether which attack the ancient authority for his failings.

In this latter part of Vesalius’s career, beholden to the court and outside of the University setting, he had lost access to cadavers for the very type of anatomical research his book exhorted. However, it is clear he was still busy re-thinking some of his earlier statements drawn from direct observation. The most substantial reworking of strictly anatomical content appears on pages 515-518, where he addresses the sense of smell and connection between the nose and the brain. His marginal comments are heavily reworked, full of deletions, re-writings, and clarifications—an indication that he had not quite made up his mind about what he wanted to say and how he wanted to say it.

The famous woodcuts themselves are also subject to adjustment and correction. In a few cases, errors (or changed opinions about) the shapes of anatomical structures are indicated. In one place, he adjusts the image of the cartilage of the eyelid to be more bell-shaped. But quite a few of these notes pertain to the relationship of the images to their captions and guide letters, with detailed instructions to the woodcutter for how to make the correction on the woodblock itself. Although Vesalius had insisted in an earlier letter to Oporinus that the guide letters would not escape the notice of his “sharp-eyed and careful” readers, many of them were indeed difficult to read even in the second revised edition, something he still sought to correct in these notes.

This incredible survival offers “a new insight into the mind of the greatest anatomist of his day,” (Nutton) and from a time period when not much detail is known about his life. Vesalius’s marginal comments reveal his zeal for accuracy and improvement, the same things that drove him to edit and then correct the Divine Galen himself.


Afterlife

The third edition of the Fabrica would never see print. Only a few years after his departure for court life in Spain, Vesalius went on an errand to the Holy Land for the Emperor from which he never returned. While on the journey back from Jerusalem in 1564, he died and was buried on the island of Zakynthos at the age of only 49. Not long after, rumors swirled—that he had killed a man (or worse: performed a vivisection) and had gone on pilgrimage as atonement. There had also been speculation among his students that he was perhaps planning a return to university life, particularly in light of the death of Falloppio in Padua—seeking an elegant exit from the stifling court life which kept him from his research. Thus, the career of the famous anatomist was cut short, and the notes to this copy of the 1555 edition are the only indications of what such a publication might have looked like.

Manuscript material related to Vesalius is extremely rare. A few letters survive, and only one other book with his annotations, a copy of the Institutiones sold in the Norman sale at Christie’s (18 March 1998, lot 211), is currently extant. In 1546, Vesalius published a short text called the China Root Epistle, ostensibly evaluating a trendy new remedy for gout but largely serving as a defense of his work and methods to his many critics. In it, he describes—with some regret—how before he left Italy for Charles V’s court, he destroyed not only all his papers and notes, works in progress and drafts, but also all his books, with his annotations in the margin.

The process of scientific development is itself a form of continuous annotation. Vesalius was keenly aware of this, seeing the medical tradition not as a sacred text to be defended but as a body of knowledge on which to build. Throughout his works, particularly in his defense of the Fabrica in the China Root Epistle, he emphasizes that books alone cannot be trusted. He rightly calls out those who “put their faith only in books” and declares that he cannot “deny faith in his own eyes.” He was extremely passionate about getting things right, an achievement only possible through constant refinement and a quality visible not only in his treatment of the medical canon but in his attitude towards his own publications.

“If because of the powerful devotion to Galen under which I labor and my special regard for him I were to leave his opinions everywhere undisturbed contrary to the testimony of my eyes and the truth of the matter, I should be willing to have my generation wander in confusion like all the ages that have followed Galen, and let his misrepresentation of the Greeks go undetected.”

Vesalius’s work is not an overthrow of Galen, but an overthrow of the conception of medical knowledge as static: reliant on authority and established tradition. The Fabrica teaches anatomists not only how to read Galen, but how to read the human body (in both illustration and reality) with a questioning mind. The present copy of his great treatise demonstrates Vesalius’s belief that all medical knowledge—both inherited and contemporary—is always subject to improvement, whether of the facts themselves or in their clarity of expression. It is a unique testament to the vitality of empiricism and scientific inquiry, in the hand of one of its greatest practitioners.