HISTORICAL ANALYSIS ON THE EVOLUTION

OF MEDICAL IDEAS

Andreas Vesalius
The Resurrection of Anatomy

Andres Vesalio
La resurrección de la anatomía

JORGE C. TRAININIMTSAC

Until the first decades of the 16th century, although ish, 1510-1568) speaks of rediscovering its value in
the teaching of anatomy had been the object of some diagnosis, “after twelve hundred years of being lost”,
contributions, in general it remained static, subject as he says in his work Ars sphygmica (Basel, 1540).
to the rigidity of the medieval legacy and the Galenic This affirmation of Galenism is also found in the text
tradition. The texts used were mediocre translations De pulsus arte et harmonia (Valladolid, 1584) by the
of the classical works, which had been translated from Spanish Luis Mercado (1520-1606).
Greek into Arabic and then into Latin. It was not until Andreas Vesalius had the virtue of establishing a
the beginning of this century that direct translations new order in anatomy. He did not lack a humanistic
from Greek into Latin were made, such as Galen’s education nor of respect for classical figures, but he
text De usu partium. At that time, the teaching of did endow his knowledge with the spirit of research
anatomy was scholastic. In his “Cáthedra”, the profes- and direct confirmation on the corpse. His own words:
sor read a text by Galen, Mondino di Luzzi, Rhazés or “anatomical dissection can be used to test speculation”
Avicenna, while the surgeon (barber) cut the corpse. represent a change in the objectivity of the scientific
This circumstance only evidenced a bookish, theoreti- method of that time. Thus, he established with his
cal knowledge, without removing from the ancient au- work a dividing line in the study of anatomy between
thors. There was no communion between the anato- the Middle Ages and the Modern Age.
mist and the studied human body. To this must be With regard to circulation, his achievements were
added the existing limitation to obtain corpses for dis- not outstanding even from an anatomical point of
section, which were authorized in number of one for view, while in physiological concepts he was a faith-
each sex and only during the winter period. All these ful follower of Galen. However, the scientific hones-
inconveniences, added to a very poor and incorrect ty of the method used to achieve anatomical reality
medical terminology, with illustrations that contrib- through human dissection lit the path towards the
uted little to clarification, and coupled with a dogmat- great goals of a period of splendor as the Renaissance.
ic attitude regarding the transmission of knowledge, Vesalius was born in Brussels on December 31,
made anatomy an uncertain subject. The positive side 1514. Belonging to a family of physicians for several
was given by the appearance of a greater number of previous generations, he had a careful education, first
universities and the contribution of progressive au- at the famous Jesuit college in Louvain and then in
thors such as Berengario da Carpi (circa 1460-1530) Paris (1533). In Louvain he wrote Paraphrasis in no-
and Giambattista Cannano (1515-1579), the latter num librum Rhazae ad regem Almansorem (1537),
mentioned by Vesalius in his Anatomicarum Gabrielis where he makes a comparison between Galenic and
Fallopii Observationum Examen (1564). Arabic medicine. In Paris he studied with Jacobo Du-
Berengario da Carpi graduated in Bologna and had bois “Silvio”, Günther von Andernach and Jean Fer-
experiences with human dissections, which allowed nel. He also cultivated the friendship of the Floren-
him to publish in 1521 Commentaria cum amplissi- tine Guido Guidi, (deceased in 1569) author of a work
mis additionibus hiperanatomian mundini. Taking called Chirugia who developed a prominent action in
a pragmatic position in relation to Aristotle’s triven- Pisa,
tricular heart and Galen’s biventricular heart, he ex- In Paris he stood out as a precocious dissector with
pressed that the pores constituted the third ventricle. an observant spirit, despite studying at a dogmatic
He also detailed the pericardial fluid and the oblique university impervious to renewal. This characteris-
position of the heart. tic led him to move to the University of Padua, which
In relation to the importance of the pulse, given in illuminated the Renaissance with its own light, and
this period of the Renaissance, Joseph Struthius (Pol- which would later be called by Vesalius “true nurse of

Rev Argent Cardiol 2023;91:159-161. http://dx.doi.org/10.7775/rac.v91.i2.20619

geniuses”. In this university he graduated as a doctor astronomer Claudius Ptolemy (2nd century AD), was
on December 5, 1537 before turning 23, immediately published during the same year.
occupying the position of explicator chirurgicae (pro- Vesalius enjoyed great fame, despite criticism from
fessor of surgery) for five years, inaugurating the line Galenists, since they reacted to his assertion that Ga-
of the great Padovan anatomists (Realdo Matteo Co- len never dissected a human corpse by himself. This
lombo, Gabriele Falloppio, Fabrizio d’Acquapendente, challenge to his work caused him a great depression,
Giulio Casserio). In his “Cáthedra” he worked cease- which led him to burn much of his medical writings.
lessly. He meticulously studied, dissected and record- Disputed by various universities, he nevertheless ac-
ed his observations, having the executed criminals as cepted the position as Charles V Physician in 1544,
material, according to a provision granted by Judge which benefited him financially, and led him to be-
Marcoantonio Contarini. At first he accepted the mor- come a consulting professional for the wealthy class.
phology emanating from Galen, but he discovered his Among them he attended King Henry IV, who during
errors as he expanded his dissections, coming to un- a tournament organized to celebrate the marriage of
derstand that the Pergamene had described anatomy his daughter Elizabeth of Valois with Philip II, suf-
based on animal dissection (“Ah, Galen, what did you fered the impact of a spear on his skull (1559). He
do with your monkeys!” he would later say in his mag- recognized in the trauma a kickback mechanism in
num opus). He personally carried out dissections in the King’s brain, the outcome of which would be fatal,
classes of up to five hundred students, placing special evidencing a special diagnostic sensitivity.
emphasis on clarifying anatomical terminology. This In 1547 he published Chinae radix (“Letters on the
indefatigable work determined that he published his Chinese root”), with a violent attack on the Galenists,
Tabulae anatomicae sex (1538) in Venice, consisting of describing an anti-syphilitic therapeutic action in this
a series of images derived from his observations. plant. In response to some ardent observations com-
In 1538, in a dissection manual called Instiutu- ing from Falloppio (circa 1523-1562) in his only work
tiones anatomicae secundum Galeni sententiam... per Observationes anatomicae (1561), Vesalius published
Joannem Guinnterium Andernachum... ab Andrea in 1564 the Anatomicarum Gabrielis Fallopii observa-
Vesalio... avectiores et emendatiores redditae, he re- tionum examen. In it he describes the venous valves,
counted a brief observation in which he synchronized from an account that Giambattista Cannano gave him
the cardiac systole with the arterial pulse, contrary to in Regensburg in 1546 and to which he assigns only
Galen’s opinion. In 1539 he published in Basel Epís- a support function, ignoring their true meaning. In
tola dolens venan axiliarem dextri cubitii in dolore lat- this text he also mentions the “ductus arteriosus” and
erali secandam (“Letter on bleeding”), on the occasion the foramen ovale. Vesalius died in 1564, returning
of a discussion that arose on this subject with the Bo- from a trip he made to the Holy Land, being buried on
logna professor Matteo Corti (1495-1542), on the spot the Ionian island of Zante or Zacynthos, in a church
where bleeding should be performed. where Cicero was reburied. For some testimonial
Vesalius’ fundamental work, the one that would groups of history, the reason why he undertook such
change traditional medical concepts, was De humanis a trip would be originated by mandate of the Spanish
corporis fabrica, libri septem (Basel) dedicated to the Inquisition, when he inadvertently dissected a corpse
King of Spain Charles V, when the author was only 28 whose heart was still beating.
years old. This 663-page text, written in Latin, con- We will now consider the value of Vesalius with
sists of VII Books and 300 illustrations apparently respect to blood circulation. There were two editions
made by Johann Stephan Van Calcar (circa 1546), of the Fabrica. In the first one published in 1543, in
who was a disciple of Titian (Italian, 1477-1576). The book III referring to the vascular system, he describes
printer of the Fabrica was Juan Oporino, and the the inferior mesenteric veins and the hemorrhoid
work was published in the year 1543, thus splitting vein. Book VI includes the study of the intrathoracic
the Galenic hegemony of almost fourteen centuries. organs. In it, when talking about the heart and ex-
Vesalius himself traveled to Basel to oversee the print- pressly referring to the left atrioventricular valve,
ing. During his stay in that city, at the local University he writes, it can be “very well compared to a bishop’s
he prepared a skeleton that is still preserved in the miter”. He describes the heart as consisting of two
Anatomical Museum, this being the oldest anatomical chambers or ventricles, since he considered the right
preparation that has come down to our days. Also, in atrium as part of the vena cava and the left atrium as
1543 he published the Epitome, which can be consid- a cavity belonging to the pulmonary veins.
ered a condensed selection of the Fabrica. It has been Although he expresses not having observed the
speculated about the possibility that Vesalius could septal pores, he admits them when writing: “the in-
have known some of Leonardo’s drawings, but no con- terventricular septum is formed by the most compact
firmation has been reached in this regard. substances of the heart. On its two faces certain excava-
Paradoxically, the other monumental work of tions abound. Of these, as far as the senses manage to
the Renaissance, On the Revolution of the Celestial perceive, none passes from the right ventricle to the left
Spheres written by Nicolás Copernicus (Polish, 1473- ventricle... we must therefore be astonished at the activ-
1543), breaking the cosmic structure of the Greek ity of the Creator, who makes the blood transpire from
HISTORICAL ANALYSIS ON THE EVOLUTION OF MEDICAL IDEAS 161

the right to the left ventricle through passages that are Paris Jacobo Dubois “Silvio” who attacked his ideas in
beyond our view”. On the other hand, in the second Vaegem cujusdam callumniarum in Hippocratis Galle-
edition of the Fabrica published in 1555, he emphati- nique rem anatomicam depulsio (1551), Francisco del
cally denies that such communication exists, writing Pozzo (deceased in 1564) author of Apology in ana-
verbatim: “although these dents are sometimes evi- tome pro Galeno contra Andream Vessalium bruxel-
dent, none, as far as the senses can reach, passes from liensem (1562) and Girolamo Capivaccio (1523-1589)
the right ventricle to the left ventricle.” who came to the controversy with his text De methodo
In this second edition he details that in the lumen anatomica (1593).
of the vessels there is a “substantia eminens”, which is The value that should be sought in Vesalius’ work
a description of the venous valves that, as we said be- on circulation is inferred from the methodological con-
fore, was communicated to him by Giambattista Can- tribution that he achieved for its future description.
nano in Regensburg. Vesalius does not understand the This importance is given by the attitude of rupture
real meaning of the function of these structures, as- that he carried out with Galenism. The prudence and
signing them only a support function. firmness with which he performed his work makes it
His work dethroning concepts of Galenism caused even more grandiose, since he used incontrovertible
violent reactions in some authors of the time, who dis- elements such as direct observation and experimenta-
played a conservative spirit. They were his teacher in tion on the corpse.