The Vesalius Continuum Conference—A Celebration of Anatomy, Art and History

by Tonya Hines and Anneliese Lilienthal

We had the great fortune to attend the Vesalius Continuum Conference celebrating the 500th anniversary of anatomist Andreas Vesalius (1514-1564) and his revolutionary book De Humani Corporis Fabrica. The conference was held September 4-8, 2014 on the Greek island of Zakynthos where Vesalius died. A diverse mix of attendees included anatomists, physicians, historians, medical illustrators, and science-inspired fine artists.

The conference opened on Thursday with ceremonial greetings and comments from dignitaries and officials from Greece and also Belgium – where Vesalius was born.

The unveiling of a new monument on the city square depicts a bronze statue of a muscle man contemplating a skull held in his outstretched arm (Fig 1). Sculpted by renowned forensic reconstruction artist Richard Neave and AEIMS President Pascale Pollier, the monument will be a lasting homage to Andreas Vesalius on Zakynthos. Nearby, the touring art exhibition Fabrica Vitae held its grand opening.

The three-day conference was divided into six sessions:

1. The Life of Andreas Vesalius
2. The Work of Vesalius: Fabrica, Epitome, Tabulae
3. The Art of Human Anatomy: Renaissance to 21st Century
4. 21st Century Teaching of Anatomy
5. 21st Century Role of Medical Artists
6. Perception of the Human Body & Sci-Art Collaborations

1. The Life

Historians presented accounts of Vesalius' life as previously published, but with new information as to the cause of death and location of his grave. Maurits Biesbrouck and Pavlos Plessas presented considerable evidence that Vesalius did not die in a shipwreck fleeing the Spanish inquisition, but rather he (and many of the passengers) contracted scurvy during the long voyage back from the Holy Land. Upon landing on Zakynthos to resupply with food and water, Vesalius fell to the ground and died. He was buried in the church Santa Maria della Grazie, which was later destroyed by earthquakes. Using GIS cartography and historical maps, Sylviane Dederix and fellow researchers, extrapolated the location of the Santa Maria della Grazie as lying near modern day Koliva and Kolokotroni streets–underneath Hotel Palatino where the Vesalius Trust Tour travelers were staying! There was much discussion and intrigue at dinner that night about the serendipity of our accommodations and the spirit of Vesalius.

2. The Work

The Fabrica was hailed as the most revolutionary book given the context of its time. Guy Cobolet gave a beautiful, illustration-rich talk as he walked us through the conventions of medical images and publishing of the time showing Vesalius' innovations of placing illustrations within the text, the use of labels, and the overall design that made the Fabrica and Epitome highly original in format.

The controversy and attacks on Vesalius by his contemporaries for disputing centuries of Galen anatomy drove him to angrily defend his work in the Epistle on the China Root. Dan Garrison recounted Vesalius's brief dismissal of the herbal china root remedy as having no medicinal use and then his lengthy response to the bitter attacks by his professor Jacob Sylvius. Vesalius argued that the new science of anatomy should devote itself less to rhetorical polemics and more to the craft of direct observation based on human dissection.

Jacqueline Vons spoke on the inscription "Vivitur ingenio, caeteris mortis erunt" of the contemplating skeleton with his hand on a skull (Fig 2). The phrase translates as, 'one lives on by the spirit, the rest shall belong to death.' Vons' idea is that this illustrated plate is a eulogy of the anatomist's genius that lives on in the book Fabrica we celebrate to this day.

Vivian Nutton presented his findings on an annotated 1555 Fabrica second edition that resides at the University of Toronto. He asserts these are Vesalius' own notations for a third edition—this is a remarkable discovery. From Vesalius' own letters, it is known that he burned all his papers, books and notations before he entered the service of Emperor Charles V.

AMI member, David Williams, presented his research on the provenance of eight copies of Vesalius' Fabrica at Cambridge University. Noting that the owners of the rare first edition Fabrica have fascinating stories in and of themselves.

Audience discussion ended the day related to the over fascination with the Fabrica when the more widely used Epitome (the abridged student version of the Fabrica) was truly responsible for the dissemination of Vesalius anatomy teachings. It was remarked that there were no lectures about the Epitome, which underwent numerous reprints and are more rare because of their daily use. The Epitome contained the marvelous manikin pop-ups, which could be cut apart and glued to make a layered flap-by-flap dissection from skin to the muscles, followed by deeper layers of the vascular and the nervous systems, and finally down to the skeleton.

3. The Art of Human Anatomy

Day two focused on anatomy and education taking us in new interesting directions. Robrecht van Hee began with a look at "Vesalius's long-term impact" on how his work (and might we add the work of Jan van Calcar) impacted medicine and surgery. The Fabrica text and illustrations helped clarify the location of vessels and nerves for surgeons, such as when locating a vein for blood letting. Moreover, the structure of the Fabrica in seven books (based on body systems) influenced the format of anatomy texts and teachings from the 16th to 21st century. This reminded us of the CIBA collection begun by Dr. Frank Netter.

Francis Wells in his talk "Realisation of the working heart" explored da Vinci's discoveries in anatomy, which unlike Vesalius' were never published. There was an interesting portion where Wells showed Leonardo's heart illustrations next to photographs of ox heart dissections highlighting the accuracy of the illustrations, because da Vinci observed ox hearts instead of human ones.

Roberta Ballestriero presented "Three Dimensional Anatomy" which in the age of 3D printing, models and animations, was a nice gesture to some of the earliest three-dimensional wax works in anatomy. She showed several remarkable anatomical ceroplastics starting with Italian works from the 17th and early 18th centuries. She highlighted the models made for obstetrical teaching, which were influenced by printed illustrations including the work of William Hunter, Anatomy of the Human Gravid Uterus 1774-1783, of which many of us are familiar.

Ruth Richardson spoke on "Gray's Anatomy." Her infectious passion, witty remarks, clear supporting visuals, original quotes, and engagement of the audience painted the story of Henry Gray (the author) and Henry Vandyke Carter (the artist) of Gray's Anatomy. She set the stage for what events were happening in the world at the time of Gray's Anatomy, and how it became a unique departure from previous works, especially due to Carter's art. Ruth discovered that the art blocks Gray purchased were too large for the paper the publishers bought, requiring revised text layouts to accommodate the larger illustrations in the first edition. A happy accident for Carter we think! While there are limited personal materials available from Henry Gray to shed light on his character, Ruth shared direct quotes from Henry Carter allowing us to see into the relationship between these two as they collaborated. After Ruth's enthusiastic talk I look forward to reading her book The Making of Mr. Gray's Anatomy!

Paolo Mazzarello presented "Golgi and the fine structure of the nervous system." We learned about the new histological staining technique developed by the Nobel Prize winning scientist, Camillo Golgi, who you may recognize as the namesake of the golgi apparatus. This staining technique helped illuminate the fine structure of neurons and it was beautiful to see Golgi's delicate drawings of neurons through this new light.

Marco Catani gave the last talk before lunch, "The art of brain imaging." He provided an interesting juxtaposition of Galen and Vesalius ranking how their roles as anatomists, philosophers, physicians and types of dissection (vivisection vs. post-mortem) took priority. Catani proceeded from Vesalius's work on the brain to contemporary brain imaging techniques that allow us to now look at the living brain and map its' pathways, the so-called connectome. We specifically looked at lateralization of the language pathway and determined that nearly everyone in the audience would like to have bilateral symmetry, even if statistically this is highly unlikely, and more so for men.

After some good Greek food to stimulate our brains and a bit of sun outside, we returned for the afternoon session.

4. 21st Century Teaching of Anatomy

Bernard Moxham suggested our modern anatomy is not really so different from the anatomy of Vesalius. He stated that traditional anatomy is taught through dissection by the students. Old anatomy was a master dissecting and demonstrating to students, while older still is studying anatomy from books that you reference rather than experience yourself. Moxham argues that it appears we are heading toward returning to this oldest form of anatomy, moving away from students experiencing hands-on dissection and referring only to text and online resources. He reminds us to focus on student-directed learning, ensuring that education is experience based and not authoritative. Further, we can utilize the virtual learning environment, but students must also have access and be allowed to share and contribute. Lastly, he asserted that anatomical experience is not only knowledge of terms and relationships, but of team skills, of ethics, of professionalism and of mortality. Anatomy should be made human and clinical, and the student experience explored through reflective arts. As medical illustrators we may all be in agreement.

Susan Standring brought us through a journey of how Gray's Anatomy has changed over time and is now embarking into the digital world with a significant portion of the 41st edition due in 2015 that will be online with multimedia. The first edition included 360 illustrations by Dr. Carter, and we believe she stated that in 2008 there were over 21,000 images. One can understand the need for digital materials to help aid in searching and retrieving content from such a vast amount of information in the 21st century.

Shane Tubbs declared that we are not done with the process of discovery in anatomy, but that we should look to surgical and clinical problems and then go to the anatomy lab in search of finding new solutions. He provided case examples of how they could manipulate or modify anatomy to solve their clinical problems. Tubbs also collaborated with Brion Benninger to present on radiology and imaging for anatomists and in clinical education. Here a finger-mounted ultrasound probe that could allow clinicians to touch and connect with their patients was presented along with how it can integrate with Google Glass to show live ultrasound to the physician. This talk highlighted how technology could be integrated into clinical practice and utilized by students during their clinical education in new ways that make the technology less apparent and the human more so.

Robert Trelease presented what a 21st century anatomy lab should be equipped with to meet student, resident, and professional needs. While curriculum changes have resulted in many schools cutting back on time in the anatomy lab for medical students, Trelease points out the importance of not only maintaining anatomy lab facilities, but how these should be set up for integration with modern medicine and the demands for longitudinal learning.

Richard Tunstall highlighted ways in which technology could help enhance the appreciation of three-dimensional anatomy relationships in education; from exploration of virtual 3D models, video on 3D LED TVs in the anatomy lab and Google's Cardboard for providing affordable virtual reality, to the hope for 3D printed physical models with tissue realism for dissection.

Tom Lewis, a recent student, closed the day providing a unique perspective on using mobile technology to learn. He shared several anatomy apps and programs that he found helpful allowing for integration of illustrations, photography, 3D virtual models, radiographs and the important ability to test oneself. However, as exciting as these technological advances are, he finished by arguing for curation by faculty to review and approve these growing digital resources for accuracy. Indeed, audience discussion was lively as to the role of imaging-based 3D models in medical education ensued between the "dissectionists" and the "visualizers."

5. 21st Century Role of Medical Artists

The third day opened with a focus on art. Wax sculptor and medical artist Eleanor Crook gave a thought-provoking lecture on the depiction of the dissected body as living écorché. Showing examples of idealized anatomy (such as the Anatomical Venus by Clemente Susini) versus the reality of cadavers (such as the tortured sculptures of Joseph Towne at the Gordon Museum), she talked about van Calcar and Vesalius' decision to depict the muscle men as living dissected anatomy. The aesthetic of progressively defleshed humans standing in a landscape (Fig 3), served as metaphors for the spiritual body and resurrection—refusing to lie down.

Rachael Allen is an artist-in-residence at several anatomy labs in the UK. Her Project ANATOME explores the way medical students first experience the human body through dissection of dead cadavers. Using drawing to open a dialog of observation and documenting, she is interested not only in anatomical understanding but also emotions about death and mortality. She works with Dr. John McLachlan on integrating art and the humanities into medical student education.

Medical illustrators Margot Cooper and Catherine Sulzmann presented the evolution of simulation trainers at their company Limbs and Things–particularly the PROMPT birthing simulator. Significant changes are occurring with medical skills training to make the simulation more life-like through the use of hybrid training techniques with standardized patients that behave and act accordingly. The medical artists role, in designing and sculpting for manufacture production with special knowledge of materials to simulate texture and tissues, is extremely important for life-like models.

The next lecture was a video by Lisa Temple-Cox, a fine artist who composited layered illustrations from the Fabrica, Alice in Wonderland, renaissance maps and her own drawings to create a visual narrative exploring the Vesalius anatomy as an Anatomical Alice. Lisa recited a spoken word text written by Glenn Harcourt while the video visually took us on Alice's journey with a magic looking glass that becomes a speculum for exploring the body's structure.

AMI member Tonya Hines presented on Open Access within the historical context of scholarly publishing during Vesalius' time (Fig 4). Hines posed the question: "As an innovator, would Vesalius have been supportive of open access to collaborate and share his research?" (Anatomist Peter Abrahams said no.) The ambitious Vesalius sought singular fame. The Tabulae and Fabrica were rampantly plagiarized and copied. Piracy helped spread Vesalius' fame and ideas but angered him immensely. For an author incensed by others copying his work without credit, why did he not give proper attribution to the Fabrica illustrators (van Calcar, Campagnola or others)? The collaborative triad of author, artist, and publisher is changing with the evolution from printing press to Internet and onto Open Access. It seems that the struggle, of van Calcar and later Henry Carter (Gray's Anatomy), to be recognized for their authorial contributions still persist for modern day medical illustrators.

The last lecture of the morning was by Lucy Lyons entitled "Drawing Parallels" where she is studying public attitudes towards display of fetal and pathology specimens in museum settings. Using drawing workshops, she is exploring why certain specimens are contentious and how the act of drawing and close observation creates a positive impact and appreciation for the objects.

6. Perception of the Human Body & Sci-Art Collaborations

After lunch we were stretched in our thinking about the fabric of life by contemporary performance artist Stelarc, whose interest in robots explores what it means to be human. He showed numerous examples of robot advancements in gait biomimicry and facial expressiveness that may extend the capabilities of the human body. However, he explained that our innate hard-wired response to faces creates an "uncanny valley" that makes human-like robots just plain creepy!

Nina Stellars uses light to explore the task envelope of our human bodies and create visual perceptions of how anatomy is seen and recorded. Mara Haseltine artwork is based on geotherapy to bring awareness of the environmental sickness of the planet and elicit social change. She creates outdoor sculptures inspired by proteins, plankton and DNA. We viewed a screening of her work set to opera "La Bohéme: A Portrait of our Oceans in Peril."

A return from coffee break brought an engaging presentation by Joanna Ebenstein about the Morbid Anatomy Museum in New York. She talked about how her work got started as a personal collection, then a blog, a book, and has grown to a museum with a highly participatory fan community.

"A Change of Heart" is a work by Andrew Carnie that explores the psychological feelings of heart transplant patients who don't feel themselves and lose a sense of identity after surgery. The idea that a heart can be replaced like a water pump in a car may be false—perhaps the soul and feelings of a person are more fluid and intercorporeal. Andrew's exhibit Hybrid Bodies connects the notion of embodiment and the complexity of organ transplantation.

The program ended with a special lecture by well-known art historian and author Martin Kemp on "Rhetorics of the Real World and Image in the Fabrica." Kemp showed visual representations of anatomy prior to Vesalius to place in context the novelty of the Fabrica. Every aspect of the book demonstrates his rigorous control of both visual and textual content. He spoke about the exacting detail and planning of the images that would require intense collaboration of anatomist and artist. As described in his 1970 paper, there is evidence that van Calcar was the artist of the muscle men. While there are 250 major plates, there are a number of small minor figures and diagrams, which Kemp believes were likely drawn by Vesalius himself (Fig 5 orbit). However, there were some audience mumblings at the suggestion that Vesalius used the outline of the muscle men within which he himself drew the circulatory system (Fig 6). Given the complexity of overlap, depth, and shading could these be drawn by Vesalius' own hand? We may never know. But his talk should serve as a message to medical illustrators to ensure their role in medical collaborations is recorded and made transparent.

Summary

Overall, it was a one-of-a kind symposium that brought together such a diverse field of scholars to celebrate a true visionary genius in Andreas Vesalius. The many people who organized the conference and chaired the sessions deserve well-earned congratulations, especially Pascale Pollier, Mark Gardiner, and Theo Dirix. We greatly enjoyed networking and meeting with UK and European medical illustrators from MAA (Medical Artists' Association of Great Britain) and AEIMS (Association Européenne des Illustrateurs Medicaux et Scientifiques).

Good Reads

Stephen Joffe. Andreas Vesalius: The Making, The Madman, and the Myth. Bloomington: AuthorHouse, 2009.

Martin Kemp. A drawing for the Fabrica; and some thoughts upon the Vesalius muscle-men. Medical History 14(3): 277-288, 1970. PubMed Central.

All presentation abstracts were published in Vesalius Acta Internationalia Historiae Medicinae 20(1), 2014.