The role of Vesalius and his contemporaries in the transfiguration of human anatomical science

The understanding of human anatomy has been an endeavour spanning thousands of years from the Egyptians and Greeks in antiquity to the present day. Scholars and scientists have overcome great barriers to discover the inner workings and complexities of the human body, from personal challenges and prejudices to obstacles placed by society. Our present understanding of anatomy has accumulated over centuries, and progressive generations of physicians have contributed to the ever-growing evidence-based knowledge. This article explores the contributions made by Vesalius and his contemporaries in the first half of the sixteenth century. These enlightened scholars advanced anatomical knowledge and, perhaps more importantly, the scientific method, directly impacting the mindset and methodologies of future anatomists. Individuals such as Berengario da Carpi and Gabriele Falloppio produced bodies of work during their lifetime that were not only important in disputing the teachings of Galen of Pergamon, which had been accepted as almost unquestionable truths for a thousand years, but also instrumental in developing a new generation of scientists. The anatomists of the late renaissance were unable to resolve many of the factual inaccuracies of Galenic teaching but provided the groundwork for scientific thinking which future generations of anatomists benefited greatly from. The principles of documenting what is observed and establishing a methodical approach to question discrepancies in experiments would go on to influence physicians such as Harvey and Malpighi to investigate and draw correct conclusions in their research and ultimately advance our understanding of human anatomy to what it is today.

Summarizing the medieval anatomy of the head and brain in a single image: Magnus Hundt (1501) and Johann Dryander (1537) as transitional pre-Vesalian anatomists

Of the early-sixteenth century pre-Vesalian anatomists, Magnus Hundt in 1501 and Johannes Eichmann (known as Johann Dryander) in 1537 both attempted to summarize the anatomy of the head and brain in a single complex figure. Dryander clearly based his illustration on the earlier one from Hundt, but he made several improvements, based in part on Dryander's own dissections. Whereas Hundt's entire monograph was medieval in character, Dryander's monograph was a mixture of medieval and early-modern frameworks; nevertheless, the corresponding illustrations of the anatomy of the head and brain in Hundt (1501) and Dryander (Dryandrum 1537) were both essentially medieval. This article examines in detail the symbology of both illustrations within the context of the medieval framework for neuroanatomy and neurophysiology. These two woodcuts of the head and brain provide the most detailed pictorial representation of medieval cranial anatomy in a printed book prior to the work of Andreas Vesalius in 1543.

Evolution of the myth of the human rete mirabile traced through text and illustrations in printed books: The case of Vesalius and his plagiarists

Andreas Vesalius initially accepted Galen's ideas concerning the rete mirabile in humans. In 1538, Vesalius drew a diagram of the human rete mirabile as a plexiform termination of the carotid arteries, where the vital spirit is transformed into the animal spirit, before being distributed from the brain along the nerves to the body. In 1540, Vesalius demonstrated the rete mirabile at a public anatomy, using a sheep's head (due to his nascent realization that he could not demonstrate this adequately in a human cadaver, potentially eliciting ridicule). By 1543, Vesalius had fully reversed himself, denied the existence of the rete mirabile in humans, and castigated himself for his prior failure to recognize this error in Galen's works. Vesalius nevertheless illustrated both the Galenic conception of the rete mirabile in humans and a schematic of the rete mirabile in ungulates. He intended the 1543 diagram of the human rete mirabile as an example of a mistake that resulted from Galen's overreliance on animals as models of human anatomy. However, in spite of Vesalius's intentions, for more than a century afterward, his figure was repeatedly and perversely plagiarized by advocates for Galenic doctrine, who misused it as a purportedly realistic representation of human anatomy and generally omitted the contrary opinions of Berengario da Carpi and Vesalius. The protracted use of stereotyped representations of the rete mirabile in extant printed illustrations provides tangible documentation of the stagnation in anatomical thought in the sixteenth and seventeenth centuries.

Then there were 12: The illustrated cranial nerves from Vesalius to Soemmerring

In the second century ce, Galen described seven pairs of cerebral nerves. He did not name the nerves, nor did he illustrate his work. Galen's descriptive texts survived until the mid-sixteenth century, when anatomists, influenced by the artistic and scientific revolution of the Renaissance, began a reformation in anatomical research. They closely observed their own dissected material and conveyed their results not only in words but commonly by lavish drawings. Many of the great anatomists reexamined the cerebral nerves, adding descriptive text or changing the classification. In 1778, Thomas Soemmerring (1755-1830) named 12 pairs of cerebral nerves upon which the modern cranial nerve nomenclature is based. Soemmerring matched his text with clear, decisive illustrations. This article describes the works of some of the great artists in the period from Vesalius to Soemmerring and how they used illustration to supplement and provide clarity for their textual descriptions of the cranial nerves.

The three fetal shunts: A story of wrong eponyms

The fetal circulatory system bypasses the lungs and liver with three shunts. The foramen ovale allows the transfer of the blood from the right to the left atrium, and the ductus arteriosus permits the transfer of the blood from the pulmonary artery to the aorta. The ductus venosus is the continuation of the umbilical vein, allowing a large part of the oxygenated blood from the placenta to join the supradiaphragmatic inferior vena cava, bypassing the fetal liver and directly connecting the right atrium. These structures are named after the physicians who are thought to have discovered them. The foramen ovale and the ductus arteriosus are called the "foramen Botalli" and the "ductus Botalli," after Leonardo Botallo (1530-c. 1587). The ductus venosus is styled "ductus Arantii" after Giulio Cesare Arantius (1530-1589). However, these eponyms have been incorrectly applied as these structures were, in fact, discovered by others earlier. Indeed, the foramen ovale and the ductus arteriosus were described by Galen of Pergamon centuries earlier (c. 129-210 AD). He understood that these structures were peculiar to the fetal heart and that they undergo closure after birth. The ductus venosus was first described by Andreas Vesalius (1514-1564) 3 years before Arantius. Therefore, the current anatomical nomenclature of the fetal cardiac shunts is historically inappropriate.

Andreas Vesalius of Brussels (1514-1564): his contribution to the field of functional neuroanatomy and the criticism to his predecessors

Until the fifteenth century, the knowledge about anatomy and function of the nervous system had been significantly influenced by theological notions. Andreas Vesalius of Brussels (1514-1564), based on human cadavers' dissections, criticized his predecessors and contributed to the construction of the current knowledge about functional neuroanatomy. Although he did not avoid mistakes, he successfully demonstrated the high value of human cadavers' dissection in anatomical teaching.

Andreas Vesalius (1515-1564) on animal cognition

Until well in the 19th century, the Aristotelian concept of the scala naturae (ladder of nature) was the most common biological theory among Western scientists. It dictated that only humans possessed a rational soul that provided the ability to reason and reflect. Michel Eyquem de Montaigne (1533-1592) was the first philosopher influential enough to lastingly posit that animals are cognitive creatures. His view stirred a fierce controversy, with René Descartes (1596-1650) leading among his many adversaries. Only after it became accepted that animals and humans alike have cognitive abilities, did the research on the influence of conscious awareness and intention on the behavior of an animal become possible in the 20th century. We found the anatomist Andreas Vesalius (1515-1564) to have already rejected the Aristotelian view on the lack of the rational soul in animals in his 1543 opus magnum De Humani Corporis Fabrica Libri Septem. His observation "that there is a difference in size according to the amount of reason that they seem to possess: man's brain is the largest, followed by the ape's, the dog's, and so on, corresponding to the amount of rational force that we deduce each animal to have" resonated some 330 years later when Darwin concluded that "the difference in mind between man and the higher animals, great as it is, certainly is one of degree and not of kind." We conclude that Vesalius was instrumental in breaking with two millenniums of dominance of the concept of lack of animal cognition.

Vesalius criticism on Galen's musculoskeletal anatomy

Galen of Pergamum (129-216/217 AD), an important Greek physician, influenced the history of medicine for more than 1400 years. However, Andreas Vesalius (1514-1564), after performing dissections of human cadavers, remarked that Galen made several mistakes due to the fact that his dissections were on animals, particularly on apes. The current study summarizes the main points in which Vesalius criticized Galen in terms of the musculoskeletal anatomy.

Developing the Brain-Early Illustrations of Cerebral Cortex and Its Gyri

BACKGROUND

Throughout the Middle Ages, most representations of the brain amounted to highly schematized ventricles housed within abstract squiggles of neural tissue. The works by the pre-eminent Flemish anatomist Andreas Vesalius in his De Humani Corporis Fabrica (1543) added considerably more accuracy and detail; still, his drawings of cerebral hemispheres do not exhibit the gyral-sulcal pattern recognized today. Identifiable cortical landmarks would not be featured in print until Cerebri Anatome (1664) by the English physician Thomas Willis.

METHODS

A review of primary and secondary sources on the subject.

RESULTS

Medieval doctors understood neurophysiology according to the cell doctrine, whereby the first cell (modern-day lateral ventricles) was responsible for sensation, the second cell (third ventricle) for cognition, and the third cell (fourth ventricle) for memory. Vesalius challenged this ventricle-centric model and resolved to portray physical form only, without the influence of conceptual function. A century later, Willis and his illustrator, Christopher Wren, citing limited clinical evidence, proposed that the corpus striatum, the white matter, and the gray matter replace the three cells, finally allowing the cortex a physiological rather than a structurally supportive role. This relocation of executive function demanded the more meticulous rendering of the brain provided in the Cerebri Anatome.

CONCLUSIONS

Thomas Willis produced anatomic drawings of the brain depicting previously ill-defined surface features, as in Fabrica by Vesalius, because of a paradigm shift in neurophysiology, emphasizing the cortex over the ventricles, not because of advances in techniques of dissection or illustration. Perhaps, as the study of the brain continues, another future revelation in neurophysiology will drive another unexpected, enduring change in the study of the structures of the nervous system.

The relationship between Vesalius and the Borgarucci family

Two of the four brothers Borgarucci were medical doctors and in one way or another, be it distantly, connected with the great master Vesalius. Giulio Borgarucci was a physician, who became a Calvinist and emigrated to England where he treated many noblemen and friends of Queen Elisabeth I. He was present at a conversation between the Italian writer and traveler Pietro Bizzari and the Venetian jeweler who witnessed Vesalius' death in Zakynthos. Prospero Borgarucci became professor of anatomy and surgery in Padua, some 20 years after Vesalius. He published several treatises on anatomy, pestilential disease, and materia medica. Prospero Borgarucci became physician to Queen Catherine de Medicis in France, and to Archduke Karl II of Habsburg in Graz. His most important work is the so-called Chirurgia Magna of Vesalius. Text and illustrations of this spurious Vesalian work point to the use of passages of the Epitome, surgical college notes and copied Vesalian images in Borgarucci's Chirurgia Magna.

Two cases of 16th century head injuries managed in royal European families

In Europe, during the 16th century, there were a number of prominent general surgeons adventurous enough to consider operating on the brain for head injuries. From the time of Hippocrates, operating on the skull and brain was considered both treacherous and too dangerous to be undertaken except on rare occasions. Operating on a member of a royal court was considered even more exceptional because if the outcome was poor, the surgeon could lose a hand or limb, or, even worse, be beheaded. The authors present two interesting cases of royal family members who underwent surgery for head injuries that were quite severe. The surgeons involved, Ambroise Paré, Andreas Vesalius, and Berengario da Carpi, were among the most prominent surgeons in Europe. Despite very challenging political situations, all were willing to undertake a complex surgical intervention on the member of a prominent royal family. The individuals involved, both royal and medical, plus the neurosurgical injuries are discussed.

Andreas Vesalius' understanding of pulmonary ventilation

The historical evolution of understanding of the mechanical aspects of respiration is not well recorded. That the anatomist Andreas Vesalius (1515-1564) first recorded many of these mechanics in De Humani Corporis Fabrica Libri Septem has received little attention. We searched a digital copy of De Fabrica (1543) and its English translation as provided by Richardson and Carman (1998-2009) for references to aspects of pulmonary ventilation. We found that Vesalius grasped the essentials of tidal and forced respiration. He recognized that atmospheric pressure carried air into the lungs, approximately 100 years before Borelli did. He described an in vivo experiment of breathing, some 120 years before John Mayow produced his artificial model. He reported on positive pressure ventilation through a tracheotomy and on its life-saving effect, some 100 years before Robert Hook did. In publicly recording his insights over 450 years ago, Vesalius laid a firm basis for our understanding of the physiology of respiration and the management of its disorders.

Andreas Vesalius' 500th Anniversary: Initial Integral Understanding of Voice Production

BACKGROUND

Voice production relies on the integrated functioning of a three-part system: respiration, phonation and resonance, and articulation. To commemorate the 500th anniversary of the great anatomist Andreas Vesalius (1515-1564), we report on his understanding of this integral system.

METHODS

The text of Vesalius' masterpiece De Humani Corporis Fabrica Libri Septum and an eyewitness report of the public dissection of three corpses by Vesalius in Bologna, Italy, in 1540, were searched for references to the voice-producing anatomical structures and their function. We clustered the traced, separate parts for the first time.

RESULTS

We found that Vesalius recognized the importance for voice production of many details of the respiratory system, the voice box, and various structures of resonance and articulation. He stressed that voice production was a cerebral function and extensively recorded the innervation of the voice-producing organs by the cranial nerves.

CONCLUSIONS

Vesalius was the first to publicly record the concept of voice production as an integrated and cerebrally directed function of respiration, phonation and resonance, and articulation. In doing so nearly 500 years ago, he laid a firm basis for the understanding of the physiology of voice production and speech and its management as we know it today.

Animals, Pictures, and Skeletons: Andreas Vesalius's Reinvention of the Public Anatomy Lesson

In this paper, I examine the procedures used by Andreas Vesalius for conducting public dissections in the early sixteenth century. I point out that in order to overcome the limitations of public anatomical demonstration noted by his predecessors, Vesalius employed several innovative strategies, including the use of animals as dissection subjects, the preparation and display of articulated skeletons, and the use of printed and hand-drawn illustrations. I suggest that the examination of these three strategies for resolving the challenges of public anatomical demonstration helps us to reinterpret Vesalius's contributions to sixteenth-century anatomy.

Andreas Vesalius' 500th anniversary: the initiation of hand and forearm myology

Andreas Vesalius (1515-1564) was the first to market an illustrated text on the freshly dissected muscular anatomy of the human hand and forearm when he published his De Fabrica Corporis Humani Libri Septem, in 1543. To commemorate his 500th birthday, we searched the second of seven books composing De Fabrica, the annotated woodcut illustrations of De Fabrica, the Tabulae Sex, and Epitome, and an eyewitness report of a public dissection by Vesalius for references to the morphology and functions of these muscles. We found Vesalius to have recognized all currently distinguished muscles except the palmaris brevis and he noted occasional absence of some muscles. Generally, he limited the origin and insertion to bones, largely disregarding attachments to membranes and fascia. Functionally, he recorded the muscles as having a single vector and operating on only one joint. We conclude that Vesalius was nearly completely correct about the anatomy of the muscles of the forearm, but much less accurate about their function.

LEVEL OF EVIDENCE

5.

The last ride of Henry II of France: orbital injury and a king's demise

Jousting was a popular pastime for royalty in the Renaissance era. Injuries were common, and the eye was particularly at risk from the splinters of the wooden lance. On June 30, 1559, Henry II of France participated in a jousting tournament to celebrate two royal weddings. In the third match, Gabriel de Montgomery struck Henry on the right shoulder and the lance splintered, sending wooden shards into his face and right orbit. Despite being cared for by the prominent physicians Ambroise Paré and Andreas Vesalius, the king died 10 days later and was found to have a cerebral abscess. The wound was not explored immediately after the injury; nevertheless, wooden foreign bodies were discovered in the orbit at the time of autopsy. The dura had not been violated, suggesting that an infection may have traveled from the orbit into the brain. Nostradamus and Luca Guarico, the astrologer to the Medici family, had prophesied the death of Henry II of France, but he ignored their warnings and thus changed the course of history in Renaissance Europe.

The first description of the absence of the palmaris longus muscle

BACKGROUND

While Realdo Colombo from Cremona, Italy has, to date, been acknowledged to be the first to describe the possible absence of the palmaris longus muscle in men in 1559, the authors found this absence to be recorded in the first edition of "De Humani Corporis Fabrica Libri Septum" by Andreas Vesalius, published in 1543.

METHOD

To commemorate Vesalius' 500th birthday, this earlier record is quoted and discussed.

RESULTS AND CONCLUSION

It remains unknown whether the observation on the absence of the palmaris longus was first done by Vesalius or was based on joined work by Vesalius and Colombo.

Andreas Vesalius' five hundreth anniversary: initiation of the rotator cuff concept

PURPOSE

The rotator cuff concept refers to the four scapulohumeral muscles that stabilize and rotate the humerus relative to the scapula. To date, the first description of the rotator cuff remained unidentified.

METHOD

In light of the 500th birthday of Andreas Vesalius (1515-1564) we searched his 1543 masterwork "Fabrica Corporis Humani Libri Septem" for references to the morphology and function of the rotator cuff muscles.

RESULT

Even though he distinguished three rather than four scapulohumeral muscles, Vesalius recognized the need for structures that prevent dislocation of the shoulder inherent to the morphology of the humeral caput and scapular socket. He recorded "three strong ligaments" and the "three muscles that rotate the arm" of which the tendons completely "embrace the ligaments of the joint" as such structures.

CONCLUSION

Vesalius defined the rotator cuff concept avant la lettre.

Rhazes in the renaissance of Andreas Vesalius

Andreas Vesalius' (1514-64) first publication was a Paraphrasis of the ninth book of the Liber ad Almansorem, written by the Arab-Persian physician and alchemist Rhazes (854-925). The role of Rhazes in Vesalius' oeuvre has thus far been much disregarded. The different ways Rhazes recurs reveal an intellectual evolution in Vesalius' work. In the Paraphrasis, Vesalius subjects Rhazes to the authority of Galen in the context of the early sixteenth-century humanist campaign for the substitution of Arab influences by Greek 'originals'. Over the years Vesalius continues his work on Rhazes, but his approach becomes more internationalistic. Ultimately, Vesalius criticises Galen while expressing sympathy for the Arab author. This may be the more significant as Rhazes could have influenced Vesalius in the act of criticising Galen - critical discussions of Galen were available to Vesalius in Latin translations of Rhazes's Liber Continens. Although Vesalius never refers to the work, it is hardly possible he was unaware of it: similarities in structure, rhetoric and form between the Continens and the De humani corporis fabrica could support this hypothesis.