The Development and Impact of Medical Illustrations

Overview

Artists were in many ways the driving force behind the study of medicine. Seeking to perfect their skills in realism and accuracy, artists, rather than professional anatomists, studied the bodies of animals and men. Not content to just observe animals, they gained first hand knowledge of anatomy through dissection.

Another great contributing force was the development of the printing press, which enabled not only textual information but also drawings to be replicated. The manufacture of paper, as well as improvements in wood engraving, made possible a growing number of illustrated books. As in all areas, the power of visual images attests to the adage that "a picture is worth a thousand words." The impact of art and visual representations was shattering.

Several illustrators of the period were responsible for this development. Johannes de Ketham (fl. 1460?) published the first illustrated medical work. Hans von Gerssdorff (1455-1529) wrote and illustrated work from the battlefield. Giacomo Berengario da Carpi (1470-1530) was a serious student of anatomy and showed bodies with the skin removed as part of a landscape. Giovanni Battista Canano (1513-1579) refined his work using copper plates. However, the greatest illustrator of the period was Andreas Vesalius (1514-1564). The publication of his De humani corporis fabrica in 1543 marked the beginning of the renaissance of medicine.

Background

Life in the fifteenth and sixteenth centuries was not a pleasant affair. Epidemics of bubonic plague, typhus, smallpox, and sexually transmitted diseases killed and maimed large numbers of the general population. Add warfare and famine, and misery was rampant.

The heritage of a thousand years of the Dark Ages was superstition and ignorance. The classical medical works interpreted by word of mouth and influenced by tradition had become a standard. But the deplorable condition among the people forced scholars to consider new interpretations and ideas. However, few findings would be translated into change for daily life for many years.

In the thirteenth century, human dissection began at Bologna to determine the causes of deaths. The dissections piqued interest in anatomy, and Mondino de Luzzi (1270-1326) wrote the first modern work on the subject. The universities began to teach anatomy and medicine as part of the natural science of the liberal arts. Other universities at Padua, Florence, Pisa, and Venice adopted this approach and were dedicated to supporting and proving the ideas of the Greek physician Galen (c. 130-c. 200).

Throughout the Middle Ages medical illustrations had appeared, but the drawings were childish, not realistic. Texts were necessarily copied by hand, and the drawings, even in medical centers, were teaching aids similar to sketches, used to represent general truths rather than being exact.

The most common type of illustration was the "Zodiac Man." This male figure is marked with points for bloodletting correlated with the zodiac signs to assist the barber-surgeons. For example, Taurus controlled and cured diseases of the neck and throat, and Scorpio controlled the genitals. The moon and constellations controlled the right way and place to bloodlet. Charts also described how to examine urine, called uroscopy. Just by looking at the color of the urine, the physician could supposedly tell what was wrong.

Medieval painters also depicted the figure of Death with grotesque grins, calling for peasants, merchants, and princes alike. Typical was the famous painting called The Dance of Death by Hans Holbein the Younger. However, with the new zeal and fervor for realism among medical scholars, such medieval caricatures of the body and its afflictions gave way to new forms of anatomical illustration.

Impact

The most startling development to affect illustration was the invention of the printing press. In 1450 Johann Gutenberg (1390?-1468) had developed movable type that could be set to make many copies. The process of making woodcuts for engraving was also refined for illustrations. Access to paper made books available to many.

The first medical work that included illustrations was Ketham's Fasciculus medicinae, published in Venice in 1491. The Latin version had six illustrations—a uroscopy chart in red and black, phlebotomy figure, zodiac man, the female viscera, wound man, and disease man. In 1493 an edition with 10 illustrations was translated into Italian. The most notable addition is a dissection scene in which a professor presides over a group of barber-surgeons cutting open a human cadaver. The illustration also reveals the transition to the formal unity of Renaissance art; the lecturer is vertical and the body is presented horizontally so that everything is symmetrical.

Hippocrates (460?-377? b.c.) had said that he who wished to become a surgeon should go to war. In the fifteenth and sixteenth centuries there were ample opportunities because wars were prevalent. In addition, there were new problems concerning the care of the wounded. No longer were the soldiers just shot with bows and arrows, but the use of gun powder, cannon balls, and lead shot would pierce the flesh, leaving gaping wounds and major infection. In 1497 Heironymus Brunschwig (1450-1533) wrote the Buch der Wund Artzney (Book of Wound Dressing), which includes the earliest printed illustration of surgical instruments. His book showed how shot wounds were poisoned by gunpowder and needed cauterizing. Hans von Gersdorff (1455?-1529) wrote and illustrated from field experience. His Feldbuch der Wundartzney (Fieldbook of Wound Dressing), describes how to extract bullets with special instruments and how to dress wounds with hot oil. He also showed how to enclose amputated stumps with animal bladders.

Jacopo Berengario da Carpi was a surgeon and anatomist at Bologna from 1502-27. It was during this time that serious inquiry into human anatomy began, and the drawings took on a unique feature. The bodies, portrayed with skin removed, were positioned to show their dissected muscles while standing and observing a landscape. One drawing from Isagogae breves (1523) shows a figure, with skin stripped, leaning on an axe with clouds, trees, and hills in the background. The landscape is set in the hills around Bologna. Another figure is sitting like a figure S on a rock.

Da Carpi's skeletal figures are also involved in the environment. One skeleton stands in front of a grave, from which he had obviously been taken, holding two other skulls in his uplifted hands. Another convention of da Carpi's medical illustration is the use of multiple views of a single part of a muscle. Leonardo da Vinci (1452-1519) also sketched multiple views in his notebooks and probably influenced these drawings.

Giovanni Battista Canano (1515-1579), while a student at the University of Ferrara, performed private dissections in his home. In 1541 he published Musculorum humani corporis pictuata dissectio, or Picture of the Dissection of the Muscles of the Human Body. The drawings, which feature the muscles of the arm, were made by the Ferranese painter Girolamo da Carpi using 27 copperplates.

Another book, Picturata dissectio, is based directly on structures of the human body and of living animals, and not on the dissection of the ape as performed by Galen. The works of Canano have two innovations. Copperplates were used for the first time, which allowed finer details than the woodcuts used by Berengario and Vesalius. Canano also featured the fine muscles of the hand. While he followed the same order as Galen, he pointed out omissions and errors. He also drew the valves of the deep veins and described their function in controlling blood flow. His illustrations showed a novel approach to myology (the study of muscles), as he depicted only a few muscles and their movement of the fingers. However, this approach was not followed by subsequent medical illustrators.

As the middle of the sixteenth century approached, medical illustrations came into their own in the works of Vesalius. Vesalius from Brussels studied at the University of Louvain and continued his education in Paris, where he was known occasionally to rob a grave to get body parts to study. Commissioned to write a comparative study of the works of Galen, who had made his conclusions using the anatomy of an ape, Vesalius pointed out more than 200 errors by the famous physician. This caused controversy, especially between Vesalius and his former friend and teacher Jacobus Sylvius, a Galen enthusiast. Vesalius published De humani corporis fabrica in Basel at the age of 28.

The text had 663 illustrations and was divided into seven books. The contrast with the conservative scenes of Ketham was obvious. The frontispiece illustration depicted Vesalius with a mass of students pressing around. He is portrayed as the dissector, and the barber-surgeons crouch under the table. A skeleton sits in the professor's chair, and a monkey and dog are vying to get in the picture. The identity of the artist who actually designed the plates is subject to debate. For years it was believed to be designed by the famous Venetian painter Titian, but more than likely it was his Dutch assistant Calcar. However, scientists agree that Vesalius's 1543 text is a pivotal work that marks the beginning of the renaissance in medicine.

The Renaissance saw an emergence of realism in art and new ideals that supported the direct and factual representation of natural phenomena. The rules of perspective and mathematics prevailed. Art had gone scientific, and by the fifteenth and sixteenth centuries the new theory was firmly established and fully accepted in the painting of masters such as Albrecht Dürer, Michelangelo, and Raphael. Likewise, science had gone artistic, and modern ideas owe much to the efforts of the theorizing artists.

EVELYN B. KELLY