Clinical Anatomy 27:1122–1127 (2014)

A GLIMPSE OF OUR PAST

Johann Vesling (1598–1649): Seventeenth Century Anatomist of Padua and His Syntagma Anatomicum SANJIB KUMAR GHOSH* Department of Anatomy, ESI-PGIMSR & ESIC Medical College, Joka, Kolkata, West Bengal, India

Johann Vesling (1598–1649) was a German anatomist and surgeon who belonged to the golden period of the illustrious University of Padua. He made significant contributions to the advancement of anatomical knowledge during the 17th century and is remembered most for his remarkable anatomical work, the Syntagma Anatomicum, which was published in 1641. He was the first to describe the soleus muscle and to emphasize its resemblance to the sole fish. He produced the earliest illustrations of the human lymphatic system and was one of the first to document observations about the thoracic duct. He was also the first to report the bifurcation of the human hepatic portal vein on entering the fissure of the liver. His observations from embryological experiments were critical for understanding the development of the four-chambered heart. He was one of the first authors to state that four pulmonary veins empty into the left atrium of the heart. Syntagma Anatomicum (1641) was the most widely used anatomical text in Europe for almost a century and was republished a number of times with editions in Latin, German, Dutch, and English. Syntagma was the first illustrated western anatomical text to reach Japan and laid the foundation for the development of European medicine there. The illustrations used in it deviated from the artistic convention that had characterized anatomical figures from the time of Vesalius, and focused instead on representing anatomical details to make them helpful for medicine and surgery. Clin. Anat. 27:1122–1127, 2014. VC 2014 Wiley Periodicals, Inc. Key words: Syntagma Anatomicum; Padua; rete mirabile; ossiculum quartum; anatomical illustration

EARLY LIFE AND CAREER Johann Vesling (1598–1649), who is mostly known by his Latinized name Johannes Veslingius, was a German anatomist and surgeon (Fig. 1). He was born in a Catholic family in Minden, Westphalia (Nordsiek, 1999). During his youth his family fled to Vienna, probably to escape religious persecution (Hintzsche, 1976). A few documents suggest that Veslingius studied medicine in Vienna, but there is no authentic evidence for this (Van Helden, 2004). However, the available literature establishes that Veslingius enrolled as a medical student at the University of Leiden in the Netherlands in November 1619 (Pagel, 1895; Nordsiek, 1999). He had an interest in botany (which he pursued throughout his life); and as advised by Ever-

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hardius Vorstius (1565–1624), his teacher in Leiden, he moved to the University of Bologna, Italy (La Cava, 1948), one of the main centers of botanical knowledge in Europe from the early part of the 16th century (Grendler, 2002). In Bologna, he was influenced by his teacher, Fabrizio Bartoletti (1576–1630), who instilled in him an enthusiasm for anatomy and *Correspondence to: Sanjib Kumar Ghosh, Department of Anatomy, ESI-PGIMSR & ESIC Medical College, Joka, Kolkata 700104, West Bengal, India. E-mail: [email protected] Received 24 May 2014; Revised 14 July 2014; Accepted 22 July 2014 Published online 14 August 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22454

Vesling and Syntagma Anatomicum 1123 Venetian government refused to reimburse Veslingius for the expenses he incurred in conducting his anatomical demonstrations (Hintzsche, 1976). Moreover, in an attempt to drive him from Venice, Veslingius was directed to serve as physician to Alvise Cornaro, a high profile Venetian statesman, when Cornaro was appointed state representative in Cairo. Veslingius and Cornaro left for Egypt at the beginning of August 1628 (Porzionato et al., 2012).

STAY IN EGYPT

Fig. 1. A portrait of Johann Vesling from his anatomical masterpiece, Syntagma Anatomicum. The Latin words around his portrait could be translated as “Johannes Veslingius Mindanus, Knight of Jerusalem, Primary Professor of Anatomy and Pharmacology of the School of Padua.” The Latin words below the image could be translated as “Veslingius flourishes by the art of Apollo, who honors him by shining purple snow on his chest.”

Veslingius studied the local flora in Egypt with great interest (Saccardo, 1895) and subsequently documented his observations in his most important botanical work, De plantis aegyptiis observationes et notae ad Prosperum Alpinum (Vesling, 1638). During his stay in Egypt, he studied the development of the chick embryo in artificially hatched eggs (Cole, 1944; Adelman, 1966). The findings related to embryology and comparative anatomy documented in his papers and letters were published posthumously by Thomas Bartholin (1616–1680), his pupil in Padua, as Observationes anatomicae et epistolae medicae (Vesling and Bartholin, 1664). On his visit to Jerusalem with Cornaro, Veslingius was made a Knight of the Order of the Holy Sepulcher (Fletcher, 2011). He was appointed professor of anatomy and surgery in the University of Padua on December 1632 (Hintzsche, 1976). His stay in Egypt proved beneficial for Veslingius as he escaped the epidemic of plague that devastated northern Italy between 1629 and 1631 (Cipolla, 1981). Moreover, association with Cornaro as his personal physician could have been decisive for Veslingius’ appointment at Padua, where university appointments were invariably associated with state patronage in those days (Nordsiek, 1999).

AS PROFESSOR IN PADUA surgery (La Cava, 1948). Apparently, Veslingius did not receive a degree from either Leiden or Bologna and he moved to Venice, where he obtained his doctoral degree in medicine (La Cava, 1948). He was appointed as instructor in anatomy in the medical college of Venice in 1627 (Castiglioni, 1937). In the winter of 1627/1628, he performed an anatomical demonstration in the presence of Venetian physicians that earned him the right to practice medicine in the city (La Cava, 1948). He also gave public lectures on anatomy in Venice. His teaching was so highly esteemed that even students from the University of Padua, the most prominent university in Europe in the field of medicine during that period, came to hear him (Hirsch, 1888; Taylor, 2009). However, his popularity as both physician and teacher did not go down well with Pompeo Caimo (1568–1631), a former professor of theoretical medicine and lecturer of anatomy in the University of Padua who was practicing medicine in Venice at that time (Hintzsche, 1976). Subsequently, in order to protect the much older Paduan professor from competition by his younger colleague, the

Veslingius returned from Egypt and assumed charge as professor of anatomy and surgery in Padua at the beginning of 1633 (Hintzsche, 1976). He was a very able teacher and complemented his lectures with drawings he prepared himself. These illustrations were later included in his anatomical masterpiece, Syntagma Anatomicum (La Cava, 1948). In 1638, he was appointed to the chair of botany in Padua (Porzionato et al., 2012). He succeeded Alpino Alpini (died 1637), the son of the great Venetian botanist Prospero Alpini (1553–1617) (Saccardo, 1985). Veslingius took this opportunity to revive his interest in botany; he ceased to lecture on surgery but retained the chair of anatomy (Porzionato et al., 2012). In the same year, he published his treatise on botany, De plantis aegyptiis. The text included the findings from his study of plants beginning from his stay in Egypt. He also documented the pharmacological uses of the flora he studied. Most of the materials in the text were additions to the findings of Prospero Alpini (Vesling, 1638) but in many cases Veslingius’ observations were more accurate than Alpini’s. Moreover, the illustrations used in

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ANATOMICAL CONTRIBUTIONS

Fig. 2. The frontispiece of Syntagma Anatomicum from the edition published in 1647. The illustration represents a public dissection by Veslingius in the old anatomical theatre of Padua, built by Fabricius. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Veslingius’ text were better than those in Alpini’s work (Saccardo, 1895). In the final years of his life, Veslingius renovated the botanical garden in Padua. His connection with the garden entailed pharmacology and this was in accordance with his lifelong interest in the study of medicinal plants (Castiglioni, 1937). Veslingius published his most remarkable work on anatomy, Syntagma Anatomicum publicis dissectionibus in auditorium usum diligenter aptatum, in 1641 (Vesling, 1641). It was the most successful anatomical text of the second half of the 17th century (Pranghofer, 2009). The first edition was somewhat deficient in illustrations as it had only two copperplates. However, Veslingius republished Syntagma Anatomicum in 1647 (Fig. 2), and in this edition his anatomical findings were illustrated with 24 copperplates (Choulant, 1920). In 1648, he was given a leave of absence from Padua that allowed him to undertake a botanical expedition to Crete, a Greek island. He returned ill and died soon afterward, on August 30, 1649 (Hintzsche, 1976). In accordance with his wishes, he was buried in the cloister of the church of Saint Anthony in Padua and a funerary monument was erected inside the Basilica of Saint Anthony (Riva et al., 2010).

In his Syntagma Anatomicum, Veslingius described anatomical structures exactly as they are seen at dissection for the benefit of medical students (Riva et al., 2010). He was the first to describe the soleus muscle, the name of which derives from its resemblance to the sole fish (Skinner, 1949). Veslingius described the muscle in Latin as “soleus, a figura piscis denominatus”, which in English means “Soleus, named for its fish shape” (Vesling, 1641). The raphe scroti or scrotal septum, a central line running over the scrotum from the anus to the root of the penis, was first described by Veslingius and is referred to as Vesling’s line (Porzionato et al., 2012). He produced the earliest illustrations of the lacteals and the human lymphatic system as a whole (Persaud, 1997; Ambrose, 2006). He also documented his observations on the thoracic duct in a letter to his pupil, Thomas Bartholin, in 1649 (Vesling and Bartholin, 1664; Ambrose, 2006). The thoracic duct was later described in detail by the French physician Jean Pecquet (1624–1674) in 1651 (Loukas et al., 2011). Veslingius was the first to report the bifurcation of the human hepatic portal vein in 1647, when he accurately illustrated the division of this vein into two main branches as it entered the fissure of the liver (Singer and Rabin, 2012). Prior to this observation, the accepted belief was that the portal vein divided into five branches on arriving at the gate of the liver, as reported by Andreas Vesalius (1514–1564) (Singer and Rabin, 2012). Recently, anatomical detail related to the bifurcation of the portal vein has become critical for the successful placement of transjugular intrahepatic portosystemic shunts (Schultz et al., 1994). Veslingius detailed the development of the four-chambered heart on the basis of his observations of chick embryos, undertaken during his stay in Egypt (Porzionato et al., 2012). He was one of the first authors to state that four pulmonary veins empty into the left atrium of the heart (Eimas, 1990). The cerebral vasculature at the base of the brain was accurately illustrated by Veslingius in the 1647 edition of the Syntagma (Fig. 3); Iulius Casserius (1552–1616) had illustrated it previously (published posthumously in 1627), but the work of Thomas Willis (1621–1675) came later, in 1664; today, the arterial circle of the brain is eponymously linked to Willis (Roberts and Tomlinson, 1992). However, there is a difference of opinion among anatomists as to whether the anterior communicating artery was correctly illustrated by Veslingius in the copperplate describing the arterial circle at the base of the brain (Porzionato et al., 2012). In the same illustration, Veslingius detailed the presence of the rete mirabile (Latin for wonderful net), represented as branches of the internal carotid artery that spread over the surface of the human brain (Pranghofer, 2009) (Fig. 3). The rete mirabile was discovered by Herophilus (335–280 B.C.) but was first described by Galen (129–216/217 A.D.) in artiodactyls, which are sub-mammalian vertebrates (Uehara et al., 1978). Veslingius upheld the idea that it existed in man, although he admitted “it could be seen more clearly in

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Fig. 3. An illustration from Veslingius’s Syntagma Anatomicum (edition of 1647; Tab. III, Cap. XIV, Fig. III) in which the cerebral vasculature at the base of the brain is displayed. The rete mirabile is indexed with the letter ‘P’ in the image. Reproduced with permission from C Cambridge Pranghofer S, Med Hist, 2009, 53, 561–586, V University Press.

unreasoning animals than in humans” (Pranghofer, 2009). The literature suggests that the carotid rete mirabile is a physiological vascular network between the external and internal carotid systems present in some vertebrate species, but rarely observed in humans in the cavernous and paracavernous regions (Karasawa et al., 1997). In recent times, a few cases have been reported that were either asymptomatic or presented with hemorrhagic/ischemic symptoms, but the overall prognosis appears to be good (Mikami et al., 2005; Sahin et al., 2010; Aburto-Murrieta and Dulce, 2011). Veslingius convincingly described the physiology of the heart, the functioning of the lungs, and the circulation of the blood on the basis of his findings from embryological studies (Riva et al., 2010). His ideas were in accordance with the theory of William Harvey (1578–1657) in this context, and Veslingius documented his acceptance of Harvey’s theory in one of his letters (Porzionato et al., 2012). Veslingius illustrated a round, very small structure attached to the side of the stapes capitulum (Fig. 4), which he described as the ossiculum quartum (fourth ossicle) and the ossiculum parvum (small bone) (Vesling, 1651). This was first described by Pieter Paaw (1564–1617) in 1615 as a sesamoid bone that develops within the stapedial tendon; it is now referred to as the ossicle of Paaw (Paaw, 1615). Paaw had

Fig. 4. A depiction of the auditory ossicles in a human fetus by Johann Vesling from chapter 8 of his 1651 edition of the Syntagma Anatomicum. He used the terms “ossiculum quartum” (fourth ossicle) and “ossiculum parvum” (small bone) to indicate a structure attached to the side of the stapes capitulum (D). Reproduced with permission from Graboyes et al., Otol Neurotol, 2011, 32, C Wolters Kluwer Health. 1185–1188, V

observed the ossicle in oxen (Graboyes et al., 2011), but Veslingius reported it in a human fetus (Vesling, 1651). In accordance with the opinions of other prominent anatomists of the 17th century, Veslingius acknowledged the presence of adrenal glands in the abdomen. He suggested that they “probably favor the evacuation of serous liquid and store the black bile, which acts as a ferment, promoting the secretion of liquid from the blood.” However, by his own admission, he was not sure about the use of the adrenals in the human body (Carmichael, 1989).

POPULARITY OF SYNTAGMA ANATOMICUM Syntagma Anatomicum was the most widely used anatomical text in Europe during the second half of the seventeenth and first half of the 18th centuries

1126 Ghosh (Castiglioni, 1941). It was republished a number of times with 16 editions in Latin, German, Dutch, and English (Riva et al., 2010). Its popularity was not limited to Europe; in 1741, a Dutch version of the Syntagma became the first illustrated western anatomical text to reach Japan (Ogawa, 1964; Murakami et al., 2007). The figures in Syntagma often served as models for illustrating anatomy textbooks published later in northern Europe (Choulant, 1920). One such text was the Anatomischen Tabellen by Johann Adam Kulmus (1689–1745), an anatomist from the free city of Danzig (Kulmus, 1722). Most of the illustrations used in Kulmus’ work were taken from the Syntagma (Luyendijk-Elshout, 1991; Riva et al., 2006). The Japanese physicians Ryotaku Maeno (1723–1803) and Genpaku Sugita (1733–1817) managed to obtain a Dutch translation of Kulmus’ book, entitled Ontleedkundige Tafelen, and took the text to Japan in 1771 (Bowers, 1970). Ontleedkundige was translated into Japanese and was published as Kaitai Shinsho in Tokyo in 1774 (Screech, 2005; Tubbs et al., 2009). Kaitai was the first western anatomical text published in Japan in Japanese (Bowers, 1970). The quality of its anatomical illustrations (mostly from the Syntagma) ensured its popularity and proved a pioneering step toward the development of European medicine in Japan (Choulant, 1920). The success of Syntagma could be attributed to the simplicity and the diagrammatic nature of the illustrations used. Veslingius focused primarily on anatomical details in his illustrations, thus making them realistic and useful for medicine and surgery (Riva et al., 2010). He avoided the theatrical attitudes and ornate landscapes that had been prevalent in anatomical figures from the time of Vesalius (Roberts and Tomlinson, 1992). Although he has been primarily credited with the break from the Vesalian tradition of anatomical illustrations characterized by grandiose human figures (prevalent in the Renaissance period), this trend was initiated by Fabricius ab Acquapendente (1533–1619), whose Tabulae Pictae (a masterpiece on anatomical illustrations) disappeared after his death (Riva et al., 2000; Smith, 2006). The influence of Fabricius on Veslingius is apparent from the praise for Fabricius in the preface of Syntagma (Riva et al., 2010).

CONTROVERSY RELATED TO THE PANCREATIC DUCT Veslingius was accused of murdering Johann Georg Wirsung in August 1643, although he was eventually acquitted. Wirsung (1589–1643) was a medical student in Padua, where he performed the autopsies before his mentor, Veslingius, presented the demonstration lectures to the public in the anatomy theater (Howard and Hess, 2002). Wirsung has been credited with discovering the main pancreatic duct in 1642, which he illustrated in a copperplate (Howard et al., 1998). However, some authors have attributed this discovery to Wirsung’s coworker Moritz Hoffman, Wirsung being hailed for confirming and disclosing it (Giardiello et al., 2007). The discovery was of great scientific value as it removed the pancreas from the list of amorphous organs and placed it correctly

among the glands (Giardiello et al., 2007). Veslingius also described the pancreatic duct (Roberts and Tomlinson, 1992), but it is not clear whether he did so before or after Wirsung. Wirsung became well established after this discovery, and conflicts between him and Veslingius began to surface (Carter, 1998). Consequently, when Wirsung was assassinated 1 year after his great discovery, Veslingius was charged with the crime on the grounds of academic jealousy.

CONCLUSION Johann Vesling was undoubtedly one of the great anatomists of the 17th century. His findings contributed significantly to the advancement of anatomical knowledge. He was the author of one of the most popular textbooks in the history of the subject. The illustrations used in his text focused on anatomical details and he consciously avoided the influence of artistic embellishments, which was a prevalent trend in those times. The efforts of such anatomists were critical for the evolution of anatomical sciences to the form familiar today.

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