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Following is the "Medical Terminology Daily" (MTD) Newsletter #107. For best results, see the online version of this publication. We appreciate your feedback and suggestions for new words (click here). Thanks to our subscribers who have sent suggestions and to our subscribers who have applied to become a contributor. Feel free to forward this Newsletter to friends and colleagues who can benefit from it, and please make sure to add our e-mail address to your "No-Spam" listing.

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"Vesalius and the Invention of the Modern Body"

Last week I attended this interdisciplinary symposium hosted by the Saint Louis University and Washington University. This three-day event was inspired by the landmark publication of Andrea Vesalius’s "De humani corporis fabrica, libri septem" (Basel, 1543 and 1555) and the new critical edition and translation of this work, the New Fabrica. Two of the keynote speakers were Daniel Garrison and  Malcolm Hast, authors of the new Fabrica by Karger Publishers. Besides them there were several internationally-renowned speakers, art exhibits, presentation of academic papers of leading research, a public anatomy demonstration, rare books workshops, and a publishers’ exhibit hall.

Because the Fabrica represented a collaborative project involving a scientist (Vesalius), a humanist (Johannes Oporinus, the printer), and an artist (Jan van Kalkar), the goal of the conference was to encourage a network of scholars working in disparate fields to explore the potential for future interdisciplinary research. This objective was clearly attained, as I was able to speak and share with rare books curators, university librarians, artists, anatomist, physicians, poets, historians, etc., all of them brought together by the shared admiration for Andreas Vesalius, his work, his publications, and his legacy.

Vesalius and the Invention of the Modern Body
There were many highlights in this symposium and I will try to cover some of them in a series of articles.  The first one was a presentation by Dr. Stephen N. Joffe, where he described the number of Vesalius' books still in existence in the US and estimates around the world. It was interesting to me that and estimated 600 first edition Fabricas were ever published, and that of those only a fraction exist today, most in university libraries!

Another highlight was the presentation by Pascale Pollier, a Belgian artist, of the Vesalius Continuum project, part of which are the Fabrica Vitae art exhibit that was available to the attendees and the public for the duration of the symposium. Another part of Vesalius Continuum was the meeting in Zakynthos, Greece in 2014. Pascale also presented the process of creation of a bust of Dr. Gunther Von Hagens, the inventor of the system of plastination.

Probably the most rewarding segments of this symposium were the question and answer sessions after each presentation.


A public anatomy

The terms “anatomy” and “dissection” are synonymous. In the days of Andreas Vesalius, the dissection of a corpse was a public event, where medical students would attend, as well as the paying public.

This event would go on for days as the dissector would explain the anatomy racing against time, as there were no means of body preservation.

Through the centuries after the public anatomies of the 1500’s, the dissection of donated bodies has been continued in the anatomy departments of medical schools helping medical students and surgeons prepare for the challenges of the practice of medicine and surgery.

A public anatomy at the University of St. Louis
A public anatomy was one of the events of the interdisciplinary symposium "Vesalius and the Invention of the Modern Body" hosted by the St. Louis University and the Washington University February 26-28, 2015. To my knowledge, a public anatomy has not been done in centuries (I may be wrong).

Some of the objectives were to demonstrate that Andrea Vesalius' description of the anatomy of the brain, its ventricular system, and the cranial nerves was logical, followed a process, and that  the Fabrica, in its seventh book can be used as a dissector. The presentation was entitled “A Fabrica-guided Neo-Vesalian Public Dissection of the Brain Ventricular System 500 Years Later at St. Louis University” by Dr. Salomon Segal.

The dissection used excerpts and images from the Fabrica, as well as an advanced HD 3D camera, showing the brain and its structures with amazing clarity. The accompanying photo of the event is not well focused because of the light conditions, but shows the setup for the presentation.

This was an extremely professional presentation and although not completely “public” per se, the variety of attendees had a great feedback on the event. Proper attention to the care and respect towards the specimens and the anonymity of the donors was maintained at all times. I consider myself honored to have been a witness and a participant to this extraordinary event. Dr. Miranda

Click here for a compilation of some of the images of the Fabrica and the dissection of the brain


Vesalius' New Fabrica

Andreas Vesalius opus magnus was the creation and the publication of his book “De Humani Corporis Fabrica, Libri Septem" (Seven books on the structure of the human body). This book was published on May 26th, 1543 by the printing press of Johannes Oporinus.

Much has been said and written about this book and the influence of Vesalius’ work on scientific thinking, the scientific method, and the displacement of dogmatic thinking based on the works of the ancient Greeks and Galen of Pergamon (129AD - 200AD) for a different view of the construction of the body based on direct and empirical observation.

Unfortunately, because of Vesalius’ following of Erasmus’ teachings on Latin, the book was written in a very difficult and circumvoluted language which made it difficult to understand. In addition, the book was very expensive for the times, with an estimated maximum printing of 600 copies. Were it not for the images and the captions, as well as the many plagiarized versions of the Fabrica in different languages, Vesalius opus magnus would have been lost to history. Harvey Cushing wrote in his Vesalius bio-bibliography of 1943:”As a book, the Fabrica has been probably more admired and less read than any publication of equal significance in the history of science”.

Although several attempts have been done to translate the Fabrica, most of the works have been incomplete, or have tried to paraphrase or correct Vesalius’ words, leaving us with a watered-down image of the author and his intent.

In 1993 Drs. Daniel H Garrison and Malcom H. Hast began a collaboration to translate the Fabrica of Vesalius. The 20- year story of how they obtained federal grants, discussed the translation, found a publisher, scanned and improved on the original images of the Fabrica, and how they even worked with Christian Mengelt to create a new typography for an annotated new Fabrica, was part of their presentation on the interdisciplinary symposium “Vesalius and the Invention of the Modern Body” hosted by the St. Louis University and the Washington University February 26-28, 2015.

Drs. Hast and Garrison with the two volumes of the new Fabrica
Drs. Hast, Miranda, and Garrison with the  new Fabrica
Title pages of the new Fabrica with the authors' signatures
This annotated new Fabrica is a translation of the 1543 first edition with comments on the 1555 second edition and it also includes passages and comments from a heavily edited 1555 second edition that has side margins comments and corrections now certified to be in Vesalius’ own handwriting. This book has been speculated to have been Vesalius’ personal copy and probably the basis of a potential third edition. This particular book is now known as "Vesalius' Annotated Fabrica"

The "New Fabrica" was published in 2014 by Karger Publishing, a company based in Basel, Switzerland, the same city where the original Fabrica was published in 1543. The ISBN is 978-3-318-02246-9. Only 948 books were published and it has now been sold out. Because of the demand, an original is now considered a rare book.

Daniel H. Garrison received his degrees from Harvard (A.B. Classics, 1959) and Berkeley (PhD Comparative Literature, 1968). He was a member of the Classics Department at Northwestern University from 1966 until his retirement in 2010. 

Malcolm H. Hast is Professor Emeritus of Otolaryngology – Head and Neck Surgery – and also past Professor of Cell and Molecular Biology (Anatomy) at Feinberg School of Medicine of Northwestern University. He is Fellow of the American Association for the Advancement of Science as well as Fellow of the Anatomical Society (UK) and a Chartered Biologist and Fellow of the Society of Biology (UK). He is also a recipient of The Gould International Award in Laryngology and a NATO Senior Fellowship in Science.

Personal note: I am honored to have met both Drs. Garrison and Hast at the symposium, shared some of the stories behind the new Fabrica and have them sign my own copy of this incredible book. Dr. Miranda

Sources:
1. "A Bio-blibliography of Andreas Vesalius" Cushung, H. 1943 Saunders


The anatomical laws of Miranda

Intended initially as a humorous view of anatomy, the "Anatomical Laws of Miranda" have a very serious objective. They support the fact that in every interventional case the operator should be extremely aware of the potential anatomical variations present. They also point to the fact that in real life, human anatomy does not look exactly like the anatomy books, models or prosections, and practice in the art of dissection and constant study are needed to ensure the proper identification of anatomical structures in surgery.

These laws are not original, they have been partially expressed at one time or another by several anatomists and surgeons, including Dr. Aaron Ruhalter and Dr. Robert Acland. What I have done is put them officially together and create the corollaries.

Efrain A. Miranda, Ph.D.
The anatomical laws of Miranda
  • 1. The only constant in anatomy is variation
  • 2. Nothing in the human body is really colored... or labeled
  • 3. No anatomical structure has the moral obligation to be where they are supposed to be

There are corollaries to these laws and visitors to this web site are invited to provide us with their thoughts and addenda to the anatomical laws.

Corollaries:

1a. In the case of the so-called "anatomical constants"...law number 1 also applies

2.a. Black and white anatomy books are sometimes better to study than color atlases

2.b. Arteries are not red, nerves are not yellow, and lymphatic vessels are definitely not green!

2c. Nothing looks exactly like the anatomy books, computer simulations, or models. Food for thought for those medical schools that are eliminating dissection from their medical curricula.

3.a. This leads to that dreadful "Oooops!" sometimes heard in surgery

3.b. This also leads to the comment "It HAS to be around here!", which is dreadful if the "here" is a patient in surgery. 

3c. It is interesting that several medical schools are moving away from cadaver disection in first year medical school and using models or computer simulations instead. No computer simulation will give the medical student the detail, variations, and feel of the tissues as actual hands-on experience. I am sure no one wants a surgeon whose first view of the internal aspect of a human body is a living patient...on the surgical table.

If you want to download a PowerPoint slide of the "Laws of Miranda" click here and follow the instructions of your browser.

A great resource to study on anatomical variations is the Illustrated Encyclopedia of Human Anatomic Variation, which was originally hosted by the University of Iowa. Today it resides at anatomyatlases.org, and the curator is Ronald A. Bergman, Ph.D.


Vesalius, Sylvius, Galen, and the “Epistle on the China Root”

UPDATED: Scientific thought today is a given. Today most of us believe something only after it is proven factually. A scientist is recognized by the capacity to change a position if the appropriate experiments, demonstrations and facts against their position are proven. A scientist holds a healthy position of doubt and even if their positions are proven for a long time, they are willing to accept a scientific counterproposal.

When a belief or a position is supported only by a belief without proof, then it falls into the realm of suppositions and religion. In this article I will not discuss this.

The above is written to support why at the time Andrea Vesalius’ opus magnum “De Humani Corporis Fabrica, Libri Septem” was condemned by so many, and how Vesalius’ words ushered the beginnings of scientific thought.

Anatomical and medical teachings flourished with the Greeks and attained its peak with Galen of Pergamon (129AD - 200AD), called by many (Vesalius included) “prince of physicians”. Galen was known for his many published works and his writings were translated into Arabic. This was important, because with the invasion of Rome of Greece many of the published works were lost and later the only way to read Galen was to translate his works back into Greek or Latin. Also many books were lost during the Dark Ages.

Title page of the Epistle on the China Root by Andreas Vesalius
After the Dark Ages decline of Medicine, the “light” of the Renaissance brought with it the belief that the Ancient Greeks were never wrong and that if anything was wrong, it was the quality of the translation and the interpretation of the works.  Early in his career and because of his knowledge of languages, Vesalius was one to work as a translator for commentaries that were made on Galen. Because of his personal dissection skills and his direct observation of the human body Vesalius started to encounter a problem: what was being taught as human anatomy by Galen’s works was wrong. In many cases Vesalius found clear evidence that Galen used goat, dog, and ape anatomy instead of human anatomy to write his works. This was a slow process of breaking with Galenic teachings. Even in the first edition of the Fabrica (1543) Vesalius, even questioning Galen, would not go too far.

In 1540, three years before the publishing of the Fabrica, Vesalius performed a public anatomy in Bologna. There is a well-written and translated diary of the dissection published by Baldasar Heseler, which many say earned him a place in the title page of the Fabrica. Heseler describes Vesalius’ dissection and lectures as well as the fierce discussions between the host, Matthaeus Cortius (1475 – 1542) and Vesalius. The elderly Cortius, Galen’s book in hand, discussed the impossibility of what Vesalius was demonstrating, arguing that Galen “just cannot be wrong”. This discussion was reenacted during one of the lectures by Rebecca Messbarger, Ph.D. at the “Vesalius and the Invention of the Modern Body” interdisciplinary symposium.

With the publication of the Fabrica the reaction of many Galenists was fierce, probably none more caustic than Jacobus Sylvius (1478 - 1555). Sylvius was a teacher of Vesalius and saw his anti-Galenic position as treason. Known for his propensity to foul language, Sylvius started a personal was against Vesalius, even publishing a small book where he called Vesalius a “madman” plus “purveyor of filth and sewage, pimp, liar, and various epithets unprintable even in our own permissive era” (excerpt from Magner, 1992). Sylvius’ publication was entitled “Vaesani cuiusdam calumniarum in Hippocratis Galenique rem anatomicam depulsio”  (A refutation of calumnies by a certain madman against Hippocratic and Galenic anatomy). Garrison (2015) explains the play on words where Sylvius  transforms “Vesalii” into “Vaesani” – the madman.

Initially Vesalius tried to be conciliatory and scientific, trying to persuade his opponents with the facts as seen in the human body. His final argument was published in October 1546 in “Epistola rationem modumque propinandi radices Chynae dedocti“ a publication known to many as the “Epistle (letter) on the China Root”. Vesalius used the excuse of writing on a controversial medicinal plant as the venue to explain in detail the reasons why he deemed Galen wrong in many aspects of human anatomy. The “Epistle on the China Root” was printed in Basel by Johannes Oporinus and the introduction was written by Andreas Vesalius’ brother Franciscus. The "Epistle on the China Root" has recently been translated (2015) by Dr. Daniel Garrison, one of the authors of the "New Fabrica".

Personal note: It is clear to me that Vesalius is not the first to promote scientific thought processes, but he is the one that used human anatomy to start the debunking (and acceptance) of portions of what was known at the time in that particular arena. Dr. Miranda

Sources
1. “Jacobus Sylvius (Jacques Dubois) 1478-1555 – Preceptor of Vesalius” JAMA (1966) 195 13; 1147
2. "Andreas Vesalius; The Making, the Madman, and the Myth" Joffe, Stephen N. Persona Publishing 2009
3. “A History of Medicine” Magner, LN Ed. M Deckker Pub 1992
4. “Vesalius: The China Root Epistle. A New Translation and Critical Edition” Garrison DH, 2015 Cambridge University Press
5. “Andreas Vesalius' first public anatomy at Bologna 1540 – An Eyewitness Report by Baldasar Heseler” Eriksson, R 1959 Almquist& Wiksells Boktryck


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