¹ In the sixteenth century, little was known about human anatomy. There had been a handful of reputable anatomists but it was not until Andreas Vesalius that the field of anatomy really began to emerge as a separate discipline. Prior to Vesalius's work, anatomy was regarded as merely a somewhat important body of knowledge with which physicians should familiarize themselves. Galen was Vesalius's most well-known predecessor and he set the standards for the way most anatomies were performed. His ideas and methods were adhered to centuries after his death. Society's views on human dissection did not change to speak of between the time of Galen and Vesalius. The main difference between the two men was Vesalius's bold way of acquiring anatomical knowledge. He found all existing knowledge on the topic incomplete and so he went about making advances in medicine the best way he knew how‹real dissections performed on human cadavers. Contrary to generations that came before him, he was not afraid to dissect humans. His publication in 1543, De Humani Corporis Fabrica, was an exquisite book on human anatomy in which information from his dissections was included. This work proved to be revolutionary to the development of anatomy as well as to the advancement of artistic technique. The title page was added to his masterpiece Fabrica for effect‹it could have been made using only text, but Vesalius chose to intertwine illustrations with the words. These illustrations proved to be powerful representations that allowed Vesalius to impact his audience in a couple different areas, thus the importance of the illustrated title page is two-fold: it introduced the practice of human dissection in expanding anatomical knowledge and it also introduced a new method of teaching that Vesalius believed was key.

Before delving into the reasons why Vesalius's work was so radical, it is necessary to have some understanding of what the accepted methods of exploring human anatomy consisted of prior to Vesalius's contributions. Almost all of Vesalius's predecessors performed dissections on animals because the authorities believed human dissection was both unethical and sacrilegious. The body was viewed as a shelter for the soul and many people believed that interfering with the body's structure was morally wrong.¹ These beliefs left anatomists in a difficult place. Without being able to perform autopsies and dissections directly on human cadavers, they were forced to extrapolate all anatomical knowledge from animals and apply it to humans as best they could. This was neither accurate, nor practical. Of Vesalius's predecessors who felt forced to work with animals, the one who was by far most widely known and well-respected was Galen. Galen (129-199 AD) concentrated most of his efforts on studying those animals he deemed to be most similar to humans in structure. Monkeys were his family of choice, and he applied his acquired knowledge of them to human beings. Only twice did he study human skeletons and unfortunately, his writings were interpreted as though he had directly observed a human cadaver. This error in interpretation was pointed out by Vesalius, making him unpopular with sixteenth century Galenists. Galen's writings were all but canonized and his words were held in utmost authority. After his death in 199, Western civilization made no advances to speak of in the field of human anatomy until Vesalius.²

The audience viewing Vesalius's title page to the Fabrica should also be clarified before discussing its revolutionary elements. De Humani Corporis Fabrica was a scientific work. Its value was appreciated best by those who were educated enough to have some understanding of anatomy. The title page to the book is an extravagant work of art and obviously involved great labor and dedication by the artist.³ It follows that in order to own a book like the Fabrica one would have had to pay a large sum of money for it. Therefore, we can separate the Fabrica's audience into members of the upper economic class and educated persons; of course, these two groups mostly consisted of the same people. A member of the middle- or low-class would probably not have read De Humani Corporis Fabrica because first, he would have difficulty gaining access to it, and second, they probably would not be able to comprehend any of the detailed scientific drawings. In addition, the language used by Vesalius was too complex and the vocabulary too extensive to be understood well by non-educated people. It is very interesting, however, that level of education and economic status are irrelevant for understanding what is taking place in the title page. This suggests that maybe Vesalius was indirectly trying to reach all people even though he knew his book would be read primarily by a select group.

Vesalius did not have direct control over the production of the title page. He made sketches that were rendered from direct observation of one of his many dissections and then supervised the production of his Fabrica; however, he did not see most of the images until after the woodcuts had already been completed. He had some of his sketches transferred for duplication on durable woodblocks for actual pictures of the human body. The title page was something over which he had influence, but he did not see the final product until after it had been completed. Whoever the artist who made the woodcut was, (his identity remains unknown)he had a very good handle on the consequences of portraying the subject matter Vesalius called for and added subtleties to the illustration accordingly.⁴

Moreover, society objected to Vesalius's dissections because Galenists doubted the existence of a need to acquire further anatomical knowledge. The audacious mentality Vesalius possessed was in contrast to the society's attitude toward the practice of anatomy because it was generally felt that if one had faith in Galen's work, there was no need to dissect. The title page to De Humani Corporis Fabrica portrays one of Vesalius's public dissections and shows him flamboyantly lecturing to a tightly-packed audience. The scene is captured in a very fluid way, meaning that the motions and expressions of the people depicted are realistic enough that one can almost feel the bustling of the room. The concept and even the idea of a human dissection taking place was shocking to the viewers. Seeing the scene depicted in the title page was thereby made more memorable to them because it went against the deeply held beliefs of their society.

When studying the title page, an interesting aspect of the subject matter is the shift in authority from the anatomist to the body itself. In many of the sketches that depict some version of a human dissection the anatomist sits a level above everyone watching or performing the dissection, giving orders and basically supervising the entire operation. In Vesalius's title page, Vesalius is not only on the same floor as his students and colleagues, but much attention has been drawn to the cadaver itself. This has been accomplished through the central location of the body in the woodcut, as well as everyone's position being angled toward it. This shift in authority is representative of Vesalius's honest pursuit of the expansion of anatomical knowledge. Another feature which exemplifies the role of authority in the title page is Vesalius's age. He is portrayed as looking well over 28, which was his age at the time the title page was made.5 Because he was so young, portraying him as older in the title page of the book might unconsciously (or consciously) cause people to lend more credit to his methods of teaching and opinions on dissection.

Although the image of the title page was shocking to many, its intent was not to offend. This idea of the title page not being offensive isn't to say that it was not meant to astound. For example, Vesalius makes a point of bringing three robed men, who represent the "old" body of anatomical knowledge, onto the floor next to his students, who represent the future of anatomy. This intermingling of "old" and "new" was something Vesalius felt was essential to the expansion of knowledge but it was not something that was seen before. He never intended to turn his peers against the work of Galen, his purpose was always to perpetuate the dissemination of accurate knowledge. Likewise, his intent was not to offend anyone in his audience with the surprising subject matter of the title page. So, while the image was possibly intended to be shocking, it was never meant to be offensive.

Prior to Vesalius, anatomists were taught primarily in lecture format with no "hands on" experience. Vesalius is standing next to both his colleagues and as his pupils. He has descended from his "chair" which is very contrary to the way dissections were usually performed. Typically the anatomist would sit in a chair similar to a throne and direct menials as to what they should and how they should do it. In the title page, these menials are shown quarreling under the surgical table like children while the dissection is taking place. Perhaps this indicates that Vesalius has no time for people who are not as concerned with the dissection as he. In the dissection he lectured to the people on either side of him while specifically referring to the parts of the anatomy that he was discussing. This exemplifies his deep interest in the idea of teaching, of sharing information, and of his willingness and desire to learn more. This teaching method of hands on learning was very revolutionary for this time and people were, again, startled to see such a direct experience for students. This characteristic of the title page makes Vesalius seem even more ahead of his time.

Furthermore, if Vesalius did specifically request to have text incorporated with images on the title page his reason in doing so would probably have been for effect. Upon opening De Humani Corporis Fabrica the very first thing one sees is the title page, which grasps people's attention and leaves them with something easily remembered. Vesalius knew people would remember the depiction of his title page because it was so unusual for most people to see and its unique characteristics would make it more memorable to its onlookers. This astounding page was the perfect introduction to a work that invalidated respected beliefs of Galen and promoted hands on medical research for the first time.

The title page to De Humani Corporis Fabrica was an informative way of conveying Vesalius's new teaching methods as well as his practice of human dissections. His ideas were so revolutionary for the sixteenth century that seeing the illustration in the very beginning of the Fabrica shocked its viewers, but Vesalius's purpose was not to offend Galenists or his other contemporaries. He merely showed a shift in authority from the anatomist to the body itself, a concept that relates to his hands-on teaching methods. Although some anatomists doubted the need to dissect human bodies based on their perceived validity of the Galen's work, Vesalius boldly pursued his quest to expand anatomical knowledge. He was unsatisfied with what he knew so he sought out fresh ways to deepen his understandings. As a result of his perseverance, the Fabrica enriched the development of the anatomical field, making it a distinct discipline in the medical profession.

Bibliography

O'Malley, Charles. Andreas Vesalius of Brussels 1514-1564. Los Angeles: University of California Press, 1964.

Rovinson, Victor. Pathfinders in Medicine. New York: Medical Review of Reviews, 1912.

Saunders, J.B. deC.M, and Charles O'Malley. Illustrations from the Works of Andreas Vesalius of Brussels. New York: Dover Publications, Inc., 1950.