Anatomies: A Cultural History of the Human Body

by Hugh Aldersey-Williams

  The only portrait of Vesalius known to be authentic is contained in one of these woodcuts. It shows him holding a dissected forearm upon which he is demonstrating the working of the hand. (It is certain that both Tulp and Rembrandt were familiar with this likeness.) He is compact and dark-complexioned with wiry, close-cropped hair and an immaculately trimmed beard. His head seems too large for his body, which is certainly diminutive compared with the cadaver he is working on. He turns towards us out of the page and fixes us with a direct glance that has more than a little impishness in it. His attitude chimes with the grim humour in some of the other drawings. In one, a muscled body stands knife in hand, triumphantly holding aloft his own excoriated skin. In another, a skeleton man leans nonchalantly on his spade having apparently effected his own disinterment. He gestures with his free arm as if to say, ‘Well, what of it?’

  But, as I say, it is the little details that are revealing about the man. Hills in the background of this illustration have been identified as those close to Padua, where, in 1537, at the exceptionally young age of twenty-three, Vesalius acceded to the chair of surgery and set about making anatomy central to the curriculum of the most important medical school in Europe. Roman ruins appear in many of the illustrations, perhaps symbolizing Vesalius’s demolition of the work of Galen, the Greek physician and anatomist active in Rome during the second century CE, whose writings had dominated medical understanding for nearly 1,400 years.

  One engraving is organized so as to present a skeleton in side view. This is the illustration that contains the Hamlet pose, with the skeleton resting its right hand on a skull, which in turn rests on a tomb. The tomb bears the inscription ‘VIVITUR INGENIO CAETERA MORTIS ERUNT’, an old Latin aphorism which can be taken impersonally to mean ‘Genius survives, the rest belongs to death’, but might be taken to refer to Vesalius’s immodest hope that his genius might outlive his rivals’. Behind the skeleton, the stump of a bush is sprigging, indicating that life is both cut off and renewed, a motif that appears in quite a few of the engravings.

  In the first illustration of the volume of the Fabrica devoted to the muscles, two putti appear around a decorated initial capital letter in the text. If you look closely, you notice they are no angels, but in fact body-snatchers. Just for fun, it seems, a subsequent illustration chooses to suspend its anatomical subject by a rope, as if it has been hanged, although the rope passes not around the neck but through the eye sockets in such a way as to pull back the head in order to expose the muscles of the throat to the viewer’s gaze. The pictures are a reminder not only of the roughness of the times but of the methods to which Vesalius had to resort in order to obtain his research materials. He tells the story of how he stole the remains of a criminal from the gibbet outside Leuven, the Flemish university city where he studied before moving on to Paris and Padua. One day, he goes for a walk ‘where the executed criminals are usually placed along the country roads – to the advantage of the students’. He comes across a dried cadaver, its flesh picked away by birds. ‘Consequently the bones were entirely bare and held together only by the ligaments so that merely the origins and insertions of the muscles had been preserved.’ With the help of a physician friend, he climbs up the post and pulls the thigh bone away from the hip, takes down the shoulder blades with arms and hands attached and brings the parts home ‘surreptitiously’, making several trips. He leaves behind the head and trunk, which are secured to the gibbet by a chain. But one night soon after, he allows himself to be shut out of the city so that he has time to liberate the rest of the body undisturbed while it is dark. ‘So great was my desire to possess those bones that in the middle of the night, alone and in the midst of all those corpses, I climbed the stake with considerable effort and did not hesitate to snatch away that which I so desired.’ He conceals the retrieved bones on the ground, and then ‘bit by bit’ takes them home as well, so that he is able to reassemble the complete skeleton in his bedroom, making up its few missing parts – a hand, a foot and both kneecaps – from other miscellaneous body remains.

  Andries van Wesel, his name Latinized as Andreas Vesalius, was born in 1514 in Brussels, the son of an apothecary, and trained in medicine at the University of Paris. Through direct observation, Vesalius largely reinvented the study of human anatomy, modernizing the understanding of Galen, the greatest medical thinker of the Classical period. Galen had brought from Greece the ideas of Aristotle and Hippocrates, the latter still regarded today as the founder of scientific medicine thanks in no small part to Galen’s championing of him, and rose in Rome to become the personal physician of the emperor Marcus Aurelius. Galen’s concept of the body, formulated in ancient Greece and persisting throughout the Roman Empire and the rise of Christianity, was one of significant parts – chief among them the brain, heart and liver, which respectively governed the bodily compartments of the head, thorax and abdomen. These parts were bound together by the four humours (blood, phlegm, black bile and yellow bile) and a thinner fluid, the spirit, which accounted for the existence of the soul. It was what we might call today a holistic view.

  Galen’s works had been rediscovered and published in Paris shortly before Vesalius arrived there as a medical student. Vesalius supported this revival, building on it with his own dissections, but also uniquely dared to refute Galen when the evidence of his own eyes did not correspond with the Classical view. An anatomical feature called the rete mirabile – the ‘wonderful net’ – illustrates the shift in understanding. The rete is a mesh of veins and arteries found wrapped around the brain in species as varied as sheep and apes. Galen and others believed it was a conduit for the spirit, and Christians subsequently accepted it as the interface between body and soul. Vesalius’s early dissections of animals gave him no reason to dispute this, but when he came to perform human dissections while preparing the Fabrica in Padua, he could not find the rete mirabile, and boldly denied its existence in humans. Vesalius’s questioning of Galen was a signal moment not only in the study of anatomy, but also in modern science, implanting the thought that while the Greeks provided a valuable foundation, their ancient knowledge was not unsurpassable. Vesalius was nevertheless careful at first not to alienate his Galenist peers and elders, and it was only in the second edition of the Fabrica, which appeared in 1555, that he finally pointed out the error.

  We can hardly wonder that medicine made little progress while so many of its ideas of anatomy were based on dissections of animal rather than human parts. Vesalius criticized Galen for this, but was not unknown to take similar shortcuts himself. His plan for the Fabrica was to verify everything by reference to the human body, but the shortage of cadavers occasionally drove him to rely on previous published sources or on animal dissections. Although he was the first to describe the prostate gland, Vesalius was generally weak on the reproductive system. His anatomy of the uterus, apparently based on a ‘monk’s mistress whose body was acquired by dubious means’, was reliable enough, but his section on the pregnant anatomy was poor, owing to the paucity of human specimens, pregnant women tending to be healthy women, and his illustration of a human foetus was disgracefully accompanied by a drawing of a canine placenta.

  The Fabrica revealed the body’s interior as a terra incognita ripe for exploration. Anatomical voyagers now set sail to claim its territories, naming body parts like new channels and islands as they went. Vesalius’s pupil Falloppio made up for his master’s shortcomings by charting the female reproductive system; as we have seen already, the tubes between the uterus and the ovaries, though actually described long before, are now named after him. Eustachi did the same for the ear. Even Nicolaes Tulp got in on the act: Tulp’s valve is the puckered portal between the small and large intestines that regulates the passage of digested food waste.

  The X-marks-the-spot approach to human anatomy makes a number of dangerous assumptions. It assumes, for example, that identified parts have a distinctive composition or function. This is only sometimes true. It also creates a sense of divided
ness, where interconnection may be what matters. Major organs may seem to have a distinct nature and yet are multiply integrated with other parts of the body. ‘Bits in between’, meanwhile, such as the diaphragm, say, which separates the organs of the chest from those in the abdomen, may be unfairly neglected because they are not seen as forming suitable discrete units.

  Carving the body up into parts does have some important advantages. A reductionist approach was essential in order for scientific progress to begin properly to understand the true functions and overturn the old symbolic model of the organs, for example. But it also introduced some troublesome new thoughts. The idea of the human body as a kind of kit that can be taken apart disturbs us because it finds, when all the parts are laid out, that the all-important soul which once seemed to inhabit the body has somehow disappeared. Disassembly also sets up the possibility that a body might be assembled – Victor Frankenstein created his monster from body parts (presumably both human and animal) stolen from ‘charnel-houses . . . dissecting room and the slaughter-house’. Mary Shelley describes the ‘miserable monster’ very sparingly. ‘His limbs were in proportion, and I had selected his features as beautiful,’ she has Frankenstein recount. But of course, when it comes to ‘bestowing animation’, those beautiful parts join to make a horrible, soulless whole.

  To investigate how the body actually worked, it was natural to start with the heart, the most dynamic of all the organs, full of moving parts driven by powerful muscles. Body function was fortunately an area where comparison with animals was on safer ground than anatomizing. Vivisection became an important tool. Human vivisection, once practised in ancient Alexandria, was ruled out by the teachings of the Christian church, but there was no restriction on experiments using living animals. If the same organ was observed to respond in a similar way in enough animals of different kinds then this could be taken to be general behaviour that would be found in humans too.

  In the mid 1540s, Realdo Colombo, Vesalius’s successor in the chair at Padua, gave the first detailed description of pulmonary circulation, the passage of blood via the lungs from one chamber of the heart to the other. (Much later it was learned that Ibn al-Nafis of Damascus had discovered this more than 300 years before.) Vesalius and others had accepted the Galenic belief that blood must pass directly through pores in the muscle wall that separates these chambers, although nobody had observed these pores. Colombo’s vivisections showed that spent blood in fact leaves the right chamber of the heart altogether, and travels via an artery to each lung, while veins from the lungs bring fresh blood into the left chamber. Apart from anything else, Colombo’s discovery offers a dramatic illustration of the gains that can be made when organs are not regarded as entirely self-contained. Aristotle had held that the blood in the left chamber is cold and that in the right is warm. Colombo was able to correct this. Blood entering the left chamber of the heart is warmer because, as we now know, it has been replenished with oxygen whose reaction with haemoglobin releases heat. He was also able to show that the most important action of the heart is the vigorous contraction that squeezes out the blood and not its subsequent expansion.

  Not all of Colombo’s experiments were as informative. In one spectacularly tasteless public demonstration, he excised a puppy from the womb of a pregnant bitch, injured it and then showed it to the mother, who licked it solicitously, heedless of her own pain. The scene apparently delighted clergy in the audience as a demonstration of the strength of maternal love even in brute creation.

  Colombo’s work prepared the ground for William Harvey’s discovery of the circulation of the blood around the body as a whole. Harvey – yet another graduate of the Padua school of medicine – was the physician to James I and Charles I of England. In his 1628 book, The Movement of the Heart and Blood in Animals, or De Motu Cordis, he includes a fulsome dedication to the latter, drawing an analogy between the heart in the body and the king within his kingdom. ‘Placed, best of Kings, as you are at the summit of human affairs, you will at all events be able to contemplate together a piece of work principal in the human body and a likeness of your own royal power,’ he wrote.

  Anatomy, Harvey was accustomed to tell his students, ‘informs the Head, guides the hand, and familiarizes the heart of a kind of necessary Inhumanity’. As the historian Ruth Richardson has pointed out, this ‘necessary Inhumanity’ is what we now call clinical detachment. Harvey certainly had it in abundance. He dissected his own father post mortem and, when his sister died too, completed his knowledge with a complementary dissection of the female anatomy – a stark reflection on the shortage of cadavers available for medical experimentation. In England, a royal annual allowance of four cadavers to surgeons established under Henry VIII was raised to just six by Charles II a century later.

  Harvey achieved his breakthrough almost in spite of himself. He was a deeply conservative man who once recommended the diarist John Aubrey go back to sources such as Aristotle and the eleventh-century Persian Avicenna if he wanted to learn medicine, and to ignore trendy ‘shitt-breeches’ like Vesalius. Fortunately, though, like Vesalius, Harvey believed the evidence of his own eyes. His examination of the beating heart in animal vivisections revealed that its valves work in one direction only, so that oxygen-rich blood returning to the heart from the lungs can only leave again through the aorta, meaning that there must be a circulation of blood around the body equal to that circulating between the heart and lungs discovered by Colombo. Harvey measured the amount of blood pumped by the heart – equivalent to about a double measure of spirits in a pub for every beat. At this rate, the body’s full quota of a gallon of blood passes through the heart in no more than a minute! It was clearly impossible that the liver, previously believed responsible for the manufacture of blood, could produce the stuff at such a rate, so Harvey concluded that it must be reused. He pointed to the width of the veins and arteries entering and leaving the heart as further evidence that great volumes of blood must be transported and, holding a beating animal heart in his hand, noted how hard it became each time its powerful muscle contracted.

  The discovery of the circulation of the blood caused Harvey some consternation. Others now saw the heart as a mechanical pump in line with René Descartes’s conception of the body-as-machine, but Harvey resisted this interpretation. He was more excited by the diagrammatic circularity of the blood’s motion through the body, which for him reinforced older ideas of cycles on the cosmic scale. Harvey’s discovery was nevertheless of fundamental importance for surgery and all branches of medicine, for example providing new clues to how disease can spread so rapidly through the body, something that had greatly puzzled physicians until then.

  On paper at least, the availability of cadavers in Britain should have improved after the passage of an act of Parliament ‘for better preventing the horrid crime of murder’ in 1752. This stipulated that the bodies of hanged criminals were not to be buried in a normal Christian fashion, but their subsequent dissection could be considered as part of their punishment. Even this step was not enough to sate the demands of the growing medical profession, however. Edinburgh was one city where medical science prospered and the demand for bodies was correspondingly high. In the graveyard of Greyfriars church, you can still see mortsafes, the iron grilles placed over graves in order to prevent the body-snatching that occasioned serious social unrest here and in other British cities throughout the eighteenth century. The body-snatchers, or resurrectionists as they were known, could get good money for fresh cadavers rifled from newly filled graves. (They took care to snatch just the body and not any possessions that might have been buried with it lest they be charged with theft – a dead body belonged to no one, but property still belonged to the relatives.)

  In Edinburgh, even the supply of dead bodies from the city’s graveyards soon proved inadequate. Between November 1827 and October 1828, William Burke and William Hare, two casual labourers from Ulster, murdered at least sixteen people in the city in order to sell their bodies for the an
atomy classes of Dr Robert Knox. It was important that the bodies were not mutilated or damaged, and so Burke and Hare selected victims who would likely be easily subdued. They then plied them with whisky before one of them would place a hand over the nose and mouth while the other lay on top of the body to suppress any struggle. For the best cadavers, Knox gave the men ten pounds.

  Knox was not especially well suited to his profession. He found the interior of the human body unpleasant and untidy, lacking in any ‘form that sense comprehends, or desires’. He couldn’t help seeing his own end in the bodies he cut open. But the external human form, it seems, was another matter. Burke’s and Hare’s third victim was an eighteen-year-old prostitute called Mary Paterson, whom Knox found so beautiful to behold that he could not bring himself to wield the knife. Instead, in a macabre reversal of the Pygmalion story, he arranged her body into a suitable reclining pose and directed an artist to produce a drawing of her as if living. He preserved her untouched body in whisky for three months more before letting his students demonstrate their skills on her. Many years later, the by then disgraced Knox published A Manual of Artistic Anatomy, in which he recalled the perfect body of Mary Paterson, like that of Venus de Milo, with no sign upon its surface to indicate ‘the presence of any internal organ or cavity’. This is a revealing definition of human beauty, especially coming from a surgeon, and a telling reaction against scientific reductionism and its body made up of parts.