The history and illustration of anatomy in the Middle Ages

Abstract

This article reviews the influence of key figures on the pictorial representation of anatomy and the evolution of anatomical illustration during the Middle Ages until the time of the Renaissance, based on medical history books, journals and ancient medical books. During the early period in the Middle Ages, most illustrations were traditional drawings of emblematic nature, oftentimes unrealistic, not only because the precise knowledge of anatomy was lacking but also because the objective was to elucidate certain principles for teaching purposes. Five figure-series that came down to us through ancient manuscripts and textbooks represent the best examples of such traditional illustrations. With the advent of human dissection in the 13th and 14th centuries, a significant transformation in the depiction of anatomy began to project the practice of human dissection, as we see in the works of Mondino de Luzzi, Henri de Mondeville and Guido de Vigevano. After the invention of book printing in the second half of the 15th century, the reproduction of books was commonly practised and the woodcut made multiplication of pictures easier. Peter of Abano, Hieronymous Brunschwig, Johannes de Ketham, Johannes Peyligk, Gregory Reisch, Magnus Hundt, Laurentius Phryesen and many more included several anatomical illustrations in their treatises that demonstrated the development of anatomical illustration during the later Middle Ages.

Keywords

Anatomy history illustration middle ages Galen Vesalius Soranus Peter of Abano Hieronymous Brunschwig Johannes de Ketham Johannes Peyligk Gregory Reisch Magnus Hunt Laurentius Phryese

Introduction

The Middle Ages is a distinctly modern concept employed to designate the period between the downfall of classical civilization and the revival of learning in the 15th century. Although it is impossible to fix with accuracy, the fall of Rome to the Goths in 476 and the fall of Constantinople to the Turks are often cited as marking the beginning and the end of the Middle Ages. Some historians set the end of the Middle Ages in about 1450, when Johnannes Gutenberg (c1398–1468) in Strasbourg introduced metal movable type for printing.

During the Middle Ages the attenuation of Greek originality, its amalgamation with deism of Christianity and the fatalism of the Orient led to stagnation of anatomical studies. Despite the fact that several sentinel events in the evolution of anatomy took place during the Middle Ages, the writings of Galen of Pergamum (129––215 or 216)¹ were largely accepted as the authority of anatomical knowledge in the Muslim East as well as in the Christian West.² Galen’s dogmatic and didactic style remained unchallenged for 1500 years until the 16th century, when Vesalius (1514–1564) shook the foundation of authority based on experimentation and observation of the human body.

Several anatomic illustrations were produced during the Middle Ages.³ For the most part they were customary drawings of emblematic nature. Drawings employed during the Middle Ages were schematic and often unrealistic not only because the precise knowledge of anatomy was lacking but also because the main purpose was to elucidate for teaching purposes certain principles by the general form and location of the organs. Eminent historians of medical illustration including Peter Jones and Emilie Savage-Smith have argued that medical illustrations during the Middle Ages were often meant precisely as diagrams or heuristic models and did not need to be realistic to achieve their pedagogical goals. This pattern can also be recognized in anatomical illustrations of later stages, even when human dissections became into scene during the 13th and 14th centuries. However, more realistic illustrations based on observation and experimentation were created later.

Nevertheless, anatomical illustrations during the Middle Ages came down to us through several ancient manuscripts and textbooks and are significant, since they depict the status of the anatomy and help us understand the evolution of anatomy. Several eminent figures played a significant role in this evolution, not only by writing anatomical treatises but also by including noteworthy examples in their treatises.

Anatomical figures from antiquity to the Middle Ages

Traditional frog-like figures

Medieval illustrators made a series of five schematic pictures, representing the osseous, nervous, muscular, venous and arterial systems, to which was added the pregnant woman, giving a crude diagrammatic view of the fetus in utero and a view of the genital organs was sometimes added. This five picture series Fünfbilderserie was investigated extensively by Karl Sudhoff (1853–1938) in German manuscripts, from cloisters at Prüfening (1154) and Scheyern (1250), in a 13th century Provençal manuscript in the Basel University Library, and even in a Persian manuscript in the India Office at The British Library in London, the Bodleian Library at Oxford and the Bibliothéque Nationale in Paris.^4,5

Sudhoff has studied manuscripts of a Persian series and shown that the five schematic pictures were also traditional in the Far East. More recently, Roger French⁶ and Savage-Smith⁷ have reviewed the Persian tradition of anatomical illustration.

Although specific examples of anatomic illustrations from the Classical Period (460–146 BC) have not been found, the medieval five-figure series probably included copies of earlier drawings. The pictures from the Prüfening-Scheyern and Oxford series and from the Provençal-Basel series descended from antiquity, according to Sudhoff, and he was of the opinion that the five-picture series were transmitted from antiquity by way of Arabic transmission and ultimately all the way from original drawings in Alexandria.

Overall, these manuscript drawings plainly were intended as crude mnemonic schemata to refresh the memory of students, and perhaps even for more popular instruction. The same pattern in depicting anatomy is maintained for the most part through the Middle Ages, as exemplified in the illustrations of the female viscera, the gravid uterus and the eye.

Illustrations of the female viscera and the gravid uterus

This subject has been studied extensively by Katharine Park in her book Secret’s of Women: Gender, Generation, and the Origins of Human Dissection.⁸ The 9th century Breslau Codex 3714 and a 12th century Copenhagen manuscript (MS 1653) give the traditional pictures of the fetus including twins in the uterus.⁵ In fact, these are based on the work of Soranus of Ephesus (98–138) and as handed down by Moscio, the author of a short Latin treatise De Mulierum Passionibus, who is reputed to have lived in the 6th century after Christ.⁹

Another traditional figure was related to the depiction of the female viscera. Of note, the Provençal-Basel series demonstrate for the first time the picture of the uterus for the first time in a manuscript drawing that was shown with six chambers or cells and a suggestion of a seventh; most medieval writers described the uterus as having seven cells.¹⁰

Another notable example was a miniature painted about 1400 AD in a Leipzig manuscript codex of 1122 that represents a nude female figure, without suggestion of the external genitals, in a slightly squatting position with the legs spread apart to show the vagina. This book by Choulant¹¹ (1791–1861) included a fetus in a standing position, in a foot presentation, with the hands covering the eyes. It seems that a common model must have existed in antiquity and at least until the Middle Ages.

Drawings of the anatomy of the eye

Most anatomical illustrations of the eye were schematic and for teaching. Sudhoff described an anonymous Anatomia Oculi in the book by Choulant¹¹ that includes the back page of a 13th-century manuscript in the Sloane collection at the British Museum (MS 420). The eyeball and its tunics are shown to be made up of circles and divided perpendicularly by two straight lines into anterior and posterior halves. In another Sloane manuscript (MS 981) from the second half of the 14th century, a short text includes another illustration of ophthalmic anatomy - a cross-section of the head in the centre of which is an eye surrounded by circles and semicircles. The Vatican Library at Rome possesses the Codex Urbinus (MS 246), a manuscript written in the second half of the 14th century, where the structure of the eye is discussed with a diagram of the arrangement of the coats of the eye in similar manner.¹¹

Dissection of the human body transforms anatomic illustration

In the 12th century the practice of dissection was first re-introduced (since antiquity) in Salerno and brief anatomical manuals were produced (Corner, 1927). The pig was used for dissection since its internal organs allegedly bore close resemblance to human organs, especially in the female. The Anatomia Porci of Copho¹³ describes this. At Salerno, the Emperor Frederick II (1194–1250) (Figure 1) for the first time conferred on physicians a licence to practise medicine, stating that the study of anatomy on the cadaver should be an important part of the instruction (about 1241).^14–16

Figure 1.

Emperor Frederick II (left) and his wife, Isabel, daughter of King John (reproduced from http://forum.alexanderpalace.org/index.php?action = profile;u = 19363;sa = showPosts).

Dissection of human bodies appears to have begun by the end of the 13th century at Bologna and elsewhere in the course of autopsy for legal purposes. The first judicial postmortem was conducted by Guglielmo da Varignana (1270–1339) at Bologna in 1302 in a case of suspected poisoning.¹⁷ Human dissection was probably introduced at Montpellier in around the first quarter of the 14th century. In the later Middle Ages, Mondino de Luzzi of Bologna led the interest in dissection.

At the start of the 14th century, images started to reflect initial attempts at human dissection but for the most part they remained schematic because dissection was not widespread and its main objective was pedagogical, as part of medical and surgical training and medico legal work rather than in academic investigation of the human body.

Illustrations in the Anatomia of Mondino de Luzzi

Mondino de Luzzi of Bologna (Mundinus), also known as Remondino de Luzzi, (1270–1326), was an Italian physician, anatomist and professor of surgery who lived and worked in Bologna.^18,19 He is often credited as the ‘restorer of anatomy’ because he made seminal contributions to the field by reintroducing the practice of public dissection of human cadavers and he wrote the first modern anatomical text, Anatomia Corporis Humani, which was completed in 1316. His treatise, first published at Padua in 1478, was more of an instruction book in dissecting techniques rather than a study of gross anatomy. Although full of Galenical errors with regard to the structure of human anatomy, preserving the old fictive anatomy of the Arabists, this work was yet the sole textbook on anatomy for over 250 years (until the end of the 16th century) in the medieval schools and it remained a standard text until the time of Vesalius. Interestingly, originally Mondino’s book did not contain any images. When the art of wood engraving was introduced in the later part of the 15th century, a few rude woodcuts appeared which represent Mondino and his method of teaching. The 1513 Strasburg edition of Anatomia Mundini contains a diagram of the heart and an astrological figure, a cadaver with thorax and abdomen opened, surrounded by the signs of the zodiac.²⁰

The several editions of Mondino, printed between 1478 and 1580, including those in the Fasciculus Medicinae owned by Johannes de Ketham, include illustrations of Mondino presiding at a dissection as instructor but these were little more than schematic representations.⁵ Nevertheless, these figures are significant since they demonstrate Mondino’s unique teaching methods at that time - he often performed dissections in person and himself served the role of demonstrator, carefully studying the cadaver.

The miniature paintings of Henri de Mondeville (1270–1320)

Henri de Mondeville, an early 14th century French surgeon who practised at Bologna and Montpellier, wrote a manuscript based on an incomplete Latin manuscript, Cyrurgia Magna, written from 1306 to 1320 and translated into French by Nicaise²¹ and kept in the Manuscript section of Bibliothéque Nationale, Paris (MS French 2030). It was also based on the original complete manuscript translated into German and published for the first time in Berlin by Julius Leopold Pagel (1851–1912) in 1892.²² Pagel also wrote Die Anatomie des Heinrich von Mondeville, which was printed in 1889 and also reviews Mondeville’s anatomic work from 1304.²³

Mondeville’s first treatise in Cyrurgia Magna was a real textbook on anatomy and contains analysis of the parts of the human body. Henri de Mondeville profited by the instruction of professors at Bologna and later settled at the school of Montpellier where he was giving anatomical lectures illustrated by a series of 13 images that stood in for the dissected cadaver. It is probable he brought these diagrams with him from his old school at Bologna.

Mondeville’s pictures are among the earliest anatomical illustrations. Exposure of the superficial muscles by removal of the skin and the original drawing of the body dissected from the back to show the viscera are free from tradition. Only one figure, the figure of Death seated, shows the squatting position with the knees apart - all the others are drawn in the standing position.

It became obvious for de Mondeville that the evolution of modern anatomy relied not only on theory and anatomical dissections but also on images, especially when anatomical dissections were so few, and so he became the first surgeon to introduce the use of visual aids in his lessons on anatomy, a real evolution.²⁴ These images also give an indication of early practice in dissection at Bologna. Overall, Mondeville’s illustrations establish several norms of traditional anatomy, namely the muscular and visceral schemata that were followed slavishly and used in teaching for almost 200 years.

Images from the Anatomie of Guido de Vigevano (1280–1349)

Guido de Vigevano, a native of Lombardy, played an important role in carrying Mondino’s methods and tradition to France. He became Physician to the Queen, Jeanne de Bourgogne, and to King Philip VI to whom he dedicated his Anatomia,²⁵ composed in 1345 and studied extensively by Ernest Wickersheimer (1880–1965).²⁶ This work is illustrated by striking figures, the subjects of dissection being portrayed in the standing position. Wickersheimer reproduced these figures from manuscript 569 in the Musée Condé (Chantilly).²⁷

As Guido explained in his introduction, he had his own text-based but diagrammatic images painted to substitute for the techniques and viewing of a dissection because dissection was prohibited in France. However, Guido’s drawings go beyond Mondeville’s in many respects. They show improved technique in dissecting, albeit rather little, of the abdomen, the cranial and the spinal cavities. The thoracic cavity is striking as to the location and shape of the heart. As a whole, they represent essentially a rather independent demonstration of dissection technique and the general configuration of the internal organs. However, they do illustrate the three divisions - the abdomen, the thorax and the head - an anatomical approach after the method of Mundinus.

Incunabula of anatomy

After the time of Mondino, with the advent of human dissection, several anatomical treatises appeared containing the first rude attempts at pictorial representation of dissected parts. These are the so-called graphic incunabula of anatomy and may suitably take in all published illustrations before the time of Vesalius.

The first typographic prints are called incunabula or cradle books. However, incunabula include only prints that appeared up to the year 1500, after which one speaks of early prints. The terms ‘incunabula' and ‘cradle book' (Latin, incunabulum = cradle) can be explained by the fact that these are the earliest book printings in which the letters are still moveable. For this reason incunabula comprise the link between manuscripts and printed book art. There are two types of incunabula: the xylographic (made from a single carved or sculpted block for each page) and the typographic (made with movable type on a printing press in the style of Johannes Gutenberg (born about 1400, died 1467 or 1468)). However, many authors reserve the term incunabulum for the typographic ones only. In graphic art, single-page woodcuts as well as early prints of copper engravings, etchings and lithographs are also considered to be incunabula.²⁸

Examples of graphic incunabula can be encountered in several editions of Mundinus, printed between 1478 and 1580, in the Conciliator Differentiarum of Peter of Abano, in the Buch der Wund-Artzny’of Hieronymus Brunschwig, in the Fasciculus Medicinae of Johannes de Ketham, in the fugitive anatomic plates (Fliegende Blätter) including the skeleton of Richard Helain, in the Philosophiae Naturalis Compendium of Johannes Peyligk, in the Antropologium’of Magnus Hundt, in Gregor Reish’s Margarita Philosophica, in the Spiegl der Artzny of Laurentius Phryesen, in the Carpi Commentaria super Anatomia Mundini (Commentary on Mundinus Anatomia) and in the Isagogae Brevis by Berengario da Carpi.⁵

Illustrations of the abdominal muscles in the Conciliator Differentiarum of Peter of Abano (1250–1315)

Peter of Abano, Petrus de Abano, was the first professor to give Padua a wide reputation among the educated. He was famous not only as a physician but also as a philosopher. His best known works were his Conciliator Differentiarum and his study on poisons, De Venenis.⁹ An illustration of the abdominal muscles in the Conciliator is noteworthy²⁹ and Garrison states that it contains the first example of the Muscleman, a full-length figure exhibiting its dissected muscles.⁵

Woodcuts in the Buch der Cirurgia, Hantwirckung der Wund-Artzny of Hieronymus Brunschwig (c1450–1512)

Hieronymus Brunschwig, a native of Strasburg, was an army surgeon. He wrote a book on wounds, Buch der Cirurgia, Hantwirckung der Wund-Artzny that contains the first detailed account of gunshot wounds in medical literature. Henry E Sigerist (1891–1957) notes some of the earliest specimens of medical illustration by woodcuts that are narrative.³⁰

Illustrations in the Fasciculus Medicinae of Johannes de Ketham (15th century)

Johannes de Ketham, a German physician, edited the Fasciculus Medicinae, a collection of medical writings for the practising physician that first appeared in a Latin edition in Venice in 1491. The Fasciculus contains a treatise on anatomy, surgery, gynaecology and obstetrics, urine, venesection and the plague. In the first edition the woodcut was first utilized for an anatomical figure. The parts of the body were labelled for the first time. In the second edition (1493), discussed by Charles Singer (1876–1960) in 1925, the poses of the figures were more natural and includes the well known picture of Mondino tutoring at an anatomical dissection.³¹

The woodcuts in Ketham’s Fasciculus³² represent a circle of 21 urine glasses, sick room and dissecting scenes. In one scene a sick person was attended by his physician and several women. Another showed a dissection with the young, beardless professor sitting in the lecturer’s chair while a barber surgeon dissected. A remarkable series of characteristic figures was included and indicates the sites of injury and disease and the most favourable locations for applying treatment. These are the zodiac-man in which schemata of the viscera are often overlaid by the zodiacal figures; the blood-letting man (Figure 2(a)), whose body is tattooed with marks indicating the best sites for venesection under the signs of the zodiac; the planet-man in which the planets or their symbols are used for signs of the zodiac; the sick-man, ringed about with names of diseases and their location in the body; the wound-man whose body is pierced all over by stones, arrows and swords, the points of incision showing where the arteries can be found for ligation (Figure 2(b)); and the pregnant woman, giving a crude diagrammatic view of the fetus in the uterus.³²

Figure 2.

(a) A figure from ‘Fasciculus Medicinae’ by Johannes de Ketham (1500) is shown representing the blood-letting (venesection) man, indicating the best sites for venesection and (b) A figure from ‘Fasciculus Medicinae’ by Johannes de Ketham (1500) representing the wound-man, whose body is pierced with arrows, stones and the points of incision showing where the arteries should be sought for ligation. (Personal archive, reproduced from UCLA Library, Charles E Young Research Library, Department of Special Collections).

The bloodletting manikin became the early model for the anatomic picture. Although simply and not drawn realistically, overall these early drawings of blood-letting, zodiac, wound manikins satisfied for a long time, until the end of the 15th century, the anatomic needs of physicians and surgeons.

Woodcuts in the Philosophiae Naturalis Compendium of Johannes Peyligk (1474–1522?)

The German anatomist, Johannes Peyligk, in the last chapter of his Philosophiae Naturalis Compendium, wrote a brief anatomy of the entire body accompanied by anatomic woodcuts of crude workmanship; this last chapter has been printed as a separate work by Peyligk as Compendiosa Capitis Physici Declaratio.³³

The 11 woodcuts were little more than diagrammatic representations after the Arabists. In one, the intestines were represented as an interlaced knot. A bust with the viscera of the three anatomical cavities was included but this was poorer and further removed from nature than the later illustrations by Magnus Hundt. Ten small woodcuts printed in the text represent separate organs.

The skeleton of Richard Helain (Ricardus Hela)

As the new art of wood engraving was turned to anatomical use after the time of Mondino, crude illustrations of the various parts of the body were put into circulation. A set of anatomical plates of this type was issued by Richard Helain, a physician of Paris, as early as 1493. They were printed at Nuremberg.³⁴ The skeleton of Helain was one of the first examples printed. Others followed quickly but compared to renderings of many contemporary and even earlier artists it is inferior, both anatomically and artistically. The parts of the body are labelled in Helain’s skeleton, which is a good example of the fugitive anatomic plates. Several fugitive plates (Fliegende Blätter) representing whole figures with the names of the parts were published either on a single broadside or on two sheets. They were generally proposed to disseminate popular information and to give instruction to barbers and surgeons. Usually they show anatomy already old-fashioned at the time they appeared, seldom a scientifically exact representation. They are now exceedingly rare.

Illustrations in the Margarita Philosophica of Gregory Reisch (1467–1525)

The Margarita Philosophica (Philosophic Pearl) of Gregory Reisch, the well-known encyclopedia of all sciences, includes diagrammatic anatomic illustrations, mostly contrary to nature (Figure 3).³⁵ The oft-copied illustration of visceral anatomy demonstrates particularly the diagrammatic crudity of most anatomical illustrations of this period. Choulant claims that the oldest printed illustration of the structure of the eye is found in the 1504 edition published by Kaspar Schott (1606–1666) at Strasburg.¹¹

Figure 3.

The title of ‘Margarita Philosophica’ by Gregory Reisch, 1504. (Personal archive, reproduced from UCLA Library, Charles E Young Research Library, Department of Special Collections.)

The Margarita Philosophica contains an illustration of the three ‘cerebral cells’ or ventricles. The anterior cell bears the legends Sensus communis, Fantasia and Imaginativa, the middle cell Cognitiva and Estimative and the posterior cell Memorativa. This localization of the senses in the cerebral ventricles was an accepted medieval teaching that was found earlier in the De Proprietatibus Rerum (Concerning the properties of Things) of Bartholomaeus Anglicus.³⁶ Bartholomaeus Anglicus (13th century) was an English Franciscan who studied at Oxford. This book was a general encyclopedia with great popularity during the Middle Ages. His views on anatomy and physiology are typical of the medieval period. According to Ralph Hermon Major (1884–1970)³⁷ the French translation published at Lyon in 1482³⁸ contains the first illustration of a dissection in any printed book.

Illustrations in the Antropologium of Magnus Hundt (1449–1519)

The Antropologium of the Leipzig Professor Magnus Hundt of Magdeburg was printed in Leipzig in 1501 (Figure 4(a)).³⁹ It contains four large and several small woodcuts, which are accepted among the earliest of anatomical illustrations that are a little more than schematic representation (Figure 4(b)). His work contains illustrations of the internal organs but without images of bones or muscles and this work seems to be the most comprehensive representation of all the internal parts up to that time. One of these illustrations shows the trachea on the right side of the neck, passing downward to the lungs; on the left side the oesophagus is represented. In the thorax are seen the lungs and the heart. The pericardium has been opened and the stomach and intestines are figured crudely. In addition, a figure of the uterus depicting the anatomy of the uterus with seven cells (Figura matricis) is noted.

Figure 4.

(a) The title page of ‘Antropologium’ by Magnus Hundt, 1501. (b) An illustration from Antropologium by Magnus Hundt, 1501, showing the anatomy of the hand. (Personal archive, reproduced from UCLA Library, Charles E Young Research Library, Department of Special Collections.)

These illustrations also give a clear idea of pre-Berengarian anatomy and seem to be the aggregate of the views entertained in the fifteenth century as to the position and shape of anatomic parts.

Figures in the Spiegl der Artzny of Laurentius Phryesen (1490–1531)

Laurentius Phryesen (Phrisius, Fries, Friesen) was a Dutch physician residing in Germany. He wrote a popular book on medicine, Spiegel der Artzny, published at Strasburg in 1518,⁴⁰ which contains two anatomical illustrations cut in wood. One woodcut represents the anatomy of the brain with six figures, the chest, and the abdomen including the diaphragm and a picture of the tongue. The other anatomical plate is committed to the skeleton with the names of the bones given in Latin in the margin. These images show marked improvement over those published by Hundt in 1501. The anatomy itself is pre-Berengarian but it is much superior to any anatomic illustration then known. The manner of representation is unusual, especially the anatomy of the brain that has been treated in a wholly new and exceptional fashion. Some illustrations of the brain were used in Johann Dryander’s Der Gantzen Artzenei Gemeiner Inhalt of 1542.⁴¹

Illustrations in the works of Berengario da Carpi (1460–1530)

Although Berengario da Carpi, Jacobus Berengarius Carpensis or Carpus, lived during the Renaissance, his illustrations were executed following experimentation and observation of the human body for the first time for many centuries. He graduated from the University of Bologna and became noted for his skill in surgery and anatomy. He improved Mondino’s book by making corrections in the text and by adding suitable illustrations. The early editions of Mondino did not contain images and those added by later editors of the work were not realistic. Berengario da Carpi wrote a commentary on the anatomy of Mundinus, Carpi Commentaria super Anatomia Mundini, published at Bologna⁴². He also wrote his Isagogae Breves (Short Teachings).⁴³

The commentary contains 20 woodcut plates that include depictions of the abdominal muscles, the veins of the limbs, the skeleton, the bones of the hands and feet, and uterine anatomy. The illustrations are true to nature and show a distinct advance over prior pictures of this class.

Berengario da Carpi was the first to substitute drawing from nature for the traditional schemata; the muscleman figure is represented as holding up the separate muscles for inspection. The same figure becomes the flayed figure in Vesalius. Berengario has a tolerable skeleton similar to those of Helain and later his picture of pregnant women in a reclining attitude became the model for many variations. Overall, his illustrations are so much better than those of his predecessors and he must be given credit as the first author producing an illustrated anatomy inspired from actual human dissection. Berengario da Carpi played a role in the transition from the artistic to scientific illustration in anatomy.⁴⁴

Conclusion

Anatomical knowledge in the Middle Ages did not rely upon experimentation and observation. Galenic doctrines were predominantly accepted and copied. Physicians hardly felt the need for anatomic reproductions from nature during the Middle Ages but, even if there had been such a need, it could not have been met satisfactorily since human bodies could not be dissected. Therefore most illustrations remained of emblematic nature and often unrealistic. With the beginning of human dissection, some transformation in the depiction of anatomy began to project the practice of human dissection, for example in the works of Mondino de Luzzi, Henri de Mondeville and Guido de Vigevano. However, for the most part, the objective of anatomic illustration remained for teaching purposes. After the invention of book printing in the second half of the 15th century, although books were often reproduced and the woodcut also made the increased multiplication of pictures possible, physicians still did not demand more than schematic-anatomic representation, perhaps because it was not conceivable that such might be possible. Anatomy was also not considered a separate field but an adjunct to surgery. So long as anatomy retained this simple function, nonrealistic and schematic figures were sufficient. The works of Peter of Abano, Hieronymous Brunschwig, Johannes de Ketham, Johannes Peyligk, Gregory Reisch, Magnus Hundt, Laurentius Phryesen and many others played a significant role in documenting these illustrations and in demonstrating the evolution and development of anatomical illustration during the later period when compared with earlier primitive drawings of the Middle Ages.

From time to time a stroke of original observation of the human body was added to the traditional figures, reflected in the anatomical illustrations of da Carpi. Starting from the second half of the 15th century, the light was dawning in all aspects of life. Anatomical illustration attained a combination of artistic and scientific feature, projected best in the works of Leonardo da Vinci. (1452–1519). Dependence on authority was giving way and finally, thanks to the work of his predecessors, Vesalius was able to establish a new method based on observation and reason. The period of good illustration of anatomy based on independent observation started with the publication of his Fabrica in 1543.⁴⁵

Footnotes

Acknowledgments

We wish to thank the UCLA Library, Charles E Young Research Library, Department of Special Collections, California, Miami University Library, Florida, USA, Leopold Franzens University Library, Innsbruck, Austria and Bayerische Staatsbibliothek, Munich, Germany.

Author biographies

Raffi Gurunluoglu, MD, PhD, is Chief and Associate Professor, Associate Fellow American College of Surgeons, Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado USA.

Aslin Gurunluoglu, MS, is with Education of Management, 7495 East 9th Avenue, Denver, Colorado USA.

Susan A Williams is with the Department of Plastic and Reconstructive Surgery, Denver Health Medical Center, Denver, Colorado USA.

Safiye Cavdar, MD, is Head and Professor, Department of Anatomy, Marmara University Health Sciences, Istanbul, Turkey.

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