Andreas Vesalius

Early life and education

Vesalius was born as Andries van Wesel to his father Anders van Wesel and mother Isabel Crabbe on 31 December 1514 in Brussels, which was then part of the Habsburg Netherlands. His great grandfather, Jan van Wesel, probably born in Wesel, received a medical degree from the University of Pavia and taught medicine in 1528 at the University of Leuven. His grandfather, Everard van Wesel, was the Royal Physician of Emperor Maximilian, while his father, Anders van Wesel, served as apothecary to Maximilian, and later valet de chambre to his successor Charles V. Anders encouraged his son to continue in the family tradition, and enrolled him in the Brethren of the Common Life in Brussels to learn Greek and Latin prior to learning medicine, according to standards of the era.

In 1528 Vesalius entered the University of Leuven (Pedagogium Castrense) taking arts, but when his father was appointed as the Valet de Chambre in 1532, he decided instead to pursue a career in the military at the University of Paris, where he relocated in 1533. There he studied the theories of Galen under the auspices of Jacques Dubois (Jacobus Sylvius) and Jean Fernel. It was during this time that he developed an interest in anatomy, and he was often found examining excavated bones in the charnel houses at the Cemetery of the Innocents.

Vesalius was forced to leave Paris in 1537 owing to the opening of hostilities between the Holy Roman Empire and France and returned to Leuven. He completed his studies there under Johann Winter von Andernach and graduated the following year. His thesis, Paraphrasis in nonum librum Rhazae medici arabis clariss. ad regem Almansorum de affectuum singularum corporis partium curatione, was a commentary on the ninth book of Rhazes. He remained at Leuven only a short time before leaving after a dispute with his professor. After settling briefly in Venice in 1536, he moved to the University of Padua (Universitas artistarum) to study for his medical doctorate, which he received in 1537.

Medical career and accomplishments

On the day of his graduation he was immediately offered the chair of surgery and anatomy (explicator chirurgiae) at Padua. He also guest-lectured at the Bologna and the Pisa. Prior to taking up his position in Padua, Vesalius traveled through Italy, and assisted the future Pope Paul IV and Ignatius of Loyola to heal those afflicted by Hansen’s disease (leprosy). In Venice, he met the illustrator Johan van Calcar, a student of Titian. It was with van Calcar that Vesalius published his first anatomical text, Tabulae Anatomicae Sex, in 1538. Previously these topics had been taught primarily from reading classical texts, mainly Galen, followed by an animal dissection by a barber–surgeon whose work was directed by the lecturer. No attempt was made to confirm Galen's claims, which were considered unassailable. Vesalius, in contrast, performed dissection as the primary teaching tool, handling the actual work himself and urging students to perform dissection themselves. Hands-on direct observation was, considered the only reliable resource, a huge break with medieval practice, which prohibited human dissection.

Vesalius created detailed illustrations of anatomy for students in the form of six large woodcut posters. When he found that some of them were being widely copied, he published them all in 1538 under the title Tabulae anatomicae sex. He followed this in 1539 with an updated version of Guinter's anatomical handbook, Institutiones anatomicae.

In 1539 he also published his Venesection letter on bloodletting. This was a popular treatment for almost any illness, but there was some debate about where to take the blood from. The classical Greek procedure, advocated by Galen, was to collect blood from a site near the location of the illness. However, the Muslim and medieval practice was to draw a smaller amount of blood from a distant location. Vesalius' pamphlet generally supported Galen's view, but with qualifications that rejected the infiltration of Galen.

In 1541 while in Bologna, Vesalius discovered that all of Galen's research had to be restricted to animals; since dissection had been banned in ancient Rome. Galen had dissected Barbary macaques instead, which he considered structurally closest to man. Even though Galen produced many errors due to the anatomical material available to him, he was a qualified examiner, but his research was weakened by stating his findings philosophically causing his facts to be based more on religion rather than science. Vesalius contributed to the new Giunta edition of Galen's collected works and began to write his own anatomical text based on his own research. Until Vesalius pointed out Galen's substitution of animal for human anatomy, it had gone unnoticed and had long been the basis of studying human anatomy. However, some people still chose to follow Galen and resented Vesalius for calling attention to the difference.

Galen had assumed that arteries carried the purest blood to higher organs such as the brain and lungs from the left ventricle of the heart, while veins carried blood to the lesser organs such as the stomach from the right ventricle. In order for this theory to be correct, some kind of opening was needed to interconnect the ventricles, and Galen claimed to have found them. So paramount was Galen's authority that for 1400 years a succession of anatomists had claimed to find these holes, until Vesalius admitted he could not find them. Nonetheless, he did not venture to dispute Galen on the distribution of blood, being unable to offer any other solution, and so supposed that it diffused through the unbroken partition between the ventricles.

Other famous examples of Vesalius disproving Galen's assertions were his discoveries that the lower jaw (mandible) was composed of only one bone, not two (which Galen had assumed based on animal dissection) and that humans lack the rete mirabile, a network of blood vessels at the base of the brain that is found in sheep and other ungulates.

In 1543, Vesalius conducted a public dissection of the body of Jakob Karrer von Gebweiler, a notorious felon from the city of Basel, Switzerland. He assembled and articulated the bones, finally donating the skeleton to the University of Basel. This preparation ("The Basel Skeleton") is Vesalius' only well-preserved skeletal preparation, and also the world's oldest surviving anatomical preparation. It is still displayed at the Anatomical Museum of the University of Basel.

In the same year Vesalius took residence in Basel to help Johannes Oporinus publish the seven-volume De humani corporis fabrica (On the fabric of the human body), a groundbreaking work of human anatomy that he dedicated to Charles V. Many believe it was illustrated by Titian's pupil Jan Stephen van Calcar, but evidence is lacking, and it is unlikely that a single artist created all 273 illustrations in a period of time so short. At about the same time he published an abridged edition for students, Andrea Vesalii suorum de humani corporis fabrica librorum epitome, and dedicated it to Philip II of Spain, the son of the Emperor. That work, now collectively referred to as the Fabrica of Vesulias, was groundbreaking in the history of medical publishing and is considered to be a major step in the development of science medicine. Because of this, it marks the establishment of anatomy as a modern descriptive science.

Though Vesalius' work was not the first such work based on actual dissection, nor even the first work of this era, the production quality, highly detailed and intricate plates, and the likelihood that the artists who produced it were clearly present in person at the dissections made it an instant classic. Pirated editions were available almost immediately, an event Vesalius acknowledged in a printer's note would happen. Vesalius was 28 years old when the first edition of Fabrica was published.

Imperial physician and death

Soon after publication, Vesalius was invited to become imperial physician to the court of Emperor Charles V. He informed the Venetian Senate that he would leave his post in Padua, which prompted Duke Cosimo I de' Medici to invite him to move to the expanding university in Pisa, which he declined. Vesalius took up the offered position in the imperial court, where he had to deal with other physicians who mocked him for being a mere barber surgeon instead of an academic working on the respected basis of theory.

Over the next eleven years Vesalius traveled with the court, treating injuries caused in battle or tournaments, performing postmortems, administering medication, and writing private letters addressing specific medical questions. During these years he also wrote the Epistle on the China root, a short text on the properties of a medical plant whose efficacy he doubted, as well as a defense of his anatomical findings. This elicited a new round of attacks on his work that called for him to be punished by the emperor. In 1551, Charles V commissioned an inquiry in Salamanca to investigate the religious implications of his methods. Although Vesalius' work was cleared by the board, the attacks continued. Four years later one of his main detractors and one-time professors, Jacobus Sylvius, published an article that claimed that the human body itself had changed since Galen had studied it.

After the abdication of Emperor Charles V, Vesalius continued at court in great favor with his son Philip II, who rewarded him with a pension for life by making him a count palatine. In 1555 he published a revised edition of De humani corporis fabrica.

In 1564 Vesalius went on a pilgrimage to the Holy Land, some said, after being accused of dissecting a living body. He sailed with the Venetian fleet under James Malatesta via Cyprus. When he reached Jerusalem he received a message from the Venetian senate requesting him again to accept the Paduan professorship, which had become vacant on the death of his friend and pupil Fallopius.

After struggling for many days with adverse winds in the Ionian Sea, he was shipwrecked on the island of Zakynthos. Here he soon died, in such debt that a benefactor kindly paid for his funeral. At the time of his death he was scarcely fifty years of age. He was buried somewhere on the island of Corfu.

For many years it was assumed that Vesalius's pilgrimage was due to pressures of the Inquisition. Today this assumption is generally considered to be without foundation and is dismissed by modern biographers. It appears the story was spread by Hubert Languet, a diplomat under Emperor Charles V and then under the Prince of Orange, who claimed in 1565 that Vesalius had performed an autopsy on an aristocrat in Spain while the heart was still beating, leading to the Inquisition's condemning him to death. The story went on to claim that Philip II had the sentence commuted to a pilgrimage. The story re-surfaced several times over the next few years, living on until recent times.

De Humani Corporis Fabrica

In 1543, Vesalius asked Johannes Oporinus to publish the book De humani corporis fabrica (On the fabric of the human body), a groundbreaking work of human anatomy he dedicated to Charles V and which many believe was illustrated by Titian's pupil Jan Stephen van Calcar.

About the same time he published another version of his great work, entitled De humani corporis fabrica librorum epitome (Abridgement of the Structure of the Human Body) more commonly known as the Epitome, with a stronger focus on illustrations than on text, so as to help readers, including medical students, to easily understand his findings. The actual text of the Epitome was an abridged form of his work in the Fabrica, and the organization of the two books was quite varied. He dedicated it to Philip II of Spain, son of the Emperor.

The Fabrica emphasized the priority of dissection and what has come to be called the "anatomical" view of the body, seeing human internal functioning as a result of an essentially corporeal structure filled with organs arranged in three-dimensional space. His book contains drawings of several organs on two leaves. This allows for the creation of three-dimensional diagrams by cutting out the organs and pasting them on flayed figures. This was in stark contrast to many of the anatomical models used previously, which had strong Galenic/Aristotelean elements, as well as elements of astrology. Although modern anatomical texts had been published by Mondino and Berenger, much of their work was clouded by reverence for Galen and Arabian doctrines.

Besides the first good description of the sphenoid bone, he showed that the sternum consists of three portions and the sacrum of five or six, and described accurately the vestibule in the interior of the temporal bone. He not only verified Estienne's observations on the valves of the hepatic veins, but also described the vena azygos, and discovered the canal which passes in the fetus between the umbilical vein and the vena cava, since named the ductus venosus. He described the omentum and its connections with the stomach, the spleen and the colon; gave the first correct views of the structure of the pylorus; observed the small size of the caecal appendix in man; gave the first good account of the mediastinum and pleura and the fullest description of the anatomy of the brain up to that time. He did not understand the inferior recesses, and his account of the nerves is confused by regarding the optic as the first pair, the third as the fifth, and the fifth as the seventh.

In this work, Vesalius also becomes the first person to describe mechanical ventilation. It is largely this achievement that has resulted in Vesalius being incorporated into the Australian and New Zealand College of Anaesthetists college arms and crest.

Excerpts

When I undertake the dissection of a human pelvis I pass a stout rope tied like a noose beneath the lower jaw and through the zygomas up to the top of the head... The lower end of the noose I run through a pulley fixed to a beam in the room so that I may raise or lower the cadaver as it hangs there or turn around in any direction to suit my purpose; ... You must take care not to put the noose around the neck, unless some of the muscles connected to the occipital bone have already been cut away.

Other publications

In 1538, Vesalius wrote Epistola, docens venam axillarem dextri cubiti in dolore laterali secandam (A letter, teaching that in cases of pain in the side, the axillary vein of the right elbow be cut), commonly known as the Venesection Letter, which demonstrated a revived venesection, a classical procedure in which blood was drawn near the site of the ailment. He sought to locate the precise site for venesection in pleurisy within the framework of the classical method. The real significance of the book is his attempt to support his arguments by the location and continuity of the venous system from his observations rather than appeal to earlier published works. With this novel approach to the problem of venesection, Vesalius posed the then striking hypothesis that anatomical dissection might be used to test speculation.

In 1546, three years after the Fabrica, he wrote his Epistola rationem modumque propinandi radicis Chynae decocti, commonly known as the Epistle on the China Root. Ostensibly an appraisal of a popular but ineffective treatment for gout, syphilis, and stone, this work is especially important as a continued polemic against Galenism and a reply to critics in the camp of his former professor Jacobus Sylvius, now an obsessive detractor.

In February 1561, Vesalius was given a copy of Gabriele Fallopio's Observationes anatomicae, friendly additions and corrections to the Fabrica. Before the end of the year Vesalius composed a cordial reply, Anatomicarum Gabrielis Fallopii observationum examen, generally referred to as the Examen. In this work he recognizes in Fallopio a true equal in the science of dissection he had done so much to create. Vesalius' reply to Fallopio was published in May 1564, a month after Vesalius' death on the Greek island of Zante (now called Zakynthos).

Skeletal system

Muscular system

Vascular and circulatory systems

Nervous system

Abdominal organs

Heart

Other achievements

Scientific and historical impact

The influence of Vesalius' plates representing the partial dissections of the human figure posing in a landscape setting is apparent in the anatomical plates prepared by the Baroque painter Pietro da Cortona (1596–1669), who executed anatomical plates with figures in dramatic poses, most of them with architectural or landscape backdrops.

During the 20th century, the American artist, Jacob Lawrence created his Vesalius Suite based on the anatomical drawings of Andreas Vesalius.

"De Fabrica received a mixed reception when it first appeared; strict Galenists deplored its attacks on their master, while other anatomists, particularly in Italy, praised it as an important contribution—the reaction that was ultimately to carry the day," concludes Katharine Park her Commentary in the 1998 De Fabrica.

Like Darwin three centuries later, Vesalius was going up against the towering authority of a tradition stretching back to the ancients—here specifically the work of Galen — with only his experience on his side. He knew what his eyes saw and his hands felt, and concluded that traditional belief was wrong. In his publications we see Vesalius doing everything he can think of to bolster his authoritative image: publishing a huge monument to himself, but presenting the work using Galen’s own flowchart; presenting himself as personal physician to the emperor and having himself depicted in a commanding position on the title page of the book; augmenting his words with illustration after illustration and recommending the experiential road to all his students far and wide. His guarantee: if you doubt what I say and show here, do your own anatomy, see for yourself and your experience will be like mine. The authority of experience won out against the authority of ancient sources and a new era dawned upon Europe.

Simultaneously Vesalius’s work was part of one of the earliest known public health programs. The Council of Doges in Venice responded to the Bubonic Plague in the mid-14th century by directing the University of Padua Medical School to devote itself to discovering the causes of plague, how it spreads, how it develops in the individual, and if possible how victims might be cured. It ultimately took three centuries to find the solution, but with Venice leading the way plague was eventually eliminated as a major killer across Europe.